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Lalani SJ, Reyes A, Kaestner E, Stark SM, Stark CEL, Lee D, Kansal L, Shih JJ, Smith CN, Paul BM, McDonald CR. Impaired Behavioral Pattern Separation in Refractory Temporal Lobe Epilepsy and Mild Cognitive Impairment. J Int Neuropsychol Soc 2022; 28:550-562. [PMID: 34078506 PMCID: PMC8965747 DOI: 10.1017/s1355617721000734] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Episodic memory impairment and hippocampal pathology are hallmark features of both temporal lobe epilepsy (TLE) and amnestic mild cognitive impairment (aMCI). Pattern separation (PS), which enables the distinction between similar but unique experiences, is thought to contribute to successful encoding and retrieval of episodic memories. Impaired PS has been proposed as a potential mechanism underling episodic memory impairment in aMCI, but this association is less established in TLE. In this study, we examined behavioral PS in patients with TLE and explored whether profiles of performance in TLE are similar to aMCI. METHOD Patients with TLE, aMCI, and age-matched, healthy controls (HCs) completed a modified recognition task that relies on PS for the discrimination of highly similar lure items, the Mnemonic Similarity Task (MST). Group differences were evaluated and relationships between clinical characteristics, California Verbal Learning Test-Second Edition scores, and MST performance were tested in the TLE group. RESULTS Patients with TLE and aMCI demonstrated poorer PS performance relative to the HCs, but performance did not differ between the two patient groups. Neither the side of seizure focus nor having hippocampal sclerosis affected performance in TLE. However, TLE patients with clinically defined memory impairment showed the poorest performance. CONCLUSION Memory performance on a task that relies on PS was disrupted to a similar extent in TLE and aMCI. The MST could provide a clinically useful tool for measuring hippocampus-dependent memory impairments in TLE and other neurological disorders associated with hippocampal damage.
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Affiliation(s)
- Sanam J Lalani
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Anny Reyes
- San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Erik Kaestner
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Shauna M Stark
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, CA, USA
| | - Craig E L Stark
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, CA, USA
| | - David Lee
- Department of Neurosciences, University of California San Diego, San Diego, CA, USA
| | - Leena Kansal
- Department of Neurosciences, University of California San Diego, San Diego, CA, USA
| | - Jerry J Shih
- Department of Neurosciences, University of California San Diego, San Diego, CA, USA
| | - Christine N Smith
- Department of Psychiatry, University of California, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, CA, USA
| | - Brianna M Paul
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Carrie R McDonald
- San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
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Kaestner E, Reyes A, Chen A, Rao J, Macari AC, Choi JY, Qiu D, Hewitt K, Wang ZI, Drane DL, Hermann B, Busch RM, Punia V, McDonald CR. Atrophy and cognitive profiles in older adults with temporal lobe epilepsy are similar to mild cognitive impairment. Brain 2021; 144:236-250. [PMID: 33279986 PMCID: PMC7880670 DOI: 10.1093/brain/awaa397] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/02/2020] [Accepted: 09/21/2020] [Indexed: 11/14/2022] Open
Abstract
Epilepsy incidence and prevalence peaks in older adults yet systematic studies of brain ageing and cognition in older adults with epilepsy remain limited. Here, we characterize patterns of cortical atrophy and cognitive impairment in 73 older adults with temporal lobe epilepsy (>55 years) and compare these patterns to those observed in 70 healthy controls and 79 patients with amnestic mild cognitive impairment, the prodromal stage of Alzheimer's disease. Patients with temporal lobe epilepsy were recruited from four tertiary epilepsy surgical centres; amnestic mild cognitive impairment and control subjects were obtained from the Alzheimer's Disease Neuroimaging Initiative database. Whole brain and region of interest analyses were conducted between patient groups and controls, as well as between temporal lobe epilepsy patients with early-onset (age of onset <50 years) and late-onset (>50 years) seizures. Older adults with temporal lobe epilepsy demonstrated a similar pattern and magnitude of medial temporal lobe atrophy to amnestic mild cognitive impairment. Region of interest analyses revealed pronounced medial temporal lobe thinning in both patient groups in bilateral entorhinal, temporal pole, and fusiform regions (all P < 0.05). Patients with temporal lobe epilepsy demonstrated thinner left entorhinal cortex compared to amnestic mild cognitive impairment (P = 0.02). Patients with late-onset temporal lobe epilepsy had a more consistent pattern of cortical thinning than patients with early-onset epilepsy, demonstrating decreased cortical thickness extending into the bilateral fusiform (both P < 0.01). Both temporal lobe epilepsy and amnestic mild cognitive impairment groups showed significant memory and language impairment relative to healthy control subjects. However, despite similar performances in language and memory encoding, patients with amnestic mild cognitive impairment demonstrated poorer delayed memory performances relative to both early and late-onset temporal lobe epilepsy. Medial temporal lobe atrophy and cognitive impairment overlap between older adults with temporal lobe epilepsy and amnestic mild cognitive impairment highlights the risks of growing old with epilepsy. Concerns regarding accelerated ageing and Alzheimer's disease co-morbidity in older adults with temporal lobe epilepsy suggests an urgent need for translational research aimed at identifying common mechanisms and/or targeting symptoms shared across a broad neurological disease spectrum.
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Affiliation(s)
- Erik Kaestner
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Anny Reyes
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Austin Chen
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Jun Rao
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Anna Christina Macari
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Joon Yul Choi
- Epilepsy Center and Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - Deqiang Qiu
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Kelsey Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Zhong Irene Wang
- Epilepsy Center and Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Bruce Hermann
- Matthews Neuropsychology Section, University of Wisconsin, Madison, WI, USA
| | - Robyn M Busch
- Epilepsy Center and Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - Vineet Punia
- Epilepsy Center and Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - Carrie R McDonald
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
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Johnson EL, Krauss GL, Lee AK, Schneider ALC, Kucharska-Newton AM, Huang J, Jack CR, Gottesman RF. Association between white matter hyperintensities, cortical volumes, and late-onset epilepsy. Neurology 2019; 92:e988-e995. [PMID: 30804067 DOI: 10.1212/wnl.0000000000007010] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/25/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To identify the association between brain vascular changes and cortical volumes on MRI and late-onset epilepsy. METHODS In 1993-1995, 1,920 participants (median age 62.7, 59.9% female) in the community-based Atherosclerosis Risk in Communities (ARIC) Study underwent MRI, and white matter hyperintensities were measured. In addition, in 2011-2013, 1,964 ARIC participants (median age 72.4, 61.1% female) underwent MRI, and cortical volumes and white matter hyperintensities were measured. We identified cases of late-onset epilepsy (starting at age 60 or later) from ARIC hospitalization records and Medicare claims data. Using the 1993-1995 MRI, we evaluated the association between white matter hyperintensities and subsequent epilepsy using survival analysis. We used the 2011-2013 MRI to conduct cross-sectional logistic regression to examine the association of cortical volumes and white matter hyperintensities with late-onset epilepsy. All models were adjusted for demographics, hypertension, diabetes, smoking, and APOE ε4 allele status. RESULTS Ninety-seven ARIC participants developed epilepsy after having an MRI in 1993-1995 (incidence 3.34 per 1,000 person-years). The degree of white matter hyperintensities measured at ages 49-72 years was associated with the risk of late-onset epilepsy (hazard ratio 1.27 per age-adjusted SD, 95% confidence interval [CI] 1.06-1.54). Lower cortical volume scores were associated cross-sectionally with higher odds of late-onset epilepsy (odds ratio 1.87, 95% CI 1.16-3.02) per age-adjusted SD. CONCLUSIONS This study demonstrates associations between earlier-life white matter hyperintensities on MRI and later-life incident epilepsy, and between cortical volumes measured later in life and late-onset epilepsy. These findings may help illuminate the causes of late-onset epilepsy.
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Affiliation(s)
- Emily L Johnson
- From the Department of Neurology (E.L.J., G.L.K., A.L.C.S., R.F.G.), Johns Hopkins University School of Medicine; Department of Epidemiology (A.K.L., R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.M.K.-N.), University of North Carolina at Chapel Hill; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; and Department of Radiology (C.R.J.), Mayo Clinic, Rochester, MN.
| | - Gregory L Krauss
- From the Department of Neurology (E.L.J., G.L.K., A.L.C.S., R.F.G.), Johns Hopkins University School of Medicine; Department of Epidemiology (A.K.L., R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.M.K.-N.), University of North Carolina at Chapel Hill; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; and Department of Radiology (C.R.J.), Mayo Clinic, Rochester, MN
| | - Alexandra K Lee
- From the Department of Neurology (E.L.J., G.L.K., A.L.C.S., R.F.G.), Johns Hopkins University School of Medicine; Department of Epidemiology (A.K.L., R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.M.K.-N.), University of North Carolina at Chapel Hill; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; and Department of Radiology (C.R.J.), Mayo Clinic, Rochester, MN
| | - Andrea L C Schneider
- From the Department of Neurology (E.L.J., G.L.K., A.L.C.S., R.F.G.), Johns Hopkins University School of Medicine; Department of Epidemiology (A.K.L., R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.M.K.-N.), University of North Carolina at Chapel Hill; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; and Department of Radiology (C.R.J.), Mayo Clinic, Rochester, MN
| | - Anna M Kucharska-Newton
- From the Department of Neurology (E.L.J., G.L.K., A.L.C.S., R.F.G.), Johns Hopkins University School of Medicine; Department of Epidemiology (A.K.L., R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.M.K.-N.), University of North Carolina at Chapel Hill; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; and Department of Radiology (C.R.J.), Mayo Clinic, Rochester, MN
| | - Juebin Huang
- From the Department of Neurology (E.L.J., G.L.K., A.L.C.S., R.F.G.), Johns Hopkins University School of Medicine; Department of Epidemiology (A.K.L., R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.M.K.-N.), University of North Carolina at Chapel Hill; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; and Department of Radiology (C.R.J.), Mayo Clinic, Rochester, MN
| | - Clifford R Jack
- From the Department of Neurology (E.L.J., G.L.K., A.L.C.S., R.F.G.), Johns Hopkins University School of Medicine; Department of Epidemiology (A.K.L., R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.M.K.-N.), University of North Carolina at Chapel Hill; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; and Department of Radiology (C.R.J.), Mayo Clinic, Rochester, MN
| | - Rebecca F Gottesman
- From the Department of Neurology (E.L.J., G.L.K., A.L.C.S., R.F.G.), Johns Hopkins University School of Medicine; Department of Epidemiology (A.K.L., R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.M.K.-N.), University of North Carolina at Chapel Hill; Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson; and Department of Radiology (C.R.J.), Mayo Clinic, Rochester, MN
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Cunnane SC, Courchesne-Loyer A, Vandenberghe C, St-Pierre V, Fortier M, Hennebelle M, Croteau E, Bocti C, Fulop T, Castellano CA. Can Ketones Help Rescue Brain Fuel Supply in Later Life? Implications for Cognitive Health during Aging and the Treatment of Alzheimer's Disease. Front Mol Neurosci 2016; 9:53. [PMID: 27458340 PMCID: PMC4937039 DOI: 10.3389/fnmol.2016.00053] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/21/2016] [Indexed: 02/02/2023] Open
Abstract
We propose that brain energy deficit is an important pre-symptomatic feature of Alzheimer's disease (AD) that requires closer attention in the development of AD therapeutics. Our rationale is fourfold: (i) Glucose uptake is lower in the frontal cortex of people >65 years-old despite cognitive scores that are normal for age. (ii) The regional deficit in brain glucose uptake is present in adults <40 years-old who have genetic or lifestyle risk factors for AD but in whom cognitive decline has not yet started. Examples include young adult carriers of presenilin-1 or apolipoprotein E4, and young adults with mild insulin resistance or with a maternal family history of AD. (iii) Regional brain glucose uptake is impaired in AD and mild cognitive impairment (MCI), but brain uptake of ketones (beta-hydroxybutyrate and acetoacetate), remains the same in AD and MCI as in cognitively healthy age-matched controls. These observations point to a brain fuel deficit which appears to be specific to glucose, precedes cognitive decline associated with AD, and becomes more severe as MCI progresses toward AD. Since glucose is the brain's main fuel, we suggest that gradual brain glucose exhaustion is contributing significantly to the onset or progression of AD. (iv) Interventions that raise ketone availability to the brain improve cognitive outcomes in both MCI and AD as well as in acute experimental hypoglycemia. Ketones are the brain's main alternative fuel to glucose and brain ketone uptake is still normal in MCI and in early AD, which would help explain why ketogenic interventions improve some cognitive outcomes in MCI and AD. We suggest that the brain energy deficit needs to be overcome in order to successfully develop more effective therapeutics for AD. At present, oral ketogenic supplements are the most promising means of achieving this goal.
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Affiliation(s)
- Stephen C Cunnane
- Research Center on Aging, SherbrookeQC, Canada; Department of Medicine, Université de Sherbrooke, SherbrookeQC, Canada; Department of Pharmacology and Physiology, Université de Sherbrooke, SherbrookeQC, Canada
| | - Alexandre Courchesne-Loyer
- Research Center on Aging, SherbrookeQC, Canada; Department of Pharmacology and Physiology, Université de Sherbrooke, SherbrookeQC, Canada
| | - Camille Vandenberghe
- Research Center on Aging, SherbrookeQC, Canada; Department of Pharmacology and Physiology, Université de Sherbrooke, SherbrookeQC, Canada
| | - Valérie St-Pierre
- Research Center on Aging, SherbrookeQC, Canada; Department of Pharmacology and Physiology, Université de Sherbrooke, SherbrookeQC, Canada
| | | | | | | | - Christian Bocti
- Research Center on Aging, SherbrookeQC, Canada; Department of Medicine, Université de Sherbrooke, SherbrookeQC, Canada
| | - Tamas Fulop
- Research Center on Aging, SherbrookeQC, Canada; Department of Medicine, Université de Sherbrooke, SherbrookeQC, Canada
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