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Overton M, Skoog J, Laukka EJ, Bodin TH, Mattsson AD, Sjöberg L, Hofer SM, Johansson L, Kulmala J, Kivipelto M, Solomon A, Skoog I, Kåreholt I, Sindi S. Sleep disturbances and change in multiple cognitive domains among older adults: a multicenter study of five Nordic cohorts. Sleep 2024; 47:zsad244. [PMID: 37708350 PMCID: PMC10925948 DOI: 10.1093/sleep/zsad244] [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: 02/09/2023] [Revised: 07/31/2023] [Indexed: 09/16/2023] Open
Abstract
STUDY OBJECTIVES We examined and compared cross-sectional and longitudinal associations between self-reported sleep disturbances and various cognitive domains in five separate Nordic European longitudinal aging studies (baseline N = 5631, mean age = 77.7, mean follow-up = 4.16 years). METHODS Comparable sleep parameters across studies included reduced sleep duration/quality, insomnia symptoms (sleep latency, waking up at night, and early awakenings), short and long sleep duration, and daytime napping. The cognitive domains were episodic memory, verbal fluency, perceptual speed, executive functioning, and global cognition (aggregated measure). A series of mixed linear models were run separately in each study and then compared to assess the level and rate of change in cognitive functioning across each sleep disturbance parameter. Models were adjusted for age, sex, education, hypnotic usage, depressive symptoms, lifestyle factors, cardiovascular, and metabolic conditions. By using a coordinated analytic approach, comparable construct-level measurements were generated, and results from identical statistical models were qualitatively compared across studies. RESULTS While the pattern of statistically significant results varied across studies, subjective sleep disturbances were consistently associated with worse cognition and steeper cognitive decline. Insomnia symptoms were associated with poorer episodic memory and participants sleeping less or more than 7-8 hours had a steeper decline in perceptual speed. In addition, daytime napping (>2 hours) was cross-sectionally and longitudinally associated with all examined cognitive domains. Most observed associations were study-specific (except for daytime napping), and a majority of association estimates remained significant after adjusting for covariates. CONCLUSION This rigorous multicenter investigation further supports the importance of sleep disturbance, including insomnia, long and short sleep duration, and daytime napping on baseline cognitive functioning and rate of change among older adults. These sleep factors may be targeted in future lifestyle interventions to reduce cognitive decline.
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Affiliation(s)
- Marieclaire Overton
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Johan Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Erika J Laukka
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Timothy Hadarsson Bodin
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Alexander Darin Mattsson
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Linnea Sjöberg
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Scott M Hofer
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Lena Johansson
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Jenni Kulmala
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK
- Theme Inflammation and Aging. Karolinska University Hospital, Stockholm, Sweden
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Alina Solomon
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK
- Theme Inflammation and Aging. Karolinska University Hospital, Stockholm, Sweden
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Ingemar Kåreholt
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Institute of Gerontology, School of Health and Welfare, Aging Research Network – Jönköping (ARN-J), Jönköping University, Jönköping, Sweden
| | - Shireen Sindi
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK
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2
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Chang SR, Liu JG, Li H, Liu MX, Shi DD, Zhou LJ. Pharmaceutical and pharmacological studies of Shen Ma Yi Zhi granule for prevention of vascular dementia: A review. Front Neurosci 2022; 16:1044572. [PMID: 36507350 PMCID: PMC9731835 DOI: 10.3389/fnins.2022.1044572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background: With dementia significantly increasing hospitalization and disability rates, worldwide aging of the population presents major challenges to public health. The majority of cases of cognitive dysfunction among the elderly, however, are characterized by an identifiable, preventable and treatable vascular component. As such, increased study of preventative methods in the context of dementia is warranted. Traditional Chinese medicine compounds have been reported to be neuroprotective and improve cognitive function via a variety of mechanisms. Shen Ma Yi Zhi granule (SMYZG) is one such collection of compounds that has been proven clinically effective. Pharmacological mechanisms of action, pharmacokinetics and clinical applications of SMYZG have been previously studied using a variety of vascular dementia animal models. SMYZG activates and regulates four main signaling pathways relevant to vascular dementia including the AMPK/PPARα/PGC-1α/UCP2, Nrf2/HO-1, HIF-1/VEGF/Notch, and VEGF/Flk-1/p8 MAPK pathways. Furthermore, SMYZG influences anti-inflammatory and anti-oxidant stress responses, reverses demyelination of brain white matter and vascular endothelium, regulates pericyte function and normalizes mitochondrial metabolism. Neuroprotective effects of SMYZG, as well as those promoting regeneration of vascular endothelium, have also been reported in studies of rat models of vascular dementia. Future research concerning SMYG is warranted for development of vascular dementia preventative management strategies.
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Affiliation(s)
- Su-rui Chang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,Graduate School, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jian-gang Liu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China,*Correspondence: Jian-gang Liu,
| | - Hao Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,Institute of Geriatrics of China Academy of Chinese Medical Sciences, Beijing, China,Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China,Hao Li,
| | - Mei-xia Liu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,Institute of Geriatrics of China Academy of Chinese Medical Sciences, Beijing, China
| | - Dan-dan Shi
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,Institute of Geriatrics of China Academy of Chinese Medical Sciences, Beijing, China
| | - Li-juan Zhou
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,Institute of Geriatrics of China Academy of Chinese Medical Sciences, Beijing, China
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Marutani N, Akamine S, Kanayama D, Gotoh S, Yanagida K, Maruyama R, Mori K, Miyamoto T, Adachi H, Sakagami Y, Yoshiyama K, Hotta M, Nagase A, Kozawa J, Maeda N, Otsuki M, Matsuoka T, Iwahashi H, Shimomura I, Murayama N, Watanabe H, Ikeda M, Mizuta I, Kudo T. Plasma NfL is associated with mild cognitive decline in patients with diabetes. Psychogeriatrics 2022; 22:353-359. [PMID: 35279914 DOI: 10.1111/psyg.12819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with diabetes are at a higher risk for cognitive decline. Thus, biomarkers that can provide early and simple detection of cognitive decline are required. Neurofilament light chain (NfL) is a cytoskeletal protein that constitutes neural axons. Plasma NfL levels are elevated when neurodegeneration occurs. Here, we investigated whether plasma NfL levels were associated with cognitive decline in patients with type 2 diabetes. METHOD This study included 183 patients with type 2 diabetes who visited Osaka University Hospital. All participants were tested for cognitive function using the Mini-Mental State Examination (MMSE) and the Rivermead Behavioural Memory Test (RBMT). NfL levels were analysed in the plasma and the relationship between NfL and cognitive function was examined. RESULTS Lower RBMT-standardized profile scores (SPS) or MMSE scores correlated with higher plasma NfL levels (one-way analysis of variance: MMSE, P = 0.0237; RBMT-SPS, P = 0.0001). Furthermore, plasma NfL levels (β = -0.34, P = 0.0005) and age (β = -0.19, P = 0.016) were significantly associated with the RBMT score after multivariable regression adjustment. CONCLUSIONS Plasma NfL levels were correlated with mild cognitive decline which is detected by the RBMT but not the MMSE in patients with type 2 diabetes. This suggests that plasma NfL levels may provide a valuable clinical tool for identifying mild cognitive decline in patients with diabetes.
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Affiliation(s)
- Noriko Marutani
- Health and Counseling Center, Osaka University, Osaka, Japan
| | - Shoshin Akamine
- Health and Counseling Center, Osaka University, Osaka, Japan
| | - Daisuke Kanayama
- Health and Counseling Center, Osaka University, Osaka, Japan.,Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shiho Gotoh
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kanta Yanagida
- Health and Counseling Center, Osaka University, Osaka, Japan
| | | | - Kohji Mori
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tesshin Miyamoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroyoshi Adachi
- Health and Counseling Center, Osaka University, Osaka, Japan.,Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yukako Sakagami
- Health and Counseling Center, Osaka University, Osaka, Japan.,Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kenji Yoshiyama
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Maki Hotta
- Department of Behavioral Neurology and Neuropsychiatry, United Graduate School of Child Development, Osaka University, Osaka, Japan
| | - Aki Nagase
- Department of Behavioral Neurology and Neuropsychiatry, United Graduate School of Child Development, Osaka University, Osaka, Japan
| | - Junji Kozawa
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Norikazu Maeda
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Metabolism and Atherosclerosis, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Michio Otsuki
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takaaki Matsuoka
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiromi Iwahashi
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Internal Medicine, Toyonaka Municipal Hospital, Osaka, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Norihito Murayama
- Research Institute, Suntory Global Innovation Center Limited, Suntory World Research Center, Tokyo, Japan
| | - Hiroshi Watanabe
- Research Institute, Suntory Global Innovation Center Limited, Suntory World Research Center, Tokyo, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ichiro Mizuta
- Health and Counseling Center, Osaka University, Osaka, Japan.,Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Kudo
- Health and Counseling Center, Osaka University, Osaka, Japan.,Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
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Gaillardin F, Bier JC, De Breucker S, Baudry S. Unraveling the Cognitive-Motor Interaction in Individuals With Amnestic Mild Cognitive Impairment. J Neurol Phys Ther 2022; 46:18-25. [PMID: 34789652 DOI: 10.1097/npt.0000000000000386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to determine whether increasing the contribution of executive functions worsens dual-task performance in individuals with amnestic mild cognitive impairment (aMCI). METHODS Fourteen individuals with aMCI (mean [SD]: 74 [4] years) and 19 control adults (71 [5] years) recalled a list of letters in the order of presentation (SPAN-O) or in alphabetic order (SPAN-A) while ascending or descending a 3-step staircase. Dual-task cost (DTC) represented the average decrement of motor and cognitive performances during dual tasks, with greater DTC indicating worse performance. RESULTS SPAN-A (P < 0.001) and stair descent (P = 0.023) increased the DTC in both groups compared with SPAN-O and stair ascent. Furthermore, individuals with aMCI had a greater DTC (93.4 [41.2]%) than the control group (48.3 [27.9]%) for SPAN-A (P < 0.001). Dual-task cost was also greater in descent (76.6 [42.1]%) than ascent (64.0 [34.5]%) in individuals with aMCI (P = 0.024) but not in the control group (P = 0.99). Significant negative partial correlations (β < -0.39; P < 0.05) were found between Montreal Cognitive Assessment score and DTC, while controlling for age and physical function. DISCUSSION AND CONCLUSIONS A greater DTC in individuals with aMCI when the cognitive task requires working memory (SPAN-A) or during complex locomotor task (descent) suggests that aMCI impedes the capacity to perform 2 tasks simultaneously when higher-order cognitive processes are challenged. Furthermore, a greater DTC in our dual-task situations appears to reflect cognitive decline, as assessed by the Montreal Cognitive Assessment score. Overall, this study indicates that increasing the contribution of executive functions worsens the cognitive-motor interaction in individuals with aMCI.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A375).
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Affiliation(s)
- Florence Gaillardin
- Laboratory of Applied Biology and Research Unit in Applied Neurophysiology (LABNeuro), Faculty for Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium (F.G., S.B.); and Departments of Cognitive and Clinical Neuropsychology (F.G.), Neurology (J.-C.B.), and Geriatrics (S.D.B.), Erasme Hospital, Brussels, Belgium
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Chamberlain JD, Sprague BN, Ross LA. Age- and time-varying associations between subjective health and episodic memory in older adults. J Gerontol B Psychol Sci Soc Sci 2021; 77:673-682. [PMID: 34329436 DOI: 10.1093/geronb/gbab142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE There are positive correlations between subjective health reports and episodic memory performance in older adults. However, previous studies have not evaluated the scope of such complex relationships, nor the potentially nonlinear magnitude of these correlations across age and time. We employed multiple subjective heath indices to evaluate the scope and nonlinearity of such relationships with memory performance. METHOD We utilized a cross-sectional (N = 2,783 at baseline) and longitudinal sample (N = 311) of healthy older adults aged 65 and older from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study. We used time-varying effects modeling (TVEM) to assess potential differences in relationship magnitudes between memory and three subjective health subscales (general health, role physical function, and physical function, from the Short Form Health Survey; SF-36) across five years. RESULTS Episodic memory positively predicted all subjective health measures cross-sectionally and longitudinally in our sample. TVEM revealed the relationships between all subjective health measures and episodic memory were stable across age. While role physical function and physical function maintained stable relationships with episodic memory across time, general health became increasingly coupled with memory five years following baseline. DISCUSSION Together, our findings highlight stable and varying relationships between episodic memory and multiple subjective health indicators across metrics of time in older adults.
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Affiliation(s)
- Jordan D Chamberlain
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Briana N Sprague
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Lesley A Ross
- Department of Psychology, Clemson University, Clemson, SC, USA
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Combining Cognitive Markers to Identify Individuals at Increased Dementia Risk: Influence of Modifying Factors and Time to Diagnosis. J Int Neuropsychol Soc 2020; 26:785-797. [PMID: 32207675 DOI: 10.1017/s1355617720000272] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We investigated the extent to which combining cognitive markers increases the predictive value for future dementia, when compared to individual markers. Furthermore, we examined whether predictivity of markers differed depending on a range of modifying factors and time to diagnosis. METHOD Neuropsychological assessment was performed for 2357 participants (60+ years) without dementia from the population-based Swedish National Study on Aging and Care in Kungsholmen. In the main sample analyses, the outcome was dementia at 6 years. In the time-to-diagnosis analyses, a subsample of 407 participants underwent cognitive testing 12, 6, and 3 years before diagnosis, with dementia diagnosis at the 12-year follow-up. RESULTS Category fluency was the strongest individual predictor of dementia 6 years before diagnosis [area under the curve (AUC) = .903]. The final model included tests of verbal fluency, episodic memory, and perceptual speed (AUC = .913); these three domains were found to be the most predictive across a range of different subgroups. Twelve years before diagnosis, pattern comparison (perceptual speed) was the strongest individual predictor (AUC = .686). However, models 12 years before diagnosis did not show significantly increased predictivity above that of the covariates. CONCLUSIONS This study shows that combining markers from different cognitive domains leads to increased accuracy in predicting future dementia 6 years later. Markers from the verbal fluency, episodic memory, and perceptual speed domains consistently showed high predictivity across subgroups stratified by age, sex, education, apolipoprotein E ϵ4 status, and dementia type. Predictivity increased closer to diagnosis and showed highest accuracy up to 6 years before a dementia diagnosis. (JINS, 2020, 00, 1-13).
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Müller T, Payton NM, Kalpouzos G, Jessen F, Grande G, Bäckman L, Laukka EJ. Cognitive, Genetic, Brain Volume, and Diffusion Tensor Imaging Markers as Early Indicators of Dementia. J Alzheimers Dis 2020; 77:1443-1453. [PMID: 32925047 PMCID: PMC7683082 DOI: 10.3233/jad-200445] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although associated with dementia and cognitive impairment, microstructural white matter integrity is a rarely used marker of preclinical dementia. OBJECTIVE We aimed to evaluate the individual and combined effects of multiple markers, with special focus on microstructural white matter integrity, in detecting individuals with increased dementia risk. METHODS A dementia-free subsample (n = 212, mean age = 71.33 years) included in the population-based Swedish National Study on Aging and Care (SNAC-K) underwent magnetic resonance imaging (T1-weighted, fluid-attenuated inversion recovery, diffusion tensor imaging), neuropsychological testing (perceptual speed, episodic memory, semantic memory, letter and category fluency), and genotyping (APOE). Incident dementia was assessed during six years of follow-up. RESULTS A global model (global cognition, APOE, total brain tissue volume: AUC = 0.920) rendered the highest predictive value for future dementia. Of the models based on specific markers, white matter integrity of the forceps major tract was included in the most predictive model, in combination with perceptual speed and hippocampal volume (AUC = 0.911). CONCLUSION Assessment of microstructural white matter integrity may improve the early detection of dementia, although the added benefit in this study was relatively small.
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Affiliation(s)
- Theresa Müller
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Nicola M. Payton
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Grégoria Kalpouzos
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Frank Jessen
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Lars Bäckman
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Erika J. Laukka
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
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8
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Payton NM, Kalpouzos G, Rizzuto D, Fratiglioni L, Kivipelto M, Bäckman L, Laukka EJ. Combining Cognitive, Genetic, and Structural Neuroimaging Markers to Identify Individuals with Increased Dementia Risk. J Alzheimers Dis 2019; 64:533-542. [PMID: 29889068 PMCID: PMC6027943 DOI: 10.3233/jad-180199] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Cognitive and biological markers have shown varying degrees of success in identifying persons who will develop dementia. Objective: To evaluate different combinations of cognitive and biological markers and identify prediction models with the highest accuracy for identifying persons with increased dementia risk. Methods: Neuropsychological assessment, genetic testing (apolipoprotein E –APOE), and structural magnetic resonance imaging (MRI) were performed for 418 older individuals without dementia (60–97 years) from a population-based study (SNAC-K). Participants were followed for six years. Results: Cognitive, genetic, and MRI markers were systematically combined to create prediction models for dementia at six years. The most predictive individual markers were perceptual speed or carrying at least one APOEɛ4 allele (AUC = 0.875). The most predictive model (AUC = 0.924) included variables from all three modalities (category fluency, general knowledge, any ɛ4 allele, hippocampal volume, white matter-hyperintensity volume). Conclusion: This study shows that combining markers within and between modalities leads to increased predictivity for future dementia. However, minor increases in predictive value should be weighed against the cost of additional tests in larger-scale screening.
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Affiliation(s)
- Nicola M Payton
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Grégoria Kalpouzos
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Stockholms Sjukhem, Research and Development Unit, Stockholm, Sweden
| | - Lars Bäckman
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Erika J Laukka
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
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Clustering and Switching Patterns in Semantic Fluency and Their Relationship to Working Memory in Mild Cognitive Impairment. Dement Neurocogn Disord 2019; 18:47-61. [PMID: 31297135 PMCID: PMC6609534 DOI: 10.12779/dnd.2019.18.2.47] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 01/24/2023] Open
Abstract
Background and Purpose Semantic verbal fluency test is a neuropsychological assessment that can sensitively detect neuropathological changes. Considering its multifactorial features tapping various cognitive domains such as semantic memory, executive function, and working memory, it is necessary to examine verbal fluency performance in association with underlying cognitive functions. The objective of the current study was to investigate semantic fluency patterns of people with mild cognitive impairment (MCI) based on clustering and switching and their relationship with working memory. Methods Twenty-six individuals with MCI and 23 normal elderly adults participated in this study. A semantic verbal fluency test (animal version) was administered and the performance was analyzed using the following measures: number of correct words, cluster size, and number of switches. Scores of digit forward (DF) and backward span tasks were employed as working memory measures. Results Analyses of variance revealed significant group differences in the numbers of correct words and switches. Multivariate logistic regression and receiver-operating characteristic analyses showed that the number of switches more sensitively distinguished MCI existence than the number of correct words. Stepwise linear regression analysis showed that DF task and age significantly predicted the number of correct words while only the DF task significantly predicted the number of switches. Conclusions Decrement in semantic verbal fluency in MCI seems to be associated with impaired switching abilities. Working memory capacity might serve as the underlying cognitive factor related to decreased verbal fluency in MCI.
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Jiang S, Yan C, Qiao Z, Yao H, Jiang S, Qiu X, Yang X, Fang D, Yang Y, Zhang L, Wang L, Zhang L. Mismatch negativity as a potential neurobiological marker of early-stage Alzheimer disease and vascular dementia. Neurosci Lett 2017; 647:26-31. [PMID: 28336337 DOI: 10.1016/j.neulet.2017.03.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 02/05/2017] [Accepted: 03/17/2017] [Indexed: 12/30/2022]
Abstract
Alzheimer's disease (AD) and vascular dementia (VD) are serious, irreversible forms of cognitive impairment, which means that an early diagnosis is essential to slow down their progression. One potential neurophysiological biomarker of these diseases is the mismatch negativity (MMN) event-related potentials (ERP) component, which reflects an automatic detection mechanism at the pre-attentive stages of information processing. We evaluated the auditory MMN response in individuals from two patient groups: those in the prodromal stages of AD (P-AD) and those in the prodromal stages of VD (P-VD). Thirty patients (15 P-AD patients and 15 P-VD patients) and 30 age-matched controls were recruited to undergo electrophysiological recordings during the presentation of an auditory deviant-standard-reverse oddball paradigm that was used to elicit genuine MMN responses. We show that over the frontal-central area, the mean amplitude of the MMN was significantly reduced in both the P-AD (p=0.017) and P-VD groups (p=0.013) compared with controls. The MMN peak latency in P-VD patients was significantly shorter than in controls (p=0.027). No MMN response differences between the P-AD and P-VD were found in either the frontal-central or the temporal areas. These results indicate that P-AD and P-VD patients exhibit impaired pre-attentive information processing mechanisms as revealed by the frontal-central area MMN response, which is associated with sensory memory and cognitive deficits.
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Affiliation(s)
- Shixiang Jiang
- Department of Medical Psychology, Public Health Institute of Harbin Medical University, Heilongjiang, China; Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Chang Yan
- Department of Pathophysiology, School of Basic Medical Sciences, Harbin Medical University, Heilongjiang, China
| | - Zhengxue Qiao
- Department of Medical Psychology, Public Health Institute of Harbin Medical University, Heilongjiang, China
| | - Haiqian Yao
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Shiquan Jiang
- Department of pain, Harbin Tiantai Hospital, Harbin, Heilongjiang, China
| | - Xiaohui Qiu
- Department of Medical Psychology, Public Health Institute of Harbin Medical University, Heilongjiang, China
| | - Xiuxian Yang
- Department of Medical Psychology, Public Health Institute of Harbin Medical University, Heilongjiang, China
| | | | - Yanjie Yang
- Department of Medical Psychology, Public Health Institute of Harbin Medical University, Heilongjiang, China.
| | - Limei Zhang
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China.
| | - Lina Wang
- Department of Pathophysiology, School of Basic Medical Sciences, Harbin Medical University, Heilongjiang, China.
| | - Liming Zhang
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Heilongjiang, China.
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11
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Boraxbekk CJ, Lundquist A, Nordin A, Nyberg L, Nilsson LG, Adolfsson R. Free Recall Episodic Memory Performance Predicts Dementia Ten Years prior to Clinical Diagnosis: Findings from the Betula Longitudinal Study. Dement Geriatr Cogn Dis Extra 2015; 5:191-202. [PMID: 26078750 PMCID: PMC4463780 DOI: 10.1159/000381535] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Early dementia diagnosis is a considerable challenge. The present study examined the predictive value of cognitive performance for a future clinical diagnosis of late-onset Alzheimer's disease or vascular dementia in a random population sample. METHODS Cognitive performance was retrospectively compared between three groups of participants from the Betula longitudinal cohort. Group 1 developed dementia 11-22 years after baseline testing (n = 111) and group 2 after 1-10 years (n = 280); group 3 showed no deterioration towards dementia during the study period (n = 2,855). Multinomial logistic regression analysis was used to investigate the predictive value of tests reflecting episodic memory performance, semantic memory performance, visuospatial ability, and prospective memory performance. RESULTS Age- and education-corrected performance on two free recall episodic memory tests significantly predicted dementia 10 years prior to clinical diagnosis. Free recall performance also predicted dementia 11-22 years prior to diagnosis when controlling for education, but not when age was added to the model. CONCLUSION The present results support the suggestion that two free recall-based tests of episodic memory function may be useful for detecting individuals at risk of developing dementia 10 years prior to clinical diagnosis.
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Affiliation(s)
| | - Anders Lundquist
- Department of Statistics, Department of Integrative Medical Biology, Stockholm, Sweden
| | - Annelie Nordin
- Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Stockholm, Sweden
| | - Lars Nyberg
- Division of Physiology, Department of Integrative Medical Biology, Stockholm, Sweden ; Division of Diagnostic Radiology, Department of Radiation Sciences, Stockholm, Sweden
| | | | - Rolf Adolfsson
- Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Stockholm, Sweden
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12
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Hamel R, Köhler S, Sistermans N, Koene T, Pijnenburg Y, van der Flier W, Scheltens P, Aalten P, Verhey F, Visser PJ, Ramakers I. The trajectory of cognitive decline in the pre-dementia phase in memory clinic visitors: findings from the 4C-MCI study. Psychol Med 2015; 45:1509-1519. [PMID: 25407094 DOI: 10.1017/s0033291714002645] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND We investigated the course of decline in multiple cognitive domains in non-demented subjects from a memory clinic setting, and compared pattern, onset and magnitude of decline between subjects who progressed to Alzheimer's disease (AD) dementia at follow-up and subjects who did not progress. METHOD In this retrospective cohort study 819 consecutive non-demented patients who visited the memory clinics in Maastricht or Amsterdam between 1987 and 2010 were followed until they became demented or for a maximum of 10 years (range 0.5-10 years). Differences in trajectories of episodic memory, executive functioning, verbal fluency, and information processing speed/attention between converters to AD dementia and subjects remaining non-demented were compared by means of random effects modelling. RESULTS The cognitive performance of converters and non-converters could already be differentiated seven (episodic memory) to three (verbal fluency and executive functioning) years prior to dementia diagnosis. Converters declined in these three domains, while non-converters remained stable on episodic memory and executive functioning and showed modest decline in verbal fluency. There was no evidence of decline in information processing speed/attention in either group. CONCLUSIONS Differences in cognitive performance between converters to AD dementia and subjects remaining non-demented could be established 7 years prior to diagnosis for episodic memory, with verbal fluency and executive functioning following several years later. Therefore, in addition to early episodic memory decline, decline in executive functions may also flag incident AD dementia. By contrast, change in information processing speed/attention seems less informative.
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Affiliation(s)
- R Hamel
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University Medical Centre,Maastricht,The Netherlands
| | - S Köhler
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University Medical Centre,Maastricht,The Netherlands
| | - N Sistermans
- Department of Neurology and Neuroscience Campus Amsterdam,VUmc Alzheimer Centre, VUmc Medical Centre,Amsterdam,The Netherlands
| | - T Koene
- Department of Medical Psychology and Neuroscience Campus Amsterdam,VUmc Alzheimer Centre, VUmc Medical Centre,Amsterdam,The Netherlands
| | - Y Pijnenburg
- Department of Neurology and Neuroscience Campus Amsterdam,VUmc Alzheimer Centre, VUmc Medical Centre,Amsterdam,The Netherlands
| | - W van der Flier
- Department of Neurology and Neuroscience Campus Amsterdam,VUmc Alzheimer Centre, VUmc Medical Centre,Amsterdam,The Netherlands
| | - P Scheltens
- Department of Neurology and Neuroscience Campus Amsterdam,VUmc Alzheimer Centre, VUmc Medical Centre,Amsterdam,The Netherlands
| | - P Aalten
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University Medical Centre,Maastricht,The Netherlands
| | - F Verhey
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University Medical Centre,Maastricht,The Netherlands
| | - P J Visser
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University Medical Centre,Maastricht,The Netherlands
| | - I Ramakers
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University Medical Centre,Maastricht,The Netherlands
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13
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Yajima K, Matsushita T, Sumitomo H, Sakurai H, Katayama T, Kanno K, Sakai M, Shigeta M, Shirabe S, Nakano T, Nishimura K, Ueki A, Kitaoka M. One-minute mental status examination for category fluency is more useful than mini-mental state examination to evaluate the reliability of insulin self-injection in elderly diabetic patients. J Diabetes Investig 2014; 5:340-4. [PMID: 24843784 PMCID: PMC4020340 DOI: 10.1111/jdi.12159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/29/2013] [Accepted: 08/18/2013] [Indexed: 11/29/2022] Open
Abstract
AIMS/INTRODUCTION We investigated the factors associated with the reliability of insulin self-injection in elderly diabetic patients receiving insulin therapy. MATERIALS AND METHODS We enrolled diabetic patients aged ≥65 years and receiving insulin therapy, and assessed their cognitive function by the mini-mental state examination and 1-min mental status examination for category fluency. We also observed their technique of insulin self-injection, and evaluated whether or not patients were able to inject insulin by themselves according to nine defined details in terms of insulin self-injection. The predictive factors for the reliability of insulin self-injection were determined by univariate and multivariate logistic regression analysis. There were 278 participants (135 males, 143 females) enrolled in the present study. RESULTS According to multivariate logistic regression analysis, only the 1-min mental status examination score was found to be a significant independent predictor of the reliability of insulin self-injection (odds ratio 0.75; 95% confidence interval 0.62-0.90; P = 0.002). CONCLUSIONS The 1-min mental status examination for category fluency can be considered more useful than mini-mental state examination to evaluate the reliability of insulin self-injection in elderly diabetic patients receiving insulin therapy.
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Affiliation(s)
- Ken Yajima
- Department of Internal MedicineFederation of National Public Service Personnel Mutual Aid AssociationsTachikawa HospitalKanagawaJapan
| | - Takaya Matsushita
- Department of Diabetology, Endocrinology and MetabolismTokyo Medical University Hachioji Medical CenterKanagawaJapan
| | - Hidetaka Sumitomo
- Division of Endocrinology and MetabolismTachikawa Sogo HospitalKanagawaJapan
| | - Hirofumi Sakurai
- Department of Geriatric MedicineTokyo Medical University HospitalKanagawaJapan
| | | | | | - Masashi Sakai
- Department of MedicineRyokufuso HospitalKanagawaJapan
| | - Masayuki Shigeta
- Division of Endocrinology and MetabolismShowa General HospitalKanagawaJapan
| | | | - Tadasumi Nakano
- Department of DiabetologyMitsubishi Kyoto HospitalKyotoJapan
| | | | - Akio Ueki
- Department of Diabetology, Endocrinology and MetabolismTokyo Medical University Hachioji Medical CenterKanagawaJapan
| | - Masafumi Kitaoka
- Division of Endocrinology and MetabolismShowa General HospitalKanagawaJapan
- Nonprofit Organization West Tokyo Diabetic AssociationTokyoJapan
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14
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Executive functions in clinical and preclinical Alzheimer's disease. Rev Neurol (Paris) 2013; 169:695-708. [DOI: 10.1016/j.neurol.2013.07.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 07/23/2013] [Accepted: 07/23/2013] [Indexed: 01/18/2023]
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15
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Brewster PW, McDowell I, Moineddin R, Tierney MC. Differential prediction of vascular dementia and Alzheimer's disease in nondemented older adults within 5 years of initial testing. Alzheimers Dement 2012; 8:528-35. [DOI: 10.1016/j.jalz.2011.09.233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 08/29/2011] [Accepted: 09/20/2011] [Indexed: 11/25/2022]
Affiliation(s)
- Paul W.H. Brewster
- Geriatric Research Unit, Brain Sciences, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
- Department of PsychologyUniversity of VictoriaVictoriaBritish ColumbiaCanada
| | - Ian McDowell
- Department of Epidemiology and Community MedicineUniversity of OttawaOttawaOntarioCanada
| | - Rahim Moineddin
- Department of Family and Community MedicineUniversity of TorontoTorontoOntarioCanada
| | - Mary C. Tierney
- Geriatric Research Unit, Brain Sciences, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
- Department of Family and Community MedicineUniversity of TorontoTorontoOntarioCanada
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16
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Di Cesare F, D'Ilario D, Fioravanti M. Differential characteristics of the aging process and the vascular cognitive impairment in the organization of memory retrieval. J Neurol Sci 2012; 322:148-51. [DOI: 10.1016/j.jns.2012.07.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 07/17/2012] [Accepted: 07/18/2012] [Indexed: 11/29/2022]
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17
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Korczyn AD, Vakhapova V, Grinberg LT. Vascular dementia. J Neurol Sci 2012; 322:2-10. [PMID: 22575403 DOI: 10.1016/j.jns.2012.03.027] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 03/19/2012] [Accepted: 03/20/2012] [Indexed: 12/22/2022]
Abstract
The epidemic growth of dementia causes great concern for the society. It is customary to consider Alzheimer's disease (AD) as the most common cause of dementia, followed by vascular dementia (VaD). This dichotomous view of a neurodegenerative disease as opposed to brain damage caused by extrinsic factors led to separate lines of research in these two entities. Indeed, accumulated data suggest that the two disorders have additive effects and probably interact; however it is still unknown to what degree. Furthermore, epidemiological studies have shown "vascular" risk factors to be associated with AD. Therefore, a clear distinction between AD and VaD cannot be made in most cases, and is furthermore unhelpful. In the absence of efficacious treatment for the neurodegenerative process, special attention must be given to the vascular component, even in patients with presumed mixed pathology. Symptomatic treatment of VaD and AD is similar, although the former is less effective. For prevention of dementia it is important to treat all factors aggressively, even in stroke survivors who do not show evidence of cognitive decline. In this review, we will give a clinical and pathological picture of the processes leading to VaD and discuss its interaction with AD.
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Affiliation(s)
- Amos D Korczyn
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
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18
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Abstract
We investigated differences between Alzheimer's disease (AD) and vascular dementia (VaD) from the appearance of the first cognitive symptoms, focusing on both time of onset and rate of accelerated decline for different cognitive functions before dementia diagnosis. Data from a longitudinal population-based study were used, including 914 participants (mean age = 82.0 years, SD = 5.0) tested with a cognitive battery (word recall and recognition, Block Design, category fluency, clock reading) on up to four occasions spanning 10 years. We fit a series of linear mixed effects models with a change point to the cognitive data, contrasting each dementia group to a control group. Significant age-related decline was observed for all five cognitive tasks. Relative to time of diagnosis, the preclinical AD persons deviated from the normal aging curve earlier (up to 9 years) compared to the preclinical VaD persons (up to 6 years). However, once the preclinical VaD persons started to decline, they deteriorated at a faster rate than the preclinical AD persons. The results have important implications for identifying the two dementia disorders at an early stage and for selecting cognitive tasks to evaluate treatment effects for persons at risk of developing AD and VaD.
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19
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Small BJ, Dixon RA, McArdle JJ. Tracking cognition-health changes from 55 to 95 years of age. J Gerontol B Psychol Sci Soc Sci 2010; 66 Suppl 1:i153-61. [PMID: 21196437 DOI: 10.1093/geronb/gbq093] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Among the key targets of inquiry in cognitive aging are (1) the description of cognitive changes with advancing age and (2) the association of such cognitive changes with modulating factors in the changing epidemiological context. METHODS In the current study, we assemble multi-occasion (up to 12 years) cognitive (speed, episodic memory, and semantic memory) and self-reported health data from the Victoria Longitudinal Study (n = 988; ages 55-95 years). RESULTS The results from piecewise random effects models using age as a basis indicated that only selected measures of episodic memory and semantic memory showed evidence of significant declines prior to age 75. After age 75, all cognitive abilities showed evidence for statistically significant declines, although the magnitude of these changes varied considerably. Performance at age 75 was correlated with self-reported health for measures of processing speed and episodic memory. Changes in health status were related to changes in some aspects of processing speed. DISCUSSIONS The results indicated that (1) for many cognitive abilities declines in performance did not manifest until after age 75 and (2) self-reported health was related to level of performance more than changes over age.
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Affiliation(s)
- Brent J Small
- School of Aging Studies, University of South Florida, Tampa, FL 33620, USA.
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20
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Is vascular cognitive impairment a useful concept? J Neurol Sci 2010; 299:2-4. [DOI: 10.1016/j.jns.2010.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 05/27/2010] [Indexed: 11/19/2022]
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21
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Jiwa NS, Garrard P, Hainsworth AH. Experimental models of vascular dementia and vascular cognitive impairment: a systematic review. J Neurochem 2010; 115:814-28. [PMID: 20731763 DOI: 10.1111/j.1471-4159.2010.06958.x] [Citation(s) in RCA: 189] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Vascular cognitive impairment (VCI) encompasses vascular dementia and is the second most common cause of dementing illness after Alzheimer's disease. The main causes of VCI are: cerebral small vessel disease; multi-infarct dementia; strategic infarct (i.e. located in a functionally-critical brain area); haemorrhage/microbleed; angiopathy (including cerebral amyloid angiopathy); severe hypoperfusion (e.g. cardiac arrhythmia); and hereditary vasculopathy (e.g. cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, CADASIL). In this systematic analysis, we aimed to relate cognitive and neuropathological features of experimental models to clinical VCI. We extracted data from 107 studies covering 16 models. These included: brief global ischaemic insults (in rats, mice or gerbils); chronic global hypoperfusion (rats, mice, gerbils); chronic hypertension (in primates or stroke-prone, spontaneously-hypertensive rats); multiple ischaemic lesions because of intra-vascular emboli (in rodents, rabbits or primates); strategic ischaemic lesions (in rats or mini-pigs); generalised vasculopathies, because of mutant Notch3, hyperhomocysteinaemia, experimental diabetes mellitus or lack of cerebral vasodilator M(5) receptors (rats or mice). Most cognitive testing showed deficits in working and reference memory. The lesions observed were microinfarcts, diffuse white matter lesions, hippocampal neuronal death, focal ischaemic lesions and micro-haemorrhages. The most-used model was bilateral carotid artery occlusion in rats, leading to chronic hypoperfusion and white matter injury.
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Affiliation(s)
- Nadim S Jiwa
- Clinical Neuroscience, Division of Clinical Sciences, St George's University of London, London, UK
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Narasimhalu K, Ang S, De Silva DA, Wong MC, Chang HM, Chia KS, Auchus AP, Chen C. Severity of CIND and MCI predict incidence of dementia in an ischemic stroke cohort. Neurology 2009; 73:1866-72. [PMID: 19949033 DOI: 10.1212/wnl.0b013e3181c3fcb7] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The utility of poststroke cognitive status, namely dementia, cognitive impairment no dementia (CIND), mild cognitive impairment (MCI), and no cognitive impairment (NCI), in predicting dementia has been previously examined. However, no studies to date have compared the ability of subtypes of MCI and CIND to predict dementia in a poststroke population. METHODS A cohort of ischemic stroke patients underwent neuropsychological assessment annually for up to 5 years. Dementia was defined using the DSM-IV criteria. Univariate and multivariable Cox proportional regression was performed to determine the ability of MCI subtypes, CIND severity, and individual domains of impairment to predict dementia. RESULTS A total of 362 patients without dementia were followed up for a mean of 3.4 years (17% drop out), with 24 developing incident dementia. Older age, previous and recurrent stroke, and CIND and MCI subtypes were significant predictors of dementia. In multivariable analysis controlling for treatment allocation, patients who were older, had previous or recurrent stroke, and had either CIND moderate or multiple domain MCI with amnestic component were at elevated risk for dementia. In multivariable domain analysis, recurrent strokes, age, and previous strokes, verbal memory, and visual memory were significant predictors of dementia. Receiver operating characteristic curve analysis showed that CIND moderate (area under the curve: 0.893) and multiple domain MCI with amnestic component (area under the curve: 0.832) were significant predictors of conversion to dementia. All other classifications of cognitive impairment had areas under the curve less than 0.7. CONCLUSION Stroke patients with cognitive impairment no dementia (CIND) moderate are at higher risk of developing dementia, while CIND mild patients are not at increased risk of developing dementia.
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Affiliation(s)
- K Narasimhalu
- Center for Molecular Epidemiology, National University of Singapore.
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23
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Hayden KM, Warren LH, Pieper CF, Østbye T, Tschanz JT, Norton MC, Breitner JCS, Welsh-Bohmer KA. Identification of VaD and AD prodromes: the Cache County Study. Alzheimers Dement 2009; 1:19-29. [PMID: 19595812 DOI: 10.1016/j.jalz.2005.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is unclear whether vascular dementia (VaD) has a cognitive prodrome, akin to the mild cognitive impairment (MCI) prodrome to Alzheimer's dementia (AD). To evaluate whether VaD has a cognitive prodrome, and if it can be differentiated from prodromal AD, we examined neuropsychological test performance of participants in a nested case-control study within a population-based cohort aged 65 or older. METHODS Participants (n = 485) were identified from the Cache County Study, a large population-based study of aging and dementia. After an average of 3 years of follow-up, a total of 62 incident dementia cases were identified (14 VaD, 48 AD). We identified a number of neuropsychological tests (executive and memory) that discriminated between diagnosed VaD and AD cases. Multivariate analyses sought to differentiate between these same groups 3 years before clinical diagnosis. RESULTS The Consortium to Establish a Registry for Alzheimer's Disease Word List Recognition Test correct recognition of foils (mean difference, 1.25; 95% confidence interval [CI], 0.42 to 2.07; p < 0.01), Logical Memory I (mean difference, 7.16; 95% CI, 0.78 to 13.55, p < 0.05), Logical Memory II delayed recall (mean difference, 8.67; 95% CI, 1.59 to 15.74, p < 0.05), and percent savings (mean difference, 51.07; 95% CI, 32.58 to 69.56, p < 0.0001) differentiated VaD from AD cases after adjustment for age, sex, education, and dementia severity. Three years before dementia diagnosis, word list recognition ("no" responses mean difference, 1.40; 95% CI, 0.64 to 2.17; p < 0.001, and "yes" responses mean difference, -1.14; 95% CI, -2.14 to -0.13; p < 0.03) discriminated between prodromal VaD and AD. CONCLUSION These results suggest that VaD has a prodromal syndrome, the cognitive features of which are distinguishable from the cognitive prodrome of AD.
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Affiliation(s)
- K M Hayden
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
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May BH, Lit M, Xue CCL, Yang AWH, Zhang AL, Owens MD, Head R, Cobiac L, Li CG, Hugel H, Story DF. Herbal medicine for dementia: a systematic review. Phytother Res 2009; 23:447-59. [DOI: 10.1002/ptr.2656] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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25
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Taler V, Phillips NA. Language performance in Alzheimer's disease and mild cognitive impairment: a comparative review. J Clin Exp Neuropsychol 2008; 30:501-56. [PMID: 18569251 DOI: 10.1080/13803390701550128] [Citation(s) in RCA: 235] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Mild cognitive impairment (MCI) manifests as memory impairment in the absence of dementia and progresses to Alzheimer's disease (AD) at a rate of around 15% per annum, versus 1-2% in the general population. It thus constitutes a primary target for investigation of early markers of AD. Language deficits occur early in AD, and performance on verbal tasks is an important diagnostic criterion for both AD and MCI. We review language performance in MCI, compare these findings to those seen in AD, and identify the primary issues in understanding language performance in MCI and selecting tasks with diagnostic and prognostic value.
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Affiliation(s)
- Vanessa Taler
- Department of Psychology/Centre for Research in Human Development, Concordia University, Montréal, Québec, Canada
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Patterns of neuropsychological impairment in MCI patients with small subcortical infarcts or hippocampal atrophy. J Int Neuropsychol Soc 2008; 14:611-9. [PMID: 18577290 DOI: 10.1017/s1355617708080831] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We investigated whether MCI patients with hippocampal atrophy or multiple subcortical infarcts demonstrate neuropsychological patterns and markers considered typical of Alzheimer's disease (AD) and of vascular dementia (VD), respectively. An extensive neuropsychological battery, including tests of memory, visual-spatial and executive functions, language, attention, praxis and psychomotor speed, was administered to 36 mild cognitive impairment (MCI) patients with hippocampal atrophy and 41 MCI patients with multiple subcortical infarcts. Both groups of MCI patients were very mildly impaired and well matched in terms of MMSE scores. A clear, disproportionately severe, episodic memory disorder was observed in MCI patients with hippocampal atrophy. A less specific neuropsychological profile, consisting of impairment on an Action Naming task that is sensitive to frontal lobe lesions, was observed in MCI patients with multiple subcortical infarcts. In MCI patients, a disproportionately severe episodic memory impairment strongly points to an Alzheimer's type brain pathology, whereas the prevalence of executive deficits and other frontal lobe symptoms are a much weaker diagnostic marker of small vessel subcortical disease.
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Bäckman L. Memory and cognition in preclinical dementia: what we know and what we do not know. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:354-60. [PMID: 18616855 DOI: 10.1177/070674370805300604] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This overview focuses on the cognitive transition between normal aging and dementia. Numerous studies indicate that individuals who will go on to develop dementia show cognitive deficits many years before the time at which a clinical diagnosis could be rendered. The degree of preclinical impairment is remarkably similar for tasks assessing episodic memory, executive functioning, and perceptual speed, consistent with the view that multiple brain alterations occur prior to clinical disease onset. Although most research in this area has dealt with Alzheimer disease (AD), several recent reports indicate that the pattern of preclinical impairment is very similar in the second largest dementia disorder, vascular dementia (VaD). This is important because currently the possibility for interventions to postpone disease onset is greater in VaD than in AD. Despite pronounced preclinical cognitive deficits in dementia, the performance distributions between cases and controls are largely overlapping, hampering the ability to identify high-risk individuals. To alleviate this problem, future research should evaluate hybrid models for the prediction of dementia. In such models, multiple indicators of cognitive functioning should be included along with markers from other domains that have been linked to subsequent dementia (such as brain imaging, genetics, and lifestyle variables). To the extent that these categories of variables add unique variance, classification accuracy will increase and the overlap in performance scores between incident cases and controls will decrease, thereby enhancing clinical usefulness. This approach would also facilitate the examination of interactive effects among classes of preclinical markers.
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Affiliation(s)
- Lars Bäckman
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden.
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Memory impairment, executive dysfunction, and intellectual decline in preclinical Alzheimer's disease. J Int Neuropsychol Soc 2008; 14:266-78. [PMID: 18282324 PMCID: PMC2763488 DOI: 10.1017/s1355617708080302] [Citation(s) in RCA: 281] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 10/30/2007] [Accepted: 10/31/2007] [Indexed: 01/15/2023]
Abstract
In the Baltimore Longitudinal Study of Aging (BLSA), we examined the temporal unfolding of declining performance on tests of episodic memory (Free Recall on the Free and Cued Selective Reminding Test), executive function (Category Fluency, Letter Fluency, and Trails), and Verbal Intelligence (Nelson, 1982; American Version of the Nelson Adult Reading Test [AMNART]) before the diagnosis of dementia in 92 subjects with incident Alzheimer's disease (AD) followed for up to 15 years before diagnosis. To examine the preclinical onset of cognitive decline, we aligned subjects at the time of initial AD diagnosis and examined the cognitive course preceding diagnosis. We found that declines in performance on tests of episodic memory accelerated 7 years before diagnosis. Declining performance on tests of executive function accelerated 2-3 years before diagnosis, and verbal intelligence declined in close proximity to diagnosis. This cognitive profile is compatible with pathologic data suggesting that structures which mediate memory are affected earlier than frontal structures during the preclinical onset of AD. It also supports the view that VIQ as estimated by the AMNART does not decline during the preclinical onset of AD.
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Scuteri A, Tesauro M, Appolloni S, Preziosi F, Brancati AM, Volpe M. Arterial stiffness as an independent predictor of longitudinal changes in cognitive function in the older individual. J Hypertens 2007; 25:1035-40. [PMID: 17414668 DOI: 10.1097/hjh.0b013e3280895b55] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cognitive decline significantly contributes to disability in older individuals. We previously demonstrated cross-sectionally that arterial stiffness [pulse wave velocity (PWV)] was associated with memory loss independently of traditional cardiovascular risk factors and of neuroimaging findings in older individuals without prior stroke. The present study aimed to evaluate PWV as a predictor of longitudinal changes in cognitive function in older individuals reporting memory problems. PARTICIPANTS AND METHODS We studied 102 older individuals (mean age 79 +/- 6 years; 31 men, 71 women) reporting memory problems. PWV was measured noninvasively by Complior. Traditional cardiovascular risk factor levels were measured. Global cognitive function was measured by the Mini-Mental State Examination (MMSE) (maximum score = 30) at baseline and at follow-up visit. Cerebral computed tomography evaluated the presence of microvascular damage or cortical atrophy. Individuals with prior stroke or atrial fibrillation were excluded. RESULTS The baseline MMSE was 22.9 +/- 5.5; 61% were hypertensive, 26.8% diabetic, 9.4% smokers, 10.5% taking statins, and 21.1% taking nitrates. The average PWV was 13.5 +/- 2.2 m/s. After a median follow-up of 12 months, the average per-year decline in MMSE was 2.9 points or 12.1%. Multiple regression models showed that PWV independently predicted cognitive decline (model R2 = 0.50). PWV was the single strongest predictor of cognitive decline, explaining 15.2% of the total variance (each 1 m/s increase in PWV was associated with an average 0.74 per-year decrease in MMSE score, P < 0.001). CONCLUSION In older individuals, arterial stiffness (PWV) is a strong predictor of loss in cognitive function, independent of age, sex, education, and traditional cardiovascular risk factors.
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Popović IM, Serić V, Demarin V. Mild cognitive impairment in symptomatic and asymptomatic cerebrovascular disease. J Neurol Sci 2007; 257:185-93. [PMID: 17328916 DOI: 10.1016/j.jns.2007.01.029] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We tried to evaluate and to compare usefulness of two brief cognitive tests in early detection of cognitive decline in subjects with increased cerebrovascular (CV) risk. As CV risk factors are recognised as important in etiology of dementia, we also aimed to determine the possible associations of specific CV risk factors and cognitive results. Patients (PGs) with first-ever stroke or TIA (N=110) and CV symptoms-free controls (CGs) with CV risk factors present (N=45) matched for age, gender and education level were tested using Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) on admission, at three- and six-month points. In all subjects, detailed CV risk factors profile was assessed. We observed the decrement in cognitive performance during the six-month study period in both groups, more evident if MoCA (p<0.001) than if MMSE was used (p=0.022). Six months after first stroke/TIA 83.6% PGs scored below normal range on MoCA. In PGs, positive associations for cognitive decrement and multiple CV risk factors (>2) were found (p=0.034 for MMSE; p=0.002 for MoCA). In CGs, positive associations were found for cognitive decrement and arterial hypertension with increased IMT values (p<0.001 for MMSE) and for multiple CV risk factors and arterial hypertension (p=0.003 for MoCA). The use of MoCA could aid to early recognition of cognitive deficits in persons with increased CV risk. Individuals with multiple CV risk factors seem to have increased risk of cognitive decline.
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Affiliation(s)
- Irena Martinić Popović
- University Department of Neurology, Sestre milosrdnice University Hospital, Vinogradska c. 29, HR-10000 Zagreb, Croatia.
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Andersson C, Blennow K, Johansson SE, Almkvist O, Engfeldt P, Lindau M, Eriksdotter-Jönhagen M. Differential CSF biomarker levels in APOE-epsilon4-positive and -negative patients with memory impairment. Dement Geriatr Cogn Disord 2007; 23:87-95. [PMID: 17124416 DOI: 10.1159/000097354] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2006] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To investigate the relationships between episodic memory, APOE genotype, CSF markers (total tau, T-tau; phospho-tau, P-tau; beta-amyloid, Abeta42) and longitudinal cognitive decline. METHODS 124 memory clinic patients were retrospectively divided into 6 groups based on (i) episodic memory function (Rey Auditory Verbal Learning Test, RAVLT): severe, moderate or no impairment (SIM, MIM or NIM), and (ii) APOE genotype (epsilon4+ or epsilon4-). CSF marker levels and cognitive decline were compared across groups. RESULTS Episodic memory function, according to RAVLT scores, was significantly correlated with CSF marker levels only among epsilon4+ subjects and not among epsilon4- subjects. When comparing the 6 subgroups, SIM epsilon4+ and MIM epsilon4+ groups showed significantly lower Abeta42 levels than the other groups. T-tau and P-tau levels were significantly increased in SIM epsilon4+ when compared to all the other groups, including the SIM epsilon4- group. However, both SIM epsilon4+ and SIM epsilon4- declined cognitively during the follow-up. CONCLUSION It remains to be determined whether APOE genotype affects the expression of biomarkers in CSF, or whether the different biomarker patterns reflect different types of disease processes in patients with progressive cognitive dysfunction.
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Affiliation(s)
- Christin Andersson
- Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
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Selnes OA, Vinters HV. Vascular cognitive impairment. ACTA ACUST UNITED AC 2006; 2:538-47. [PMID: 16990827 DOI: 10.1038/ncpneuro0294] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Accepted: 07/21/2006] [Indexed: 11/09/2022]
Abstract
Cognitive impairment commonly accompanies clinical syndromes associated with vascular disease of the brain. Because of evolving definitional criteria, however, the frequency of cognitive impairment attributable to cerebrovascular disease is difficult to determine. Dementia occurs in up to one-third of elderly patients with stroke, a subset of whom have Alzheimer's disease (AD) rather than a pure vascular dementia syndrome. In fact, pure vascular dementia has been shown to be uncommon in most large autopsy series. A mixed etiology of AD and cerebrovascular disease is thought to become more common with increasing age, although no clinical criteria for the diagnosis of AD with cerebrovascular disease are currently available. Epidemiological studies have implicated subcortical small-vessel disease as a risk factor for cognitive impairment and dementia, but the cognitive expression and clinical significance of MRI white matter changes in individual patients is difficult to establish. The frequency of specific neuropathologic features of vascular cognitive impairment depends largely on study inclusion criteria. Cerebral meningocortical microangiopathies with distinctive clinicopathological profiles are associated with dementia in both sporadic cases and familial syndromes. In patients with AD, the contribution of amyloid-beta protein to the degree of cognitive impairment has not been clearly defined.
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Affiliation(s)
- Ola A Selnes
- Cognitive Neuroscience Division, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205-1910, USA.
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Alves TCDTF, Busatto GF. Regional cerebral blood flow reductions, heart failure and Alzheimer's disease. Neurol Res 2006; 28:579-87. [PMID: 16945208 DOI: 10.1179/016164106x130416] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES To discuss whether there are similarities between the functional brain abnormalities detectable in association with the diagnoses of heart failure (HF) and Alzheimer's disease (AD), focusing particularly on neuroimaging findings in vivo. METHODS Using an electronic database (Medline), we reviewed imaging studies that have evaluated resting cerebral blood flow (CBF), resting glucose metabolism or amyloid deposition in groups of subjects suffering AD or HF compared with healthy controls. RESULTS Single photon emission computed tomography (SPECT) investigations have reported global CBF reductions in HF groups compared with controls. In one recent SPECT study using modern voxel-based methods for image analysis, regional CBF deficits in the pre-cuneus and posterior cingulate gyrus were detected in a sample of HF sufferers relative to controls. The regional distribution of functional deficits in the latter study was similar to that found in many positron emission tomography (PET) investigations of glucose metabolism at early AD stages, as well as in recent PET investigations of amyloid deposition in AD. DISCUSSION Imaging studies have rarely investigated whether there are localized functional brain deficits in association with HF. Recent regional CBF SPECT data provide preliminary anatomic support to a view that AD-like brain changes may develop in HF patients, possibly as a consequence of chronic CBF reductions. Additional studies of larger HF samples are needed to confirm this possibility, preferably using PET measures that have afforded greater sensitivity and specificity to identify brain functional abnormalities associated with the diagnosis of AD, such as indices of glucose metabolism and amyloid deposition.
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Twamley EW, Ropacki SAL, Bondi MW. Neuropsychological and neuroimaging changes in preclinical Alzheimer's disease. J Int Neuropsychol Soc 2006; 12:707-35. [PMID: 16961952 PMCID: PMC1621044 DOI: 10.1017/s1355617706060863] [Citation(s) in RCA: 176] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Revised: 03/13/2006] [Accepted: 03/21/2006] [Indexed: 11/07/2022]
Abstract
Alzheimer's disease (AD) is a common, devastating form of dementia. With the advent of promising symptomatic treatment, the importance of recognizing AD at its very earliest stages has increased. We review the extant neuropsychological and neuroimaging literature on preclinical AD, focusing on longitudinal studies of initially nondemented individuals and cross-sectional investigations comparing at-risk with normal individuals. We systematically reviewed 91 studies of neuropsychological functioning, structural neuroimaging, or functional neuroimaging in preclinical AD. The neuropsychological studies indicated that preclinical AD might be characterized by subtle deficits in a broad range of neuropsychological domains, particularly in attention, learning and memory, executive functioning, processing speed, and language. Recent findings from neuroimaging research suggest that volume loss and cerebral blood flow or metabolic changes, particularly in the temporal lobe, may be detected before the onset of dementia. There exist several markers of a preclinical period of AD, in which specific cognitive and biochemical changes precede the clinical manifestations. The preclinical indicators of AD reflect early compromise of generalized brain integrity and temporal lobe functioning in particular.
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Affiliation(s)
- Elizabeth W Twamley
- Department of Psychiatry, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
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Hudon C, Belleville S, Souchay C, Gély-Nargeot MC, Chertkow H, Gauthier S. Memory for gist and detail information in Alzheimer's disease and mild cognitive impairment. Neuropsychology 2006; 20:566-77. [PMID: 16938019 DOI: 10.1037/0894-4105.20.5.566] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Two experiments examined different forms of gist and detail memory in people with Alzheimer's disease (AD) and those with amnestic mild cognitive impairment (MCI). In Experiment 1, 14 AD, 14 MCI, and 22 control participants were assessed with the Deese-Roediger-McDermott paradigm. Results indicated that false recognition of nonstudied critical lures (gist memory) was diminished in the AD compared with the MCI and control groups; the two latter cohorts performed similarly. In Experiment 2, 14 AD, 20 MCI, and 26 control participants were tested on a text memory task. Results revealed that recall of both macropropositions (gist information) and micropropositions (detail information) decreased significantly in AD and in MCI as compared with control participants. This experiment also revealed that the impairment was comparable between gist and detail memory. In summary, the results were consistent across experiments in the AD but not in the MCI participants. The discrepancy in MCI participants might be explained by differences in the degree of sensitivity of the experimental procedures and/or by the differences in the cognitive processes these procedures assessed.
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Affiliation(s)
- Carol Hudon
- Centre de recherche de l'Institut universitaire de geriatrie de Montreal, PQ, Canada.
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Jones S, Laukka EJ, Bäckman L. Differential verbal fluency deficits in the preclinical stages of Alzheimer's disease and vascular dementia. Cortex 2006; 42:347-55. [PMID: 16771040 DOI: 10.1016/s0010-9452(08)70361-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We examined patterns of early and late word generation in category and letter fluency among persons in the preclinical stages of Alzheimer's disease (AD) and vascular dementia (VaD). The sample consisted of 20 preclinical VaD persons, 66 preclinical AD persons, and 267 control persons, sampled from the community. Persons in the preclinical phase of AD and VaD were similarly impaired in letter fluency, although the preclinical VaD group outperformed their AD counterparts in category fluency. This pattern of results is consistent with the notion that category fluency is relatively more dependent on the medial-temporal lobe, whereas letter fluency relies more on frontal regions. The patterns of fluency impairment in preclinical AD and VaD generalized across early and late word retrieval.
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Affiliation(s)
- Sari Jones
- Aging Research Center - ARC, Division of Geriatric Epidemiology, Neurotec, Karolinska Institute, Stockholm, Sweden.
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Gunstad J, Bausserman L, Paul RH, Tate DF, Hoth K, Poppas A, Jefferson AL, Cohen RA. C-reactive protein, but not homocysteine, is related to cognitive dysfunction in older adults with cardiovascular disease. J Clin Neurosci 2006; 13:540-6. [PMID: 16723232 PMCID: PMC2748307 DOI: 10.1016/j.jocn.2005.08.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2004] [Accepted: 08/09/2005] [Indexed: 10/24/2022]
Abstract
Cardiovascular disease (CVD) is a risk factor for cognitive impairment and dementia. Recent studies implicate homocysteine (HCY) and C-reactive protein (CRP) in this increased risk, as both are associated with cognitive dysfunction in demented and non-demented patients. However, it remains unclear whether they confer added risk in older adults with CVD. A total of 126 older CVD patients underwent blood and neuropsychological evaluation as part of a prospective examination of the neurocognitive consequences of CVD. A subset of these participants (n=37) also underwent neuroimaging to quantify the degree of white matter disease. After adjusting for demographic and medical factors, no significant relationship emerged between HCY and cognitive performance. In contrast, CRP showed significant independent relationships to test performance, including global cognitive performance, attention/psychomotor function, executive function, memory, and visuospatial abilities. Neither HCY nor CRP was related to extent of white matter disease or whole brain volume on magnetic resonance imaging. Further study is needed to identify mechanisms by which inflammatory processes impact on cognitive function and to determine whether reducing circulating levels of inflammatory markers results in improved cognition.
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Affiliation(s)
- John Gunstad
- Brown Medical School, Providence, Rhode Island, USA.
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Piefke M, Fink GR. Recollections of one's own past: the effects of aging and gender on the neural mechanisms of episodic autobiographical memory. ACTA ACUST UNITED AC 2006; 210:497-512. [PMID: 16172875 DOI: 10.1007/s00429-005-0038-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Episodic autobiographical recollection is the most complex form of human memory. It relies on interactions between episodic memory, associated emotions, and a sense of self-continuity along the time axis of one's personal life history. Evidence exists that autobiographical memory performance as well as its underlying brain mechanisms are influenced by genetic, physiological, psychological, situational, and social-cultural factors. In particular, age (normal cognitive aging as well as age of memories, as defined by the time interval elapsed since information encoding) and gender affect both the performance level and the neural substrates of autobiographical recollection. In this review, studies concerned with aging and gender effects on autobiographical memory are discussed with reference to other age- and gender-related influences on human cognition, as well as clinical data on demented patients. Both age and gender act upon the functional hemispheric lateralization of autobiographical recollection and the prefrontal, hippocampal and parahippocampal engagement in information processing. On the performance level, re-collective qualities such as episodic detail and emotional intensity of autobiographical memories are modulated by both factors. Although the effects of aging and gender on human brain function are built upon different genetic and physiological mechanisms, they influence at least in part the same neurofunctional and behavioral dimensions of autobiographical recollection. Interestingly, age- and gender-related specificities in the neural mechanisms of autobiographical recollection need not be reflected on the performance level.
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Affiliation(s)
- Martina Piefke
- Institute of Medicine, Research Center Jülich, Leo-Brand Str. 5, 52425, Jülich, Germany.
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Bäckman L, Jones S, Berger AK, Laukka EJ, Small BJ. Cognitive impairment in preclinical Alzheimer's disease: a meta-analysis. Neuropsychology 2005; 19:520-31. [PMID: 16060827 DOI: 10.1037/0894-4105.19.4.520] [Citation(s) in RCA: 466] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
To determine the size of the impairment across different cognitive domains in preclinical Alzheimer's disease (AD), a meta-analysis based on 47 studies involving 9,097 controls and 1,207 preclinical AD cases was conducted. There were marked preclinical deficits in global cognitive ability, episodic memory, perceptual speed, and executive functioning; somewhat smaller deficits in verbal ability, visuospatial skill, and attention; and no preclinical impairment in primary memory. Younger age (< 75 years) and shorter follow-up intervals (< 3 years) were associated with larger effect sizes for both global cognitive ability and episodic memory. For global cognitive ability, studies that used population-based sampling yielded larger effect sizes; for episodic memory, larger differences were seen in studies that preidentified groups in terms of baseline cognitive impairment. Within episodic memory, delayed testing and recall-based assessment resulted in the largest effect sizes. The authors conclude that deficits in multiple cognitive domains are characteristic of AD several years before clinical diagnosis. The generalized nature of the deficit is consistent with recent observations that multiple brain structures and functions are affected long before the AD diagnosis.
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Affiliation(s)
- Lars Bäckman
- Aging Research Center, Division of Geriatric Epidemiology, Neurotec, Karolinska Institute, Stockholm, Sweden.
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Chao LL, Schuff N, Kramer JH, Du AT, Capizzano AA, O'Neill J, Wolkowitz OM, Jagust WJ, Chui HC, Miller BL, Yaffe K, Weiner MW. Reduced medial temporal lobe N-acetylaspartate in cognitively impaired but nondemented patients. Neurology 2005; 64:282-9. [PMID: 15668426 PMCID: PMC1851679 DOI: 10.1212/01.wnl.0000149638.45635.ff] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND N-acetylaspartate (NAA) in the medial temporal lobe (MTL) and parietal lobe gray matter (GM) is diminished in Alzheimer disease (AD). Because NAA is considered a marker of neuronal integrity, reduced medial temporal and parietal lobe NAA could be an early indication of dementia-related pathology in elderly individuals. OBJECTIVES 1) To determine whether cognitively impaired but nondemented (CIND) elderly individuals exhibit a similar pattern of reduced medial temporal and parietal lobe NAA as AD patients. 2) To compare regional NAA patterns, hippocampal and neocortical gray matter (GM) volumes in CIND patients who remained cognitively stable and those who became demented over 3.6 years of follow-up. 3) To examine the relationship between memory performance, medial temporal lobe NAA, and hippocampal volume. METHODS Seventeen CIND, 24 AD, and 24 cognitively normal subjects were studied using MRSI and MRI. RESULTS Relative to controls, CIND patients had reduced MTL NAA (19 to 21%, p = 0.005), hippocampal (11 to 14%, p < or = 0.04), and neocortical GM (5%, p = 0.05) volumes. CIND patients who later became demented had less MTL NAA (26%, p = 0.01), hippocampal (17 to 23%, p < or = 0.05), and neocortical GM (13%, p = 0.02) volumes than controls, but there were no significant differences between stable CIND patients and controls. MTL NAA in combination with hippocampal volume improved discrimination of CIND and controls over hippocampal volume alone. In AD and CIND patients, decreased MTL NAA correlated significantly with impaired memory performance. CONCLUSION Reduced medial temporal lobe N-acetylaspartate, together with reduced hippocampal and neocortical gray matter volumes, may be early indications of dementia-related pathology in subjects at high risk for developing dementia.
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Affiliation(s)
- L L Chao
- Magnetic Resonance Unit, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, 116R, San Francisco, CA 94121, USA.
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