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Chanti-Ketterl M, Pieper CF, Yaffe K, Plassman BL. Associations Between Traumatic Brain Injury and Cognitive Decline Among Older Male Veterans: A Twin Study. Neurology 2023; 101:e1761-e1770. [PMID: 37673685 PMCID: PMC10634649 DOI: 10.1212/wnl.0000000000207819] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/10/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Traumatic brain injuries (TBIs) are associated with increased risk of dementia, but whether lifetime TBI influences cognitive trajectories in later life is less clear. Cognitive interventions after TBI may improve cognitive trajectories and delay dementia. Because twins share many genes and environmental factors, we capitalize on the twin study design to examine the association between lifetime TBI and cognitive decline. METHODS Participants were members of the National Academy of Sciences-National Research Council's Twin Registry of male veterans of World War II with self or proxy-reported history of TBI and with up to 4 observations over 12 years of the modified Telephone Interview for Cognitive Status (TICS-m). We used linear random-effects mixed models to analyze the association between TBI and TICS-m in the full sample and among co-twins discordant for TBI. Additional TBI predictor variables included number of TBIs, severity (loss of consciousness [LOC]), and age of first TBI (age <25 vs 25+ years [older age TBI]). Models were adjusted for age (centered at 70 years), age-squared, education, wave, twin pair, lifestyle behaviors, and medical conditions. RESULTS Of 8,662 participants, 25% reported TBI. History of any TBI (β = -0.56, 95% CI -0.73 to -0.39), TBI with LOC (β = -0.51, 95% CI -0.71 to -0.31), and older age TBI (β = -0.66, 95% CI -0.90 to -0.42) were associated with lower TICS-m scores at 70 years. TBI with LOC (β = -0.03, 95% CI -0.05 to -0.001), more than one TBI (β = -0.05, 95% CI -0.09 to -0.002,), and older age TBI (β = -0.06, 95% CI -0.09 to -0.03) were associated with faster cognitive decline. Among monozygotic pairs discordant for TBI (589 pairs), history of any TBI (β = -0.55, 95% CI -0.91 to -0.19) and older age TBI (β = -0.74, 95% CI -1.22 to -0.26) were associated with lower TICS-m scores at 70 years. Those with more than one TBI (β = -0.13, 95% CI -0.23 to -0.03) and older age TBI (β = -0.07, 95% CI -0.13 to -0.002) showed greater cognitive decline compared with their co-twin without TBI. DISCUSSION These findings support an association of the effect of TBI on cognitive score and the rapidity of cognitive decline in later life. The results in monozygotic pairs, who share all genes and many exposures, particularly in early life, provide additional evidence of a causal relationship between TBI and poorer late-life cognitive outcomes.
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Affiliation(s)
- Marianne Chanti-Ketterl
- From the Department of Psychiatry and Behavioral Sciences (M.C.-K.); Center for Aging and Human Development (M.C.-K., C.F.P., B.L.P.), Duke University Medical Center, Durham, NC; Departments of Biostatistics and Bioinformatics (C.F.P.); Departments of Psychiatry and Behavioral Sciences, Neurology and Epidemiology and Biostatistics (K.Y.), University of California, San Francisco and San Francisco Veterans Affairs Medical Center; and Department of Neurology (B.L.P.), Duke University Medical Center, Durham, NC.
| | - Carl F Pieper
- From the Department of Psychiatry and Behavioral Sciences (M.C.-K.); Center for Aging and Human Development (M.C.-K., C.F.P., B.L.P.), Duke University Medical Center, Durham, NC; Departments of Biostatistics and Bioinformatics (C.F.P.); Departments of Psychiatry and Behavioral Sciences, Neurology and Epidemiology and Biostatistics (K.Y.), University of California, San Francisco and San Francisco Veterans Affairs Medical Center; and Department of Neurology (B.L.P.), Duke University Medical Center, Durham, NC
| | - Kristine Yaffe
- From the Department of Psychiatry and Behavioral Sciences (M.C.-K.); Center for Aging and Human Development (M.C.-K., C.F.P., B.L.P.), Duke University Medical Center, Durham, NC; Departments of Biostatistics and Bioinformatics (C.F.P.); Departments of Psychiatry and Behavioral Sciences, Neurology and Epidemiology and Biostatistics (K.Y.), University of California, San Francisco and San Francisco Veterans Affairs Medical Center; and Department of Neurology (B.L.P.), Duke University Medical Center, Durham, NC
| | - Brenda L Plassman
- From the Department of Psychiatry and Behavioral Sciences (M.C.-K.); Center for Aging and Human Development (M.C.-K., C.F.P., B.L.P.), Duke University Medical Center, Durham, NC; Departments of Biostatistics and Bioinformatics (C.F.P.); Departments of Psychiatry and Behavioral Sciences, Neurology and Epidemiology and Biostatistics (K.Y.), University of California, San Francisco and San Francisco Veterans Affairs Medical Center; and Department of Neurology (B.L.P.), Duke University Medical Center, Durham, NC
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Abdullah L, Nkiliza A, Niedospial D, Aldrich G, Bartenfelder G, Keegan A, Hoffmann M, Mullan M, Klimas N, Baraniuk J, Crawford F, Krengel M, Chao L, Sullivan K. Genetic association between the APOE ε4 allele, toxicant exposures and Gulf war illness diagnosis. Environ Health 2023; 22:51. [PMID: 37415220 PMCID: PMC10324249 DOI: 10.1186/s12940-023-01002-w] [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: 04/13/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Exposure to nerve agents, pyridostigmine bromide (PB), pesticides, and oil-well fires during the 1991 Gulf War (GW) are major contributors to the etiology of Gulf War Illness (GWI). Since the apolipoprotein E (APOE) ε4 allele is associated with the risk of cognitive decline with age, particularly in the presence of environmental exposures, and cognitive impairment is one of the most common symptoms experienced by veterans with GWI, we examined whether the ε4 allele was associated with GWI. METHODS Using a case-control design, we obtained data on APOE genotypes, demographics, and self-reported GW exposures and symptoms that were deposited in the Boston Biorepository and Integrative Network (BBRAIN) for veterans diagnosed with GWI (n = 220) and healthy GW control veterans (n = 131). Diagnosis of GWI was performed using the Kansas and/or Center for Disease Control (CDC) criteria. RESULTS Age- and sex-adjusted analyses showed a significantly higher odds ratio for meeting the GWI case criteria in the presence of the ε4 allele (Odds ratio [OR] = 1.84, 95% confidence interval [CI = 1.07-3.15], p ≤ 0.05) and with two copies of the ε4 allele (OR = 1.99, 95% CI [1.23-3.21], p ≤ 0.01). Combined exposure to pesticides and PB pills (OR = 4.10 [2.12-7.91], p ≤ 0.05) as well as chemical alarms and PB pills (OR = 3.30 [1.56-6.97] p ≤ 0.05) during the war were also associated with a higher odds ratio for meeting GWI case criteria. There was also an interaction between the ε4 allele and exposure to oil well fires (OR = 2.46, 95% CI [1.07-5.62], p ≤ 0.05) among those who met the GWI case criteria. CONCLUSION These findings suggest that the presence of the ε4 allele was associated with meeting the GWI case criteria. Gulf War veterans who reported exposure to oil well fires and have an ε4 allele were more likely to meet GWI case criteria. Long-term surveillance of veterans with GWI, particularly those with oil well fire exposure, is required to better assess the future risk of cognitive decline among this vulnerable population.
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Affiliation(s)
- L Abdullah
- Roskamp Institute, Sarasota, FL, USA.
- James A. Haley VA Hospital, Tampa, FL, USA.
| | - A Nkiliza
- James A. Haley VA Hospital, Tampa, FL, USA
| | | | - G Aldrich
- Roskamp Institute, Sarasota, FL, USA
- James A. Haley VA Hospital, Tampa, FL, USA
| | | | - A Keegan
- Roskamp Institute, Sarasota, FL, USA
| | | | - M Mullan
- Roskamp Institute, Sarasota, FL, USA
| | - N Klimas
- Nova Southeastern University, Ft Lauderdale, FL, USA
- Miami VA Medical Center GRECC, Miami, FL, USA
| | - J Baraniuk
- Department of Medicine, Georgetown University, Washington, DC, USA
| | - F Crawford
- Roskamp Institute, Sarasota, FL, USA
- James A. Haley VA Hospital, Tampa, FL, USA
| | - M Krengel
- Boston University School of Medicine, Boston, MA, USA
| | - L Chao
- University of California, San Francisco, CA, USA
| | - K Sullivan
- Boston University School of Public Health, Boston, MA, USA
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Anderson C, Carmichael J, Hicks AJ, Burke R, Ponsford J. Interaction between APOE ɛ4 and Age Is Associated with Emotional Distress One Year after Moderate-Severe Traumatic Brain Injury. J Neurotrauma 2023; 40:326-336. [PMID: 35996348 DOI: 10.1089/neu.2022.0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Emotional distress is common following moderate-severe traumatic brain injury (TBI) and is associated with poorer post-injury outcomes. Previously investigated sociodemographic, psychological, and injury-related factors account for only a small proportion of variance in post-TBI emotional distress, highlighting a need to consider other factors such as genetic factors. The apolipoprotein E gene (APOE) has been commonly studied in the TBI literature, with the ɛ4 allele linked to worse neuronal repair and recovery. Few studies have investigated the potential relationship between APOE ɛ4 and emotional distress after moderate-severe TBI, and results have been varied. We examined whether APOE ɛ4 was associated with emotional distress 1 year following moderate-severe TBI, and whether this relationship was moderated by age, sex, and TBI severity (as indexed by the duration of post-traumatic amnesia [PTA]). Moderate-severe TBI survivors provided saliva samples following inpatient admission to a TBI rehabilitation hospital. They completed a self-report measure of emotional distress, the Hospital Anxiety and Depression Scale (HADS), at a follow-up interview ∼1 year post-injury. Complete genetic and follow-up data were available for 441 moderate-severe TBI survivors (mean age = 39.42 years; 75% male). We constructed a linear regression model that included APOE ɛ4 carriage status (carrier vs. non-carrier) and interactions with age, sex, and TBI severity (APOE × age, APOE × sex, APOE × age × sex, and APOE × PTA duration) to predict total score on the HADS, while covarying for the main effects of age, sex, PTA duration, and previous head injury. There was a significant main effect of APOE ɛ4, whereby ɛ4 carriers reported less emotional distress than non-carriers (p = 0.04). However, we also found a significant interaction with age such that APOE ɛ4 carriers reported increasingly greater emotional distress with older age compared with non-carriers (p = 0.01). A sensitivity analysis (n = 306) suggested that the APOE × age interaction, and main effects of age and previous head injury, were not unique to individuals with pre-injury mental health problems (n = 136). However, the main effect of APOE ɛ4 was no longer significant when individuals with pre-injury mental health problems were removed. Our findings highlight the importance of considering moderation of genetic associations, suggesting that APOE ɛ4 may be a risk factor for emotional distress specifically among older survivors of moderate-severe TBI. If these findings can be independently replicated, APOE ɛ4 carriage status, interpreted in the context of age, could be incorporated into risk prediction models of emotional distress after moderate-severe TBI, enhancing targeted early detection and intervention efforts.
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Affiliation(s)
- Chloe Anderson
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institutes for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jai Carmichael
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institutes for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institutes for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Richard Burke
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institutes for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
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Gibbons LE, Power MC, Walker RL, Kumar RG, Murphy A, Latimer CS, Nolan AL, Melief EJ, Beller A, Bogdani M, Keene CD, Larson EB, Crane PK, Dams-O'Connor K. Association of Traumatic Brain Injury with Late Life Neuropathological Outcomes in a Community-Based Cohort. J Alzheimers Dis 2023; 93:949-961. [PMID: 37125552 DOI: 10.3233/jad-221224] [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] [Indexed: 05/02/2023]
Abstract
BACKGROUND Prior studies into the association of head trauma with neuropathology have been limited by incomplete lifetime neurotrauma exposure characterization. OBJECTIVE To investigate the neuropathological sequelae of traumatic brain injury (TBI) in an autopsy sample using three sources of TBI ascertainment, weighting findings to reflect associations in the larger, community-based cohort. METHODS Self-reported head trauma with loss of consciousness (LOC) exposure was collected in biennial clinic visits from 780 older adults from the Adult Changes in Thought study who later died and donated their brain for research. Self-report data were supplemented with medical record abstraction, and, for 244 people, structured interviews on lifetime head trauma. Neuropathology outcomes included Braak stage, CERAD neuritic plaque density, Lewy body distribution, vascular pathology, hippocampal sclerosis, and cerebral/cortical atrophy. Exposures were TBI with or without LOC. Modified Poisson regressions adjusting for age, sex, education, and APOE ɛ4 genotype were weighted back to the full cohort of 5,546 participants. RESULTS TBI with LOC was associated with the presence of cerebral cortical atrophy (Relative Risk 1.22, 95% CI 1.02, 1.42). None of the other outcomes was associated with TBI with or without LOC. CONCLUSION TBI with LOC was associated with increased risk of cerebral cortical atrophy. Despite our enhanced TBI ascertainment, we found no association with the Alzheimer's disease-related neuropathologic outcomes among people who survived to at least age 65 without dementia. This suggests the pathophysiological processes underlying post-traumatic neurodegeneration are distinct from the hallmark pathologies of Alzheimer's disease.
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Affiliation(s)
- Laura E Gibbons
- General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Melinda C Power
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Rod L Walker
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Raj G Kumar
- Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alia Murphy
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Caitlin S Latimer
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Amber L Nolan
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Erica J Melief
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Allison Beller
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Marika Bogdani
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - C Dirk Keene
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Eric B Larson
- General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Paul K Crane
- General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Amgalan A, Maher AS, Imms P, Ha MY, Fanelle TA, Irimia A. Functional Connectome Dynamics After Mild Traumatic Brain Injury According to Age and Sex. Front Aging Neurosci 2022; 14:852990. [PMID: 35663576 PMCID: PMC9158471 DOI: 10.3389/fnagi.2022.852990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
Neural and cognitive deficits after mild traumatic brain injury (mTBI) are paralleled by changes in resting state functional correlation (FC) networks that mirror post-traumatic pathophysiology effects on functional outcomes. Using functional magnetic resonance images acquired both acutely and chronically after injury (∼1 week and ∼6 months post-injury, respectively), we map post-traumatic FC changes across 136 participants aged 19-79 (52 females), both within and between the brain's seven canonical FC networks: default mode, dorsal attention, frontoparietal, limbic, somatomotor, ventral attention, and visual. Significant sex-dependent FC changes are identified between (A) visual and limbic, and between (B) default mode and somatomotor networks. These changes are significantly associated with specific functional recovery patterns across all cognitive domains (p < 0.05, corrected). Changes in FC between default mode, somatomotor, and ventral attention networks, on the one hand, and both temporal and occipital regions, on the other hand, differ significantly by age group (p < 0.05, corrected), and are paralleled by significant sex differences in cognitive recovery independently of age at injury (p < 0.05, corrected). Whereas females' networks typically feature both significant (p < 0.036, corrected) and insignificant FC changes, males more often exhibit significant FC decreases between networks (e.g., between dorsal attention and limbic, visual and limbic, default-mode and somatomotor networks, p < 0.0001, corrected), all such changes being accompanied by significantly weaker recovery of cognitive function in males, particularly older ones (p < 0.05, corrected). No significant FC changes were found across 35 healthy controls aged 66-92 (20 females). Thus, male sex and older age at injury are risk factors for significant FC alterations whose patterns underlie post-traumatic cognitive deficits. This is the first study to map, systematically, how mTBI impacts FC between major human functional networks.
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Affiliation(s)
- Anar Amgalan
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Alexander S. Maher
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Phoebe Imms
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Michelle Y. Ha
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Timothy A. Fanelle
- Corwin D. Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
- Corwin D. Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
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Hellstrøm T, Andelic N, Holthe ØØ, Helseth E, Server A, Eiklid K, Sigurdardottir S. APOE-ε4 Is Associated With Reduced Verbal Memory Performance and Higher Emotional, Cognitive, and Everyday Executive Function Symptoms Two Months After Mild Traumatic Brain Injury. Front Neurol 2022; 13:735206. [PMID: 35250800 PMCID: PMC8888909 DOI: 10.3389/fneur.2022.735206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Substantial variance exists in outcomes after mild traumatic brain injury (MTBI), and these differences are not fully explained by injury characteristics or severity. Genetic factors are likely to play a role in this variance. Objectives The aim of this study was to examine associations between the apolipoprotein (APOE)-ε4 allele and memory measures at two months post-MTBI and to evaluate whether subjective cognitive and affective symptoms were associated with APOE-ε4 status. Based on previous research, it was hypothesized that APOE-ε4 carriers would show poorer verbal memory performance compared to APOE-ε4 non-carriers. Methods Neuropsychological data at two months post-injury and blood samples that could be used to assess APOE genotype were available for 134 patients with MTBI (mean age 39.2 years, 62% males, 37% APOE-ε4 carriers). All patients underwent computed tomography at hospital admission and magnetic resonance imaging four weeks post-injury. Results The APOE-ε4 + status was associated with decreased immediate memory recall (p = 0.036; β = −0.10, 95% CI [−0.19, −0.01]). Emotional, cognitive, and everyday executive function symptoms at two months post-injury were significantly higher in APOE-ε4 carriers compared to non-carriers. Conclusion The APOE-ε4+ allele has a negative effect on verbal memory and symptom burden two months after MTBI.
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Affiliation(s)
- Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- *Correspondence: Torgeir Hellstrøm
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Research Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Øyvor Øistensen Holthe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Eirik Helseth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Andres Server
- Section of Neuroradiology, Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Kristin Eiklid
- Department of Medical Genetic, Oslo University Hospital, Oslo, Norway
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Motor Cortex Function in APOE4 Carriers and Noncarriers. J Clin Neurophysiol 2021; 38:553-557. [PMID: 32576807 DOI: 10.1097/wnp.0000000000000738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The ε4 allele of the apolipoprotein-E gene has been associated with disease activity including Alzheimer disease, multiple sclerosis, and cardiovascular disease. Individuals who possess the ε4 variant of this gene (ε4 carriers) also demonstrate higher levels of cognitive impairment and lower motor scores compared with noncarriers. The purpose of this study was to establish whether there is a difference in motor cortex function between apoε4 carriers and noncarriers. We hypothesized that carriers would have lower levels of excitability and excitatory transmitter (glutamate) and similar levels of intracortical inhibition and inhibitory neurotransmitter (gamma-aminobutyric acid) than noncarriers. METHODS Fifty-two participants provided saliva samples to determine apoε4 carrier status. Measures of motor cortex excitability and inhibition were obtained using transcranial magnetic stimulation, and measures of glutamate and gamma-aminobutyric acid concentrations were obtained using proton magnetic resonance spectroscopy. RESULTS No significant differences in transcranial magnetic stimulation (P ≥ 0.19) or proton magnetic resonance spectroscopy measures (P ≥ 0.90) were found between carriers and noncarriers. CONCLUSIONS The results from this study suggest that motor cortex function, as assessed by transcranial magnetic stimulation measures of excitability and inhibition, and MRS measures of excitatory and inhibitory neurotransmitter are similar in those who possess an apoε4 allele and those who do not.
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Simmons KE, Healey KL, Li Q, Moore SD, Klein RC. Effects of sex and genotype in human APOE-targeted replacement mice on alcohol self-administration measured with the automated IntelliCage system before and after repeated mild traumatic brain injury. Alcohol Clin Exp Res 2021; 45:2231-2245. [PMID: 34585391 DOI: 10.1111/acer.14717] [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: 06/07/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few studies have examined the association between APOE genotype and alcohol use. Although some of these studies have reported outcomes associated with a history of drinking, none have examined alcohol-seeking behavior. In addition, no preclinical studies have examined alcohol use as a function of APOE genotype with or without traumatic brain injury. METHODS Male and female human APOE3- and APOE4-targeted replacement (TR) mice were used to assess voluntary alcohol seeking longitudinally using a 2-bottle choice paradigm conducted within the automated IntelliCage system prior to and following repeated mild TBI (rmTBI). Following an acquisition phase in which the concentration of ethanol (EtOH) was increased to 12%, a variety of drinking paradigms that included extended alcohol access (EAA1 and EAA2), alcohol deprivation effect (ADE), limited access drinking in the dark (DID), and progressive ratio (PR) were used to assess alcohol-seeking behavior. Additional behavioral tasks were performed to measure cognitive function and anxiety-like behavior. RESULTS All groups readily consumed increasing concentrations of EtOH (4-12%) during the acquisition phase. During the EAA1 period (12% EtOH), there was a significant genotype effect in both males and females for EtOH preference. Following a 3-week abstinence period, mice received sham or rmTBI resulting in a genotype- and sex-independent main effect of rmTBI on the recovery of righting reflex and a main effect of rmTBI on spontaneous home-cage activity in females only. Reintroduction of 12% EtOH (EAA2) resulted in a significant effect genotype for alcohol preference in males with APOE4 mice displaying increased preference and motivation for alcohol compared with APOE3 mice independent of TBI while in females, there was a significant genotype × TBI interaction under the ADE and DID paradigms. Finally, there was a main effect of rmTBI on increased risk-seeking behavior in both sexes, but no effect on spatial learning or cognitive flexibility. CONCLUSION These results suggest that sex and APOE genotype play a significant role in alcohol consumption and may subsequently influence long-term recovery following traumatic brain insults.
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Affiliation(s)
- Kathryn E Simmons
- Trinity College of Arts and Sciences, Duke University, Durham, North Carolina, USA
| | - Kati L Healey
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA
| | - Qiang Li
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA
| | - Scott D Moore
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA.,Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Rebecca C Klein
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA.,Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
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Mollayeva T, Mollayeva S, Pacheco N, Colantonio A. Systematic Review of Sex and Gender Effects in Traumatic Brain Injury: Equity in Clinical and Functional Outcomes. Front Neurol 2021; 12:678971. [PMID: 34566834 PMCID: PMC8461184 DOI: 10.3389/fneur.2021.678971] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/09/2021] [Indexed: 01/12/2023] Open
Abstract
Background: Although traumatic brain injury (TBI) is a leading cause of death and disability in male and female patients worldwide, little is known about the effect of sex and gender on TBI outcomes. Objectives: This systematic review summarizes the evidence on the effect of sex and gender on core TBI outcomes. Methods: All English-language studies from six literature databases that addressed core outcomes in adults with TBI and included sex or gender, TBI severity, and age in their analyses were considered eligible. Two reviewers extracted data, and two reviewers assessed study quality using tools recommended by the National Institutes of Health. The results were sorted according to time post-injury, injury severity, gender equity ranking of the study's country of origin, and outcomes studied. The results from the included studies were grouped based on the approach taken in reporting their respective findings. Results and Limitations: Of 172 articles assessed, 58 studies were selected, comprising 1, 265, 955 participants with TBI (67% male across all studies) of all injury severities. All studies were conducted in countries with a very high or high human development index, while the Gender Inequality Index (GII) varied. While the heterogeneity across studies limited any meaningful conclusions with respect to the role of sex and gender, we did observe that as gender equality ranking improved, differences between male and female participants in outcomes would diminish. Inclusion of social equity parameters in the studies was limited. Conclusions and Implications: The non-uniform findings observed bring forth the need to develop and use a comprehensive and consistent methodology in the study of sex and gender post-TBI, incorporating social equity parameters to uncover the potential social underpinnings of gender effects on health and functional outcomes. Systematic Review Registration: CRD42018098697.
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Affiliation(s)
- Tatyana Mollayeva
- KITE Toronto Rehabilitation Institute University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Acquired Brain Injury Research Lab, Temerty Faculty of Medicine University of Toronto, Toronto, ON, Canada.,School of Occupational Therapy, Western University, London, ON, Canada
| | - Shirin Mollayeva
- Acquired Brain Injury Research Lab, Temerty Faculty of Medicine University of Toronto, Toronto, ON, Canada
| | - Nicole Pacheco
- Acquired Brain Injury Research Lab, Temerty Faculty of Medicine University of Toronto, Toronto, ON, Canada.,School of Occupational Therapy, Western University, London, ON, Canada
| | - Angela Colantonio
- KITE Toronto Rehabilitation Institute University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Acquired Brain Injury Research Lab, Temerty Faculty of Medicine University of Toronto, Toronto, ON, Canada.,Department of Epidemiology, Dalla Lana School of Public Health University of Toronto, Toronto, ON, Canada
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10
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Apolipoprotein e (APOE) ε4 genotype influences memory performance following remote traumatic brain injury in U.S. military service members and veterans. Brain Cogn 2021; 154:105790. [PMID: 34487993 DOI: 10.1016/j.bandc.2021.105790] [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: 03/19/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to examine the association between the apolipoprotein E (APOE) ε4 allele and neurocognitive functioning following traumatic brain injury (TBI) in military service members and veterans (SMVs). Participants included 176 SMVs with a history of remote TBI (≥1 year post-injury), categorized into mild (n = 100), moderate (n = 40), and severe (n = 36) TBI groups. Participants completed a neuropsychological assessment and APOE genotyping (n = 46 ε4+, n = 130 ε4-). Neurocognitive composite scores representing memory, executive functioning, and visual processing speed were computed. ANCOVAs adjusting for race, education, combat exposure, and PTSD symptom severity showed a significant main effect of ε4 on the memory composite, such that ε4+ SMVs exhibited poorer memory performance than ε4- SMVs. When ε2 allele carriers were removed from the analyses, associations with memory were strengthened, demonstrating a possible protective effect of the ε2 allele. No main effect of TBI group was identified on any cognitive composite, nor were there any significant TBI group × ε4 status interactions for any cognitive composite. Future studies with larger samples are needed to verify these findings, but our results suggest an important relationship between ε4 status and memory functioning following remote TBI of all severities.
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11
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Carmichael J, Hicks AJ, Spitz G, Gould KR, Ponsford J. Moderators of gene-outcome associations following traumatic brain injury. Neurosci Biobehav Rev 2021; 130:107-124. [PMID: 34411558 DOI: 10.1016/j.neubiorev.2021.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/04/2021] [Accepted: 08/13/2021] [Indexed: 12/14/2022]
Abstract
The field of genomics is the principal avenue in the ongoing development of precision/personalised medicine for a variety of health conditions. However, relating genes to outcomes is notoriously complex, especially when considering that other variables can change, or moderate, gene-outcome associations. Here, we comprehensively discuss moderation of gene-outcome associations in the context of traumatic brain injury (TBI), a common, chronically debilitating, and costly neurological condition that is under complex polygenic influence. We focus our narrative review on single nucleotide polymorphisms (SNPs) of three of the most studied genes (apolipoprotein E, brain-derived neurotrophic factor, and catechol-O-methyltransferase) and on three demographic variables believed to moderate associations between these SNPs and TBI outcomes (age, biological sex, and ethnicity). We speculate on the mechanisms which may underlie these moderating effects, drawing widely from biomolecular and behavioural research (n = 175 scientific reports) within the TBI population (n = 72) and other neurological, healthy, ageing, and psychiatric populations (n = 103). We conclude with methodological recommendations for improved exploration of moderators in future genetics research in TBI and other populations.
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Affiliation(s)
- Jai Carmichael
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.
| | - Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Gershon Spitz
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Kate Rachel Gould
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
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12
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McFadyen CA, Zeiler FA, Newcombe V, Synnot A, Steyerberg E, Gruen RL, Rosand J, Palotie A, Maas AI, Menon DK. Apolipoprotein E4 Polymorphism and Outcomes from Traumatic Brain Injury: A Living Systematic Review and Meta-Analysis. J Neurotrauma 2021; 38:1124-1136. [PMID: 30848161 PMCID: PMC8054520 DOI: 10.1089/neu.2018.6052] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The mortality of traumatic brain injury (TBI) has been largely static despite advances in monitoring and imaging techniques. Substantial variance exists in outcome, not fully accounted for by baseline characteristics or injury severity, and genetic factors likely play a role in this variance. The aims of this systematic review were to examine the evidence for a link between the apolipoprotein E4 (APOE4) polymorphism and TBI outcomes and where possible, to quantify the effect size via meta-analysis. We searched EMBASE, MEDLINE, CINAHL, and gray literature in December 2017. We included studies of APOE genotype in relation to functional adult TBI outcomes. Methodological quality was assessed using the Quality in Prognostic Studies Risk of Bias Assessment Instrument and the prognostic studies adaptation of the Grading of Recommendations Assessment, Development and Evaluation tool. In addition, we contacted investigators and included an additional 160 patients whose data had not been made available for previous analyses, giving a total sample size of 2593 patients. Meta-analysis demonstrated higher odds of a favorable outcome following TBI in those not possessing an ApoE ɛ4 allele compared with ɛ4 carriers and homozygotes (odds ratio 1.39, 95% confidence interval 1.05 to 1.84; p = 0.02). The influence of APOE4 on neuropsychological functioning following TBI remained uncertain, with multiple conflicting studies. We conclude that the ApoE ɛ4 allele confers a small risk of poor outcome following TBI, with analysis by TBI severity not possible based on the currently available published data. Further research into the long-term neuropsychological impact and risk of dementia is warranted.
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Affiliation(s)
| | - Frederick A. Zeiler
- Division of Anesthesia, University of Cambridge, Cambridge, United Kingdom
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
- Clinician Investigator Program, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Virginia Newcombe
- Division of Anesthesia, University of Cambridge, Cambridge, United Kingdom
| | - Anneliese Synnot
- Center for Excellence in Traumatic Brain Injury Research, National Trauma Research Institute, Monash University, Alfred Hospital, Melbourne, Australia
- Cochrane Consumers and Communication Review Group, Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Ewout Steyerberg
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Russel L. Gruen
- NTU Institute for Health Technologies and Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Jonathan Rosand
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aarno Palotie
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew I.R. Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - David K. Menon
- Division of Anesthesia, University of Cambridge, Cambridge, United Kingdom
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13
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Apolipoprotein E ( APOE) ε4 Status Moderates the Relationship Between Close-Range Blast Exposure and Cognitive Functioning. J Int Neuropsychol Soc 2021; 27:315-328. [PMID: 33138883 DOI: 10.1017/s1355617720001034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Recent studies suggest that close-range blast exposure (CBE), regardless of acute concussive symptoms, may have negative long-term effects on brain health and cognition; however, these effects are highly variable across individuals. One potential genetic risk factor that may impact recovery and explain the heterogeneity of blast injury's long-term cognitive outcomes is the inheritance of an apolipoprotein (APOE) ε4 allele, a well-known genetic risk factor for Alzheimer's disease. We hypothesized that APOE ε4 carrier status would moderate the impact of CBE on long-term cognitive outcomes. METHODS To test this hypothesis, we examined 488 post-9/11 veterans who completed assessments of neuropsychological functioning, psychiatric diagnoses, history of blast exposure, military and non-military mild traumatic brain injuries (mTBIs), and available APOE genotypes. We separately examined the effects of CBE on attention, memory, and executive functioning in individuals with and without the APOE ε4 allele. RESULTS As predicted, we observed a differential impact of CBE status on cognition as a function of APOE ε4 status, in which CBE ε4 carriers displayed significantly worse neuropsychological performance, specifically in the domain of memory. These results persisted after adjusting for clinical, demographic, and genetic factors and were not observed when examining other neurotrauma variables (i.e., lifetime or military mTBI, distant blast exposure), though these variables displayed similar trends. CONCLUSIONS These results suggest APOE ε4 carriers are more vulnerable to the impact of CBE on cognition and highlight the importance of considering genetic risk when studying cognitive effects of neurotrauma.
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14
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Collins JM, Woodhouse A, Bye N, Vickers JC, King AE, Ziebell JM. Pathological Links between Traumatic Brain Injury and Dementia: Australian Pre-Clinical Research. J Neurotrauma 2020; 37:782-791. [PMID: 32046575 DOI: 10.1089/neu.2019.6906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) can cause persistent cognitive changes and ongoing neurodegeneration in the brain. Accumulating epidemiological and pathological evidence implicates TBI in the development of Alzheimer's disease, the most common cause of dementia. Further, the TBI-induced form of dementia, called chronic traumatic encephalopathy, shares many pathological hallmarks present in multiple different diseases which cause dementia. The inflammatory and neuritic responses to TBI and dementia overlap, indicating that they may share common pathological mechanisms and that TBI may ultimately cause a pathological cascade culminating in the development of dementia. This review explores Australian pre-clinical research investigating the pathological links between TBI and dementia.
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Affiliation(s)
- Jessica M Collins
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Adele Woodhouse
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Nicole Bye
- School of Pharmacy, and College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - James C Vickers
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia.,School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Anna E King
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Jenna M Ziebell
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
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15
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Smith EE, Smith JAD, Juengst SB. Cognitive process scores associated with self-reported behavioral dysfunction on the Frontal Systems Behavior Scale (FrSBe) in chronic traumatic brain injury. J Clin Exp Neuropsychol 2019; 42:90-100. [DOI: 10.1080/13803395.2019.1676882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Emily E. Smith
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jason A. D. Smith
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shannon B. Juengst
- Department of Physical Medicine & Rehabilitation, Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, TX, USA
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16
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Gupte R, Brooks W, Vukas R, Pierce J, Harris J. Sex Differences in Traumatic Brain Injury: What We Know and What We Should Know. J Neurotrauma 2019; 36:3063-3091. [PMID: 30794028 PMCID: PMC6818488 DOI: 10.1089/neu.2018.6171] [Citation(s) in RCA: 261] [Impact Index Per Article: 52.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
There is growing recognition of the problem of male bias in neuroscience research, including in the field of traumatic brain injury (TBI) where fewer women than men are recruited to clinical trials and male rodents have predominantly been used as an experimental injury model. Despite TBI being a leading cause of mortality and disability worldwide, sex differences in pathophysiology and recovery are poorly understood, limiting clinical care and successful drug development. Given growing interest in sex as a biological variable affecting injury outcomes and treatment efficacy, there is a clear need to summarize sex differences in TBI. This scoping review presents an overview of current knowledge of sex differences in TBI and a comparison of human and animal studies. We found that overall, human studies report worse outcomes in women than men, whereas animal studies report better outcomes in females than males. However, closer examination shows that multiple factors including injury severity, sample size, and experimental injury model may differentially interact with sex to affect TBI outcomes. Additionally, we explore how sex differences in mitochondrial structure and function might contribute to possible sex differences in TBI outcomes. We propose recommendations for future investigations of sex differences in TBI, which we hope will lead to improved patient management, prognosis, and translation of therapies from bench to bedside.
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Affiliation(s)
- Raeesa Gupte
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, Kansas
| | - William Brooks
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
- Hoglund Brain Center, University of Kansas Medical Center, Kansas City, Kansas
- The University of Kansas Clinical and Translational Sciences Institute, University of Kansas Medical Center, Kansas City, Kansas
| | - Rachel Vukas
- School of Medicine, Dykes Library of Health Sciences, University of Kansas Medical Center, Kansas City, Kansas
| | - Janet Pierce
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Janna Harris
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, Kansas
- Hoglund Brain Center, University of Kansas Medical Center, Kansas City, Kansas
- Address correspondence to: Janna Harris, PhD, Hoglund Brain Imaging Center, MS 1052, 3901 Rainbow Boulevard, Kansas City, KS 66160
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17
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Cognitive Performance in Young APOE ε4 Carriers: A Latent Variable Approach for Assessing the Genotype-Phenotype Relationship. Behav Genet 2019; 49:455-468. [PMID: 31177340 DOI: 10.1007/s10519-019-09961-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 05/26/2019] [Indexed: 02/07/2023]
Abstract
The ε4 allele of the apolipoprotein (APOE) gene is a widely recognized genetic risk factor for developing Alzheimer's disease in older age. However, it is controversial whether there is a positive impact of the APOE ε4 allele on human cognitive performance in young adulthood, possibly representing a case of antagonistic pleiotropy. Here we explored associations of the APOE ε4 allele with cognitive ability in young adulthood. In contrast to previous studies, we used structural equation modeling that allows a multivariate measurement of the cognitive phenotype. Results based on four independent samples (N1 = 245; N2 = 300; N3 = 244; N4 = 206) overall revealed a complex effect of the APOE ε4 genotype on cognitive ability in young adulthood: Whereas the ε4 allele tends to be negatively associated with cognitive performance in individuals with lower education levels, there might be a weak positive association in persons with higher education-a finding that is partly in line with the antagonistic pleiotropy view on APOE and cognitive ability. The education-related findings support protective effects of environmental factors.
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18
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Louis ED, Joyce JL, Cosentino S. Mind the gaps: What we don't know about cognitive impairment in essential tremor. Parkinsonism Relat Disord 2019; 63:10-19. [PMID: 30876840 DOI: 10.1016/j.parkreldis.2019.02.038] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/18/2019] [Accepted: 02/23/2019] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Although the hallmark feature of essential tremor (ET) is tremor, there is growing appreciation that cognitive impairment also occurs, including increased prevalence of mild cognitive impairment (MCI) and increased prevalence and incidence of dementia. With emerging knowledge of ET-cognitive impairment, come fundamental questions regarding its course, bases, predictors and clinical outcomes. Studies in the general population and in Parkinson's disease (PD), a related movement disorder, offer a starting point from which to begin filling these clinically important knowledge gaps. METHODS A PubMed search (June 2018) identified articles for this review. RESULTS Much of our knowledge of cognitive impairment in ET is of the static condition (e.g., prevalence of cognitive impairment in ET), with nearly no information on its bases, predictors and dynamics (i.e., course, and clinical outcomes). In PD, where such data have been published, rates of cognitive decline and conversion to MCI/dementia are higher than in the general population. Predictors of cognitive change in PD and the general population have also been identified, yet they only partially overlap one another. CONCLUSION The predictors and dynamics of cognitive impairment have been investigated fairly extensively in the general population, to a somewhat lesser extent in PD, and are emerging only now in ET. We suggest that longitudinal studies specific to ET are needed, and we outline variables to be considered in these investigations. Increased knowledge of ET-cognitive impairment will facilitate meaningful counseling of patients and their families.
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Affiliation(s)
- Elan D Louis
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Jillian L Joyce
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Stephanie Cosentino
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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19
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Chia AA, Power E, Kenny B, Elbourn E, McDonald S, Tate R, MacWhinney B, Turkstra L, Holland A, Togher L. Patterns of early conversational recovery for people with traumatic brain injury and their communication partners. Brain Inj 2019; 33:690-698. [DOI: 10.1080/02699052.2019.1571632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- An An Chia
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Emma Power
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- Discipline of Speech Pathology, UTS Graduate School of Health, University of Technology, Sydney, Australia
| | - Belinda Kenny
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
| | - Elise Elbourn
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
| | - Skye McDonald
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Robyn Tate
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Brian MacWhinney
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Lyn Turkstra
- Department of Communicative Disorders, University of Wisconsin-Madison, Madison, WI, USA
| | - Audrey Holland
- Department of Speech, Language and Hearing Sciences, University of Arizona, Tucson, AZ, USA
| | - Leanne Togher
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Sydney, NSW, Australia
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20
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Clark IA, Vissel B. Therapeutic implications of how TNF links apolipoprotein E, phosphorylated tau, α-synuclein, amyloid-β and insulin resistance in neurodegenerative diseases. Br J Pharmacol 2018; 175:3859-3875. [PMID: 30097997 PMCID: PMC6151331 DOI: 10.1111/bph.14471] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/26/2018] [Accepted: 07/23/2018] [Indexed: 12/24/2022] Open
Abstract
While cytokines such as TNF have long been recognized as essential to normal cerebral physiology, the implications of their chronic excessive production within the brain are now also increasingly appreciated. Syndromes as diverse as malaria and lead poisoning, as well as non‐infectious neurodegenerative diseases, illustrate this. These cytokines also orchestrate changes in tau, α‐synuclein, amyloid‐β levels and degree of insulin resistance in most neurodegenerative states. New data on the effects of salbutamol, an indirect anti‐TNF agent, on α‐synuclein and Parkinson's disease, APOE4 and tau add considerably to the rationale of the anti‐TNF approach to understanding, and treating, these diseases. Therapeutic advances being tested, and arguably useful for a number of the neurodegenerative diseases, include a reduction of excess cerebral TNF, whether directly, with a specific anti‐TNF biological agent such as etanercept via Batson's plexus, or indirectly via surgically implanting stem cells. Inhaled salbutamol also warrants investigating further across the neurodegenerative disease spectrum. It is now timely to integrate this range of new information across the neurodegenerative disease spectrum, rather than keep seeing it through the lens of individual disease states.
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Affiliation(s)
- I A Clark
- Research School of Biology, Australian National University, Canberra, Australia
| | - B Vissel
- Centre for Neuroscience and Regenerative Medicine, Faculty of Science, University of Technology, Sydney, NSW, Australia.,St. Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
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21
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Merritt VC, Clark AL, Sorg SF, Evangelista ND, Werhane ML, Bondi MW, Schiehser DM, Delano-Wood L. Apolipoprotein E (APOE) ε4 genotype is associated with reduced neuropsychological performance in military veterans with a history of mild traumatic brain injury. J Clin Exp Neuropsychol 2018; 40:1050-1061. [DOI: 10.1080/13803395.2018.1508555] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - Alexandra L. Clark
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego (SDSU/UCSD), San Diego, CA, USA
| | - Scott F. Sorg
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | | | - Madeleine L. Werhane
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego (SDSU/UCSD), San Diego, CA, USA
| | - Mark W. Bondi
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Dawn M. Schiehser
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
| | - Lisa Delano-Wood
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
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22
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Oliveira T, Starkweather A, Ramesh D, Fetta J, Kelly DL, Lyon DE, Sargent L. Putative mechanisms of cognitive decline with implications for clinical research and practice. Nurs Forum 2018; 53:10.1111/nuf.12247. [PMID: 29345733 PMCID: PMC6438756 DOI: 10.1111/nuf.12247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Multiple intrinsic and extrinsic mechanisms contribute to vulnerability of cognitive decline and nurses play a significant role in assisting individuals and families to use strategies for healthy cognitive aging. The objective of this narrative review is to provide a synthesis of the intrinsic and extrinsic mechanisms of cognitive decline and conditions that are associated with cognitive decline. Well-established intrinsic mechanisms of cognitive decline include aging, apolipoprotein E (APOE) ε4 carrier status, SORL1 mutations, neuroinflammation, mitochondrial dysfunction, amyloid deposition, and demyelination. Extrinsic risk factors include obesity, diabetes, hypertension, elevated lipid panel, metabolic syndrome, depression, traumatic brain injury, substance use, heart failure, and stroke. The various definitions of cognitive decline as well as the intrinsic and extrinsic factors that impact cognition as humans age should be incorporated in future clinical research studies. Nurses may use this information to help patients make lifestyle choices regarding cognitive health.
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Affiliation(s)
- Tadeu Oliveira
- School of Nursing, University of Connecticut, Storrs, CT
| | | | - Divya Ramesh
- School of Nursing, University of Connecticut, Storrs, CT
| | - Joseph Fetta
- School of Nursing, University of Connecticut, Storrs, CT
| | | | - Debra E. Lyon
- College of Nursing, University of Florida, Gainesville, FL
| | - Lana Sargent
- School of Nursing, Virginia Commonwealth University, Richmond, VA
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23
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Optimization of brain metabolism using metabolic-targeted therapeutic hypothermia can reduce mortality from traumatic brain injury. J Trauma Acute Care Surg 2017; 83:296-304. [PMID: 28452885 DOI: 10.1097/ta.0000000000001522] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Therapeutic hypothermia is widely used to treat traumatic brain injuries (TBIs). However, determining the best hypothermia therapy strategy remains a challenge. We hypothesized that reducing the metabolic rate, rather than reaching a fixed body temperature, would be an appropriate target because optimizing metabolic conditions especially the brain metabolic environment may enhance neurologic protection. A pilot single-blind randomized controlled trial was designed to test this hypothesis, and a nested metabolomics study was conducted to explore the mechanics thereof. METHODS Severe TBI patients (Glasgow Coma Scale score, 3-8) were randomly divided into the metabolic-targeted hypothermia treatment (MTHT) group, 50% to 60% rest metabolic ratio as the hypothermia therapy target, and the body temperature-targeted hypothermia treatment (BTHT) control group, hypothermia therapy target of 32°C to 35°C body temperature. Brain and circulatory metabolic pool blood samples were collected at baseline and on days 1, 3, and 7 during the hypothermia treatment, which were selected randomly from a subgroup of MTHT and BTHT groups. The primary outcome was mortality. Using H nuclear magnetic resonance technology, we tracked and located the disturbances of metabolic networks. RESULTS Eighty-eight severe TBI patients were recruited and analyzed from December 2013 to December 2014, 44 each were assigned in the MTHT and BTHT groups (median age, 42 years; 69.32% men; mean Glasgow Coma Scale score, 6.17 ± 1.02). The mortality was significantly lower in the MTHT than the BTHT group (15.91% vs. 34.09%; p = 0.049). From these, eight cases of MTHT and six cases from BTHT group were enrolled for metabolomics analysis, which showed a significant difference between the brain and circulatory metabolic patterns in MTHT group on day 7 based on the model parameters and scores plots. Finally, metabolites representing potential neuroprotective monitoring parameters for hypothermia treatment were identified through H nuclear magnetic resonance metabolomics. CONCLUSION MTHT can significantly reduce the mortality of severe TBI patients. Metabolomics research showed that this strategy could effectively improve brain metabolism, suggesting that reducing the metabolic rate to 50% to 60% should be set as the hypothermia therapy target. LEVEL OF EVIDENCE Therapeutic study, Level I.
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Yue JK, Robinson CK, Burke JF, Winkler EA, Deng H, Cnossen MC, Lingsma HF, Ferguson AR, McAllister TW, Rosand J, Burchard EG, Sorani MD, Sharma S, Nielson JL, Satris GG, Talbott JF, Tarapore PE, Korley FK, Wang KK, Yuh EL, Mukherjee P, Diaz‐Arrastia R, Valadka AB, Okonkwo DO, Manley GT. Apolipoprotein E epsilon 4 (APOE-ε 4) genotype is associated with decreased 6-month verbal memory performance after mild traumatic brain injury. Brain Behav 2017; 7:e00791. [PMID: 28948085 PMCID: PMC5607554 DOI: 10.1002/brb3.791] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 06/28/2017] [Accepted: 07/02/2017] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The apolipoprotein E (APOE) ε4 allele associates with memory impairment in neurodegenerative diseases. Its association with memory after mild traumatic brain injury (mTBI) is unclear. METHODS mTBI patients (Glasgow Coma Scale score 13-15, no neurosurgical intervention, extracranial Abbreviated Injury Scale score ≤1) aged ≥18 years with APOE genotyping results were extracted from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot) study. Cohorts determined by APOE-ε4(+/-) were assessed for associations with 6-month verbal memory, measured by California Verbal Learning Test, Second Edition (CVLT-II) subscales: Immediate Recall Trials 1-5 (IRT), Short-Delay Free Recall (SDFR), Short-Delay Cued Recall (SDCR), Long-Delay Free Recall (LDFR), and Long-Delay Cued Recall (LDCR). Multivariable regression controlled for demographic factors, seizure history, loss of consciousness, posttraumatic amnesia, and acute intracranial pathology on computed tomography (CT). RESULTS In 114 mTBI patients (APOE-ε4(-)=79; APOE-ε4(+)=35), ApoE-ε4(+) was associated with long-delay verbal memory deficits (LDFR: B = -1.17 points, 95% CI [-2.33, -0.01], p = .049; LDCR: B = -1.58 [-2.63, -0.52], p = .004), and a marginal decrease on SDCR (B = -1.02 [-2.05, 0.00], p = .050). CT pathology was the strongest predictor of decreased verbal memory (IRT: B = -8.49, SDFR: B = -2.50, SDCR: B = -1.85, LDFR: B = -2.61, LDCR: B = -2.60; p < .001). Seizure history was associated with decreased short-term memory (SDFR: B = -1.32, p = .037; SDCR: B = -1.44, p = .038). CONCLUSION The APOE-ε4 allele may confer an increased risk of impairment of 6-month verbal memory for patients suffering mTBI, with implications for heightened surveillance and targeted therapies. Acute intracranial pathology remains the driver of decreased verbal memory performance at 6 months after mTBI.
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Affiliation(s)
- John K. Yue
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Caitlin K. Robinson
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - John F. Burke
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Ethan A. Winkler
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Hansen Deng
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Maryse C. Cnossen
- Department of Public HealthErasmus Medical CenterRotterdamThe Netherlands
| | - Hester F. Lingsma
- Department of Public HealthErasmus Medical CenterRotterdamThe Netherlands
| | - Adam R. Ferguson
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | | | - Jonathan Rosand
- Program in Medical and Population GeneticsThe Broad Institute at MIT and HarvardCambridgeMAUSA
- Department of NeurologyHarvard Medical SchoolBostonMAUSA
| | - Esteban G. Burchard
- Department of Bioengineering and Therapeutic SciencesUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Marco D. Sorani
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Sourabh Sharma
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Stritch School of Medicine at Loyola UniversityMaywoodILUSA
| | - Jessica L. Nielson
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Gabriela G. Satris
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Jason F. Talbott
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
- Department of RadiologyUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Phiroz E. Tarapore
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Frederick K. Korley
- Department of Emergency MedicineUniversity of Michigan at Ann ArborAnn ArborMIUSA
| | - Kevin K.W. Wang
- Departments of Psychiatry and NeuroscienceUniversity of FloridaGainesvilleFLUSA
| | - Esther L. Yuh
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Department of RadiologyUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Pratik Mukherjee
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Department of RadiologyUniversity of California, San FranciscoSan FranciscoCAUSA
| | | | - Alex B. Valadka
- Department of Neurological SurgeryVirginia Commonwealth UniversityRichmondVAUSA
| | - David O. Okonkwo
- Department of Neurological SurgeryUniversity of Pittsburgh Medical CenterPittsburghPAUSA
| | - Geoffrey T. Manley
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
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Kurowski BG, Treble-Barna A, Pitzer AJ, Wade SL, Martin LJ, Chima RS, Jegga A. Applying Systems Biology Methodology To Identify Genetic Factors Possibly Associated with Recovery after Traumatic Brain Injury. J Neurotrauma 2017; 34:2280-2290. [PMID: 28301983 DOI: 10.1089/neu.2016.4856] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Traumatic brain injury (TBI) is one of the leading causes of morbidity and mortality worldwide. It is linked with a number of medical, neurological, cognitive, and behavioral sequelae. The influence of genetic factors on the biology and related recovery after TBI is poorly understood. Studies that seek to elucidate the impact of genetic influences on neurorecovery after TBI will lead to better individualization of prognosis and inform development of novel treatments, which are considerably lacking. Current genetic studies related to TBI have focused on specific candidate genes. The objectives of this study were to use a system biology-based approach to identify biologic processes over-represented with genetic variants previously implicated in clinical outcomes after TBI and identify unique genes potentially related to recovery after TBI. After performing a systematic review to identify genes in the literature associated with clinical outcomes, we used the genes identified to perform a systems biology-based integrative computational analysis to ascertain the interactions between molecular components and to develop models for regulation and function of genes involved in TBI recovery. The analysis identified over-representation of genetic variants primarily in two biologic processes: response to injury (cell proliferation, cell death, inflammatory response, and cellular metabolism) and neurocognitive and behavioral reserve (brain development, cognition, and behavior). Overall, this study demonstrates the use of a systems biology-based approach to identify unique/novel genes or sets of genes important to the recovery process. Findings from this systems biology-based approach provide additional insight into the potential impact of genetic variants on the underlying complex biological processes important to TBI recovery and may inform the development of empirical genetic-related studies for TBI. Future studies that combine systems biology methodology and genomic, proteomic, and epigenetic approaches are needed in TBI.
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Affiliation(s)
- Brad G Kurowski
- 1 Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - Amery Treble-Barna
- 2 Division of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Alexis J Pitzer
- 3 Department of Psychology, Xavier University , Cincinnati, Ohio
| | - Shari L Wade
- 1 Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - Lisa J Martin
- 1 Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - Ranjit S Chima
- 1 Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - Anil Jegga
- 1 Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati, Ohio
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Osborn AJ, Mathias JL, Fairweather-Schmidt AK, Anstey KJ. Anxiety and comorbid depression following traumatic brain injury in a community-based sample of young, middle-aged and older adults. J Affect Disord 2017; 213:214-221. [PMID: 27919428 DOI: 10.1016/j.jad.2016.09.045] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/02/2016] [Accepted: 09/27/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Anxiety is common following a traumatic brain injury (TBI), but who is most at risk, and to what extent, is not well understood. METHODS Longitudinal data from a randomly-selected community sample (Wave 1: 7397, Wave 2: 6621 and Wave 3: 6042) comprising three adult cohorts (young: 20-24 years of age, middle-aged: 40-44, older: 60-64), were analysed. The association between TBI history, anxiety and comorbid depression was assessed, controlling for age, sex, marital/employment status, medical conditions, recent life events, alcohol consumption, social support and physical activity. RESULTS Thirteen percent of the sample had sustained a TBI by Wave 3, 35% of whom had sustained multiple TBIs. Cross-sectional analyses revealed that clinically-significant anxiety was more common in people who had sustained a TBI. Longitudinal analyses demonstrated an increased risk of anxiety post-TBI, even after controlling for potential demographic, health and psychosocial confounds. Anxiety was more common than depression, although 10% of those with a TBI experienced comorbid anxiety/depression. LIMITATIONS TBIs were not medically confirmed and anxiety and depression were only assessed every four years by self-report, rather than clinical interview. Sample attrition resulted in the retention of healthier individuals at each wave. CONCLUSIONS TBIs are associated with a lifelong increased risk of experiencing clinically-significant anxiety, highlighting the chronic nature of TBI sequelae. Positive lifestyle changes (e.g., increasing physical activity, reducing alcohol consumption) may decrease the risk of anxiety problems in the early years after a TBI. Comorbid anxiety and depression was common, indicating that both should be monitored and treated.
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Affiliation(s)
- A J Osborn
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - J L Mathias
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia.
| | - A K Fairweather-Schmidt
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia; School of Psychology, Flinders University, Bedford Park, South Australia, Australia; Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australia
| | - K J Anstey
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australia
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Lin Y, Luo LL, Sun J, Gao W, Tian Y, Park E, Baker A, Chen J, Jiang R, Zhang J. Relationship of Circulating CXCR4 + EPC with Prognosis of Mild Traumatic Brain Injury Patients. Aging Dis 2017; 8:115-127. [PMID: 28203485 PMCID: PMC5287384 DOI: 10.14336/ad.2016.0610] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 06/10/2016] [Indexed: 01/09/2023] Open
Abstract
To investigate the changes of circulating endothelial progenitor cells (EPCs) and stromal cell-derived factor-1α (SDF-1α)/CXCR4 expression in patients with mild traumatic brain injury (TBI) and the correlation between EPC level and the prognosis of mild TBI. 72 TBI patients (57 mild TBI, 15 moderate TBI patients) and 25 healthy subjects (control) were included. The number of circulating EPCs, CD34+, and CD133+ cells and the percentage of CXCR4+ cells in each cell population at 1,4,7,14,21 days after TBI were counted by flow cytometer. SDF-1α levels in serum were detected by ELISA assay. The patients were divided into poor and good prognosis groups based on Extended Glasgow Outcome Scale and Activity of Daily Living Scale at 3 months after TBI. Correlation analysis between each detected index and prognosis of mild TBI was performed. Moderate TBI patients have higher levels of SDF-1α and CXCR4 expression than mild TBI patients (P < 0.05). The percentage of CXCR4+ EPCs at day 7 post-TBI was significantly higher in mild TBI patients with poor prognosis than the ones with good prognosis (P < 0.05). HAMA and HAMD scores in mild TBI patients were significantly lower than moderate TBI patients (P < 0.05) in early term. The percentage of CXCR4+ EPCs at day 7 after TBI was significantly correlated with the prognosis outcome at 3 months. The mobilization of circulating EPCs can be induced in mild TBI. The expression of CXCR4+ in EPCs at 7 days after TBI reflects the short-term prognosis of brain injury, and could be a potential biological marker for prognosis prediction of mild TBI.
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Affiliation(s)
- Yunpeng Lin
- 1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin 300052, China
| | - Lan Lan Luo
- 2Department off Psychological Science, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jian Sun
- 1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin 300052, China
| | - Weiwei Gao
- 1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin 300052, China
| | - Ye Tian
- 1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin 300052, China
| | - Eugene Park
- 3Department of Traumatic Critical Care Unit, St. Michael's Hospital, Toronto, Canada
| | - Andrew Baker
- 3Department of Traumatic Critical Care Unit, St. Michael's Hospital, Toronto, Canada
| | - Jieli Chen
- 4Department of Neurology, Henry Ford Hospital, Detroit, MI USA; 5Department of Geriatrics, Tianjin Geriatrics Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Rongcai Jiang
- 1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin 300052, China
| | - Jianning Zhang
- 1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin 300052, China
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Abstract
OBJECTIVES The aim of this study was to characterize the neuropsychological profile of lifetime traumatic brain injury (TBI) in older Veterans. METHODS Participants were 169 older Veterans [mean age=79.1 years (range, 51-97 years), 89% male, 92% Caucasian], 88 with lifetime TBI and 81 without TBI, living in Veterans' retirement homes in independent residence. TBI history was ascertained with the Ohio State TBI Identification Method structured interview. Cognition was assessed with neuropsychological tests: Raw scores were converted to Z-scores compared to age-corrected normative data and combined into five domain composite Z-scores (attention/working memory, learning/memory, language, processing speed, executive functioning). We investigated the association between TBI and performance in each cognitive domain in linear mixed effects models, with and without adjustment for demographics, medical comorbidities, and psychiatric variables. RESULTS Compared to those without TBI, older Veterans with TBI had greater deficits in processing speed (estimate=-.52; p=.01; f 2=.08 in fully adjusted model) and executive functioning (estimate=-.41; p=.02; f 2=.06 in fully adjusted model) but performed similarly in the attention/working memory, learning/memory, and language domains (all p>.05). TBI-associated deficits were most prominent among individuals with multiple mild TBIs and those with any moderate-to-severe TBI, but were not clearly present among those with single mild TBI. CONCLUSIONS The neuropsychological profile of lifetime TBI in older Veterans is characterized by slowed processing speed and executive dysfunction, especially among those with greater injury burden. This pattern may reflect long-standing deficits or a TBI-associated cognitive decline process distinct from Alzheimer's disease. (JINS, 2017, 23, 56-64).
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Hercher LS, Caudle M, Griffin J, Herzog M, Matviychuk D, Tidwell J. Student-Athletes' Views on APOE Genotyping for Increased Risk of Poor Recovery after a Traumatic Brain Injury. J Genet Couns 2016; 25:1267-1275. [PMID: 27207686 DOI: 10.1007/s10897-016-9965-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/28/2016] [Indexed: 11/28/2022]
Abstract
Use of apolipoprotein E genotyping to personalize the risk of a poor recovery after traumatic brain injury is complicated by the potential for genetic discrimination and the potential to reveal an increased risk for late onset Alzheimer's disease. We developed a survey to gauge interest in testing among athletes participating in National Collegiate Athletic Association programs. Eight hundred and forty seven student-athletes were surveyed to determine their interest in genetic testing, their willingness to share the results of testing with parents, coaches and physicians, their concerns about privacy and/or discrimination, and their interest in genetic counseling. Nearly three quarters of respondents expressed some level of interest in testing, with the largest number describing themselves as 'possibly interested' (54.9 %, n = 463) and a smaller number describing themselves as 'very interested' (18.9 %, n = 159). Most student-athletes said that receiving secondary information about their risk for late-onset Alzheimer's disease made them more likely to test (50.6 %, n = 426) rather than less likely to test (12.4 %, n = 104). Student-athletes were open to apolipoprotein E genotyping and willing to share test results with their parents, coaches and physicians. They did not anticipate that test results would impact their behavior or ability to play. Testing programs may be welcome but should provide clear information as to risks and benefits.
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Affiliation(s)
- Laura S Hercher
- Sarah Lawrence College Joan H. Marks Graduate Program in Human Genetics, 1 Mead Way, Bronxville, NY, 10708, USA.
| | - Michelle Caudle
- Sarah Lawrence College Joan H. Marks Graduate Program in Human Genetics, 1 Mead Way, Bronxville, NY, 10708, USA
| | - Julie Griffin
- Weisskopf Child Evaluation Center, Department of Pediatrics, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Matthew Herzog
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Diana Matviychuk
- Medical Genetics Unit, Kingston General Hospital, Kingston, ON, Canada
| | - Jenna Tidwell
- Cancer Risk and Prevention Program, MemorialCare Cancer Institute at MemorialCare Health System, Laguna Hills, CA, USA
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Lawrence DW, Comper P, Hutchison MG, Sharma B. The role of apolipoprotein E episilon (ɛ)-4 allele on outcome following traumatic brain injury: A systematic review. Brain Inj 2015; 29:1018-31. [DOI: 10.3109/02699052.2015.1005131] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Braverman ER, Han D, Oscar-Berman M, Karikh T, Truesdell C, Dushaj K, Kreuk F, Li M, Stratton D, Blum K. Menopause Analytical Hormonal Correlate Outcome Study (MAHCOS) and the association to brain electrophysiology (P300) in a clinical setting. PLoS One 2014; 9:e105048. [PMID: 25251414 PMCID: PMC4174522 DOI: 10.1371/journal.pone.0105048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 07/20/2014] [Indexed: 11/18/2022] Open
Abstract
Various studies have demonstrated that increased leptin levels and obesity are inversely related to cognitive decline in menopausal women. It is hypothesized that adiposity is inversely correlated with cognitive decline, as women with increased weight are less vulnerable to diminishing cognition. However, it is increasingly observed that menopausal women, even with increased adiposity, experience significant cognitive decline. Positron emission tomography (PET) has been used to analyze cognitive function and processing in menopausal women. Evoked potentials (P300) and neurophysiologic tests have validated brain metabolism in cognitively impaired patients. Post-hoc analyses of 796 female patients entering PATH Medical Clinic, between January 4, 2009 and February 24, 2013, were performed as part of the "Menopause Analytical Hormonal Correlate Outcome Study" (MAHCOS). Patient age range was 39-76 years (46.7 ± 0.2). P300 latency and amplitude correlated with a number of hormones: follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, estrone, estriol, DHEA, pregnenolone, progesterone, free and total testosterone, thyroid stimulating hormone (TSH), Vitamins D 1.25 and D 25OH, leptin, and insulin-like growth factor-binding protein 3 (IGF-BP3). Corrected statistics did not reveal significant associations with P300 latency or amplitude for these hormones except for leptin plasma levels. However, factor analysis showed that FSH and LH clustered together with Vitamin D1.25 and Vitamin D25OH, P300 latency (not amplitude), and log leptin were found to be associated in the same cluster. Utilizing regression analysis, once age adjusted, leptin was the only significant predictor for latency or speed (p = 0.03) with an effect size of 0.23. Higher plasma leptin levels were associated with abnormal P300 speed (OR = 0.98). Our findings show a significant relationship of higher plasma leptin levels, potentially due to leptin resistance, and prolonged P300 latency. This suggests leptin resistance may delay electrophysiological processing of memory and attention, which appears to be the first of such an association.
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Affiliation(s)
- Eric R. Braverman
- Department of Clinical Neurology, PATH Foundation NY, New York, New York, United States of America
- Department of Psychiatry, University of Florida, College of Medicine and McKnight Brain Institute, Gainesville, Florida, United States of America
| | - David Han
- Department of Management Science and Statistics, University of Texas at San Antonio, San Antonio, Texas, United States of America
| | - Marlene Oscar-Berman
- Departments of Psychiatry, Neurology, and Anatomy & Neurobiology, Boston University School of Medicine, and Boston VA Healthcare System, Boston, Massachusetts, United States of America
| | - Tatiana Karikh
- Department of Clinical Neurology, PATH Foundation NY, New York, New York, United States of America
| | - Courtney Truesdell
- Department of Clinical Neurology, PATH Foundation NY, New York, New York, United States of America
| | - Kristina Dushaj
- Department of Clinical Neurology, PATH Foundation NY, New York, New York, United States of America
| | - Florian Kreuk
- Department of Clinical Neurology, PATH Foundation NY, New York, New York, United States of America
| | - Mona Li
- Department of Clinical Neurology, PATH Foundation NY, New York, New York, United States of America
| | - Danielle Stratton
- Department of Clinical Neurology, PATH Foundation NY, New York, New York, United States of America
| | - Kenneth Blum
- Department of Clinical Neurology, PATH Foundation NY, New York, New York, United States of America
- Department of Psychiatry, University of Florida, College of Medicine and McKnight Brain Institute, Gainesville, Florida, United States of America
- Department of Psychiatry, Human Integrated Services Unit, University of Vermont, Center for Clinical and Translational Science, Burlington, Vermont, United States of America
- Institute of Integrative Omics and Applied Biotechnology, Nonakuri, Purba Medinipur, West Bengal, India
- Dominion Diagnostics, LLC., North Kingstown, Rhode Island, United States of America
- * E-mail:
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Reuter-Lorenz PA, Park DC. How does it STAC up? Revisiting the scaffolding theory of aging and cognition. Neuropsychol Rev 2014; 24:355-70. [PMID: 25143069 PMCID: PMC4150993 DOI: 10.1007/s11065-014-9270-9] [Citation(s) in RCA: 511] [Impact Index Per Article: 51.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 08/07/2014] [Indexed: 12/11/2022]
Abstract
"The Scaffolding Theory of Aging and Cognition (STAC)", proposed in 2009, is a conceptual model of cognitive aging that integrated evidence from structural and functional neuroimaging to explain how the combined effects of adverse and compensatory neural processes produce varying levels of cognitive function. The model made clear and testable predictions about how different brain variables, both structural and functional, were related to cognitive function, focusing on the core construct of compensatory scaffolding. The present paper provides a revised model that integrates new evidence about the aging brain that has emerged since STAC was published 5 years ago. Unlike the original STAC model, STAC-r incorporates life-course factors that serve to enhance or deplete neural resources, thereby influencing the developmental course of brain structure and function, as well as cognition, over time. Life-course factors also influence compensatory processes that are engaged to meet cognitive challenge, and to ameliorate the adverse effects of structural and functional decline. The revised model is discussed in relation to recent lifespan and longitudinal data as well as emerging evidence about the effects of training interventions. STAC-r goes beyond the previous model by combining a life-span approach with a life-course approach to understand and predict cognitive status and rate of cognitive change over time.
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Affiliation(s)
- Patricia A Reuter-Lorenz
- Department of Psychology, The University of Michigan, 530 Church Street, Ann Arbor, MI, 48109, USA,
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