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den Brok MGHE, van Dalen JW, Marcum ZA, Busschers WB, van Middelaar T, Hilkens N, Klijn CJM, Moll van Charante EP, van Gool WA, Crane PK, Larson EB, Richard E. Year-by-Year Blood Pressure Variability From Midlife to Death and Lifetime Dementia Risk. JAMA Netw Open 2023; 6:e2340249. [PMID: 37902753 PMCID: PMC10616718 DOI: 10.1001/jamanetworkopen.2023.40249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/18/2023] [Indexed: 10/31/2023] Open
Abstract
Importance High visit-to-visit blood pressure variability (BPV) in late life may reflect increased dementia risk better than mean systolic blood pressure (SBP). Evidence from midlife to late life could be crucial to understanding this association. Objective To determine whether visit-to-visit BPV at different ages was differentially associated with lifetime incident dementia risk in community-dwelling individuals. Design, Setting, and Participants This cohort study analyzed data from the Adult Changes in Thought (ACT) study, an ongoing population-based prospective cohort study in the US. Participants were 65 years or older at enrollment, community-dwelling, and without dementia. The study focused on a subset of deceased participants with brain autopsy data and whose midlife to late-life blood pressure data were obtained from Kaiser Permanente Washington medical archives and collected as part of the postmortem brain donation program. In the ACT study, participants underwent biennial medical assessments, including cognitive screening. Data were collected from 1994 (ACT study enrollment) through November 2019 (data set freeze). Data analysis was performed between March 2020 and September 2023. Exposures Visit-by-visit BPV at ages 60, 70, 80, and 90 years, calculated using the coefficient of variation of year-by-year SBP measurements over the preceding 10 years. Main Outcomes and Measures All-cause dementia, which was adjudicated by a multidisciplinary outcome adjudication committee. Results A total of 820 participants (mean [SD] age at enrollment, 77.0 [6.7] years) were analyzed and included 476 females (58.0%). A mean (SD) of 28.4 (8.4) yearly SBP measurements were available over 31.5 (9.0) years. The mean (SD) follow-up time was 32.2 (9.1) years in 27 885 person-years from midlife to death. Of the participants, 372 (45.4%) developed dementia. The number of participants who were alive without dementia and had available data for analysis ranged from 280 of those aged 90 years to 702 of those aged 70 years. Higher BPV was not associated with higher lifetime dementia risk at age 60, 70, or 80 years. At age 90 years, BPV was associated with 35% higher dementia risk (hazard ratio [HR], 1.35; 95% CI, 1.02-1.79). Meta-regression of HRs calculated separately for each age (60-90 years) indicated that associations of high BPV with higher dementia risk were present only at older ages, whereas the association of SBP with dementia gradually shifted direction linearly from being incrementally to inversely associated with older ages. Conclusions and Relevance In this cohort study, high BPV indicated increased lifetime dementia risk in late life but not in midlife. This result suggests that high BPV may indicate increased dementia risk in older age but might be less viable as a midlife dementia prevention target.
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Affiliation(s)
- Melina G. H. E. den Brok
- Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Neurology, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
| | - Jan Willem van Dalen
- Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Neurology, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
| | | | - Wim B. Busschers
- Department of General Practice, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
| | - Tessa van Middelaar
- Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Neurology, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
| | - Nina Hilkens
- Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Catharina J. M. Klijn
- Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Eric P. Moll van Charante
- Department of General Practice, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
| | - Willem A. van Gool
- Department of Public and Occupational Health, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
| | - Paul K. Crane
- School of Medicine, University of Washington, Seattle
| | - Eric B. Larson
- School of Medicine, University of Washington, Seattle
- Kaiser Permanente Washington Health Research Institute Seattle, Seattle
| | - Edo Richard
- Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
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Lin FV, Heffner KL. Autonomic nervous system flexibility for understanding brain aging. Ageing Res Rev 2023; 90:102016. [PMID: 37459967 PMCID: PMC10530154 DOI: 10.1016/j.arr.2023.102016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023]
Abstract
A recent call was made for autonomic nervous system (ANS) measures as digital health markers for early detection of Alzheimer's disease and related dementia (AD/ADRD). Nevertheless, contradictory or inconclusive findings exist. To help advance understanding of ANS' role in dementia, we draw upon aging and dementia-related literature, and propose a framework that centers on the role of ANS flexibility to guide future work on application of ANS function to differentiating the degree and type of dementia-related brain pathologies. We first provide a brief review of literature within the past 10 years on ANS and dementia-related brain pathologies. Next, we present an ANS flexibility model, describing how the model can be applied to understand these brain pathologies, as well as differentiate or even be leveraged to modify typical brain aging and dementia. Lastly, we briefly discuss the implication of the model for understanding resilience and vulnerability to dementia-related outcomes.
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Affiliation(s)
- Feng V Lin
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA; Wu Tsai Neurosciences Institute, Stanford University, USA.
| | - Kathi L Heffner
- School of Nursing, University of Rochester, USA; Department of Psychiatry, School of Medicine and Dentistry, University of Rochester, USA; Department of Medicine, School of Medicine and Dentistry, University of Rochester, USA
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Sun F. The impact of blood pressure variability on cognition: current limitations and new advances. J Hypertens 2023; 41:888-905. [PMID: 37016905 PMCID: PMC10158606 DOI: 10.1097/hjh.0000000000003422] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/18/2023] [Accepted: 02/23/2023] [Indexed: 04/06/2023]
Abstract
Dementia is the most common neurodegenerative disease in the aging population. Emerging evidence indicates that blood pressure (BP) variability is correlated with cognitive impairment and dementia independent of mean BP levels. The state-of-the-art review summarizes the latest evidence regarding the impact of BP variability on cognition in cognitively intact populations, patients with mild cognitive impairment, and different dementia types, focusing on the important confounding factors and new advances. This review also summarizes the potential mechanisms underlying the relationship between BP variability and cognitive impairment, and dementia, briefly discussing sex differences in the relationship. At last, current limitations and future perspectives are discussed to optimize BP management in preventing cognitive impairment and dementia.
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Affiliation(s)
- Fen Sun
- Department of Anatomy, College of Basic Medicine
- Key Laboratory of Organ Development and Regeneration of Zhejiang Province, Hangzhou Normal University, Hangzhou, Zhejiang, China
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Kong D, Tan R, Gao Y, Gao S, Feng Z, Qi H, Shen B, Yang L, Shen X, Jing X, Zhao X. Arterial Baroreflex Dysfunction Promotes Neuroinflammation by Activating the Platelet CD40L/Nuclear Factor Kappa B Signaling Pathway in Microglia and Astrocytes. Neurochem Res 2023; 48:1691-1706. [PMID: 36592325 PMCID: PMC10119255 DOI: 10.1007/s11064-022-03852-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/06/2022] [Accepted: 12/20/2022] [Indexed: 01/03/2023]
Abstract
Arterial baroreflex (ABR) dysfunction has previously been associated with neuroinflammation, the most common pathological feature of neurological disorders. However, the mechanisms mediating ABR dysfunction-induced neuroinflammation are not fully understood. In the present study, we investigated the role of platelet CD40 ligand (CD40L) in neuroinflammation in an in vivo model of ABR dysfunction, and microglia and astrocyte activation in vitro. ABR dysfunction was induced in Sprague‒Dawley rats by sinoaortic denervation (SAD). We used ELSA and immunofluorescence to assess the effect of platelet CD40L on glial cell polarization and the secretion of inflammatory factors. By flow cytometry, we found that rats subjected to SAD showed a high level of platelet microaggregation and upregulation of CD40L on the platelet surface. The promotion of platelet invasion and accumulation was also observed in the brain tissues of rats subjected to SAD. In the animal model and cultured N9 microglia/C6 astrocytoma cells, platelet CD40L overexpression promoted neuroinflammation and activated M1 microglia, A1 astrocytes, and the nuclear factor kappa B (NFκB) signaling pathway. These effects were partially blocked by inhibiting platelet activity with clopidogrel or inhibiting CD40L-mediated signaling. Our results suggest that during ABR dysfunction, CD40L signaling in platelets converts microglia to the M1 phenotype and astrocytes to the A1 phenotype, activating NFκB and resulting in neuroinflammation. Thus, our study provides a novel understanding of the pathogenesis of ABR dysfunction-induced neuroinflammation and indicates that targeting platelet CD40L is beneficial for treating central nervous system (CNS) disorders associated with ABR dysfunction.
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Affiliation(s)
- Deping Kong
- Institute of Pharmacology, Shandong First Medical University & Shandong Academy of Medical Sciences, No. 619 Changcheng Road, 271016, Tai'an, People's Republic of China
| | - Rui Tan
- Institute of Pharmacology, Shandong First Medical University & Shandong Academy of Medical Sciences, No. 619 Changcheng Road, 271016, Tai'an, People's Republic of China
| | - Yongfeng Gao
- Institute of Pharmacology, Shandong First Medical University & Shandong Academy of Medical Sciences, No. 619 Changcheng Road, 271016, Tai'an, People's Republic of China
| | - Shan Gao
- Institute of Pharmacology, Shandong First Medical University & Shandong Academy of Medical Sciences, No. 619 Changcheng Road, 271016, Tai'an, People's Republic of China
| | - Zhaoyang Feng
- Institute of Pharmacology, Shandong First Medical University & Shandong Academy of Medical Sciences, No. 619 Changcheng Road, 271016, Tai'an, People's Republic of China
| | - Huibin Qi
- Institute of Pharmacology, Shandong First Medical University & Shandong Academy of Medical Sciences, No. 619 Changcheng Road, 271016, Tai'an, People's Republic of China
| | - Bowen Shen
- Institute of Pharmacology, Shandong First Medical University & Shandong Academy of Medical Sciences, No. 619 Changcheng Road, 271016, Tai'an, People's Republic of China
| | - Lili Yang
- Institute of Pharmacology, Shandong First Medical University & Shandong Academy of Medical Sciences, No. 619 Changcheng Road, 271016, Tai'an, People's Republic of China
| | - Xuri Shen
- Institute of Pharmacology, Shandong First Medical University & Shandong Academy of Medical Sciences, No. 619 Changcheng Road, 271016, Tai'an, People's Republic of China
| | - Xiuli Jing
- School of Chemistry and Pharmaceutical Engineering, Shandong First Medical University & Shandong Academy of Medical Science, 271016, Tai'an, China
| | - Xiaomin Zhao
- Institute of Pharmacology, Shandong First Medical University & Shandong Academy of Medical Sciences, No. 619 Changcheng Road, 271016, Tai'an, People's Republic of China.
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Mueller BR, Ray C, Benitez A, Robinson-Papp J. Reduced cardiovagal baroreflex sensitivity is associated with postural orthostatic tachycardia syndrome (POTS) and pain chronification in patients with headache. Front Hum Neurosci 2023; 17:1068410. [PMID: 36992793 PMCID: PMC10040804 DOI: 10.3389/fnhum.2023.1068410] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/24/2023] [Indexed: 03/16/2023] Open
Abstract
BackgroundNon-cephalgic symptoms including orthostatic intolerance, fatigue, and cognitive impairment, are common in patients with chronic headache disorders and may result from alterations in the autonomic nervous system. However, little is known about the function of autonomic reflexes, which regulate cardiovascular homeostasis and cerebral perfusion in patients with headache.MethodsAutonomic function testing data from patients with headache collected between January 2018 and April 2022 was retrospectively analyzed. Through review of EMR we determined headache pain chronicity and patient self-report of orthostatic intolerance, fatigue, and cognitive impairment. Composite Autonomic Severity Score (CASS), CASS subscale scores, and cardiovagal and adrenergic baroreflex sensitivities were used to quantify autonomic reflex dysfunction. Descriptive analyses (Mann-Whitney-U or χ2, as appropriate) determined associations between autonomic reflex dysfunction and POTS as well as chronic headache. Binomial logistic regression adjusted for age and sex. Spearman’s rank correlation determined the association between the total CASS score and the number of painless symptoms reported by each participant.ResultsWe identified 34 patients meeting inclusion criteria, of whom there were 16 (47.0%) with orthostatic intolerance, 17 (50.0%) with fatigue, 11 (32.4%) with cognitive complaints, and 11 (32.4%) with Postural Orthostatic Tachycardia Syndrome (POTS). The majority of participants had migraine (n = 24, 70.6%), were female (n = 23, 67.6%) and had a chronic (>15 headache days in a month) headache disorder (n = 26, 76.5%). Reduced cardiovagal baroreflex sensitivity (BRS-V) independently predicted chronic headache [aOR: 18.59 (1.16, 297.05), p = 0.039] and POTS [aOR: 5.78 (1.0, 32.5), p = 0.047]. The total CASS was correlated with the total number of non-painful features in the expected direction (r = 0.46, p = 0.007).ConclusionAbnormal autonomic reflexes may play an important role in pain chronification and the development of POTS in patients with headache.
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Baroreflex sensitivity is associated with markers of hippocampal gliosis and dysmyelination in patients with psychosis. Clin Auton Res 2023; 33:101-110. [PMID: 36877302 DOI: 10.1007/s10286-023-00929-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/20/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE Hippocampal dysfunction plays a key role in the pathology of psychosis. Given hippocampal sensitivity to changes in cerebral perfusion, decreased baroreflex function could contribute to psychosis pathogenesis. This study had two aims: (1) To compare baroreflex sensitivity in participants with psychosis to two control groups: participants with a nonpsychotic affective disorder and participants with no history of psychiatric disease; (2) to examine the relationship between hippocampal neurometabolites and baroreflex sensitivities in these three groups. We hypothesized that baroreflex sensitivity would be reduced and correlated with hippocampal neurometabolite levels in participants with psychosis, but not in the control groups. METHODS We assessed baroreflex sensitivity during the Valsalva maneuver separated into vagal and adrenergic components. Metabolite concentrations for cellular processes were quantitated in the entire multivoxel hippocampus using H1-MR spectroscopic (MRS) imaging and were compared with baroreflex sensitivities in the three groups. RESULTS Vagal baroreflex sensitivity (BRS-V) was reduced in a significantly larger proportion of participants with psychosis compared with patients with nonpsychotic affective disorders, whereas participants with psychosis had increased adrenergic baroreflex sensitivity (BRS-A) compared with participants with no history of psychiatric disease. Only in psychotic cases were baroreflex sensitivities associated with hippocampal metabolite concentrations. Specifically, BRS-V was inversely correlated with myo-inositol, a marker of gliosis, and BRS-A was positively correlated with energy dependent dysmyelination (choline, creatine) and excitatory activity (GLX). CONCLUSIONS Abnormal baroreflex sensitivity is common in participants with psychosis and is associated with MRS markers of hippocampal pathology. Future longitudinal studies are needed to examine causality.
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Lagatta DC, Fassini A, Terzian AL, Corrêa FMA, Resstel LBM. The medial prefrontal cortex and the cardiac baroreflex activity: physiological and pathological implications. Pflugers Arch 2023; 475:291-307. [PMID: 36695881 DOI: 10.1007/s00424-022-02786-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/16/2022] [Accepted: 12/25/2022] [Indexed: 01/26/2023]
Abstract
The cardiac baroreflex is an autonomic neural mechanism involved in the modulation of the cardiovascular system. It influences the heart rate and peripheral vascular resistance to preserve arterial blood pressure within a narrow variation range. This mechanism is mainly controlled by medullary nuclei located in the brain stem. However, supramedullary areas, such as the ventral portion of medial prefrontal cortex (vMPFC), are also involved. Particularly, the glutamatergic NMDA/NO pathway in the vMPFC can facilitate baroreflex bradycardic and tachycardic responses. In addition, cannabinoid receptors in this same area can reduce or increase those cardiac responses, possibly through alteration in glutamate release. This vMPFC network has been associated to cardiovascular responses during stressful situations. Recent results showed an involvement of glutamatergic, nitrergic, and endocannabinoid systems in the blood pressure and heart rate increases in animals after aversive conditioning. Consequently, baroreflex could be modified by the vMPFC neurotransmission during stressful situations, allowing necessary cardiovascular adjustments. Remarkably, some mental, neurological and neurodegenerative disorders can involve damage in the vMPFC, such as posttraumatic stress disorder, major depressive disorder, Alzheimer's disease, and neuropathic pain. These pathologies are also associated with alterations in glutamate/NO release and endocannabinoid functions along with baroreflex impairment. Thus, the vMPFC seems to play a crucial role on the baroreflex control, either during pathological or physiological stress-related responses. The study of baroreflex mechanism under such pathological view may be helpful to establish causality mechanisms for the autonomic and cardiovascular imbalance found in those conditions. It can explain in the future the reasons of the high cardiovascular risk some neurological and neurodegenerative disease patients undergo. Additionally, the present work offers insights on the possible contributions of vMPFC dysfunction on baroreflex alterations, which, in turn, may raise questions in what extent other brain areas may play a role in autonomic deregulation under such pathological situations.
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Affiliation(s)
- Davi C Lagatta
- Faculty of Pharmaceutical Sciences, Food and Nutrition, Federal University of Mato Grosso do Sul, MS, 79070-900, Campo Grande, Brazil
| | - Aline Fassini
- Department of Pharmacology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, SP, 14090-900, Brazil
| | - Ana L Terzian
- Department of Pharmacology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, SP, 14090-900, Brazil
| | - Fernando M A Corrêa
- Department of Pharmacology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, SP, 14090-900, Brazil
| | - Leonardo B M Resstel
- Department of Pharmacology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, SP, 14090-900, Brazil.
- Center for Interdisciplinary Research On Applied Neurosciences (NAPNA), Medical School of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, Brazil.
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The role of the autonomic nervous system in cerebral blood flow regulation in dementia: A review. Auton Neurosci 2022; 240:102985. [DOI: 10.1016/j.autneu.2022.102985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/28/2022] [Accepted: 04/28/2022] [Indexed: 11/19/2022]
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Nagai M, Kato M, Dote K. Visit-to-visit blood pressure variability in mild cognitive impairment: A possible marker of Alzheimer's disease in the SPRINT study? J Clin Hypertens (Greenwich) 2021; 23:2129-2132. [PMID: 34806836 PMCID: PMC8696211 DOI: 10.1111/jch.14388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Michiaki Nagai
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Masaya Kato
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Keigo Dote
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
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Costa MD, Redline S, Hughes TM, Heckbert SR, Goldberger AL. Prediction of Cognitive Decline Using Heart Rate Fragmentation Analysis: The Multi-Ethnic Study of Atherosclerosis. Front Aging Neurosci 2021; 13:708130. [PMID: 34512310 PMCID: PMC8428192 DOI: 10.3389/fnagi.2021.708130] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/06/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Heart rate fragmentation (HRF), a new non-invasive metric quantifying cardiac neuroautonomic function, is associated with increasing age and cardiovascular disease. Since these are risk factors for cognitive decline and dementia, in the Multi-Ethnic Study of Atherosclerosis (MESA), we investigated whether disrupted cardiac neuroautonomic function, evidenced by increased HRF, would be associated with worse cognitive function assessed concurrently and at a later examination, and with greater cognitive decline. Methods: HRF was derived from the ECG channel of the polysomnographic recordings obtained in an ancillary study (n = 1,897) conducted in conjunction with MESA exam 5 (2010-2012). Cognitive function was assessed at exam 5 and 6.4 ± 0.5 years later at exam 6 (2016-2018) with tests of global cognitive performance (the Cognitive Abilities Screening Instrument, CASI), processing speed (Digit Symbol Coding, DSC) and working memory (Digit Span). Multivariable regression models were used to quantify the associations between HRF indices and cognitive scores. Results: The participants' mean age was 68 ± 9 years (54% female). Higher HRF at baseline was independently associated with lower cognitive scores at both exams 5 and 6. Specifically, in cross-sectional analyses, a one-standard deviation (SD) (13.7%) increase in HRF was associated with a 0.51 (95% CI: 0.17-0.86) points reduction in CASI and a 1.12 (0.34-1.90) points reduction in DSC. Quantitatively similar effects were obtained in longitudinal analyses. A one-SD increase in HRF was associated with a 0.44 (0.03-0.86) and a 1.04 (0.28-1.81) points reduction in CASI and DSC from exams 5 to 6, respectively. HRF added predictive value to the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE-APOE-ε4) risk score and to models adjusted for serum concentration of NT-proBNP, an analyte associated with cognitive impairment and dementia. Conclusion: Increased HRF assessed during sleep was independently associated with diminished cognitive performance (concurrent and future) and with greater cognitive decline. These findings lend support to the links between cardiac neuroautonomic regulation and cognitive function. As a non-invasive, repeatable and inexpensive probe, HRF technology may be useful in monitoring cognitive status, predicting risk of dementia and assessing therapeutic interventions.
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Affiliation(s)
- Madalena D. Costa
- Margret and H. A. Rey Institute for Non-linear Dynamics in Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Timothy M. Hughes
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Susan R. Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Ary L. Goldberger
- Margret and H. A. Rey Institute for Non-linear Dynamics in Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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Longitudinal changes in the control mechanisms for blood pressure and cerebral blood flow in Alzheimer's disease: Secondary results of a randomized controlled trial. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2021; 2:100024. [PMID: 36324723 PMCID: PMC9616442 DOI: 10.1016/j.cccb.2021.100024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 11/21/2022]
Abstract
Cerebral autoregulation and baroreflex sensitivity are two key mechanisms that regulate the homeostasis of blood pressure and brain perfusion. For the first time, we performed repeated measurements of these mechanisms in a sample of Alzheimer's disease patients . In this sample, we found no evidence that these mechanisms become impaired over time. These patients did not demonstrate increased vulnerability towards starting mild blood pressure lowering therapy. This paves the way for further studies that investigate the safety and benefits of antihypertensive treatment in Alzheimer's disease
Objective Dynamic cerebral autoregulation (dCA) and baroreflex sensitivity (BRS) are key mechanisms involved in the homeostasis of blood pressure (BP) and cerebral blood flow. We assessed changes in these mechanisms in Alzheimer's disease (AD) during a 1.5 year follow-up. Methods In this secondary analysis of a randomized controlled trial we measured beat-to-beat BP, heart rate, and cerebral blood flow velocity at baseline, 0.5 and 1.5 years, during: rest (spontaneous oscillations), repeated sit-stand maneuvers (induced oscillations), an orthostatic challenge, and hypo- and hypercapnia. dCA was estimated using transfer function analysis and the autoregulatory index on spontaneous and induced oscillations. BRS was estimated by calculating the heart rate response to BP changes during induced oscillations. Linear mixed models were used to assess changes over time. Results 56 patients were included (mean age:73 ± 6 years, 57% female). BRS did not change over time. dCA parameters showed small changes after 0.5 years, suggestive of a reduction in efficiency (e.g. higher gain [linear mixed effect model: B = 0.09, SE = 0.03, P = 0.008] and lower phase [B = -9.7, SE= 3.2, P = 0.004] in the very low frequency domain, and lower autoregulatory index during induced oscillations [B = -0.69, SE = 0.26, P = 0.010]). These changes did not show further progression after 1.5 years of follow-up. Discussion In this sample of patients with dementia due to AD we found no evidence that dCA or BRS become impaired during AD progression. This paves the way for further studies that investigate the safety and benefits of antihypertensive treatment in patients with AD.
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Ma Y, Tully PJ, Hofman A, Tzourio C. Blood Pressure Variability and Dementia: A State-of-the-Art Review. Am J Hypertens 2020; 33:1059-1066. [PMID: 32710605 DOI: 10.1093/ajh/hpaa119] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 12/30/2022] Open
Abstract
Accumulating evidence demonstrates that blood pressure variability (BPV) may contribute to target organ damage, causing coronary heart disease, stroke, and renal disease independent of the level of blood pressure (BP). Several lines of evidence have also linked increased BPV to a higher risk of cognitive decline and incident dementia. The estimated number of dementia cases worldwide is nearly 50 million, and this number continues to grow with increasing life expectancy. Because there is no effective treatment to modify the course of dementia, targeting modifiable vascular factors continues as a top priority for dementia prevention. A clear understanding of the role of BPV in dementia may shed light on the etiology, early prevention, and novel therapeutic targets of dementia, and has therefore gained substantial attention from researchers and clinicians. This review summarizes state-of-art evidence on the relationship between BPV and dementia, with a specific focus on the epidemiological evidence, the underlying mechanisms, and potential intervention strategies. We also discuss challenges and opportunities for future research to facilitate optimal BP management and the clinical translation of BPV for the risk assessment and prevention of dementia.
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Affiliation(s)
- Yuan Ma
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Phillip J Tully
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Albert Hofman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Christophe Tzourio
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, CHU Bordeaux, Bordeaux, France
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13
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Rangon CM, Krantic S, Moyse E, Fougère B. The Vagal Autonomic Pathway of COVID-19 at the Crossroad of Alzheimer's Disease and Aging: A Review of Knowledge. J Alzheimers Dis Rep 2020; 4:537-551. [PMID: 33532701 PMCID: PMC7835993 DOI: 10.3233/adr-200273] [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] [Accepted: 11/17/2020] [Indexed: 12/11/2022] Open
Abstract
Coronavirus Disease 2019 (COVID-19) pandemic-triggered mortality is significantly higher in older than in younger populations worldwide. Alzheimer's disease (AD) is related to aging and was recently reported to be among the major risk factors for COVID-19 mortality in older people. The symptomatology of COVID-19 indicates that lethal outcomes of infection rely on neurogenic mechanisms. The present review compiles the available knowledge pointing to the convergence of COVID-19 complications with the mechanisms of autonomic dysfunctions in AD and aging. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is prone to neuroinvasion from the lung along the vagus nerve up to the brainstem autonomic nervous centers involved in the coupling of cardiovascular and respiratory rhythms. The brainstem autonomic network allows SARS-CoV-2 to trigger a neurogenic switch to hypertension and hypoventilation, which may act in synergy with aging- and AD-induced dysautonomias, along with an inflammatory "storm". The lethal outcomes of COVID-19, like in AD and unhealthy aging, likely rely on a critical hypoactivity of the efferent vagus nerve cholinergic pathway, which is involved in lowering cardiovascular pressure and systemic inflammation tone. We further discuss the emerging evidence supporting the use of 1) the non-invasive stimulation of vagus nerve as an additional therapeutic approach for severe COVID-19, and 2) the demonstrated vagal tone index, i.e., heart rate variability, via smartphone-based applications as a non-serological low-cost diagnostic of COVID-19. These two well-known medical approaches are already available and now deserve large-scale testing on human cohorts in the context of both AD and COVID-19.
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Affiliation(s)
- Claire-Marie Rangon
- Pain and Neuromodulation Unit, Division of Neurosurgery, Hôpital Fondation Ophtalmologique A. De Rothschild, Paris, France
| | - Slavica Krantic
- Sorbonne Université, St. Antoine Research Center (CRSA), Inserm UMRS-938, Hopital St-Antoine, Paris, France
| | - Emmanuel Moyse
- INRAE Centre Val-de-Loire, Physiology of Reproduction and Behavior Unit (PRC, UMR-85), Team ER2, Nouzilly, France
| | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Hospital, Tours, France
- Education, Ethics, Health (EA 7505), Tours University, Tours, France
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14
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Ribeiro VT, de Souza LC, Simões E Silva AC. Renin-Angiotensin System and Alzheimer's Disease Pathophysiology: From the Potential Interactions to Therapeutic Perspectives. Protein Pept Lett 2020; 27:484-511. [PMID: 31886744 DOI: 10.2174/0929866527666191230103739] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/27/2019] [Accepted: 11/16/2019] [Indexed: 12/21/2022]
Abstract
New roles of the Renin-Angiotensin System (RAS), apart from fluid homeostasis and Blood Pressure (BP) regulation, are being progressively unveiled, since the discoveries of RAS alternative axes and local RAS in different tissues, including the brain. Brain RAS is reported to interact with pathophysiological mechanisms of many neurological and psychiatric diseases, including Alzheimer's Disease (AD). Even though AD is the most common cause of dementia worldwide, its pathophysiology is far from elucidated. Currently, no treatment can halt the disease course. Successive failures of amyloid-targeting drugs have challenged the amyloid hypothesis and increased the interest in the inflammatory and vascular aspects of AD. RAS compounds, both centrally and peripherally, potentially interact with neuroinflammation and cerebrovascular regulation. This narrative review discusses the AD pathophysiology and its possible interaction with RAS, looking forward to potential therapeutic approaches. RAS molecules affect BP, cerebral blood flow, neuroinflammation, and oxidative stress. Angiotensin (Ang) II, via angiotensin type 1 receptors may promote brain tissue damage, while Ang-(1-7) seems to elicit neuroprotection. Several studies dosed RAS molecules in AD patients' biological material, with heterogeneous results. The link between AD and clinical conditions related to classical RAS axis overactivation (hypertension, heart failure, and chronic kidney disease) supports the hypothesized role of this system in AD. Additionally, RAStargeting drugs as Angiotensin Converting Enzyme inhibitors (ACEis) and Angiotensin Receptor Blockers (ARBs) seem to exert beneficial effects on AD. Results of randomized controlled trials testing ACEi or ARBs in AD are awaited to elucidate whether AD-RAS interaction has implications on AD therapeutics.
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Affiliation(s)
- Victor Teatini Ribeiro
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Leonardo Cruz de Souza
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil.,Department of Internal Medicine, Service of Neurology, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ana Cristina Simões E Silva
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
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15
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Abstract
PURPOSE To review the recent developments on the effect of chronic high mean arterial blood pressure (MAP) on cerebral blood flow (CBF) autoregulation and supporting the notion that CBF autoregulation impairment has connection with chronic cerebral diseases. Method: A narrative review of all the relevant papers known to the authors was conducted. Results: Our understanding of the connection between cerebral perfusion impairment and chronic high MAP and cerebral disease is rapidly evolving, from cerebral perfusion impairment being the result of cerebral diseases to being the cause of cerebral diseases. We now better understand the intertwined impact of hypertension and Alzheimer's disease (AD) on cerebrovascular sensory elements and recognize cerebrovascular elements that are more vulnerable to these diseases. Conclusion: We conclude with the suggestion that the sensory elements pathology plays important roles in intertwined mechanisms of chronic high MAP and AD that impact cerebral perfusion.
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Affiliation(s)
- Noushin Yazdani
- College of Public Health, University of South Florida , Tampa, FL, USA
| | - Mark S Kindy
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida , Tampa, FL, USA.,Biomedical Research, James A. Haley VA Medical Center , Tampa, FL, USA
| | - Saeid Taheri
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida , Tampa, FL, USA.,Byrd Neuroscience Institute, University of South Florida , Tampa, FL, USA
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16
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Ogoh S, Tarumi T. Cerebral blood flow regulation and cognitive function: a role of arterial baroreflex function. J Physiol Sci 2019; 69:813-823. [PMID: 31444691 PMCID: PMC10717347 DOI: 10.1007/s12576-019-00704-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/13/2019] [Indexed: 10/26/2022]
Abstract
A strict adequate perfusion pressure via arterial baroreflex for the delivery of oxygen to the tissues of the body is well established; however, the importance of baroreflex for cerebral blood flow (CBF) is unclear. On the other hand, there is convincing evidence for arterial baroreflex function playing an important role in maintaining brain homeostasis, e.g., cerebral metabolism, cerebral hemodynamics, and cognitive function. For example, mild cognitive impairment attenuates the sensitivity of baroreflex, and Alzheimer's disease further decreases it. These clinical findings suggest that CBF and cerebral function are affected by systemic blood pressure regulation via the arterial baroreflex. However, dysfunction of arterial baroreflex is likely to affect CBF regulation as well as the underlying neuronal function, but identifying how this is achieved is arduous since neurological diseases affect systemic as well as cerebral circulation independently. Recent insights into the influence of blood pressure regulation via the arterial baroreflex on cerebral function and blood flow regulation may help elucidate this important question. This review summarizes some update findings regarding direct (autonomic regulation) and indirect (systemic blood pressure regulation) contributions of the arterial baroreflex to the maintenance of cerebral vasculature regulation.
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Affiliation(s)
- Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, 2100 Kujirai, Kawagoe, Saitama, 350-8585, Japan.
| | - Takashi Tarumi
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan
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17
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Tamuli D, Kaur M, Boligarla A, Jaryal AK, Srivastava AK, Deepak KK. Depressed baroreflex sensitivity from spontaneous oscillations of heart rate and blood pressure in SCA1 and SCA2. Acta Neurol Scand 2019; 140:350-358. [PMID: 31343735 DOI: 10.1111/ane.13151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/20/2019] [Accepted: 07/21/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To assess the time and frequency domain measures of cardiac autonomic activity/tone in patients of genetically defined spinocerebellar ataxia (SCA) types 1 and 2, as well as to decipher the probable associations among the cardiovascular autonomic parameters and genetic and clinical characteristics. MATERIALS AND METHODS Simultaneous 5-min recording of RR interval (RRI) and blood pressure (BP) for the calculation of heart rate variability (HRV), blood pressure variability (BPV) and baroreflex sensitivity (BRS) were performed in genotypically confirmed SCA1 (n = 31) and SCA2 (n = 40) patients and healthy controls (n = 40). Additionally, the International Cooperative Ataxia Rating Scale (ICARS) was used for scoring of clinical severity in SCA patients. RESULTS Time and frequency domain parameters of HRV, BPV and BRS were depressed in SCA1 and SCA2 subtypes as compared to controls, although there was no statistically significant difference in autonomic tone between the two SCA subtypes. On correlation analysis, autonomic tone parameters were found to be associated with the clinical and genetic features of the SCA subtypes. Also, ICARS was associated with the genotype (CAG repeat length) in SCA2 patents. CONCLUSIONS Cardiac autonomic tone is depressed in both SCA1 and 2 as compared to healthy controls while the two SCA subtypes do not differ in terms of autonomic tone. Also, a typical association exists between disease characteristics and autonomic indices.
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Affiliation(s)
- Dibashree Tamuli
- Department of Physiology All India Institute of Medical Sciences New Delhi India
| | - Manpreet Kaur
- Department of Physiology VMMC & Safdarjung Hospital New Delhi India
| | - Anasuya Boligarla
- Department of Physiology All India Institute of Medical Sciences New Delhi India
| | - Ashok K. Jaryal
- Department of Physiology All India Institute of Medical Sciences New Delhi India
| | - Achal K. Srivastava
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Kishore K. Deepak
- Department of Physiology All India Institute of Medical Sciences New Delhi India
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18
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Wearable Technology for Detecting Significant Moments in Individuals with Dementia. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6515813. [PMID: 31662986 PMCID: PMC6778872 DOI: 10.1155/2019/6515813] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/05/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022]
Abstract
The detection of significant moments can support the care of individuals with dementia by making visible what is most meaningful to them and maintaining a sense of interpersonal connection. We present a novel intelligent assistive technology (IAT) for the detection of significant moments based on patterns of physiological signal changes in individuals with dementia and their caregivers. The parameters of the IAT are tailored to each individual's idiosyncratic physiological response patterns through an iterative process of incorporating subjective feedback on videos extracted from candidate significant moments identified through the IAT algorithm. The IAT was tested on three dyads (individual with dementia and their primary caregiver) during an eight-week movement program. Upon completion of the program, the IAT identified distinct, personal characteristics of physiological responsiveness in each participant. Tailored algorithms could detect moments of significance experienced by either member of the dyad with an agreement with subjective reports of 70%. These moments were constituted by both physical and emotional significances (e.g., experiences of pain or anxiety) and interpersonal significance (e.g., moments of heighted connection). We provide a freely available MATLAB toolbox with the IAT software in hopes that the assistive technology community can benefit from and contribute to these tools for understanding the subjective experiences of individuals with dementia.
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19
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Issac TG, Chandra SR, Gupta N, Rukmani MR, Deepika S, Sathyaprabha TN. Autonomic dysfunction: A comparative study of patients with Alzheimer's and frontotemporal dementia - A pilot study. J Neurosci Rural Pract 2019; 8:84-88. [PMID: 28149088 PMCID: PMC5225730 DOI: 10.4103/0976-3147.193545] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: In frontotemporal dementia (FTD) and Alzheimer's disease (AD), central autonomic structures get affected early. An insight into autonomic functions in these patients is likely to be of diagnostic importance and thus help in prognosticating and also probably explain unexplained sudden death in some of these patients. Objectives: The objective of this study is to identify autonomic dysfunction prevailing in patients. Then, if there is dysfunction, is the pattern same or different in these two conditions. And if different it will serve as an additional biomarker for specific diagnosis. Patients and Methods: There were 25 patients and 25 controls and six patients and three controls in AD and FTD groups, respectively. The participants who were recruited were assessed for heart rate variability and conventional cardiac autonomic function testing. The parameters were analyzed using LabChart version 7 software and compared with control population using appropriate statistical methods using SPSS version 22 software. Results: The mean overall total power was low in the FTD group (P < 0.001), and there was significant reduction in the standard deviation of normal-to-normal intervals and root mean square of successive differences (P < 0.001) with elevated sympathovagal balance in the FTD group (P = 0.04). Patients with AD also showed sympathetic dominance, but there was in addition parasympathetic suppression unlike in the FTD group. Conclusion: This study reveals autonomic dysfunction in patients with FTD and AD. Both conditions show sympathetic dominance, probably consecutive to the involvement of central autonomic regulatory structures as a shared domain. It remains to be confirmed if these findings are the cause or effect of neurodegeneration and might open up newer territories of research based on the causal role of neurotransmitters in these regions and thus lead to novel therapeutic options such as yoga. The presence of parasympathetic suppression in AD in addition helps differentiate these two conditions.
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Affiliation(s)
- Thomas Gregor Issac
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Neelesh Gupta
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Malligurki Raghurama Rukmani
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - S Deepika
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - T N Sathyaprabha
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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20
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Toledo C, Lucero C, Andrade DC, Díaz HS, Schwarz KG, Pereyra KV, Arce-Álvarez A, López NA, Martinez M, Inestrosa NC, Del Rio R. Cognitive impairment in heart failure is associated with altered Wnt signaling in the hippocampus. Aging (Albany NY) 2019; 11:5924-5942. [PMID: 31447429 PMCID: PMC6738419 DOI: 10.18632/aging.102150] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/31/2019] [Indexed: 12/23/2022]
Abstract
Age represents the highest risk factor for death due to cardiovascular disease. Heart failure (HF) is the most common cardiovascular disease in elder population and it is associated with cognitive impairment (CI), diminishing learning and memory process affecting life quality and mortality in these patients. In HF, CI has been associated with inadequate O2 supply to the brain; however, an important subset of HF patients displays CI with almost no alteration in cerebral blood flow. Importantly, nothing is known about the pathophysiological mechanisms underpinning CI in HF with no change in brain tissue perfusion. Here, we aimed to study memory performance and learning function in a rodent model of HF that shows no change in blood flow going to the brain. We found that HF rats presented learning impairments and memory loss. In addition, HF rats displayed a decreased level of Wnt/β-catenin signaling downstream elements in the hippocampus, one pathway implicated largely in aging diseases. Taken together, our results suggest that in HF rats CI is associated with dysfunction of the Wnt/β-catenin signaling pathway. The mechanisms involved in the alterations of Wnt/β-catenin signaling in HF and its contribution to the development/maintenance of CI deserves future investigations.
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Affiliation(s)
- Camilo Toledo
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Excelencia de Biomedicina en Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile
| | - Claudia Lucero
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - David C Andrade
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Investigación en Fisiología del Ejercicio, Universidad Mayor, Santiago, Chile
| | - Hugo S Díaz
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Karla G Schwarz
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Katherin V Pereyra
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexis Arce-Álvarez
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás A López
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Milka Martinez
- Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nibaldo C Inestrosa
- Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Excelencia de Biomedicina en Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile
| | - Rodrigo Del Rio
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Excelencia de Biomedicina en Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile
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21
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Toledo C, Andrade DC, Díaz HS, Inestrosa NC, Del Rio R. Neurocognitive Disorders in Heart Failure: Novel Pathophysiological Mechanisms Underpinning Memory Loss and Learning Impairment. Mol Neurobiol 2019; 56:8035-8051. [PMID: 31165973 DOI: 10.1007/s12035-019-01655-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/20/2019] [Indexed: 01/01/2023]
Abstract
Heart failure (HF) is a major public health issue affecting more than 26 million people worldwide. HF is the most common cardiovascular disease in elder population; and it is associated with neurocognitive function decline, which represent underlying brain pathology diminishing learning and memory faculties. Both HF and neurocognitive impairment are associated with recurrent hospitalization episodes and increased mortality rate in older people, but particularly when they occur simultaneously. Overall, the published studies seem to confirm that HF patients display functional impairments relating to attention, memory, concentration, learning, and executive functioning compared with age-matched controls. However, little is known about the molecular mechanisms underpinning neurocognitive decline in HF. The present review round step recent evidence related to the possible molecular mechanism involved in the establishment of neurocognitive disorders during HF. We will make a special focus on cerebral ischemia, neuroinflammation and oxidative stress, Wnt signaling, and mitochondrial DNA alterations as possible mechanisms associated with cognitive decline in HF. Also, we provide an integrative mechanism linking pathophysiological hallmarks of altered cardiorespiratory control and the development of cognitive dysfunction in HF patients. Graphical Abstract Main molecular mechanisms involved in the establishment of cognitive impairment during heart failure. Heart failure is characterized by chronic activation of brain areas responsible for increasing cardiac sympathetic load. In addition, HF patients also show neurocognitive impairment, suggesting that the overall mechanisms that underpin cardiac sympathoexcitation may be related to the development of cognitive disorders in HF. In low cardiac output, HF cerebral infarction due to cardiac mural emboli and cerebral ischemia due to chronic or intermittent cerebral hypoperfusion has been described as a major mechanism related to the development of CI. In addition, while acute norepinephrine (NE) release may be relevant to induce neural plasticity in the hippocampus, chronic or tonic release of NE may exert the opposite effects due to desensitization of the adrenergic signaling pathway due to receptor internalization. Enhanced chemoreflex drive is a major source of sympathoexcitation in HF, and this phenomenon elevates brain ROS levels and induces neuroinflammation through breathing instability. Importantly, both oxidative stress and neuroinflammation can induce mitochondrial dysfunction and vice versa. Then, this ROS inflammatory pathway may propagate within the brain and potentially contribute to the development of cognitive impairment in HF through the activation/inhibition of key molecular pathways involved in neurocognitive decline such as the Wnt signaling pathway.
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Affiliation(s)
- C Toledo
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - D C Andrade
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de investigación en fisiología del ejercicio, Universidad Mayor, Santiago, Chile
| | - H S Díaz
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - N C Inestrosa
- Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile
| | - R Del Rio
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile. .,Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile. .,Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile.
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22
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de Heus RA, de Jong DL, Sanders ML, van Spijker GJ, Oudegeest-Sander MH, Hopman MT, Lawlor BA, Olde Rikkert MG, Claassen JA. Dynamic Regulation of Cerebral Blood Flow in Patients With Alzheimer Disease. Hypertension 2018; 72:139-150. [DOI: 10.1161/hypertensionaha.118.10900] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 02/09/2018] [Accepted: 04/05/2018] [Indexed: 01/18/2023]
Abstract
Cerebral autoregulation and baroreflex sensitivity are key mechanisms that maintain cerebral blood flow. This study assessed whether these control mechanisms are affected in patients with dementia and mild cognitive impairment due to Alzheimer disease, as this would increase the risks of antihypertensive treatment. We studied 53 patients with dementia (73.1 years [95% confidence interval (CI), 71.4–74.8]), 37 patients with mild cognitive impairment (69.2 years [95% CI, 66.4–72.0]), and 47 controls (69.4 years [95% CI, 68.3–70.5]). Beat-to-beat blood pressure (photoplethysmography), heart rate, and cerebral blood flow velocity (transcranial Doppler) were measured during 5-minute rest (sitting) and 5 minutes of orthostatic challenges, using repeated sit-to-stand maneuvers. Cerebral autoregulation was assessed using transfer function analysis and the autoregulatory index. Baroreflex sensitivity was estimated with transfer function analysis and by calculating the heart rate response to blood pressure changes during the orthostatic challenges. Dementia patients had the lowest cerebral blood flow velocity (
P
=0.004). During rest, neither transfer function analysis nor the autoregulatory index indicated impairments in cerebral autoregulation. During the orthostatic challenges, higher autoregulatory index (
P
=0.011) and lower transfer function gain (
P
=0.017), indicating better cerebral autoregulation, were found in dementia (4.56 arb. unit [95% CI, 4.14–4.97]; 0.59 cm/s per mm Hg [95% CI, 0.51–0.66]) and mild cognitive impairment (4.59 arb. unit [95% CI, 4.04–5.13]; 0.51 cm/s per mm Hg [95% CI, 0.44–0.59]) compared with controls (3.71 arb. unit [95% CI, 3.35–4.07]; 0.67 cm/s per mm Hg [95% CI, 0.59–0.74]). Baroreflex sensitivity measures did not differ between groups. In conclusion, the key mechanisms to control blood pressure and cerebral blood flow are not reduced in 2 stages of Alzheimer disease compared with controls, both in rest and during orthostatic changes that reflect daily life challenges.
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Affiliation(s)
- Rianne A.A. de Heus
- From the Department of Geriatric Medicine, Radboud Alzheimer Centre (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
- Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
| | - Daan L.K. de Jong
- From the Department of Geriatric Medicine, Radboud Alzheimer Centre (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
- Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
| | - Marit L. Sanders
- From the Department of Geriatric Medicine, Radboud Alzheimer Centre (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
- Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
| | - Gerrita J. van Spijker
- From the Department of Geriatric Medicine, Radboud Alzheimer Centre (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
- Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
| | - Madelijn H. Oudegeest-Sander
- From the Department of Geriatric Medicine, Radboud Alzheimer Centre (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
- Department of Physiology (M.H.O.-S., M.T.H.), Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
| | - Maria T. Hopman
- Department of Physiology (M.H.O.-S., M.T.H.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Brian A. Lawlor
- Mercer's Institute for Research on Ageing, St. James's Hospital and Global Brain Health Institute, Trinity College Dublin, Ireland (B.A.L.)
| | - Marcel G.M. Olde Rikkert
- From the Department of Geriatric Medicine, Radboud Alzheimer Centre (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
- Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
| | - Jurgen A.H.R. Claassen
- From the Department of Geriatric Medicine, Radboud Alzheimer Centre (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
- Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands (R.A.A.d.H., D.L.K.d.J., M.L.S., G.J.v.S., M.H.O.-S., M.G.M.O.R., J.A.H.R.C.)
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Medial prefrontal cortex TRPV1 and CB1 receptors modulate cardiac baroreflex activity by regulating the NMDA receptor/nitric oxide pathway. Pflugers Arch 2018; 470:1521-1542. [PMID: 29845313 DOI: 10.1007/s00424-018-2149-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/10/2018] [Accepted: 04/27/2018] [Indexed: 12/23/2022]
Abstract
The ventral medial prefrontal cortex (vMPFC) facilitates the cardiac baroreflex response through N-methyl-D-aspartate (NMDA) receptor activation and nitric oxide (NO) formation by neuronal NO synthase (nNOS) and soluble guanylate cyclase (sGC) triggering. Glutamatergic transmission is modulated by the cannabinoid receptor type 1 (CB1) and transient receptor potential vanilloid type 1 (TRPV1) receptors, which may inhibit or stimulate glutamate release in the brain, respectively. Interestingly, vMPFC CB1 receptors decrease cardiac baroreflex responses, while TRPV1 channels facilitate them. Therefore, the hypothesis of the present study is that the vMPFC NMDA/NO pathway is regulated by both CB1 and TRPV1 receptors in the modulation of cardiac baroreflex activity. In order to test this assumption, we used male Wistar rats that had stainless steel guide cannulae bilaterally implanted in the vMPFC. Subsequently, a catheter was inserted into the femoral artery, for cardiovascular recordings, and into the femoral vein for assessing baroreflex activation. The increase in tachycardic and bradycardic responses observed after the microinjection of a CB1 receptors antagonist into the vMPFC was prevented by an NMDA antagonist as well as by the nNOS and sGC inhibition. NO extracellular scavenging also abolished these responses. These same pharmacological manipulations inhibited cardiac reflex enhancement induced by TRPV1 agonist injection into the area. Based on these results, we conclude that vMPFC CB1 and TRPV1 receptors inhibit or facilitate the cardiac baroreflex activity by stimulating or blocking the NMDA activation and NO synthesis.
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Nagai M, Dote K, Kato M, Sasaki S, Oda N, Kagawa E, Nakano Y, Yamane A, Higashihara T, Miyauchi S, Tsuchiya A. Visit-to-Visit Blood Pressure Variability and Alzheimer's Disease: Links and Risks. J Alzheimers Dis 2018; 59:515-526. [PMID: 28598842 DOI: 10.3233/jad-161172] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
While hypertension has been shown to be a risk factor for vascular dementia, several studies have also demonstrated that hypertension also increases the risk of Alzheimer's disease (AD). Although the relationship between visit-to-visit blood pressure variability (VVV) and cognitive impairment, including AD, have been provided, the mechanisms remain poorly understood. This review paper focuses on the relationship of VVV with AD and summarizes the pathophysiology underlying that relationship, which appears to be mediated by arterial stiffness.
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Affiliation(s)
- Michiaki Nagai
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Keigo Dote
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Masaya Kato
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Shota Sasaki
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Noboru Oda
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Eisuke Kagawa
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Yoshinori Nakano
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Aya Yamane
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | | | - Shunsuke Miyauchi
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Akane Tsuchiya
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
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25
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Avolio A, Kim MO, Adji A, Gangoda S, Avadhanam B, Tan I, Butlin M. Cerebral Haemodynamics: Effects of Systemic Arterial Pulsatile Function and Hypertension. Curr Hypertens Rep 2018; 20:20. [PMID: 29556793 DOI: 10.1007/s11906-018-0822-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Concepts of pulsatile arterial haemodynamics, including relationships between oscillatory blood pressure and flow in systemic arteries, arterial stiffness and wave propagation phenomena have provided basic understanding of underlying haemodynamic mechanisms associated with elevated arterial blood pressure as a major factor of cardiovascular risk, particularly the deleterious effects of isolated systolic hypertension in the elderly. This topical review assesses the effects of pulsatility of blood pressure and flow in the systemic arteries on the brain. The review builds on the emerging notion of the "pulsating brain", taking into account the high throughput of blood flow in the cerebral circulation in the presence of mechanisms involved in ensuring efficient and regulated cerebral perfusion. RECENT FINDINGS Recent studies have provided evidence of the relevance of pulsatility and hypertension in the following areas: (i) pressure and flow pulsatility and regulation of cerebral blood flow, (ii) cerebral and systemic haemodynamics, hypertension and brain pathologies (cognitive impairment, dementia, Alzheimer's disease), (iii) stroke and cerebral small vessel disease, (iv) cerebral haemodynamics and noninvasive estimation of cerebral vascular impedance, (v) cerebral and systemic pulsatile haemodynamics and intracranial pressure, (iv) response of brain endothelial cells to cyclic mechanical stretch and increase in amyloid burden. Studies to date, producing increasing epidemiological, clinical and experimental evidence, suggest a potentially significant role of systemic haemodynamic pulsatility on structure and function of the brain.
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Affiliation(s)
- Alberto Avolio
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia.
| | - Mi Ok Kim
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Audrey Adji
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia.,St. Vincent's Clinic, Victor Chang Cardiac Research Institute, University of New South Wales, Sydney, Australia
| | - Sumudu Gangoda
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Bhargava Avadhanam
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Isabella Tan
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Mark Butlin
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia
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26
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Ho L, Legere M, Li T, Levine S, Hao K, Valcarcel B, Pasinetti GM. Autonomic Nervous System Dysfunctions as a Basis for a Predictive Model of Risk of Neurological Disorders in Subjects with Prior History of Traumatic Brain Injury: Implications in Alzheimer's Disease. J Alzheimers Dis 2018; 56:305-315. [PMID: 27911325 DOI: 10.3233/jad-160948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Autonomic dysfunction is very common in patients with dementia, and its presence might also help in differential diagnosis among dementia subtypes. Various central nervous system structures affected in Alzheimer's disease (AD) are also implicated in the central autonomic nervous system (ANS) regulation. For example, deficits in central cholinergic function in AD could likely lead to autonomic dysfunction. We recently developed a simple, readily applicable evaluation for monitoring ANS disturbances in response to traumatic brain injury (TBI). This ability to monitor TBI allows for the possible detection and targeted prevention of long-term, detrimental brain responses caused by TBI that lead to neurodegenerative diseases such as AD. We randomly selected and extracted de-identified medical record information from subjects who have been assessed using the ANS evaluation protocol. Using machine learning strategies in the analysis of information from individual as well as a combination of ANS evaluation protocol components, we identified a novel prediction model that is effective in correctly segregating between cases with or without a documented history of TBI exposure. Results from our study support the hypothesis that trauma-induced ANS dysfunctions may contribute to clinical TBI features. Because autonomic dysfunction is very common in AD patients it is possible that TBI may also contribute to AD and/or other forms of dementia through these novel mechanisms. This study provides a novel prediction model to physiologically assess the likelihood of subjects with prior history of TBI to develop clinical TBI complications, such as AD.
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Affiliation(s)
- Lap Ho
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Geriatric Research, Education & Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | | | | | - Samara Levine
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ke Hao
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Breanna Valcarcel
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Giulio M Pasinetti
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Geriatric Research, Education & Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
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27
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Abstract
OBJECTIVE Higher blood pressure variability (BPV), independent of mean blood pressure (BP), has been associated with adverse health outcomes. We investigated the association between visit-to-visit BPV and functional decline in older adults at high cardiovascular risk. METHODS In PROspective Study of Pravastatin in the Elderly at Risk, 4745 participants with mean age of 75.2 years and high cardiovascular risk were followed for a mean of 3.2 years. BP was measured in every 3 months during the first 18 months. BPV was defined as the intraindividual SD of measurements across these visits. Functional status in basic and instrumental activities of daily living was measured using the Barthel (ADL) and Lawton (IADL) scales, first at 18 months and then during follow-up until 48 months. Functional decline was calculated over this period. RESULTS BPV was not cross-sectionally associated with functional status at 18 months. Higher SBPV was associated with steeper functional decline, whereas DBPV was not. Each 10 mmHg higher SBPV was associated with a 0.064 (95% confidence interval 0.016-0.112, P = 0.009) annual decline in ADL score and with a 0.078 decline (95% confidence interval 0.020-0.136, P = 0.008) in IADL score. These associations were not modified by sex, hypertension or antihypertensives. These findings were independent of mean BP, cardiovascular risk factors and morbidities and cognition. CONCLUSION Higher visit-to-visit SBPV but not DBPV was associated with steeper functional decline in older adults at high cardiovascular risk. Higher SBPV is a novel risk factor for functional decline.
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28
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Decreased baroreflex sensitivity in Parkinson's disease is associated with orthostatic hypotension. J Neurol Sci 2017; 377:207-211. [DOI: 10.1016/j.jns.2017.03.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 03/11/2017] [Accepted: 03/27/2017] [Indexed: 11/18/2022]
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29
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Ye JJ, Lee KT, Lin JS, Chuang CC. Observing continuous change in heart rate variability and photoplethysmography-derived parameters during the process of pain production/relief with thermal stimuli. J Pain Res 2017; 10:527-533. [PMID: 28331355 PMCID: PMC5348136 DOI: 10.2147/jpr.s129287] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Continuously monitoring and efficiently managing pain has become an important issue. However, no study has investigated a change in physiological parameters during the process of pain production/relief. This study modeled the process of pain production/relief using ramped thermal stimulation (no pain: 37°C water, process of pain production: a heating rate of 1°C/min, and subject feels pain: water kept at the painful temperature for each subject, with each segment lasting 10 min). In this duration, the variation of the heat rate variability and photoplethysmography-derived parameters was observed. A total of 40 healthy individuals participated: 30 in the trial group (14 males and 16 females with a mean age of 22.5±1.9 years) and 10 in the control group (7 males and 3 females with a mean age of 22.5±1.3 years). The results showed that the numeric rating scale value was 5.03±1.99 when the subjects felt pain, with a temperature of 43.54±1.70°C. Heart rate, R-R interval, low frequency, high frequency, photoplethysmography amplitude, baseline, and autonomic nervous system state showed significant changes during the pain production process, but these changes differed during the period Segment D (painful temperature 10: min). In summary, the study observed that physiological parameters changed qualitatively during the process of pain production and relief and found that the high frequency, low frequency, and photoplethysmography parameters seemed to have different responses in four situations (no pain, pain production, pain experienced, and pain relief). The trends of these variations may be used as references in the clinical setting for continuously observing pain intensity.
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Affiliation(s)
- Jing-Jhao Ye
- Department of Biomedical Engineering, Chung Yuan Christian University, Chung Li, Taiwan
| | - Kuan-Ting Lee
- Department of Biomedical Engineering, Chung Yuan Christian University, Chung Li, Taiwan
| | - Jing-Siang Lin
- Department of Biomedical Engineering, Chung Yuan Christian University, Chung Li, Taiwan
| | - Chiung-Cheng Chuang
- Department of Biomedical Engineering, Chung Yuan Christian University, Chung Li, Taiwan
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30
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Bassi A, Bozzali M. Potential Interactions between the Autonomic Nervous System and Higher Level Functions in Neurological and Neuropsychiatric Conditions. Front Neurol 2015; 6:182. [PMID: 26388831 PMCID: PMC4559639 DOI: 10.3389/fneur.2015.00182] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 08/10/2015] [Indexed: 11/17/2022] Open
Abstract
The autonomic nervous system (ANS) maintains the internal homeostasis by continuously interacting with other brain structures. Its failure is commonly observed in many neurological and neuropsychiatric disorders, including neurodegenerative and vascular brain diseases, spinal cord injury, and peripheral neuropathies. Despite the different underlying pathophysiological mechanisms, ANS failure associates with various forms of higher level dysfunctions, and may also negatively impact on patients’ clinical outcome. In this review, we will discuss potential relationships between ANS and higher level dysfunctions in a selection of neurological and neuropsychiatric disorders. In particular, we will focus on the effect of a documented fall in blood pressure fulfilling the criteria for orthostatic hypotension and/or autonomic-reflex impairment on cognitive performances. Some evidence supports the hypothesis that cardiovascular autonomic failure may play a negative prognostic role in most neurological disorders. Despite a clear causal relationship between ANS involvement and higher level dysfunctions that is still controversial, this might have implications for neuro-rehabilitation strategies aimed at improving patients’ clinical outcome.
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Affiliation(s)
- Andrea Bassi
- Clinical and Behavioural Neurology Laboratory, IRCCS Santa Lucia Foundation , Rome , Italy
| | - Marco Bozzali
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation , Rome , Italy
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Laosiripisan J, Tarumi T, Gonzales MM, Haley AP, Tanaka H. Association between cardiovagal baroreflex sensitivity and baseline cerebral perfusion of the hippocampus. Clin Auton Res 2015; 25:213-8. [PMID: 26280218 DOI: 10.1007/s10286-015-0296-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/23/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE A failure to control perfusion pressure due to impaired baroreflex sensitivity (BRS) could potentially cause chronic brain hypoperfusion, leading to cognitive dysfunction. The primary aim of this study was to determine whether BRS was associated with regional cerebral blood flow as measured by MRI arterial spin labeling (ASL) technique. METHODS Baroreflex sensitivity was measured using the Valsalva maneuver technique in 52 middle-aged normotensive adults (49 ± 1 years), and phase IV of the Valsalva maneuver was used for analyses. Cerebral perfusion was measured using the ASL MRI technique in 10 pre-determined brain regions of interest. RESULTS Hippocampal perfusion was correlated with BRS (R (2) = 0.17, P = 0.01). No association was observed between BRS and cerebral perfusion in the other brain regions of interest. Partial correlational analyses revealed that BRS was an important predictor of hippocampal perfusion, explaining 11 % of the variability independent of other covariates. When participants were divided into tertiles of BRS (11.8 ± 1.9 and 3.5 ± 0.1 ms/mmHg for the highest and lowest tertiles), regional cerebral perfusion of the hippocampus was significantly lower in the lowest BRS tertile than in the highest tertile (39.1 ± 4.3 and 60.5 ± 8.4 ml/100 g/min). CONCLUSIONS Baroreflex sensitivity in midlife is positively associated with regional cerebral perfusion of the hippocampus, and impaired BRS appears to be related to brain hypoperfusion even in apparently healthy middle-aged adults. Future longitudinal studies based on the present cross-sectional findings may help to further define the relationship between BRS to cognitive dysfunction.
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Affiliation(s)
- Jitanan Laosiripisan
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, 78712, USA
| | - Takashi Tarumi
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, 78712, USA
| | - Mitzi M Gonzales
- Department of Psychology, University of Texas at Austin, Austin, TX, 78712, USA
| | - Andreana P Haley
- Department of Psychology, University of Texas at Austin, Austin, TX, 78712, USA
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, 78712, USA.
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32
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Transcutaneous vagus nerve stimulation boosts associative memory in older individuals. Neurobiol Aging 2015; 36:1860-7. [DOI: 10.1016/j.neurobiolaging.2015.02.023] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 01/12/2023]
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33
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Affiliation(s)
- Jurgen A.H.R. Claassen
- From the Department of Geriatric Medicine, Donders Institute for Brain, Cognition, and Behaviour, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
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Böhm M, Schumacher H, Leong D, Mancia G, Unger T, Schmieder R, Custodis F, Diener HC, Laufs U, Lonn E, Sliwa K, Teo K, Fagard R, Redon J, Sleight P, Anderson C, O'Donnell M, Yusuf S. Systolic blood pressure variation and mean heart rate is associated with cognitive dysfunction in patients with high cardiovascular risk. Hypertension 2015; 65:651-61. [PMID: 25583157 DOI: 10.1161/hypertensionaha.114.04568] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
UNLABELLED Elevated systolic blood pressure (SBP) correlates to cognitive decline and incident dementia. The effects of heart rate (HR), visit to visit HR variation, and visit to visit SBP variation are less well established. Patients without preexisting cognitive dysfunction (N=24 593) were evaluated according to mean SBP, SBP visit to visit variation (coefficient of variation [standard deviation/mean×100%], CV), mean HR, and visit to visit HR variation (HR-CV) in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial and the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease. Cognitive function was assessed with mini mental state examination. Cognitive dysfunction (fall in mini mental state examination ≤24 points), important cognitive decline (drop of ≥5 points), and cognitive deterioration (drop of >1 point per year or decline to <24 points) were assessed. SBP and HR were measured over 10.7±2.2 (mean±SD) visits. Mean SBP, mean HR, and SBP-CV were associated with cognitive decline, dysfunction, and deterioration (all P<0.01, unadjusted). After adjustment, only SBP-CV (P=0.0030) and mean HR (P=0.0008) remained predictors for cognitive dysfunction (odds ratios [95% confidence intervals], 1.32 [1.10-1.58] for 5th versus 1st quintile of SBP-CV and 1.40 [1.18-1.66] for 5th versus 1st quintile of mean HR). Similar effects were observed for cognitive decline and deterioration. SBP-CV and mean HR showed additive effects. In conclusion, SBP-CV and mean HR are independent predictors of cognitive decline and cognitive dysfunction in patients at high CV risk. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT 00153101.
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Affiliation(s)
- Michael Böhm
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.).
| | - Helmut Schumacher
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Darryl Leong
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Giuseppe Mancia
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Thomas Unger
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Roland Schmieder
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Florian Custodis
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Hans-Christoph Diener
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Ulrich Laufs
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Eva Lonn
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Karen Sliwa
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Koon Teo
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Robert Fagard
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Josep Redon
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Peter Sleight
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Craig Anderson
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Martin O'Donnell
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Salim Yusuf
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
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35
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Picano E, Bruno RM, Ferrari GF, Bonuccelli U. Cognitive impairment and cardiovascular disease: so near, so far. Int J Cardiol 2014; 175:21-9. [PMID: 24856805 DOI: 10.1016/j.ijcard.2014.05.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 04/30/2014] [Accepted: 05/05/2014] [Indexed: 01/08/2023]
Abstract
In the spectrum of cognitive impairment, ranging from "pure" vascular dementia to Alzheimer's disease (AD), clinical interest has recently expanded from the brain to also include the vessels, shifting the pathophysiological focus from the leaves of synaptic dysfunction to the sap of cerebral microcirculation and the roots of cardiovascular function. From a diagnostic viewpoint, a thorough clinical evaluation of individuals presenting cognitive impairment might systematically include the assessment of the major cardiovascular rings of the chain linking regional perfusion to brain function: 1) lung (with assessment of asthma, chronic obstructive pulmonary disease, obstructive sleep apnea syndrome); 2) heart function (with clinical examination and echocardiography) and cardiovascular risk factors; 3) orthostatic hypotension (with medical history and measurement of heart rate and blood pressure in supine and upright positions); 4) aorta and large artery stiffness (with assessment of pulse wave velocity); 5) large cerebro-vascular vessel status (with neuroimaging techniques); 6) assessment of microcirculation (with cerebrovascular reactivity testing with transcranial Doppler sonography or MRI perfusion imaging); and 7) assessment of venous cerebral circulation. The apparent difference in approaches to "brain" and "vascular" environmental enrichment with physical, cognitive and sensorial training is conceptually identical to that of a constant gardener caring for an unhealthy tree, watering the leaves ("train the brain") or simply the roots ("mind the vessel"). The therapeutic difference probably consists in the amount and quality of water added to the tree, rather than by where one pours it, with either a top-down (leaves to roots) or bottom-up (roots to leaves) approach.
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Affiliation(s)
| | | | | | - Ubaldo Bonuccelli
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
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36
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Liu J, Zhu YS, Khan MA, Brunk E, Martin-Cook K, Weiner MF, Cullum CM, Lu H, Levine BD, Diaz-Arrastia R, Zhang R. Global brain hypoperfusion and oxygenation in amnestic mild cognitive impairment. Alzheimers Dement 2013; 10:162-70. [PMID: 23871763 DOI: 10.1016/j.jalz.2013.04.507] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 04/22/2013] [Accepted: 04/30/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND To determine if global brain hypoperfusion and oxygen hypometabolism occur in patients with amnestic mild cognitive impairment (aMCI). METHODS Thirty-two aMCI and 21 normal subjects participated. Total cerebral blood flow (TCBF), cerebral metabolic rate of oxygen (CMRO2), and brain tissue volume were measured using color-coded duplex ultrasonography (CDUS), near-infrared spectroscopy (NIRS), and MRI. TCBF was normalized by total brain tissue volume (TBV) for group comparisons (nTCBF). Cerebrovascular resistance (CVR) was calculated as mean arterial pressure divided by TCBF. RESULTS Reductions in nTCBF by 9%, CMRO2 by 11%, and an increase in CVR by 13% were observed in aMCI relative to normal subjects. No group differences in TBV were observed. nTCBF was correlated with CMRO2 in normal controls, but not in aMCI. CONCLUSIONS Global brain hypoperfusion, oxygen hypometabolism, and neurovascular decoupling observed in aMCI suggest that changes in cerebral hemodynamics occur early at a prodromal stage of Alzheimer's disease, which can be assessed using low-cost and bedside-available CDUS and NIRS technology.
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Affiliation(s)
- Jie Liu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yong-Sheng Zhu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Muhammad Ayaz Khan
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Estee Brunk
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA
| | - Kristin Martin-Cook
- Department of Neurology and Neurotherapeutics and the Alzheimer's Disease Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Myron F Weiner
- Department of Neurology and Neurotherapeutics and the Alzheimer's Disease Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Neurology and Neurotherapeutics and the Alzheimer's Disease Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hanzhang Lu
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ramon Diaz-Arrastia
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Rong Zhang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Neurology and Neurotherapeutics and the Alzheimer's Disease Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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