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Hawkins MA, Keirns NG, Baraldi AN, Layman HM, Stout ME, Smith CE, Gunstad J, Hildebrand DA, Vohs KD, Lovallo WR. Baseline associations between biomarkers, cognitive function, and self-regulation indices in the Cognitive and Self-regulatory Mechanisms of Obesity Study. Obes Sci Pract 2021; 7:669-681. [PMID: 34877006 PMCID: PMC8633928 DOI: 10.1002/osp4.537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/10/2021] [Accepted: 05/15/2021] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Understanding how biological, cognitive, and self-regulatory factors are related to obesity, and weight regulation is clearly needed to optimize obesity prevention and treatment. The objective of this investigation was to understand how baseline biological, cognitive, and self-regulatory factors are related to adiposity at the initiation of a behavioral weight loss intervention among treatment-seeking adults with overweight/obesity. METHODS Participants (N = 107) in the Cognitive and Self-regulatory Mechanisms of Obesity Study (Identifier-NCT02786238) completed a baseline assessment with anthropometric, cardiometabolic, inflammatory, cognitive function, and self-regulation measures as part of a larger on-going trial. Data were analyzed with linear regression. RESULTS At baseline, body mass index, body fat percentage, and waist circumference (WC) were positively associated with fasting insulin and insulin resistance. Higher WC was related to higher fasting glucose and hemoglobin A1c (HbA1c). Higher glucose and insulin resistance levels were related to lower list sorting working memory. Higher glucose and HbA1c levels were negatively associated with reading scores. Cognitive function and self-regulation indices were unrelated. CONCLUSIONS In adults with overweight/obesity entering a weight loss treatment study: (1) elevated WC and associated glycemic impairment were negatively associated with cognition, (2) poorer executive function and reading abilities were associated with poorer glycemic control, and (3) objectively measured cognitive functions were unrelated to self-reported/behavioral measures of self-regulation. Such findings increase understanding of the relationships between adiposity, biomarkers, cognition, and self-regulation at treatment initiation and may ultimately inform barriers to successful obesity treatment response.
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Affiliation(s)
| | - Natalie G. Keirns
- Department of PsychologyOklahoma State UniversityStillwaterOklahomaUSA
| | - Amanda N. Baraldi
- Department of PsychologyOklahoma State UniversityStillwaterOklahomaUSA
| | - Harley M. Layman
- Department of PsychologyOklahoma State UniversityStillwaterOklahomaUSA
| | - Madison E. Stout
- Department of PsychologyOklahoma State UniversityStillwaterOklahomaUSA
| | - Caitlin E. Smith
- Department of PsychologyOklahoma State UniversityStillwaterOklahomaUSA
- Department of Psychiatry & Behavioral SciencesMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - John Gunstad
- Department of Psychological SciencesKent State UniversityKentOhioUSA
| | - Deana A. Hildebrand
- Department of Nutritional SciencesOklahoma State UniversityStillwaterOklahomaUSA
| | - Kathleen D. Vohs
- Carlson School of ManagementUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - William R. Lovallo
- Oklahoma City VA Medical CenterOklahoma CityOklahomaUSA
- Department of Psychiatry and Behavioral SciencesUniversity of Oklahoma Health Sciences CenterOklahoma CityOklahomaUSA
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Richards E, Thornton IM, Bayer A, Tales A. Inhibitory control deficits in vascular cognitive impairment revealed using the MILO task. Neuropsychologia 2021; 155:107794. [PMID: 33610617 DOI: 10.1016/j.neuropsychologia.2021.107794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/29/2021] [Accepted: 02/15/2021] [Indexed: 02/08/2023]
Abstract
We used the MILO (Multi-Item Localization) task to characterise the performance of a group of older adults diagnosed with mild to moderate vascular cognitive impairment (VCI). The MILO task is designed to explore the temporal context of visual search and in addition to measuring overall completion time, provides a profile of serial reaction time (SRT) patterns across all items in a sequence. Of particular interest here is the Vanish/Remain MILO manipulation that can identify problems with inhibitory control during search. Typically, SRT functions closely overlap, regardless of whether items Vanish or Remain visible when selected, indicating an ability to ignore previously selected targets. Based on the distributed nature of VCI-related pathology and previous visual search studies from our group, we speculated that MILO performance would be compromised in this group of participants when items remained visible after being selected relative to when they vanished. Compared to cognitively healthy, age-matched control participants, the performance of VCI participants was characterised by overall slowing, increased error rates, and crucially, a compromised ability to ignore past locations. As predicted, the Vanish versus Remain SRT functions of VCI participants significantly diverged towards the end of the sequence, which was not the case for control groups. Overall, our findings suggest that the MILO task could be a useful tool for identifying non-age-related changes in behaviour with patient populations, and more generally hints at a possible inhibitory deficit in VCI.
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Affiliation(s)
- Emma Richards
- Centre for Innovative Ageing, Swansea University, Swansea, SA2 8PP, Wales, UK
| | - Ian M Thornton
- Department of Cognitive Science, University of Malta, Msida, MSD 2080, Malta
| | - Antony Bayer
- School of Medicine, Cardiff University, Cardiff, CF64 2XX, Wales, UK
| | - Andrea Tales
- Centre for Innovative Ageing, Swansea University, Swansea, SA2 8PP, Wales, UK.
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3
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Brown CA, Schmitt FA, Smith CD, Gold BT. Distinct patterns of default mode and executive control network circuitry contribute to present and future executive function in older adults. Neuroimage 2019; 195:320-332. [PMID: 30953834 PMCID: PMC6536351 DOI: 10.1016/j.neuroimage.2019.03.073] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/16/2019] [Accepted: 03/30/2019] [Indexed: 11/26/2022] Open
Abstract
Executive function (EF) performance in older adults has been linked with functional and structural profiles within the executive control network (ECN) and default mode network (DMN), white matter hyperintensities (WMH) burden and levels of Alzheimer's disease (AD) pathology. Here, we simultaneously explored the unique contributions of these factors to baseline and longitudinal EF performance in older adults. Thirty-two cognitively normal (CN) older adults underwent neuropsychological testing at baseline and annually for three years. Neuroimaging and AD pathology measures were collected at baseline. Separate linear regression models were used to determine which of these variables predicted composite EF scores at baseline and/or average annual change in composite ΔEF scores over the three-year follow-up period. Results demonstrated that low DMN deactivation, high ECN activation and WMH burden were the main predictors of EF scores at baseline. In contrast, poor DMN and ECN WM microstructure and higher AD pathology predicted greater annual decline in EF scores. Subsequent mediation analysis demonstrated that DMN WM microstructure uniquely mediated the relationship between AD pathology and ΔEF. These results suggest that functional activation patterns within the DMN and ECN and WMHs contribute to baseline EF while structural connectivity within these networks impact longitudinal EF performance in older adults.
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Affiliation(s)
- Christopher A Brown
- Department of Neuroscience, University of Kentucky, Lexington, KY, 40536, USA
| | - Frederick A Schmitt
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, 40536, USA; Department of Neurology, University of Kentucky, Lexington, KY, 40536, USA; Department of Psychiatry, University of Kentucky, Lexington, KY, 40536, USA
| | - Charles D Smith
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, 40536, USA; Department of Neurology, University of Kentucky, Lexington, KY, 40536, USA; Magnetic Resonance Imaging and Spectroscopy Center, University of Kentucky, Lexington, KY, 40536, USA
| | - Brian T Gold
- Department of Neuroscience, University of Kentucky, Lexington, KY, 40536, USA; Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, 40536, USA; Magnetic Resonance Imaging and Spectroscopy Center, University of Kentucky, Lexington, KY, 40536, USA.
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Fernando HJ, Cohen R, Gullett JM, Friedman J, Ayzengart A, Porges E, Woods AJ, Gunstad J, Ochoa CM, Cusi K, Gonzalez-Louis R, Donahoo WT. Neurocognitive Deficits in a Cohort With Class 2 and Class 3 Obesity: Contributions of Type 2 Diabetes and Other Comorbidities. Obesity (Silver Spring) 2019; 27:1099-1106. [PMID: 31116012 PMCID: PMC6666310 DOI: 10.1002/oby.22508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/02/2019] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study examined the relationship between specific metabolic and vascular risk factors and cognition in adults with severe obesity. METHODS A total of 129 adults (with BMI ≥ 35 kg/m2 ) underwent a baseline clinical evaluation and neuropsychological assessment. Regression analyses examined the relationship between cognition and medical factors (BMI, hemoglobin A1c, diabetes, hypertension, continuous positive airway pressure use, obstructive sleep apnea [OSA], and osteoarthritis). RESULTS Diabetes was associated with deficits in overall cognitive performance and with deficits in the executive processing speed and verbal fluency domains. Hemoglobin A1c was inversely related to overall cognitive performance and deficits in the attention domain. Participants using continuous positive airway pressure to treat OSA had stronger learning and memory performance, whereas OSA was associated with reduced total learning. Elevated BMI together with diabetes diagnosis was associated with reduced verbal fluency and greater variability in sustained attention. CONCLUSIONS Obesity-associated comorbidities most notably appeared to have a greater relative influence on cognitive performance than BMI itself in adults with severe obesity. This likely reflects the fact that a very elevated BMI was ubiquitous and thereby probably exerted a similar influence among all adults in the cohort. Accordingly, in the context of severe obesity, diabetes and other comorbidities may have greater sensitivity to cognitive deficits than BMI alone.
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Affiliation(s)
- Heshan J. Fernando
- University of Florida, Department of Clinical and Health Psychology, Gainesville, FL
| | - Ronald Cohen
- University of Florida, Department of Clinical and Health Psychology, Gainesville, FL
| | - Joseph M. Gullett
- University of Florida, Department of Clinical and Health Psychology, Gainesville, FL
| | - Jeffrey Friedman
- University of Florida, Division of General Surgery, Gainesville, FL
| | | | - Eric Porges
- University of Florida, Department of Clinical and Health Psychology, Gainesville, FL
| | - Adam J. Woods
- University of Florida, Department of Clinical and Health Psychology, Gainesville, FL
| | | | - Christa M. Ochoa
- University of Florida, Department of Clinical and Health Psychology, Gainesville, FL
| | - Kenneth Cusi
- University of Florida, Division of Endocrinology, Diabetes & Metabolism, Gainesville, FL
| | - Rachel Gonzalez-Louis
- University of Florida, Department of Clinical and Health Psychology, Gainesville, FL
| | - William T. Donahoo
- University of Florida, Division of Endocrinology, Diabetes & Metabolism, Gainesville, FL
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Woods AJ, Cohen R, Marsiske M, Alexander GE, Czaja SJ, Wu S. Augmenting cognitive training in older adults (The ACT Study): Design and Methods of a Phase III tDCS and cognitive training trial. Contemp Clin Trials 2018; 65:19-32. [PMID: 29313802 PMCID: PMC5803439 DOI: 10.1016/j.cct.2017.11.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/27/2017] [Accepted: 11/29/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Adults over age 65 represent the fastest growing population in the US. Decline in cognitive abilities is a hallmark of advanced age and is associated with loss of independence and dementia risk. There is a pressing need to develop effective interventions for slowing or reversing the cognitive aging process. While certain forms of cognitive training have shown promise in this area, effects only sometimes transfer to neuropsychological tests within or outside the trained domain. This paper describes a NIA-funded Phase III adaptive multisite randomized clinical trial, examining whether transcranial direct current stimulation (tDCS) of frontal cortices enhances neurocognitive outcomes achieved from cognitive training in older adults experiencing age-related cognitive decline: the Augmenting Cognitive Training in Older Adults study (ACT). METHODS ACT will enroll 360 participants aged 65 to 89 with age-related cognitive decline, but not dementia. Participants will undergo cognitive training intervention or education training-control combined with tDCS or sham tDCS control. Cognitive training employs a suite of eight adaptive training tasks focused on attention/speed of processing and working memory from Posit Science BrainHQ. Training control involves exposure to educational nature/history videos and related content questions of the same interval/duration as the cognitive training. Participants are assessed at baseline, after training (12weeks), and 12-month follow-up on our primary outcome measure, NIH Toolbox Fluid Cognition Composite Score, as well as a comprehensive neurocognitive, functional, clinical and multimodal neuroimaging battery. SIGNIFICANCE The findings from this study have the potential to significantly enhance efforts to ameliorate cognitive aging and slow dementia.
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Affiliation(s)
- Adam J Woods
- Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, United States.
| | - Ronald Cohen
- Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, United States
| | - Michael Marsiske
- Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, United States
| | - Gene E Alexander
- Departments of Psychology and Psychiatry, Neuroscience and Physiological Sciences Graduate Interdisciplinary Programs, BIO5 Institute, and McKnight Brain Institute, University of Arizona, Tucson, AZ, United States
| | - Sara J Czaja
- Center on Aging, Department of Psychiatry and Behavioral Sciences, McKnight Brain Institute, Miller School of Medicine, University of Miami, United States
| | - Samuel Wu
- Department of Biostatistics, University of Florida, United States
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Wallin A, Román GC, Esiri M, Kettunen P, Svensson J, Paraskevas GP, Kapaki E. Update on Vascular Cognitive Impairment Associated with Subcortical Small-Vessel Disease. J Alzheimers Dis 2018; 62:1417-1441. [PMID: 29562536 PMCID: PMC5870030 DOI: 10.3233/jad-170803] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2017] [Indexed: 02/06/2023]
Abstract
Subcortical small-vessel disease (SSVD) is a disorder well characterized from the clinical, imaging, and neuropathological viewpoints. SSVD is considered the most prevalent ischemic brain disorder, increasing in frequency with age. Vascular risk factors include hypertension, diabetes, hyperlipidemia, elevated homocysteine, and obstructive sleep apnea. Ischemic white matter lesions are the hallmark of SSVD; other pathological lesions include arteriolosclerosis, dilatation of perivascular spaces, venous collagenosis, cerebral amyloid angiopathy, microbleeds, microinfarcts, lacunes, and large infarcts. The pathogenesis of SSVD is incompletely understood but includes endothelial changes and blood-brain barrier alterations involving metalloproteinases, vascular endothelial growth factors, angiotensin II, mindin/spondin, and the mammalian target of rapamycin pathway. Metabolic and genetic conditions may also play a role but hitherto there are few conclusive studies. Clinical diagnosis of SSVD includes early executive dysfunction manifested by impaired capacity to use complex information, to formulate strategies, and to exercise self-control. In comparison with Alzheimer's disease (AD), patients with SSVD show less pronounced episodic memory deficits. Brain imaging has advanced substantially the diagnostic tools for SSVD. With the exception of cortical microinfarcts, all other lesions are well visualized with MRI. Diagnostic biomarkers that separate AD from SSVD include reduction of cerebrospinal fluid amyloid-β (Aβ)42 and of the ratio Aβ42/Aβ40 often with increased total tau levels. However, better markers of small-vessel function of intracerebral blood vessels are needed. The treatment of SSVD remains unsatisfactory other than control of vascular risk factors. There is an urgent need of finding targets to slow down and potentially halt the progression of this prevalent, but often unrecognized, disorder.
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Affiliation(s)
- Anders Wallin
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg Sweden and Memory Clinic at Department of Neuropsychiatry, Sahlgrenska University, Hospital, Gothenburg, Sweden
| | - Gustavo C. Román
- Department of Neurology, Methodist Neurological Institute, Houston, TX, USA
- Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Margaret Esiri
- Neuropathology Department, West Wing, John Radcliffe Hospital, Oxford, UK
| | - Petronella Kettunen
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg Sweden and Memory Clinic at Department of Neuropsychiatry, Sahlgrenska University, Hospital, Gothenburg, Sweden
- Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing, John Radcliffe Hospital, Oxford, UK
| | - Johan Svensson
- Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - George P. Paraskevas
- 1st Department of Neurology, Neurochemistry Unit, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisabeth Kapaki
- 1st Department of Neurology, Neurochemistry Unit, National and Kapodistrian University of Athens, Athens, Greece
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Liebel SW, Jones EC, Oshri A, Hallowell ES, Jerskey BA, Gunstad J, Sweet LH. Cognitive processing speed mediates the effects of cardiovascular disease on executive functioning. Neuropsychology 2016; 31:44-51. [PMID: 27841458 DOI: 10.1037/neu0000324] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE The goal of this study was to examine the hypothesized mediating role of cognitive processing speed (CPS) in the relationship between cardiovascular disease (CVD) and executive functioning (EF). We investigated whether the processing-speed hypothesis in aging also explains the unique contribution that CPS may have to EF deficits in CVD patients. METHOD A neuropsychological assessment, including multiple measures of CPS and EF, was administered to 21 older adults with a history of CVD and 73 older adults with no history of CVD. Structural equation models were used to measure the indirect associations between CVD and 6 EF task outcomes through a CPS factor. Competing indirect links were assessed using the product-of-coefficients (α*β) approach with bias-corrected bootstrap confidence intervals. RESULTS CVD was significantly, negatively related to CPS (β = -.239, 95% CI [-.457, -.021]). CPS was significantly, positively related to an EF composite score (β = .566, 95% CI [.368, .688]). CVD was significantly, negatively related to the EF composite score (β = -.137, 95% CI [-.084, -.211]). The indirect links from CVD to the individual measures of the EF composite score via CPS were all significant. CVD most adversely affected tasks of cognitive flexibility and inhibition indirectly through CPS. CONCLUSION With the present study, we have demonstrated that the processing-speed hypothesis in aging extends to older adult patients with CVD. Reduced CPS significantly underlies the link between CVD status and poorer EF. Individuals with CVD demonstrated poorer CPS and EF than those without CVD, and CPS was specifically implicated as a CVD-related mechanism leading to worse EF. (PsycINFO Database Record
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Affiliation(s)
| | | | - Assaf Oshri
- Human Development and Family Sciences and Department of Psychology, University of Georgia
| | | | - Beth A Jerskey
- Department of Psychiatry, Warren Alpert Medical School of Brown University
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Salminen LE, Schofield PR, Pierce KD, Zhao Y, Luo X, Wang Y, Laidlaw DH, Cabeen RP, Conturo TE, Tate DF, Akbudak E, Lane EM, Heaps JM, Bolzenius JD, Baker LM, Cagle LM, Paul RH. Neuromarkers of the common angiotensinogen polymorphism in healthy older adults: A comprehensive assessment of white matter integrity and cognition. Behav Brain Res 2015; 296:85-93. [PMID: 26318936 DOI: 10.1016/j.bbr.2015.08.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 08/18/2015] [Accepted: 08/20/2015] [Indexed: 10/23/2022]
Abstract
The common angiotensinogen (AGT) M268T polymorphism (rs699; historically referred to as M235T) has been identified as a significant risk factor for cerebrovascular pathologies, yet it is unclear if healthy older adults carrying the threonine amino acid variant have a greater risk for white matter damage in specific fiber tracts. Further, the impact of the threonine variant on cognitive function remains unknown. The present study utilized multiple indices of diffusion tensor imaging (DTI) and neuropsychological assessment to examine the integrity of specific white matter tracts and cognition between individuals with homozygous genotypes of M268T (MetMet n=27, ThrThr n=27). Differences in subcortical hyperintensity (SH) volume were also examined between groups. Results indicated that the threonine variant was associated with significantly reduced integrity in the superior longitudinal fasciculus (SLF) and the cingulate gyrus segment of the cingulum bundle (cingulum CG) compared to those with the methionine variant, and poorer cognitive performance on tests of attention/processing speed and language. Despite these associations, integrity of these tracts did not significantly mediate relationships between cognition and genetic status, and SH did not differ significantly between groups. Collectively our results suggest that the threonine variant of M268T is a significant risk factor for abnormalities in specific white matter tracts and cognitive domains in healthy older adults, independent of SH burden.
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Affiliation(s)
- Lauren E Salminen
- University of Missouri-St. Louis, Department of Psychological Sciences, 1 University Blvd., Stadler Hall 442A, St. Louis, MO 63121, USA.
| | - Peter R Schofield
- Neuroscience Research Australia, Barker Street Randwick, Sydney, NSW 2031, Australia; School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Kerrie D Pierce
- Neuroscience Research Australia, Barker Street Randwick, Sydney, NSW 2031, Australia
| | - Yi Zhao
- Brown University, Department of Biostatistics and Center for Statistical Sciences, Providence, RI 02912, USA
| | - Xi Luo
- Brown University, Department of Biostatistics and Center for Statistical Sciences, Providence, RI 02912, USA
| | - Youdan Wang
- Brown University, Department of Biostatistics and Center for Statistical Sciences, Providence, RI 02912, USA
| | - David H Laidlaw
- Brown University, Computer Science Department, Providence, RI 02912, USA
| | - Ryan P Cabeen
- Brown University, Computer Science Department, Providence, RI 02912, USA
| | - Thomas E Conturo
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, 510 S. Kingshighway, St. Louis, MO 63110, USA
| | - David F Tate
- Missouri Institute of Mental Health,4633 World Parkway Circle, Berkeley, MO 63134-3115, USA
| | - Erbil Akbudak
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, 510 S. Kingshighway, St. Louis, MO 63110, USA
| | - Elizabeth M Lane
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Jodi M Heaps
- Missouri Institute of Mental Health,4633 World Parkway Circle, Berkeley, MO 63134-3115, USA
| | - Jacob D Bolzenius
- University of Missouri-St. Louis, Department of Psychological Sciences, 1 University Blvd., Stadler Hall 442A, St. Louis, MO 63121, USA
| | - Laurie M Baker
- University of Missouri-St. Louis, Department of Psychological Sciences, 1 University Blvd., Stadler Hall 442A, St. Louis, MO 63121, USA
| | - Lee M Cagle
- University of Missouri-St. Louis, Department of Psychological Sciences, 1 University Blvd., Stadler Hall 442A, St. Louis, MO 63121, USA
| | - Robert H Paul
- University of Missouri-St. Louis, Department of Psychological Sciences, 1 University Blvd., Stadler Hall 442A, St. Louis, MO 63121, USA; Missouri Institute of Mental Health,4633 World Parkway Circle, Berkeley, MO 63134-3115, USA
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Deep versus periventricular white matter lesions and cognitive function in a community sample of middle-aged participants. J Int Neuropsychol Soc 2012; 18:874-85. [PMID: 22687604 DOI: 10.1017/s1355617712000677] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The association of cerebral white matter lesions (WMLs) with cognitive status is not well understood in middle-aged individuals. Our aim was to determine the specific contribution of periventricular hyperintensities (PVHs) and deep white matter hyperintensities (DWMHs) to cognitive function in a community sample of asymptomatic participants aged 50 to 65 years. One hundred stroke- and dementia-free adults completed a comprehensive neuropsychological battery and brain MRI protocol. Participants were classified according to PVH and DWMH scores (Fazekas scale). We dichotomized our sample into low grade WMLs (participants without or with mild lesions) and high grade WMLs (participants with moderate or severe lesions). Analyses were performed separately in PVH and DWMH groups. High grade DWMHs were associated with significantly lower scores in executive functioning (-0.45 standard deviations [SD]), attention (-0.42 SD), verbal fluency (-0.68 SD), visual memory (-0.52 SD), visuospatial skills (-0.79 SD), and psychomotor speed (-0.46 SD). Further analyses revealed that high grade DWMHs were also associated with a three- to fourfold increased risk of impaired scores (i.e.,<1.5 SD) in executive functioning, verbal fluency, visuospatial skills, and psychomotor speed. Our findings suggest that only DWMHs, not PVHs, are related to diminished cognitive function in middle-aged individuals. (JINS, 2012, 18, 1-12).
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10
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Abstract
BACKGROUND The neurobiological basis of increased risk of dementia in stroke patients is unclear, though there are several related pathological changes, including white matter hyperintensities (WMH), and medial temporal atrophy. Subcortical gray matter structures have also been implicated in dementia resulting from vascular pathology, particularly vascular dementia. This study aimed to investigate the contribution of changes in subcortical gray matter structures to post-stroke dementia (PSD). METHODS T1- and T2-weighted images and T2-weighted fluid-attenuated inversion recovery (FLAIR) images were obtained on a 3-Tesla magnetic resonance (MR) system, in four groups aged over 75 years: post-stroke with dementia (PSD; 8), post-stroke no dementia (PSnoD; 33), Alzheimer's disease (AD; 26) and controls (30). Automated software was used to measure the volume of thalamus, putamen, caudate nucleus, and hippocampus as well as total WMH volume. The number of subcortical lacunes was also counted. RESULTS The number of caudate lacunes was higher in the PSnoD group, compared with AD (p = 0.029) and controls (p = 0.019). The putamen volume was smaller in the stroke and AD groups, when compared with controls. In the whole stroke group, putamen lacunes were correlated with impairment in memory (Rey test; ρ = -0.365; p = 0.031), while WMH and hippocampal volume both correlated with global dysfunction. CONCLUSION Our findings implicate a variety of neurobiological substrates of dementia, such as small vessel disease and Alzheimer pathology, which develop after stroke in an old older population, with a contribution from subcortical brain structures.
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Grande LJ, Rudolph JL, Milberg WP, Barber C, McGlinchey RE. Detecting cognitive impairment in individuals at risk for cardiovascular disease: the "Clock-in-the-Box" screening test. Int J Geriatr Psychiatry 2011; 26:969-75. [PMID: 21845599 PMCID: PMC3110989 DOI: 10.1002/gps.2635] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 08/13/2010] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the performance on the Clock-in-the-Box (CIB), a screening measure for cognitive function, relative to neuropsychological testing in an older population with cardiovascular risk. METHODS A prospective cohort of older patients (>50 years) with cardiovascular risk was recruited to perform the CIB and complete a brief neuropsychological battery consisting of Trailmaking tests, the Hopkins Verbal Learning Test (HVLT), and fluency tasks. Performance on the CIB was scored according to standard criteria (range 0-8, 0-worst). The performance on the total CIB, working memory subscale (CIB-WM), and planning/organization (COB-PO) was compared to neuropsychological measures. RESULTS The cohort (n = 127) was older (age 67 ± 7 years) and diverse with 33% female (n = 42) and 42% non-white race (n = 53). Cardiac risk factors were prevalent: hypertension (83%), hyperlipidemia (74%), overweight (84%), diabetes (48%), prior cardiac disease (39%), and smoking (11%). The CIB (mean 6.5 ± 1.3) took 84 ± 21 s on average to complete and had good inter-rater reliability (κ = 0.809, p < 0.01). The CIB-WM subscale was significantly correlated with performance on Trailmaking B and HVLT learning, recall, and recognition. The CIB-PO subscale was significantly associated with semantic and phonemic fluency, Trailmaking B, and HVLT learning and recall. In regression modeling, CIB-WM significantly predicted performance on HVLT learning, recall, and retention. CIB-PO subscale predicted performance on Trailmaking B, HVLT learning, and HVLT recall. CONCLUSIONS The CIB is a brief cognitive screening instrument with good reliability and predictive validity in a CV risk population. The CIB-WM and CIB-PO subscales could provide utility for clinicians.
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Affiliation(s)
- Laura J. Grande
- Geriatric Research Education & Clinical Center, Boston VA Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - James L. Rudolph
- Geriatric Research Education & Clinical Center, Boston VA Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
| | - William P. Milberg
- Geriatric Research Education & Clinical Center, Boston VA Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Colleen Barber
- Geriatric Research Education & Clinical Center, Boston VA Healthcare System, Boston, MA, USA
| | - Regina E. McGlinchey
- Geriatric Research Education & Clinical Center, Boston VA Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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12
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Influence of education on subcortical hyperintensities and global cognitive status in vascular dementia. J Int Neuropsychol Soc 2011; 17:531-6. [PMID: 21385518 PMCID: PMC5370165 DOI: 10.1017/s1355617711000324] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Subcortical hyperintensities (SH) on neuroimaging are a prominent feature of vascular dementia (VaD) and SH severity correlates with cognitive impairment in this population. Previous studies demonstrated that SH burden accounts for a degree of the cognitive burden among VaD patients, although it remains unclear if individual factors such as cognitive reserve influence cognitive status in VaD. To address this issue, we examined 36 individuals diagnosed with probable VaD (age = 77.56; education = 12). All individuals underwent MMSE evaluations and MRI brain scans. We predicted that individuals with higher educational attainment would exhibit less cognitive difficulty despite similar levels of SH volume, compared to individuals with less educational attainment. A regression analysis revealed that greater SH volume was associated with lower scores on the MMSE. Additionally, education moderated the relationship between SH volume and MMSE score, demonstrating that individuals with higher education had higher scores on the MMSE despite similar degrees of SH burden. These results suggest that educational attainment buffers the deleterious effects of SH burden on cognitive status among VaD patients.
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13
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Cohen RA, Poppas A, Forman DE, Hoth KF, Haley AP, Gunstad J, Jefferson AL, Tate DF, Paul RH, Sweet LH, Ono M, Jerskey BA, Gerhard-Herman M. Vascular and cognitive functions associated with cardiovascular disease in the elderly. J Clin Exp Neuropsychol 2009; 31:96-110. [PMID: 18608677 PMCID: PMC2739675 DOI: 10.1080/13803390802014594] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study examines the relationship between systemic vascular function, neurocognitive performance, and structural brain abnormalities on magnetic resonance imaging (MRI) among geriatric outpatients with treated, stable cardiovascular disease and no history of neurological illness (n = 88, ages 56-85 years). Vascular function was assessed by cardiac ejection fraction and output, sequential systolic and diastolic blood pressures, flow mediated brachial artery reactivity (BAR), and carotid intima media thickness (IMT). White matter hyperintensities (WMH) on MRI were quantified and examined relative to cognitive and vascular function. Principal component analysis revealed two primary vascular components: one associated with cardiac function, the other with atherosclerotic burden/endothelial dysfunction. Both factors were significantly associated with cognitive function and WMH volume. Reduced systolic variability and increased IMT were most strongly related to reduced attention, executive function, and information-processing speed. These findings suggest the possibility that systemic vascular indices may provide proxy measures of cerebrovascular dysfunction and reinforce the importance of achieving greater understanding of interaction between systemic vascular disease and brain dysfunction among elderly people with cardiovascular disease.
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Affiliation(s)
- Ronald A Cohen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA.
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14
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Alves GS, Alves CEDO, Lanna ME, Moreira DM, Engelhardt E, Laks J. Subcortical ischemic vascular disease and cognition: A systematic review. Dement Neuropsychol 2008; 2:82-90. [PMID: 29213548 PMCID: PMC5619575 DOI: 10.1590/s1980-57642009dn20200002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Accepted: 05/06/2008] [Indexed: 11/22/2022] Open
Abstract
Subcortical Ischemic Vascular Disease (SIVD) is underdiagnosed. This review investigates the relationship among SIVD severity, cognitive status and neuroimaging markers. METHODS Cohort, cross-sectional and case control studies were searched on ISI, Medline, Scielo, PsychoInfo and LILACS databases published between 1995 and 2006. RESULTS The most impaired cognitive domains were executive, attentional and memory retrieval mechanisms. These cognitive features were frequently associated to White Matter Lesions (WML). CONCLUSIONS WML is an independent factor in cognitive decline. However, the threshold for this impact is not yet clearly established.
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Affiliation(s)
| | | | - Maria Elisa Lanna
- Institute of Psychiatry, Federal University of Rio de
Janeiro, Brazil
| | - Denise Madeira Moreira
- Institute of Neurology, Federal University of Rio de
Janeiro, Brazil
- Radiology Service of the Procardíaco Hospital,
Brazil
| | - Eliasz Engelhardt
- Institute of Neurology, Federal University of Rio de
Janeiro, Brazil
| | - Jerson Laks
- Institute of Psychiatry, Federal University of Rio de
Janeiro, Brazil
- State University of Rio de Janeiro, Brazil
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15
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Yochim BP, Lequerica A, MacNeill SE, Lichtenberg PA. Cognitive initiation and depression as predictors of future instrumental activities of daily living among older medical rehabilitation patients. J Clin Exp Neuropsychol 2008; 30:236-44. [PMID: 18938675 DOI: 10.1080/13803390701370006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Brian P. Yochim
- a University of Colorado at Colorado Springs , Colorado Springs, CO, USA
| | - Anthony Lequerica
- b Kessler Medical Rehabilitation Research and Education Corporation , West Orange, NJ, USA
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16
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Yochim BP, MacNeill SE, Lichtenberg PA. “Vascular Depression” Predicts Verbal Fluency in Older Adults. J Clin Exp Neuropsychol 2007; 28:495-508. [PMID: 16624780 DOI: 10.1080/13803390590949322] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Past research has found links among cerebrovascular risk factors (CVRFs), depression, and cognition in older adults. This study investigated how well baseline cerebrovascular burden and depression predicted verbal fluency three and six months later. Participants were 139 medical rehabilitation patients, age 60 and above. The Geriatric Depression Scale, Charlson Co-Morbidity Index, and Dementia Rating Scale were administered at baseline, and verbal fluency was measured three and six months later. Structural equation modeling found that depression significantly predicted verbal fluency at both time points, independently of demographic variables, baseline cognition, or medical burden. CVRFs correlated with depressive symptoms but did not independently predict verbal fluency. Findings suggest that vascular depression may be a possible signal of impaired brain integrity, consistent with Alexopoulos and colleague's (2000) conceptual framework.
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Affiliation(s)
- Brian P Yochim
- VA Northern California Health Care System, Martinez, 94553, USA.
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17
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Fukui T, Hieda S, Bocti C. Do lesions involving the cortical cholinergic pathways help or hinder efficacy of donepezil in patients with Alzheimer's disease? Dement Geriatr Cogn Disord 2007; 22:421-31. [PMID: 16974095 DOI: 10.1159/000095801] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2006] [Indexed: 11/19/2022] Open
Abstract
AIMS To investigate the influences of vascular lesions detected by MRI, lesions involving the cortical cholinergic pathways and hippocampal thickness on therapeutic responsiveness to donepezil in patients with Alzheimer's disease (AD). METHODS The study cohort contained 67 patients with probable AD. We used the revised Hasegawa Dementia Rating (HDS-R) and the Clock Drawing Test (CDT) to evaluate drug efficacy for 24 months. The Cholinergic Pathways Hyperintensities Scale (CHIPS), a newly developed visual scale, was used to semiquantify lesions on the cholinergic pathways. RESULTS Over the 24-month period, the results of the CDT showed more apparent and constant association with white matter hyperintensities (WMH) and lesions on the cholinergic pathways than the HDS-R. WMH may enhance, while lesions on the cholinergic pathways may attenuate sensitivity to donepezil treatment when judged by the CDT. No apparent association between the thicknesses of hippocampi with baseline cognition or therapeutic responsiveness to donepezil was found. CONCLUSION Donepezil may be more efficacious when further executive dysfunction caused by WMH is added to AD dementia and less so when cholinergic reserves are further impinged upon by lesions involving the cortical cholinergic pathways.
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Affiliation(s)
- Toshiya Fukui
- Division of Neurology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Japan.
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18
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Carotid artery intima-media thickness and cognition in cardiovascular disease. Int J Cardiol 2006; 121:148-54. [PMID: 17196687 DOI: 10.1016/j.ijcard.2006.10.032] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Revised: 10/16/2006] [Accepted: 10/21/2006] [Indexed: 11/20/2022]
Abstract
BACKGROUND Increased carotid artery intima-media thickness (IMT) is a non-invasive marker of systemic arterial disease. Increased IMT has been associated with atherosclerosis, abnormal arterial mechanics, myocardial infarction, and stroke. Given evidence of a relationship between cardiovascular health and attention-executive-psychomotor functioning, the purpose of this study was to examine IMT in relation to neuropsychological test performance in patients with a variety of cardiovascular diagnoses. METHODS One hundred and nine participants, ages 55 to 85, underwent neuropsychological assessment and B-mode ultrasound of the left common carotid artery. IMT was calculated using an automated algorithm based on a validated edge-detection technique. The relationship between IMT and measures of language, memory, visual-spatial abilities and attention-executive-psychomotor functioning was modeled using hierarchical linear regression analyses adjusted for age, education, sex, cardiovascular risk, current systolic blood pressure, and history of coronary artery disease (CAD). RESULTS Increased IMT was associated with significantly lower performance in the attention-executive-psychomotor domain (IMT beta=-0.26, p<.01), independent of age, education, sex, cardiovascular risk, current systolic blood pressure, and CAD (F(10,100)=3.61, p<.001). IMT was not significantly related to language, memory, or visual-spatial abilities. CONCLUSIONS Our findings suggest that, in patients with cardiovascular disease, IMT may be associated with the integrity of frontal subcortical networks responsible for attention-executive-psychomotor performance. Future studies are needed to clarify the mechanisms by which IMT affects cognition and examine potential interactions between increased IMT and other measures of cardiovascular health such as blood pressure variability, cardiac systolic performance, and systemic perfusion.
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19
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Mueller SG, Schuff N, Weiner MW. Evaluation of treatment effects in Alzheimer's and other neurodegenerative diseases by MRI and MRS. NMR IN BIOMEDICINE 2006; 19:655-68. [PMID: 16986115 PMCID: PMC1820857 DOI: 10.1002/nbm.1062] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Neurodegeneration refers to a large clinically and pathologically heterogeneous disease entity associated with slowly progressive neuronal loss in different anatomical and functional systems of the brain. Neurodegenerative diseases often affect cognition, e.g. Alzheimer's disease (AD), dementia with Lewy bodies and vascular dementia, or different aspects of the motor system, e.g., amyotrophic lateral sclerosis, Parkinson's disease and ataxic disorders. Owing to increasing knowledge about the mechanisms leading to neurodegeneration, the development of treatments able to modify the neurodegenerative process becomes possible for the first time. Currently, clinical outcome measures are used to assess the efficacy of such treatments. However, most clinical outcome measures have a low test-retest reliability and thus considerable measurement variance. Therefore, large patient populations and long observation times are needed to detect treatment effects. Furthermore, clinical outcome measures cannot distinguish between symptomatic and disease-modifying treatment effects. Therefore, alternative biomarkers including neuroimaging may take on a more important role in this process. Because MR scanners are widely available and allow for non-invasive detection and quantification of changes in brain structure and metabolism, there is increasing interest in the use of MRI/MRS to monitor objectively treatment effects in clinical trials of neurodegenerative diseases. Particularly volumetric MRI has been used to measure atrophy rates in treatment trials of AD because the relationship between atrophic changes and neuron loss is well established and correlates well with clinical measures. More research is needed to determine the value of other MR modalities, i.e. diffusion, perfusion and functional MRI and MR spectroscopy, for clinical trials with neuroprotective drugs.
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Affiliation(s)
- S. G. Mueller
- Center of Imaging of Neurodegenerative Diseases, Veterans Administration Medical Center, Department of Radiology, University of California San Francisco, San Francisco, CA 94121, USA
| | - N. Schuff
- Center of Imaging of Neurodegenerative Diseases, Veterans Administration Medical Center, Department of Radiology, University of California San Francisco, San Francisco, CA 94121, USA
| | - M. W. Weiner
- Center of Imaging of Neurodegenerative Diseases, Veterans Administration Medical Center, Department of Radiology, University of California San Francisco, San Francisco, CA 94121, USA
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20
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Buffon F, Porcher R, Hernandez K, Kurtz A, Pointeau S, Vahedi K, Bousser MG, Chabriat H. Cognitive profile in CADASIL. J Neurol Neurosurg Psychiatry 2006; 77:175-80. [PMID: 16421118 PMCID: PMC2077584 DOI: 10.1136/jnnp.2005.068726] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The spectrum of cognitive alterations associated with CADASIL, a model of pure vascular dementia, has not been thoroughly evaluated. OBJECTIVES The aims of this study were: (i) to describe the cognitive profile in CADASIL patients according to age; (ii) to compare the profile of patients with dementia with that of patients without dementia; and (iii) to determine the association between alterations in performance in different cognitive domains. METHODS Forty two consecutive individuals with CADASIL (35-73 years old) were investigated. Cognitive skills were analysed in five domains (executive functions, reasoning, attention, memory, visuospatial abilities) according to age and compared between patients with and without dementia. Associations between cognitive performance and stroke were tested. RESULTS The youngest patients presented with attention (69%), memory (70%), and executive disturbances (100%). Visuospatial abilities and reasoning deteriorated with age, mainly after the age of 60. About one quarter of patients had dementia, and 75% of these were >60 years of age. Age >60 years was associated with a Rankin score >3 and a significant deficit in all cognitive domains. No association was found between dementia and the number of ischaemic attacks. Episodic memory disorder was characterised by difficulties in retrieval rather than impairment of the encoding process. CONCLUSION Cognitive decline in CADASIL is dominated by early impairment of executive functions. Skills in other cognitive domains deteriorate with age and are found to be diffusely impaired in patients with dementia. The relative preservation of the encoding process in episodic memory impairment, even in individuals with dementia, is noteworthy.
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Affiliation(s)
- F Buffon
- Department of Neurology, Hôpital Lariboisière, 2 rue Ambroise Paré, 75010, Paris, France
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21
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Jokinen H, Kalska H, Mäntylä R, Ylikoski R, Hietanen M, Pohjasvaara T, Kaste M, Erkinjuntti T. White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. J Neurol Neurosurg Psychiatry 2005; 76:1229-33. [PMID: 16107356 PMCID: PMC1739804 DOI: 10.1136/jnnp.2004.055657] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Cerebral white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) are a recognised risk factor for post-stroke dementia. Their specific relations to cognitive impairment are still not well known. The purpose of this study was to explore how the severity and location of WMHs predict neuropsychological test performance in the context of other brain lesions in elderly stroke patients. METHODS In the Helsinki Stroke Aging Memory Study, 323 patients, aged from 55 to 85 years, completed a detailed neuropsychological test battery and MRI 3 months after an ischaemic stroke. The demographic and MRI predictors of cognition were studied with sequential linear regression analyses. RESULTS After age, education and total infarct volume were controlled for, the overall degree of WMHs predicted poor performance in tests of mental speed, executive functions, memory, and visuospatial functions, but not in those of short term memory storage or verbal conceptualisation. However, the contribution of separate white matter regions was relatively low. Only the lesions along the bodies of lateral ventricles were independently associated with speed and executive measures. Additionally, general cortical atrophy clearly predicted a wide range of cognitive deficits while infarct volume had less relevance. Further analyses revealed that executive functions act as a strong mediator between the relationship of WMHs to memory and visuospatial functions. CONCLUSIONS The degree of WMHs is independently related to post-stroke cognitive decline. The most affected cognitive domains seem to be executive functions and speed of mental processing, which may lead to secondary deficits of memory and visuospatial functions.
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Affiliation(s)
- H Jokinen
- Department of Neurology, Helsinki University Central Hospital, P.O. Box 302, FIN-00029 HUS, Helsinki, Finland.
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22
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Paul RH, Haque O, Gunstad J, Tate DF, Grieve SM, Hoth K, Brickman AM, Cohen R, Lange K, Jefferson AL, MacGregor KL, Gordon E. Subcortical hyperintensities impact cognitive function among a select subset of healthy elderly. Arch Clin Neuropsychol 2005; 20:697-704. [PMID: 15941646 PMCID: PMC2733246 DOI: 10.1016/j.acn.2005.02.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2004] [Revised: 02/28/2005] [Accepted: 02/28/2005] [Indexed: 10/25/2022] Open
Abstract
Previous studies have examined the impact of subcortical hyperintensities (SH), a proxy measure of cerebrovascular disease, on the cognitive abilities of otherwise healthy older adults. However, there remains a limited understanding as to what extent this MRI marker of pathological processes explains the decline in specific cognitive functions that occur nearly ubiquitously with advanced age, especially in relation to other age-related imaging markers. In the present study we compared cognitive abilities between a sample of 53 older healthy adults (age range=50-79) and a sample of 53 younger adults (age range=21-40). As expected, the older group performed significantly worse on most cognitive measures compared to the younger group. Frontal volume and total grey matter volume were also significantly reduced among the older individuals compared to the younger individuals. SH volume was consistently associated with cognitive function in older adults, though, this relationship was evident only for a relatively small subset of older individuals with the most severe SH. These data suggest that the relationship between SH and cognition in the elderly is driven by a subset of individuals who may be in the earliest stages of vascular cognitive impairment. Further, the findings suggest that cognitive aging is largely determined by factors other than SH for most older adults.
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Affiliation(s)
- Robert H Paul
- Brown Medical School, Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, 1 Hoppin Street, Providence, RI 02903, USA.
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Paul RH, Gunstad J, Poppas A, Tate DF, Foreman D, Brickman AM, Jefferson AL, Hoth K, Cohen RA. Neuroimaging and cardiac correlates of cognitive function among patients with cardiac disease. Cerebrovasc Dis 2005; 20:129-33. [PMID: 16006761 PMCID: PMC3222237 DOI: 10.1159/000086803] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Accepted: 04/15/2005] [Indexed: 11/19/2022] Open
Abstract
In the present study, we examined the relationships between whole brain volume (WBV), subcortical hyperintensities (SH), indices of cardiac disease and cognitive function in nondemented cardiac patients with evidence of mild cerebrovascular disease. A total of 27 individuals with evidence of cardiac disease underwent neuropsychological examination, neuroimaging, and cardiac assessment. Cognition was assessed with the Dementia Rating Scale-2 (DRS). WBV and SH were quantified using a semi-automated thresholding program based on MRI. Correlational analyses revealed that WBV predicted performance on the overall DRS score, the attention subscale and the initiation/perseveration scale. SH were significantly associated with performance on the attention subscale, and the initiation/perseveration subscale. Regression analyses revealed that SH accounted for most of the variance in the initiation/perseveration scale, whereas WBV accounted for most of the variance in the attention scale. The only cardiac structural or functional variable related to the neurological indices was aortic diameter, which was strongly related to both neuroimaging variables, as well as performances on the DRS attention and initiation/perseveration subscales. Our results highlight the importance of overall brain parenchyma in determining cognitive status among patients at risk for cognitive decline and suggest that select indices of structural cardiac morphology may be related to the early phases of cerebrovascular disease and cognitive status.
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Affiliation(s)
- Robert H Paul
- Center for Behavioral Medicine, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, R.I. 02903, USA
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Gootjes L, Teipel SJ, Zebuhr Y, Schwarz R, Leinsinger G, Scheltens P, Möller HJ, Hampel H. Regional distribution of white matter hyperintensities in vascular dementia, Alzheimer's disease and healthy aging. Dement Geriatr Cogn Disord 2005; 18:180-8. [PMID: 15211074 DOI: 10.1159/000079199] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2004] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND White matter hyperintensities (WMH) on MRI scans indicate lesions of the subcortical fiber system. The regional distribution of WMH may be related to their pathophysiology and clinical effect in vascular dementia (VaD), Alzheimer's disease (AD) and healthy aging. METHODS Regional WMH volumes were measured in MRI scans of 20 VaD patients, 25 AD patients and 22 healthy elderly subjects using FLAIR sequences and surface reconstructions from a three-dimensional MRI sequence. RESULTS The intraclass correlation coefficient for interrater reliability of WMH volume measurements ranged between 0.99 in the frontal and 0.72 in the occipital lobe. For each cerebral lobe, the WMH index, i.e. WMH volume divided by lobar volume, was highest in VaD and lowest in healthy controls. Within each group, the WMH index was higher in frontal and parietal lobes than in occipital and temporal lobes. Total WMH index and WMH indices in the frontal lobe correlated significantly with the MMSE score in VaD. Category fluency correlated with the frontal lobe WMH index in AD, while drawing performance correlated with parietal and temporal lobe WMH indices in VaD. CONCLUSIONS A similar regional distribution of WMH between the three groups suggests a common (vascular) pathogenic factor leading to WMH in patients and controls. Our findings underscore the potential of regional WMH volumetry to determine correlations between subcortical pathology and cognitive impairment.
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Affiliation(s)
- L Gootjes
- Alzheimer Memorial Center and Geriatric Psychiatry Branch, Dementia and Neuroimaging Section, Department of Psychiatry, Ludwig Maximilian University, Munich, Germany
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Stephens S, Kenny RA, Rowan E, Allan L, Kalaria RN, Bradbury M, Ballard CG. Neuropsychological characteristics of mild vascular cognitive impairment and dementia after stroke. Int J Geriatr Psychiatry 2004; 19:1053-7. [PMID: 15481073 DOI: 10.1002/gps.1209] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Post-stroke cognitive impairment is frequent, with characteristic impairments of attentional and executive performance. OBJECTIVE The study aims to determine whether the profile and severity of impairment in vascular Cognitive Impairment No Dementia (vascular CIND) is intermediate between that seen in stroke patients without significant cognitive impairment and patients with post-stroke dementia and thus to establish if the potential value of vascular CIND is a useful concept for predicting further cognitive decline and dementia in stroke patients. METHODS Stroke patients (n=381) > 75 were recruited from representative hospital-based stroke registers in Tyneside and Wearside, UK. Sixty six age matched controls were also recruited. A detailed battery of neuropsychological assessments was completed 3 months post stroke. RESULTS Deficits of attention (z=5.7; p <0.0001) and executive function (z=5.9; p <0.0001) were seen even in stroke patients without vascular CIND, compared to controls. However, stroke patients with CIND were significantly more impaired again on tests of executive function (z=10.3; p <0.0001) compared to those not meeting CIND criteria; and also had greater impairments of memory (z=10.4; p <0.0001) and language expression (z=10.1; p <0.0001). A similar overall profile of deficits was evident in the CIND and the dementia group, but specific deficits were significantly more pronounced in those with dementia, particularly in orientation (z=7.2; p <0.0001) and memory (z=5.8; p <0.0001). CONCLUSIONS The current study indicates that attentional and executive impairments are frequent in stroke patients, but deficits of memory, orientation and language are more indicative of CIND and dementia. Further longitudinal studies are required to clarify the relationship between specific lesions and the progression of specific cognitive deficits in post-stroke patients.
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Affiliation(s)
- S Stephens
- Wolfson Research Centre, Newcastle General Hospital, Newcastle, UK.
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26
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Burton EJ, Kenny RA, O'Brien J, Stephens S, Bradbury M, Rowan E, Kalaria R, Firbank M, Wesnes K, Ballard C. White Matter Hyperintensities Are Associated With Impairment of Memory, Attention, and Global Cognitive Performance in Older Stroke Patients. Stroke 2004; 35:1270-5. [PMID: 15118186 DOI: 10.1161/01.str.0000126041.99024.86] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The importance of white matter hyperintensities (WMH) for cognitive performance in older stroke patients is largely unknown. We hypothesized that processing speed and executive dysfunction will be associated with frontal WMH whereas impaired memory will be associated with temporal WMH. METHODS Neuropsychological assessments using the Cambridge Cognitive Examination (CAMCOG) and the Cognitive Drug Research (CDR) were completed for 96 stroke survivors aged older than 75 and 23 age-matched controls. Magnetic resonance imaging whole-brain axial FLAIR images were undertaken to visualize WMH and an automated threshold technique was used to determine their volume. RESULTS In comparison to controls, the stroke patients had significantly greater volume of WMH in all key areas. Within the stroke group, a consistent pattern of significant association was identified between total and frontal WHM volumes and attention and processing speed tasks (eg, choice reaction time [right: R=0.24 P=0.02; left: R=0.26, P=0.01]), but not with executive function. There were significant associations between memory and temporal WMH volumes (right: R=0.27, P=0.008; left: R=0.20, P=0.047). CONCLUSIONS In older stroke patients, cognitive processing speed and performance on measures of attention are significantly associated with WMH volume, particularly in the frontal lobe regions, whereas memory impairment is associated with the volume of temporal lobe WMH.
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Affiliation(s)
- Emma J Burton
- Institute for Ageing and Health, Newcastle General Hospital, Newcastle, UK
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28
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Current awareness in geriatric psychiatry. Bibliography. Int J Geriatr Psychiatry 2003; 18:91-98. [PMID: 12569951 DOI: 10.1002/gps.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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