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van Amerongen S, Das S, Kamps S, Goossens J, Bongers B, Pijnenburg YAL, Vanmechelen E, Vijverberg EGB, Teunissen CE, Verberk IMW. Cerebrospinal fluid biomarkers and cognitive trajectories in patients with Alzheimer's disease and a history of traumatic brain injury. Neurobiol Aging 2024; 141:121-128. [PMID: 38908030 DOI: 10.1016/j.neurobiolaging.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/07/2024] [Accepted: 06/13/2024] [Indexed: 06/24/2024]
Abstract
Traumatic brain injury (TBI) and Alzheimer's disease (AD) have overlapping mechanisms but it remains unknown if pathophysiological characteristics and cognitive trajectories in AD patients are influenced by TBI history. Here, we studied AD patients (stage MCI or dementia) with TBI history (ADTBI+, n=110), or without (ADTBI-, n=110) and compared baseline CSF concentrations of amyloid beta 1-42 (Aβ42), phosphorylated tau181 (pTau181), total tau, neurofilament light chain (NfL), synaptosomal associated protein-25kDa (SNAP25), neurogranin (Ng), neuronal pentraxin-2 (NPTX2) and glutamate receptor-4 (GluR4), as well as differences in cognitive trajectories using linear mixed models. Explorative, analyses were repeated within stratified TBI groups by TBI characteristics (timing, severity, number). We found no differences in baseline CSF biomarker concentrations nor in cognitive trajectories between ADTBI+ and ADTBI- patients. TBI >5 years ago was associated with higher NPTX2 and a tendency for higher SNAP25 concentrations compared to TBI ≤ 5 years ago, suggesting that TBI may be associated with long-term synaptic dysfunction only when occurring before onset or in a pre-clinical disease stage of AD.
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Affiliation(s)
- Suzan van Amerongen
- Amsterdam Neuroscience, Neurodegeneration, De Boelelaan 1085, Amsterdam 1081 HV, the Netherlands; Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, De Boelelaan 1118, Amsterdam 1081 HV, the Netherlands.
| | - Shreyasee Das
- Neurochemistry Laboratory, Department of Laboratory Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Boelelaan 1117, Amsterdam 1081 HV, the Netherlands; ADx NeuroSciences, Technologiepark-Zwijnaarde 6, Gent 9052, Belgium
| | - Suzie Kamps
- Amsterdam Neuroscience, Neurodegeneration, De Boelelaan 1085, Amsterdam 1081 HV, the Netherlands; Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, De Boelelaan 1118, Amsterdam 1081 HV, the Netherlands
| | - Julie Goossens
- ADx NeuroSciences, Technologiepark-Zwijnaarde 6, Gent 9052, Belgium
| | - Bram Bongers
- Neurochemistry Laboratory, Department of Laboratory Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Boelelaan 1117, Amsterdam 1081 HV, the Netherlands
| | - Yolande A L Pijnenburg
- Amsterdam Neuroscience, Neurodegeneration, De Boelelaan 1085, Amsterdam 1081 HV, the Netherlands; Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, De Boelelaan 1118, Amsterdam 1081 HV, the Netherlands
| | | | - Everard G B Vijverberg
- Amsterdam Neuroscience, Neurodegeneration, De Boelelaan 1085, Amsterdam 1081 HV, the Netherlands; Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, De Boelelaan 1118, Amsterdam 1081 HV, the Netherlands
| | - Charlotte E Teunissen
- Amsterdam Neuroscience, Neurodegeneration, De Boelelaan 1085, Amsterdam 1081 HV, the Netherlands; Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, De Boelelaan 1118, Amsterdam 1081 HV, the Netherlands; Neurochemistry Laboratory, Department of Laboratory Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Boelelaan 1117, Amsterdam 1081 HV, the Netherlands
| | - Inge M W Verberk
- Amsterdam Neuroscience, Neurodegeneration, De Boelelaan 1085, Amsterdam 1081 HV, the Netherlands; Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, De Boelelaan 1118, Amsterdam 1081 HV, the Netherlands; Neurochemistry Laboratory, Department of Laboratory Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Boelelaan 1117, Amsterdam 1081 HV, the Netherlands
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Vaibhav K, Gulhane M, Ahluwalia P, Kumar M, Ahluwalia M, Rafiq AM, Amble V, Zabala MG, Miller JB, Goldman L, Mondal AK, Deak F, Kolhe R, Arbab AS, Vale FL. Single episode of moderate to severe traumatic brain injury leads to chronic neurological deficits and Alzheimer's-like pathological dementia. GeroScience 2024:10.1007/s11357-024-01183-3. [PMID: 38733547 DOI: 10.1007/s11357-024-01183-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Traumatic brain injury (TBI) is one of the foremost causes of disability and mortality globally. While the scientific and medical emphasis is to save lives and avoid disability during acute period of injury, a severe health problem can manifest years after injury. For instance, TBI increases the risk of cognitive impairment in the elderly. Remote TBI history was reported to be a cause of the accelerated clinical trajectory of Alzheimer's disease-related dementia (ADRD) resulting in earlier onset of cognitive impairment and increased AD-associated pathological markers like greater amyloid deposition and cortical thinning. It is not well understood whether a single TBI event may increase the risk of dementia. Moreover, the cellular signaling pathways remain elusive for the chronic effects of TBI on cognition. We have hypothesized that a single TBI induces sustained neuroinflammation and disrupts cellular communication in a way that results later in ADRD pathology. To test this, we induced TBI in young adult CD1 mice and assessed the behavioral outcomes after 11 months followed by pathological, histological, transcriptomic, and MRI assessment. On MRI scans, these mice showed significant loss of tissue, reduced CBF, and higher white matter injury compared to sham mice. We found these brains showed progressive atrophy, markers of ADRD, sustained astrogliosis, loss of neuronal plasticity, and growth factors even after 1-year post-TBI. Because of progressive neurodegeneration, these mice had motor deficits, showed cognitive impairments, and wandered randomly in open field. We, therefore, conclude that progressive pathology after adulthood TBI leads to neurodegenerative conditions such as ADRD and impairs neuronal functions.
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Affiliation(s)
- Kumar Vaibhav
- Brain Injury, Senescence, and Translational Neuroscience Lab, Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA.
- Transdisciplinary Research Initiative in Inflammaging and Brain Aging (TRIBA), Augusta University, Augusta, GA, USA.
| | - Mayuri Gulhane
- Brain Injury, Senescence, and Translational Neuroscience Lab, Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
| | - Pankaj Ahluwalia
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Manish Kumar
- Brain Injury, Senescence, and Translational Neuroscience Lab, Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Meenakshi Ahluwalia
- Brain Injury, Senescence, and Translational Neuroscience Lab, Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Ashiq M Rafiq
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Vibha Amble
- Center for Undergraduate Research Studies, Augusta University, Augusta, GA, USA
| | - Manuela G Zabala
- Center for Undergraduate Research Studies, Augusta University, Augusta, GA, USA
| | - Jacob B Miller
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
- The Graduate School, Augusta University, Augusta, GA, USA
| | - Liam Goldman
- Brain Injury, Senescence, and Translational Neuroscience Lab, Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
| | - Ashis K Mondal
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Ferenc Deak
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Ravindra Kolhe
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Ali S Arbab
- Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Fernando L Vale
- Brain Injury, Senescence, and Translational Neuroscience Lab, Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
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3
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Taskina D, Zhu C, Schwab N, Hazrati LN. Brain pathology and symptoms linked to concussion history: beyond chronic traumatic encephalopathy. Brain Commun 2024; 6:fcad314. [PMID: 38560515 PMCID: PMC10977958 DOI: 10.1093/braincomms/fcad314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/13/2023] [Accepted: 02/23/2024] [Indexed: 04/04/2024] Open
Abstract
Repeated head trauma acquired through sports injuries has been associated with the development of long-term disabling symptoms that negatively impact the quality of life. In this retrospective case series, 52 male former professional athletes involved in contact sports and with a history of multiple concussions were evaluated for chronic clinical symptoms and post-mortem neuropathological diagnoses. The clinical symptoms of 19 cases were examined in greater detail for symptom type, severity and duration. Information on neurological, psychiatric and physical symptoms, substance use profiles and concussion histories was obtained from the athletes' next of kin and assessed in relation to post-mortem neuropathological diagnoses. Cases were categorized into three different neuropathological groups: no major neuropathological findings, the presence of only chronic traumatic encephalopathy (CTE) and the diagnosis(es) of other neurodegenerative diseases. Age at death and the presence of DNA damage in the post-mortem brains were analysed for correlation with the clinical symptoms. In this case series, 14/52 (26.9%) cases (mean age 48.2 ± 11.4) had neuropathological evidence of low-stage/low-burden CTE. A total of 11/52 (21.2%) cases (mean age 38.7 ± 12.7) presented a similar profile and severity of behavioural symptoms to those with CTE, despite the lack of significant post-mortem neuropathological findings. A total of 27/52 (51.9%) cases (mean age 75.5 ± 8.7) presented with complex post-mortem neurodegenerative diagnoses, including Alzheimer's disease and other mixed pathologies, and clinical symptoms associated with language, memory and sensory dysfunction. The presence of DNA damage in the brain was found in all neuropathological groups, predominantly in the ependymal lining of ventricles, and phosphorylated histone H2AX staining was correlated with higher age at death (r = 0.59) and symptoms of language dysfunction (r = 0.56). Findings from our case series suggest that post-concussive symptoms are not driven by CTE. Our findings show that proteinopathies alone may not account for the complexity of the clinical manifestations and suggest the possibility of other drivers, such as DNA damage, as potentially useful markers of brain trauma. Broadening the search for biological markers that reflect the effects of brain injury, even when proteinopathy is not observed, and taking a symptom-driven approach are therefore advised.
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Affiliation(s)
- Daria Taskina
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Cherrie Zhu
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Nicole Schwab
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Lili-Naz Hazrati
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario M5S 1A8, Canada
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Garcia MJ, Leadley R, Ross J, Bozeat S, Redhead G, Hansson O, Iwatsubo T, Villain N, Cummings J. Prognostic and Predictive Factors in Early Alzheimer's Disease: A Systematic Review. J Alzheimers Dis Rep 2024; 8:203-240. [PMID: 38405341 PMCID: PMC10894607 DOI: 10.3233/adr-230045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/24/2023] [Indexed: 02/27/2024] Open
Abstract
Background Alzheimer's disease (AD) causes progressive decline of cognition and function. There is a lack of systematic literature reviews on prognostic and predictive factors in its early clinical stages (eAD), i.e., mild cognitive impairment due to AD and mild AD dementia. Objective To identify prognostic factors affecting eAD progression and predictive factors for treatment efficacy and safety of approved and/or under late-stage development disease-modifying treatments. Methods Databases were searched (August 2022) for studies reporting prognostic factors associated with eAD progression and predictive factors for treatment response. The Quality in Prognostic Factor Studies tool or the Cochrane risk of bias tool were used to assess risk of bias. Two reviewers independently screened the records. A single reviewer performed data extraction and quality assessment. A second performed a 20% check. Content experts reviewed and interpreted the data collected. Results Sixty-one studies were included. Self-reporting, diagnosis definition, and missing data led to high risk of bias. Population size ranged from 110 to 11,451. Analyses found data indicating that older age was and depression may be associated with progression. Greater baseline cognitive impairment was associated with progression. APOE4 may be a prognostic factor, a predictive factor for treatment efficacy and predicts an adverse response (ARIA). Elevated biomarkers (CSF/plasma p-tau, CSF t-tau, and plasma neurofilament light) were associated with disease progression. Conclusions Age was the strongest risk factor for progression. Biomarkers were associated with progression, supporting their use in trial selection and aiding diagnosis. Baseline cognitive impairment was a prognostic factor. APOE4 predicted ARIA, aligning with emerging evidence and relevant to treatment initiation/monitoring.
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Affiliation(s)
| | - Regina Leadley
- Mtech Access Ltd, IT Centre, Innovation Way, Heslington, York, UK
| | - Janine Ross
- Mtech Access Ltd, IT Centre, Innovation Way, Heslington, York, UK
| | | | | | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Lund, Sweden
| | | | - Nicolas Villain
- AP-HP Sorbonne Université, Pitié-Salpêtrière Hospital, Department of Neurology, Institute of Memory and Alzheimer’s Disease, Paris, France
- Sorbonne Université, INSERM U1127, CNRS 7225, Institut du Cerveau –ICM, Paris, France
| | - Jeffrey Cummings
- Chambers-Grundy Center for TransformativeNeuroscience, Department of Brain Health, School of IntegratedHealth Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
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5
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Bonilla-Santos J, González-Hernández A, Cala-Martínez DY, Gómez-Morales DF, Calceto-Garavito LN, Forero-Aldana AE, González-Montealegre RA, Cardona Cumaco YA, Rojas-Bernal LA, Zabaleta-Orozco MA, Parra MA. Prevalence of Mild Cognitive Impairment in Southern Regions of Colombia. J Alzheimers Dis Rep 2023; 7:1455-1464. [PMID: 38225967 PMCID: PMC10789289 DOI: 10.3233/adr-230041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/26/2023] [Indexed: 01/17/2024] Open
Abstract
Background Recent reports suggest that by 2050 there will be an increase of around 310% of cases affected by dementia in Latin American countries. A previous study in a Southern region reported one of the highest prevalences of dementia in Latin America. Objective To investigate the prevalence of mild cognitive impairment associated with low education, rurality, and demographic characteristics. Methods A cross-sectional study recruited a community-dwelling sample of 823 adults from rural and urban areas of two Southern provinces of Colombia from 2020-2022. Participants were assessed with a neuropsychological protocol validated in Colombia. To obtain general and region-specific prevalence rates, age, sex, schooling, and socioeconomic level were considered and controlled for. Results Most of the participants reported low education and socioeconomic level, the participation of women was higher. It was determined that the prevalence of mild cognitive impairment (MCI) was 53.6%, with 56.6% in the province of Caquetá followed by 51.9% in the province of Huila. The amnestic MCI represented 42.6%, the amnestic multi-domain was 39%, the non-amnestic 16.55%, and the non-amnestic multi-domain 1.81%. Our participants reported comorbidities such as diabetes and hypertension. We also observed a relationship between exposure to pesticides and MCI. Conclusions We observed one of the highest prevalences of MCI in Latin America reported to date. Variables such as age, gender, and education proved risk factors for MCI in the explored regions. Our findings are very much in line with recent studies that highlight the influence of non-canonical risk factors of dementia in underrepresented countries from Latin America.
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Affiliation(s)
- Jasmin Bonilla-Santos
- Department of Psychology, Universidad Cooperativa de Colombia, Neiva, Colombia
- Neurocognition and Psychophysiology Laboratory, Universidad Surcolombiana, Neiva, Colombia
| | | | - Dorian Yisela Cala-Martínez
- Department of Psychology, Universidad Cooperativa de Colombia, Neiva, Colombia
- Neurocognition and Psychophysiology Laboratory, Universidad Surcolombiana, Neiva, Colombia
| | | | | | | | | | | | - Luz Angela Rojas-Bernal
- Instituto del cerebro, Hospital Universitario Mayor Méderi, Universidad del Rosario, Bogotá, Colombia
- Clinical Neuropsychology, Universidad Surcolombiana, Neiva, Colombia
| | | | - Mario Alfredo Parra
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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Dogan EO, Bouley J, Zhong J, Harkins AL, Keeler AM, Bosco DA, Brown RH, Henninger N. Genetic ablation of Sarm1 attenuates expression and mislocalization of phosphorylated TDP-43 after mouse repetitive traumatic brain injury. Acta Neuropathol Commun 2023; 11:206. [PMID: 38124145 PMCID: PMC10731794 DOI: 10.1186/s40478-023-01709-4] [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: 08/15/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Traumatic brain injury (TBI), particularly when moderate-to-severe and repetitive, is a strong environmental risk factor for several progressive neurodegenerative disorders. Mislocalization and deposition of transactive response DNA binding protein 43 (TDP-43) has been reported in both TBI and TBI-associated neurodegenerative diseases. It has been hypothesized that axonal pathology, an early event after TBI, may promote TDP-43 dysregulation and serve as a trigger for neurodegenerative processes. We sought to determine whether blocking the prodegenerative Sarm1 (sterile alpha and TIR motif containing 1) axon death pathway attenuates TDP-43 pathology after TBI. We subjected 111 male Sarm1 wild type, hemizygous, and knockout mice to moderate-to-severe repetitive TBI (rTBI) using a previously established injury paradigm. We conducted serial neurological assessments followed by histological analyses (NeuN, MBP, Iba-1, GFAP, pTDP-43, and AT8) at 1 month after rTBI. Genetic ablation of the Sarm1 gene attenuated the expression and mislocalization of phosphorylated TDP-43 (pTDP-43) and accumulation of pTau. In addition, Sarm1 knockout mice had significantly improved cortical neuronal and axonal integrity, functional deficits, and improved overall survival after rTBI. In contrast, removal of one Sarm1 allele delayed, but did not prevent, neurological deficits and neuroaxonal loss. Nevertheless, Sarm1 haploinsufficient mice showed significantly less microgliosis, pTDP-43 pathology, and pTau accumulation when compared to wild type mice. These data indicate that the Sarm1-mediated prodegenerative pathway contributes to pathogenesis in rTBI including the pathological accumulation of pTDP-43. This suggests that anti-Sarm1 therapeutics are a viable approach for preserving neurological function after moderate-to-severe rTBI.
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Affiliation(s)
- Elif O Dogan
- Department of Neurology, University of Massachusetts Chan Medical School, 55 Lake Ave, North, Worcester, MA, 01655, USA
| | - James Bouley
- Department of Neurology, University of Massachusetts Chan Medical School, 55 Lake Ave, North, Worcester, MA, 01655, USA
| | - Jianjun Zhong
- Department of Neurology, University of Massachusetts Chan Medical School, 55 Lake Ave, North, Worcester, MA, 01655, USA
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ashley L Harkins
- Department of Neurology, University of Massachusetts Chan Medical School, 55 Lake Ave, North, Worcester, MA, 01655, USA
- Graduate Program in Neuroscience, Morningside Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, MA, 01655, USA
- Horae Gene Therapy Center, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
| | - Allison M Keeler
- Horae Gene Therapy Center, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
- NeuroNexus Institute, University of Massachusetts Chan Medical School, Worcester, MA, 01605, USA
| | - Daryl A Bosco
- Department of Neurology, University of Massachusetts Chan Medical School, 55 Lake Ave, North, Worcester, MA, 01655, USA
| | - Robert H Brown
- Department of Neurology, University of Massachusetts Chan Medical School, 55 Lake Ave, North, Worcester, MA, 01655, USA
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Chan Medical School, 55 Lake Ave, North, Worcester, MA, 01655, USA.
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Ave, North, Worcester, MA, 01655, USA.
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Cummins TL, Doré V, Feizpour A, Krishnadas N, Bourgeat P, Elias A, Lamb F, Williams R, Hopwood M, Landau S, Villemagne VL, Weiner M, Rowe CC. Tau, β-Amyloid, and Glucose Metabolism Following Service-Related Traumatic Brain Injury in Vietnam War Veterans: The Australian Imaging Biomarkers and Lifestyle Study of Aging-Veterans Study (AIBL-VETS). J Neurotrauma 2023; 40:1086-1097. [PMID: 36855333 PMCID: PMC10398748 DOI: 10.1089/neu.2022.0172] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Traumatic brain injury (TBI) is common among military veterans and has been associated with an increased risk of dementia. It is unclear if this is due to increased risk for Alzheimer's disease (AD) or other mechanisms. This case control study sought evidence for AD, as defined by the 2018 National Institute on Aging - Alzheimer's Association (NIA-AA) research framework, by measuring tau, β-amyloid, and glucose metabolism using positron emission tomography (PET) in veterans with service-related TBI. Seventy male Vietnam war veterans-40 with TBI (age 68.0 ± 2.5 years) and 30 controls (age 70.1 ± 5.3 years)-with no prior diagnosis of dementia or mild cognitive impairment underwent β-amyloid (18F-Florbetaben), tau (18F-Flortaucipir), and fluorodeoxyglucose (18F-FDG) PET. The TBI cohort included 15 participants with mild, 16 with moderate, and nine with severe injury. β-Amyloid level was calculated using the Centiloid (CL) method and tau was measured by standardized uptake value ratios (SUVRs) using the cerebellar cortex as reference region. Analyses were adjusted for age and APOE-e4. The findings were validated in an independent cohort from the Department of Defense-Alzheimer's Disease Neuroimaging Initiative (DOD ADNI) study. There were no significant nor trending differences in β-amyloid or tau levels or 18F-FDG uptake between the TBI and control groups before and after controlling for covariates. The β-amyloid and tau findings were replicated in the DOD ADNI validation cohort and persisted when the Australian Imaging Biomarkers and Lifestyle study of aging-Veterans study (AIBL-VETS) and DOD ADNI cohorts were combined (114 TBI vs. 87 controls in total). In conclusion, no increase in the later life accumulation of the neuropathological markers of AD in veterans with a remote history of TBI was identified.
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Affiliation(s)
- Tia L. Cummins
- Department of Molecular Imaging and Therapy, Center for PET, Austin Health, Melbourne, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Vincent Doré
- Department of Molecular Imaging and Therapy, Center for PET, Austin Health, Melbourne, Victoria, Australia
- The Australian eHealth Research Centre, CSIRO, Brisbane, Queensland, Australia
| | - Azadeh Feizpour
- Department of Molecular Imaging and Therapy, Center for PET, Austin Health, Melbourne, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Natasha Krishnadas
- Department of Molecular Imaging and Therapy, Center for PET, Austin Health, Melbourne, Victoria, Australia
- Florey Department of Neurosciences and Mental Health, The University of Melbourne, Victoria, Australia
| | - Pierrick Bourgeat
- The Australian eHealth Research Centre, CSIRO, Brisbane, Queensland, Australia
| | - Alby Elias
- Department of Molecular Imaging and Therapy, Center for PET, Austin Health, Melbourne, Victoria, Australia
- Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - Fiona Lamb
- Department of Molecular Imaging and Therapy, Center for PET, Austin Health, Melbourne, Victoria, Australia
| | - Robert Williams
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
- Melbourne Brain Center Imaging Unit, The University of Melbourne, Victoria, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - Susan Landau
- Helen Wills Neuroscience Institute, University of California, Berkeley, California, USA
| | - Victor L. Villemagne
- Department of Molecular Imaging and Therapy, Center for PET, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Victoria, Australia
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael Weiner
- University of California, San Francisco, California, USA
| | - Christopher C. Rowe
- Department of Molecular Imaging and Therapy, Center for PET, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Victoria, Australia
- The Australian Dementia Network (ADNeT), Melbourne, Victoria, Australia
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8
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Putri SSF, Irfannuddin I, Murti K, Kesuma Y, Darmawan H, Koibuchi N. The role of gut microbiota on cognitive development in rodents: a meta-analysis. J Physiol Sci 2023; 73:10. [PMID: 37193943 DOI: 10.1186/s12576-023-00869-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/28/2023] [Indexed: 05/18/2023]
Abstract
Cognitive function includes learning, remembering and using acquired information. Emerging studies indicate the correlation between microbiota and cognitive function. Higher abundance of a specific gut microbiota, such as Bacteroidetes may improve cognitive abilities. However, another study reported different result. These results suggest that further systematic analysis is required to determine the effect of the gut microbiota abundance on cognitive development. The aim of this study is to summarize the abundance of the specific gut microbiota and cognitive development using meta-analysis. PubMed, ScienceDirect, and Clinical-Key were used as data bases to perform the literature search. Phylum Bacteroidetes, and family Lactobacillaceae were more abundant in cognitive-behavioral enhancement (CBE), whereas Firmicutes, Proteobacteria, Actinobacteria, and family Ruminococcaceae were less abundant in CBE. Differences in gut microbiota abundance are influenced by differences in stage of cognitive dysfunction, intervention, and strain of gut microbiota.
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Affiliation(s)
| | | | - Krisna Murti
- Faculty of Medicine, Universitas Sriwijaya, Palembang, 30126, Indonesia
| | - Yudianita Kesuma
- Faculty of Medicine, Universitas Sriwijaya, Palembang, 30126, Indonesia
| | - Hardi Darmawan
- Faculty of Medicine, Universitas Sriwijaya, Palembang, 30126, Indonesia
| | - Noriyuki Koibuchi
- Department of Integrative Physiology, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-8511, Japan
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9
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Laic RAG, Verheyden J, Bruyninckx D, Lebegge P, Sloten JV, Depreitere B. Profound prospective assessment of radiological and functional outcome 6 months after TBI in elderly. Acta Neurochir (Wien) 2023; 165:849-864. [PMID: 36922467 DOI: 10.1007/s00701-023-05546-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/02/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Recovery after traumatic brain injury (TBI) in older adults is usually affected by the presence of comorbidities, leading to more severe sequelae in this age group than in younger patients. However, there are only few reports that prospectively perform in-depth assessment of outcome following TBI in elderly. OBJECTIVE This study aims at documenting structural brain characteristics and functional outcome and quality of life in elderly patients 6 months after TBI and comparing these data with healthy volunteers undergoing the same assessments. METHODS Thirteen TBI patients ≥ 65 years old, admitted to the University Hospitals Leuven (Belgium), between 2019 and 2022 due to TBI, including all injury severities, and a group of 13 healthy volunteers with similar demographic characteristics were prospectively included in the study. At admission, demographic, injury, and CT scan data were collected in our database. Six months after the accident, a brain MRI scan and standardized assessments of frailty, sleep quality, cognitive function, motor function, and quality of life were conducted. RESULTS A total of 13 patients and 13 volunteers were included in the study, with a median age of 74 and 73 years, respectively. Nine out of the 13 patients presented with a mild TBI. The patient group had a significantly higher level of frailty than the control group, presenting a mean Reported Edmonton Frailty Scale score of 5.8 (SD 2.7) vs 0.7 (SD 1.1) (p < 0.01). No statistically significant differences were found between patient and control brain volumes, fluid attenuated inversion recovery white matter hyperintensity volumes, number of lesions and blackholes, and fractional anisotropy values. Patients demonstrated a significantly higher median reaction time in the One Touch Stockings of Cambridge (22.3 s vs 17.6, p = 0.03) and Reaction Time (0.5 s vs 0.4 s, p < 0.01) subtests in the Cambridge Neuropsychological Test Automated Battery. Furthermore, patients had a lower mean score on the first Box and Blocks test with the right hand (46.6 vs 61.7, p < 0.01) and a significantly higher mean score in the Timed-Up & Go test (13.1 s vs 6.2 s, p = 0.02) and Timed Up & Go with cognitive dual task (16.0 s vs 10.2 s, p < 0.01). Substantially lower QOLIBRI total score (60.4 vs 85.4, p < 0.01) and QOLIBRI-OS total score (53.8 vs 88.5, p < 0.01) were also observed in the patients' group. CONCLUSION In this prospective study, TBI patients ≥ 65 years old when compared with elder controls showed slightly worse cognitive performance and poorer motor function, higher fall risk, but a substantially reduced QoL at 6 months FU, as well as significantly higher frailty, even when the TBI is classified as mild. No statistically significant differences were found in structural brain characteristics on MRI. Future studies with larger sample sizes are needed to refine the impact of TBI versus frailty on function and QoL in elderly.
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10
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Ng PY, McNeely TL, Baker DJ. Untangling senescent and damage-associated microglia in the aging and diseased brain. FEBS J 2023; 290:1326-1339. [PMID: 34873840 PMCID: PMC9167891 DOI: 10.1111/febs.16315] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/16/2021] [Accepted: 12/06/2021] [Indexed: 01/10/2023]
Abstract
Microglial homeostasis has emerged as a critical mediator of health and disease in the central nervous system. In their neuroprotective role as the predominant immune cells of the brain, microglia surveil the microenvironment for debris and pathogens, while also promoting neurogenesis and performing maintenance on synapses. Chronological ageing, disease onset, or traumatic injury promotes irreparable damage or deregulated signaling to reinforce neurotoxic phenotypes in microglia. These insults may include cellular senescence, a stable growth arrest often accompanied by the production of a distinctive pro-inflammatory secretory phenotype, which may contribute to age- or disease-driven decline in neuronal health and cognition and is a potential novel therapeutic target. Despite this increased scrutiny, unanswered questions remain about what distinguishes senescent microglia and non-senescent microglia reacting to insults occurring in ageing, disease, and injury, and how central the development of senescence is in their pivot from guardian to assailant. To intelligently design future studies to untangle senescent microglia from other primed and reactionary states, specific criteria must be developed that define this population and allow for comparisons between different model systems. Comparing microglial activity seen in homeostasis, ageing, disease, and injury allows for a more coherent understanding of when and how senescent and other harmful microglial subpopulations should be targeted.
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Affiliation(s)
- Pei Y Ng
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - Taylor L McNeely
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - Darren J Baker
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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11
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Hanrahan JG, Burford C, Nagappan P, Adegboyega G, Rajkumar S, Kolias A, Helmy A, Hutchinson PJ. Is dementia more likely following traumatic brain injury? A systematic review. J Neurol 2023; 270:3022-3051. [PMID: 36810827 DOI: 10.1007/s00415-023-11614-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The association between traumatic brain injury (TBI) and dementia is controversial, and of growing importance considering the ageing demography of TBI. OBJECTIVE To review the scope and quality of the existing literature investigating the relationship between TBI and dementia. METHODS We conducted a systematic review following PRISMA guidelines. Studies that compared TBI exposure and dementia risk were included. Studies were formally assessed for quality with a validated quality-assessment tool. RESULTS 44 studies were included in the final analysis. 75% (n = 33) were cohort studies and data collection was predominantly retrospective (n = 30, 66.7%). 25 studies (56.8%) found a positive relationship between TBI and dementia. Clearly defined and valid measures of assessing TBI history were lacking (case-control studies-88.9%, cohort studies-52.9%). Most studies failed to justify a sample size (case-control studies-77.8%, cohort studies-91.2%), blind assessors to exposure (case-control-66.7%) or blind assessors to exposure status (cohort-3.00%). Studies that identified a relationship between TBI and dementia had a longer median follow-up time (120 months vs 48 months, p = 0.022) and were more likely to use validated TBI definitions (p = 0.01). Studies which clearly defined TBI exposure (p = 0.013) and accounted for TBI severity (p = 0.036) were also more likely to identify an association between TBI and dementia. There was no consensus method by which studies diagnosed dementia and neuropathological confirmation was only available in 15.5% of studies. CONCLUSIONS Our review suggests a relationship between TBI and dementia, but we are unable to predict the risk of dementia for an individual following TBI. Our conclusions are limited by heterogeneity in both exposure and outcome reporting and by poor study quality. Future studies should; (a) use validated methods to define TBI, accounting for TBI severity; (b) follow consensus agreement on criteria for dementia diagnosis; and (c) undertake follow-up that is both longitudinal, to determine if there is a progressive neurodegenerative change or static post-traumatic deficit, and of sufficient duration.
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Affiliation(s)
- John Gerrard Hanrahan
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Charlotte Burford
- Department of General Surgery, East Kent University Hospitals NHS Foundation Trust, Ashford, UK.
| | - Palani Nagappan
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Gideon Adegboyega
- Bart's and the London Medical School, Queen Mary University of London, London, UK
| | - Shivani Rajkumar
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Angelos Kolias
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Adel Helmy
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Peter John Hutchinson
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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12
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Kintu TM, Katengeke V, Kamoga R, Nguyen T, Najjuma JN, Kitya D, Wakida EK, Obua C, Rukundo GZ. Cognitive impairment following traumatic brain injury in Uganda: Prevalence and associated factors. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001459. [PMID: 36962918 PMCID: PMC10021383 DOI: 10.1371/journal.pgph.0001459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/13/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND As the burden of dementia continues to rise in sub-Saharan Africa, it is crucial to develop an evidence base for potentially modifiable risk factors such as Traumatic Brain Injury (TBI). Cognitive impairment may result from TBI and since it is an established prodromal form of dementia, we investigated the burden of cognitive impairment and associated factors in persons with a history of TBI in southwestern Uganda. METHODS This was a community-based quantitative study with a cross-sectional design among 189 persons with a history of TBI in southwestern Uganda. Data were collected by the research team in March and June 2022 and entered into Kobo Toolbox before being transferred to RStudio version 4.1.0 for cleaning and analysis. Data were analyzed at a 5% level of significance. RESULTS Most study participants had some form of cognitive impairment (56.1%), with 43.1% of the participants having mild cognitive impairment (MCI). Cognitive impairment was associated with older age (p-value<0.001); loss of consciousness following the TBI (p-value = 0.019) and a history of tobacco use (p-value = 0.003). As a measure of severity of the TBI, loss of consciousness (aOR = 4.09; CI = 1.57-11.76; p<0.01) and older age (aOR = 1.04; CI = 1.01-1.07; p<0.01) were identified as risk factors for cognitive impairment. CONCLUSION There is a high burden of cognitive impairment among individuals with a history of TBI in southwestern Uganda, and most associated risk factors are potentially modifiable. Long-term follow-up of TBI patients would enable early identification of some risks. Patients with TBI could benefit from behavioural modifications such as restriction of alcohol intake and tobacco use to slow down the progression into dementia.
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Affiliation(s)
- Timothy Mwanje Kintu
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Vanessa Katengeke
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ronald Kamoga
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Tricia Nguyen
- California University of Science and Medicine, Colton, California, United States of America
| | | | - David Kitya
- Department of Neurosurgery, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edith K Wakida
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medical Education, California University of Science and Medicine, Colton, California, United States of America
| | - Celestino Obua
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
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13
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Li W, Deng W. Platelet-to-lymphocyte ratio predicts short-term mortality in patients with moderate to severe traumatic brain injury. Sci Rep 2022; 12:13976. [PMID: 35978006 PMCID: PMC9385644 DOI: 10.1038/s41598-022-18242-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/08/2022] [Indexed: 11/15/2022] Open
Abstract
An easily accessible biomarker with good diagnostic power for patients with traumatic brain injury (TBI) was needed to predict the short-term mortality. Studies have shown that platelet-to-lymphocyte ratio (PLR) is a biomarker for patients with tumor. This study aimed to identify the relationship between PLR and short-term mortality in patients with moderate to severe TBI. This is a retrospective cohort study. We selected patients with moderate to severe TBI who were admitted to the emergency department of The First Affiliated Hospital of Zhengzhou University. Biomarkers were collected within 24 h after admission. To investigate their relationship with short-term mortality, Cox proportional hazards regression and ROC curve analysis were performed. A total number of 170 patients was included. 47 (27.6%) patients had died and 123 (72.4%) patients were survived by the end of the study. Patients with different Rotterdam CT score (HR = 1.571, 95%CI 1.232–2.002, p < 0.001) or PLR levels (HR = 1.523, 95%CI 1.110–2.090, p = 0.009) had significant different mortality rates. The AUC curve analysis showed that the AUC of Rotterdam CT score and PLR groups were 0.729 (95%CI 0.638–0.821, p < 0.001) and 0.711 (95%CI 0.618–0.803 p < 0.001), respectively. PLR level is an independent biomarker with great diagnostic power for short-term mortality in patients with moderate to severe brain injury.
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Affiliation(s)
- Wenjuan Li
- Department of Neuro-Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wenjing Deng
- Department of Neuro-Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
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14
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LoBue C, Kelley BJ, Hart J, Helphrey J, Schaffert J, Cullum CM, Peters ME, Douglas PM. Mild Traumatic Brain Injury Is Related to Elevated Cerebrospinal Fluid Tau in Alzheimer's Disease Dementia. J Alzheimers Dis 2022; 87:1491-1496. [PMID: 35491792 PMCID: PMC9241585 DOI: 10.3233/jad-220112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Few studies have examined an association between mild traumatic brain injury (mTBI) and Alzheimer's disease (AD). For this reason, we compared an AD dementia group with an mTBI history (n = 10) to a matched AD control group (n = 20) on measures of cognitive function, cerebral glucose metabolism, and markers of amyloid and tau deposition. Only a trend and medium-to-large effect size for higher phosphorylated and total tau was identified for the mTBI group. A history of mTBI may be associated with greater tau in AD, indicating a potential pathway for increasing risk for AD, though further evaluation with larger samples is needed.
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Affiliation(s)
- Christian LoBue
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Brendan J. Kelley
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - John Hart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX,Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX,School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX
| | - Jessica Helphrey
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeff Schaffert
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - C. Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX,Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Matthew E. Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Peter M. Douglas
- Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, TX
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15
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Schneider BS, Arciniegas DB, Harenski C, Clarke GJB, Kiehl KA, Koenigs M. The prevalence, characteristics, and psychiatric correlates of traumatic brain injury in incarcerated individuals: an examination in two independent samples. Brain Inj 2021; 35:1690-1701. [PMID: 35067151 PMCID: PMC8884136 DOI: 10.1080/02699052.2021.2013534] [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: 01/24/2023]
Abstract
PRIMARY OBJECTIVE Identify the prevalence, characteristics, and psychological correlates of traumatic brain injury (TBI) among incarcerated individuals. RESEARCH DESIGN Three aims: (1) Determine the prevalence and characteristics of TBI in 1469 adults incarcerated in Wisconsin state prisons (1064 men, 405 women); (2) Characterize the relationship between mild TBI and mental illness in a sub-sample of men and women; (3) Reproduce the findings from Aim 1 and Aim 2 in an independent sample of 1015 adults incarcerated in New Mexico state prisons (600 men, 415 women). METHODS AND PROCEDURES Standardized TBI assessment with structured clinical interviews and self-report questionnaires. MAIN OUTCOMES AND RESULTS Rates of TBI were approximately five times greater than the general population, with a substantially higher rate of TBI caused by assault. In the Wisconsin sample, mild TBI was associated with greater levels of post-traumatic stress disorder (PTSD) among women (but not among men). In the New Mexico sample, TBI of any severity was associated with greater levels of major depressive disorder (MDD) among women (but not among men). CONCLUSIONS This study thus provides novel data on TBI and its correlates among individuals incarcerated in state prisons, and highlights a specific treatment need within the prison population.
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Affiliation(s)
- Brett S. Schneider
- Department of Psychiatry, University of Wisconsin-Madison, 53719,Department of Psychology, University of Wisconsin-Madison 53706
| | - David B. Arciniegas
- Marcus Institute for Brain Health, University of Colorado-Anschutz Medical Campus, Aurora, Colorado 80045,Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuqerque, New Mexico 87106
| | - Carla Harenski
- The MIND Research Network, Albuquerque, New Mexico 87106
| | | | - Kent A. Kiehl
- The MIND Research Network, Albuquerque, New Mexico 87106,Departments of Psychology, Neuroscience and Law, University of New Mexico, Albuquerque, New Mexico 87106
| | - Michael Koenigs
- Department of Psychiatry, University of Wisconsin-Madison, 53719,Corresponding Author , Michael Koenigs, 6001 Research Park Boulevard, Madison, WI 53719
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16
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Gu D, Ou S, Liu G. Traumatic Brain Injury and Risk of Dementia and Alzheimer's Disease: A Systematic Review and Meta-Analysis. Neuroepidemiology 2021; 56:4-16. [PMID: 34818648 DOI: 10.1159/000520966] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/14/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Previous studies have investigated the potential role of traumatic brain injury (TBI) in subsequent development of dementia and Alzheimer's disease (AD) but reported inconsistent results. We aim to determine the association between TBI and subsequent occurrence of dementia and AD. METHODS We performed a systematic search in PubMed and Web of Science for studies that quantitatively investigated the association between TBI and risk of dementia and AD and were published on or before September 21, 2021. A random-effect model was used to combine the estimates. RESULTS Twenty-five eligible articles were included in this meta-analysis. The results suggested that TBI was associated with an increased risk of dementia (pooled odds ratio [OR] = 1.81, 95% confidence interval [CI] = 1.53 - 2.14). However, no association was observed between TBI and Alzheimer's disease (pooled OR = 1.02, 95% CI = 0.91 - 1.15). In the subgroup analysis, TBI with loss of consciousness was not associated with risk of dementia (pooled OR = 0.96, 95% CI = 0.84 - 1.09). Besides, Asian ethnicity, male gender, and mean age of the participants less than 65 were associated with a higher risk of dementia. CONCLUSION Our study suggests an increased risk of dementia among individuals with TBI, highlighting the need for more intensive medical monitoring and health education in individuals with TBI. Biological mechanisms linking TBI and the development of dementia are needed in future studies.
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Affiliation(s)
- Dongqing Gu
- Department of Epidemiology and Biostatistics, First Affiliated Hospital, Army Medical University, Chongqing, China,
| | - Shan Ou
- Department of Anesthesiology, First People's Hospital of Chengdu, Chengdu, China
| | - Guodong Liu
- The Eighth Department, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
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17
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Stopa BM, Tahir Z, Mezzalira E, Boaro A, Khawaja A, Grashow R, Zafonte RD, Smith TR, Gormley WB, Izzy S. The Impact of Age and Severity on Dementia After Traumatic Brain Injury: A Comparison Study. Neurosurgery 2021; 89:810-818. [PMID: 34392366 DOI: 10.1093/neuros/nyab297] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/07/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Growing evidence associates traumatic brain injury (TBI) with increased risk of dementia, but few studies have evaluated associations in patients younger than 55 yr using non-TBI orthopedic trauma (NTOT) patients as controls to investigate the influence of age and TBI severity, and to identify predictors of dementia after trauma. OBJECTIVE To investigate the relationship between TBI and dementia in an institutional group. METHODS Retrospective cohort study (2000-2018) of TBI patients aged 45 to 100 yr vs NTOT controls. Primary outcome was dementia after TBI (followed ≤10 yr). Cox proportional hazards models were used to assess risk of dementia; logistic regression models assessed predictors of dementia. RESULTS Among 24 846 patients, TBI patients developed dementia (7.5% vs 4.6%) at a younger age (78.6 vs 82.7 yr) and demonstrated higher 10-yr mortality than controls (27% vs 14%; P < .001). Mild TBI patients had higher incidence of dementia (9%) than moderate/severe TBI (5.4%), with lower 10-yr mortality (20% vs 31%; P < .001). Risk of dementia was significant in all mild TBI age groups, even 45 to 54 yr (hazard ratio 4.1, 95% CI 2.7-7.8). A total of 10-yr cumulative incidence was higher in mild TBI (14.4%) than moderate/severe TBI (11.3%) and controls (6.8%) (P < .001). Predictors of dementia include TBI, sex, age, hypertension, hyperlipidemia, stroke, depression, anxiety, and Injury Severity Score. CONCLUSION Mild and moderate/severe TBI patients experienced higher incidence of dementia, even in the youngest group (45-54 yr old), than NTOT controls. All TBI patients, especially middle-aged adults with minor injury who are more likely to be overlooked, should be monitored for dementia.
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Affiliation(s)
- Brittany M Stopa
- Computational Neuroscience Outcomes Center at Harvard, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Zabreen Tahir
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elisabetta Mezzalira
- Computational Neuroscience Outcomes Center at Harvard, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alessandro Boaro
- Computational Neuroscience Outcomes Center at Harvard, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Institute of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, Universiy of Verona, Verona, Italy
| | - Ayaz Khawaja
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Neurology, Wayne State University, Detroit, Michigan, USA
| | - Rachel Grashow
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Football Players Healthy Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Ross D Zafonte
- Football Players Healthy Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Timothy R Smith
- Computational Neuroscience Outcomes Center at Harvard, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - William B Gormley
- Computational Neuroscience Outcomes Center at Harvard, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Saef Izzy
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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18
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Chosy EJ, Gross N, Meyer M, Liu CY, Edland SD, Launer LJ, White LR. Brain Injury and Later-Life Cognitive Impairment and Neuropathology: The Honolulu-Asia Aging Study. J Alzheimers Dis 2021; 73:317-325. [PMID: 31771050 DOI: 10.3233/jad-190053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Findings are inconsistent regarding the role of traumatic head injury in the subsequent development of neurologic outcomes. OBJECTIVE Examine the relationship between head injury and later cognitive impairment. METHODS A sample of 3,123 Japanese-American men was assessed for history of head injury and evaluated for cognitive impairment using the Cognitive Abilities Screening Instrument (CASI). For a subsample of 676 respondents, neuropathologic results from those with and without head injury were compared. RESULTS Although the crude model showed an association between history of head injury and later severe cognitive impairment, the relationship lost significance in the adjusted model (OR = 1.320, CI: 0.90-1.93), regardless of time between injury and impairment. Similar to cognitive impairment, hippocampal sclerosis was observed significantly more in the brains of respondents with a history of head injury in the crude model, but the relationship weakened in the adjusted model (OR = 1.462, CI: 0.68-3.12). After adjustment, decedents with a head injury demonstrated marginally higher brain weight (OR = 1.003, CI: 1.00-1.01). CONCLUSION We did not find a relationship between head injury and subsequent cognitive decline in this cohort. The neuropathology results also displayed no strong association between history of head injury and specific brain lesions and characteristics. These results support other findings in prospective cohorts. However, they could be influenced by the demographic make-up of the sample (male Japanese-Americans) or by the observation that the majority reported only a single head injury.
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Affiliation(s)
- E Julia Chosy
- Pacific Health Research and Education Institute, Honolulu, HI, USA
| | - Noele Gross
- Pacific Health Research and Education Institute, Honolulu, HI, USA
| | - Marnie Meyer
- Pacific Health Research and Education Institute, Honolulu, HI, USA
| | - Catherine Y Liu
- Pacific Health Research and Education Institute, Honolulu, HI, USA
| | | | - Lenore J Launer
- National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Lon R White
- Pacific Health Research and Education Institute, Honolulu, HI, USA
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19
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Bray MJC, Richey LN, Bryant BR, Krieg A, Jahed S, Tobolowsky W, LoBue C, Peters ME. Traumatic brain injury alters neuropsychiatric symptomatology in all-cause dementia. Alzheimers Dement 2021; 17:686-691. [PMID: 33470043 DOI: 10.1002/alz.12225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Traumatic brain injury (TBI) may alter the course of neuropsychiatric symptom (NPS) onset during dementia development. The connection among TBI, NPS, and dementia progression is of increasing interest to researchers and clinicians. METHODS Incidence of NPS was examined in participants with normal cognition who progressed to all-cause dementia based on whether TBI history was present (n = 130) or absent (n = 849). Survival analyses were used to examine NPS incidence across 7.6 ± 3.0 years of follow-up. RESULTS Participants with TBI history had increased prevalence and incidence of apathy (44.7% vs 29.9%, P = .0062; HRadj. = 1.708, P = .0018) and motor disturbances (17.2% vs 9.5%, P = .0458; HRadj. = 2.023, P = .0168), controlling for demographics and type of dementia diagnosis. Earlier anxiety onset was associated with TBI (692 days prior to dementia diagnosis vs 161 days, P = .0265). DISCUSSION History of TBI is associated with increased risk for and earlier onset of NPS in the trajectory of dementia development.
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Affiliation(s)
- Michael J C Bray
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lisa N Richey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Barry R Bryant
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Akshay Krieg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sahar Jahed
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - William Tobolowsky
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christian LoBue
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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20
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Krivanek TJ, Gale SA, McFeeley BM, Nicastri CM, Daffner KR. Promoting Successful Cognitive Aging: A Ten-Year Update. J Alzheimers Dis 2021; 81:871-920. [PMID: 33935078 PMCID: PMC8293659 DOI: 10.3233/jad-201462] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
A decade has passed since we published a comprehensive review in this journal addressing the topic of promoting successful cognitive aging, making this a good time to take stock of the field. Because there have been limited large-scale, randomized controlled trials, especially following individuals from middle age to late life, some experts have questioned whether recommendations can be legitimately offered about reducing the risk of cognitive decline and dementia. Despite uncertainties, clinicians often need to at least make provisional recommendations to patients based on the highest quality data available. Converging lines of evidence from epidemiological/cohort studies, animal/basic science studies, human proof-of-concept studies, and human intervention studies can provide guidance, highlighting strategies for enhancing cognitive reserve and preventing loss of cognitive capacity. Many of the suggestions made in 2010 have been supported by additional research. Importantly, there is a growing consensus among major health organizations about recommendations to mitigate cognitive decline and promote healthy cognitive aging. Regular physical activity and treatment of cardiovascular risk factors have been supported by all of these organizations. Most organizations have also embraced cognitively stimulating activities, a heart-healthy diet, smoking cessation, and countering metabolic syndrome. Other behaviors like regular social engagement, limiting alcohol use, stress management, getting adequate sleep, avoiding anticholinergic medications, addressing sensory deficits, and protecting the brain against physical and toxic damage also have been endorsed, although less consistently. In this update, we review the evidence for each of these recommendations and offer practical advice about behavior-change techniques to help patients adopt brain-healthy behaviors.
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Affiliation(s)
- Taylor J. Krivanek
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Seth A. Gale
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Brittany M. McFeeley
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Casey M. Nicastri
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Kirk R. Daffner
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
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21
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Huang V, Hogan DB, Ismail Z, Maxwell CJ, Smith EE, Callahan BL. Evaluating the Real-World Representativeness of Participants with Mild Cognitive Impairment in Canadian Research Protocols: a Comparison of the Characteristics of a Memory Clinic Patients and Research Samples. Can Geriatr J 2020; 23:297-328. [PMID: 33282050 PMCID: PMC7704078 DOI: 10.5770/cgj.23.416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Studies of mild cognitive impairment (MCI) employ rigorous eligibility criteria, resulting in sampling that may not be representative of the broader clinical population. Objective To compare the characteristics of MCI patients in a Calgary memory clinic to those of MCI participants in published Canadian studies. Methods Clinic participants included 555 MCI patients from the PROspective Registry of Persons with Memory SyMPToms (PROMPT) registry in Calgary. Research participants included 4,981 individuals with MCI pooled from a systematic literature review of 112 original, English-language peer-reviewed Canadian studies. Both samples were compared on baseline sociodemographic variables, medical and psychiatric comorbidities, and cognitive performance for MCI due to Alzheimer’s disease and Parkinson’s disease. Results Overall, clinic patients tended to be younger, more often male, and more educated than research participants. Psychiatric disorders, traumatic brain injury, and sensory impairment were commonplace in PROMPT (up to 83% affected) but > 80% studies in the systematic review excluded these conditions. PROMPT patients also performed worse on global cognition measures than did research participants. Conclusion Stringent eligibility criteria in Canadian research studies excluded a considerable subset of MCI patients with comorbid medical or psychiatric conditions. This exclusion may contribute to differences in cognitive performance and outcomes compared to real-world clinical samples.
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Affiliation(s)
- Vivian Huang
- Department of Psychology, Ryerson University, Toronto, ON
| | - David B Hogan
- Cumming School of Medicine, University of Calgary, Calgary, AB.,Hotchkiss Brain Institute, Calgary, AB
| | - Zahinoor Ismail
- Cumming School of Medicine, University of Calgary, Calgary, AB.,Hotchkiss Brain Institute, Calgary, AB.,Mathison Centre for Mental Health Research & Education, Calgary, AB.,Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Colleen J Maxwell
- Hotchkiss Brain Institute, Calgary, AB.,Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, ON
| | - Eric E Smith
- Cumming School of Medicine, University of Calgary, Calgary, AB.,Hotchkiss Brain Institute, Calgary, AB
| | - Brandy L Callahan
- Hotchkiss Brain Institute, Calgary, AB.,Mathison Centre for Mental Health Research & Education, Calgary, AB.,Department of Psychology, University of Calgary, Calgary, AB
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22
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Age-Related Changes in the Association Between Traumatic Brain Injury and Dementia in Older Men and Women. J Head Trauma Rehabil 2020; 36:E139-E146. [PMID: 33201033 DOI: 10.1097/htr.0000000000000624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate age-related changes in the association between traumatic brain injury (TBI) and dementia in older men and women separately. SETTING A total of 243 general practices in the UK. PARTICIPANTS This study included 4760 patients who received a first TBI diagnosis between 1995 and 2010 (index date), and 4760 patients without TBI who were matched to those with TBI by age, sex, index year, Charlson Comorbidity Index, alcohol dependence, and physician (index date: a randomly selected visit date). DESIGN Retrospective cohort study. MAIN MEASURES Incidence of dementia in the decade following index date. RESULTS Within 10 years of index date, 8.8% of men with TBI and 4.8% of those without TBI were diagnosed with dementia, while the respective figures were 9.0% and 6.7% in women (P values < .01). There was a significant association between TBI and dementia in men (hazard ratio [HR] = 2.29, 95% confidence interval [CI]: 1.64-3.19) and in women (HR = 1.33, 95% CI: 1.07-1.64). Furthermore, the association between TBI and dementia was significant in men aged 60 to 70 (HR = 2.51, 95% CI: 1.27-4.96) and 71 to 80 years (HR = 3.00, 95% CI: 1.82-4.93), whereas the relationship was only significant and potentially unreliable in women aged 81 to 90 years (HR = 1.49, 95% CI: 1.03-2.14). CONCLUSIONS The age-related relationship between TBI and dementia differed between men and women. More research of a prospective nature and including behavioral data is needed to better understand these differences.
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23
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LoBue C, Munro C, Schaffert J, Didehbani N, Hart J, Batjer H, Cullum CM. Traumatic Brain Injury and Risk of Long-Term Brain Changes, Accumulation of Pathological Markers, and Developing Dementia: A Review. J Alzheimers Dis 2020; 70:629-654. [PMID: 31282414 DOI: 10.3233/jad-190028] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Traumatic brain injuries (TBI) have received widespread media attention in recent years as being a risk factor for the development of dementia and chronic traumatic encephalopathy (CTE). This has sparked fears about the potential long-term effects of TBI of any severity on cognitive aging, leading to a public health concern. This article reviews the evidence surrounding TBI as a risk factor for the later development of changes in brain structure and function, and an increased risk of neurodegenerative disorders. A number of studies have shown evidence of long-term brain changes and accumulation of pathological biomarkers (e.g., amyloid and tau proteins) related to a history of moderate-to-severe TBI, and research has also demonstrated that individuals with moderate-to-severe injuries have an increased risk of dementia. While milder injuries have been found to be associated with an increased risk for dementia in some recent studies, reports on long-term brain changes have been mixed and often are complicated by factors related to injury exposure (i.e., number of injuries) and severity/complications, psychiatric conditions, and opioid use disorder. CTE, although often described as a neurodegenerative disorder, remains a neuropathological condition that is poorly understood. Future research is needed to clarify the significance of CTE pathology and determine whether that can explain any clinical symptoms. Overall, it is clear that most individuals who sustain a TBI (particularly milder injuries) do not experience worse outcomes with aging, as the incidence for dementia is found to be less than 7% across the literature.
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Affiliation(s)
- Christian LoBue
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Catherine Munro
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey Schaffert
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nyaz Didehbani
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John Hart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hunt Batjer
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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24
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Derrig H, Lavrencic LM, Broe GA, Draper B, Cumming RG, Garvey G, Hill TY, Daylight G, Chalkley S, Mack H, Lasschuit D, Delbaere K, Radford K. Mild cognitive impairment in Aboriginal Australians. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12054. [PMID: 32864414 PMCID: PMC7443744 DOI: 10.1002/trc2.12054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/01/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Aboriginal Australians have among the highest rates of dementia worldwide, yet no study has investigated the subtypes, risk factors, or longer term outcomes of mild cognitive impairment (MCI) in this population. METHODS A total of 336 community-dwelling Aboriginal Australians aged ≥60 years participated in a longitudinal study, completing a structured interview at baseline. MCI (amnestic subtype, aMCI; non-amnestic subtype, naMCI) and dementia were diagnosed via cognitive screening, medical assessment, and clinical consensus. Associations between life-course factors and baseline MCI subtypes were examined using logistic regression. Conversion to dementia was assessed at 6-year follow-up. RESULTS Prevalent aMCI (n = 24) was associated with older age (odds ratio [OR] = 1.68, 95% confidence interval [CI]: 1.12 to 2.53), head injury (OR = 3.19, 95% CI: 1.35 to 7.56), symptoms of depression (OR = 1.52, 95% CI: 1.04 to 2.24), and lower blood pressure (OR = 0.53, 95% CI: 0.33 to 0.86). Prevalent naMCI (n = 29) was associated with low education (OR = 4.46, 95% CI: 1.53 to 13.05), unskilled work history (OR = 5.62, 95% CI: 2.07 to 13.90), higher body mass index (OR = 1.99, 95% CI: 1.30 to 3.04), and moderate to severe hearing loss (OR = 2.82, 95% CI: 1.06 to 7.55). A small proportion of MCI cases reverted to intact at follow-up (15%), but most remained stable (44%), developed dementia and/or died (41%). DISCUSSION Sociodemographic and clinical factors both contributed to baseline MCI and were distinct for MCI subtypes, with similar patterns of conversion to dementia for amnestic and non-amnestic MCI.
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Affiliation(s)
- Hannah Derrig
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
| | - Louise M. Lavrencic
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- UNSW Ageing Futures InstituteUniversity of New South WalesSydneyAustralia
- School of Public health and Community MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Gerald A. Broe
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- UNSW Ageing Futures InstituteUniversity of New South WalesSydneyAustralia
- School of Public health and Community MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Brian Draper
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- UNSW Ageing Futures InstituteUniversity of New South WalesSydneyAustralia
- Prince of Wales HospitalRandwickNew South WalesAustralia
| | - Robert G Cumming
- School of Public healthUniversity of SydneySydneyNew South WalesAustralia
| | - Gail Garvey
- Menzies School of Health ResearchBrisbaneQueenslandAustralia
| | - Thi Yen Hill
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Prince of Wales HospitalRandwickNew South WalesAustralia
| | - Gail Daylight
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
| | - Simon Chalkley
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
| | - Holly Mack
- University of Technology SydneySydneyNew South WalesAustralia
| | - Danielle Lasschuit
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- Prince of Wales HospitalRandwickNew South WalesAustralia
| | - Kim Delbaere
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- UNSW Ageing Futures InstituteUniversity of New South WalesSydneyAustralia
- School of Public health and Community MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Kylie Radford
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- UNSW Ageing Futures InstituteUniversity of New South WalesSydneyAustralia
- School of Medical SciencesUniversity of New South WalesSydneyNew South WalesAustralia
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25
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Slavoaca D, Muresanu D, Birle C, Rosu OV, Chirila I, Dobra I, Jemna N, Strilciuc S, Vos P. Biomarkers in traumatic brain injury: new concepts. Neurol Sci 2020; 41:2033-2044. [PMID: 32157587 DOI: 10.1007/s10072-019-04238-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 12/30/2019] [Indexed: 12/21/2022]
Abstract
Traumatic brain injury is a multifaceted condition that encompasses a spectrum of injuries: contusions, axonal injuries in specific brain regions, edema, and hemorrhage. Brain injury determines a broad clinical and disability spectrum due to the implication of various cellular pathways, genetic phenotypes, and environmental factors. It is challenging to predict patient outcomes, to appropriately evaluate the patients, to determine a suitable treatment strategy and rehabilitation program, and to communicate with patient relatives. Biomarkers detected from body fluids are potential evaluation tools for traumatic brain injury patients. These may serve as internal indicators of cerebral damage, delivering valuable information about the dynamic cellular, biochemical, and molecular environments. The diagnostic and prognostic value of biomarkers tested both in animal models of traumatic brain injury is still under question, despite a considerable scientific literature. Recent publications emphasize that a more realistic approach involves combining multiple types of biomarkers with other investigative tools (imaging, outcome scales, and genetic polymorphisms). Additionally, there is increasing interest in the use of biomarkers as tools for treatment monitoring and as surrogate outcome variables to facilitate the design of distinct randomized controlled trials. This review highlights the latest available evidence regarding biomarkers in adults after traumatic brain injury and discusses new approaches in the evaluation of this patient group.
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Affiliation(s)
- Dana Slavoaca
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400486, Cluj-Napoca, Romania
| | - Dafin Muresanu
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400486, Cluj-Napoca, Romania.
| | - Codruta Birle
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400486, Cluj-Napoca, Romania
| | - Olivia Verisezan Rosu
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400486, Cluj-Napoca, Romania
| | - Ioana Chirila
- Neurology Clinic, Cluj Emergency County Hospital, Cluj-Napoca, Romania
| | - Iulia Dobra
- Neurology Clinic, Cluj Emergency County Hospital, Cluj-Napoca, Romania
| | - Nicoleta Jemna
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400486, Cluj-Napoca, Romania
| | - Stefan Strilciuc
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400486, Cluj-Napoca, Romania
| | - Pieter Vos
- Department of Neurology, Slingeland Hospital, Doetinchem, The Netherlands
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26
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Zhao X, Wang L, Ge C, Liu X, Chen M, Zhang C. Effect of Process-Based Multi-Task Cognitive Training Program on Executive Function in Older Adults With Mild Cognitive Impairment: Study Rationale and Protocol Design for a Randomized Controlled Trial. Front Psychiatry 2020; 11:655. [PMID: 32848901 PMCID: PMC7396621 DOI: 10.3389/fpsyt.2020.00655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/24/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Recent research from both human and animal studies confirms that cognitive training gains a considerable effect on multiple cognitive domains in older adults with mild cognitive impairment. Previous studies have yet paid scant attention to executive function training. Little is known about whether this specific benefit translates to maintaining long-term effectiveness and transfer effects are. This study is designed as an effort to address this issue. OBJECTIVE The program aimed to evaluate the effect of process-based multi-task cognitive training on executive function and further explore its long-term effects and transfer effects in older adults with MCI. Furthermore, we will explore the neural correlates latent the changed performances underlying the cognitive intervention. METHODS This program is a single-blinded, randomized, prospective clinical trial to test the effect of process-based multi-task cognitive training in older adults with MCI. Ninety participants with MCI will be recruited and randomly assigned to the cognitive training group (n=45) and the wait-list control group (n=45). The cognitive training group will receive 10 weeks of process-based multi-task cognitive training and health education twice a week, at 40~60 min per session. While the wait-list control group will only receive 10 weeks of health education during the research period. The effect is measured using the executive function, neuropsychological assessment performance and related brain activity assessed with electroencephalogram parameters (slowness and complexity of the EEG) at baseline, after 10 weeks of training, and a 3-month follow-up. RESULTS The study is currently ongoing. Recruitment began in March 2019 and will conclude at the end of 2020. Effects of the process-based multi-task cognitive training on executive function in older adults with MCI will be described in intention-to-treat analysis and protocol set principle. We will also explore the potential long-term effects and transfer effects. DISCUSSION If a process-based multi-task cognitive training program results in positive changes to executive function in older adults with MCI, this might provide a viable and potential approach to delay the cognitive decline. Clinical Trial Registration: ChiCTR1900020585. Registered on January 09, 2019. http://www.chictr.org.cn/showproj.aspx?proj=34664.
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Affiliation(s)
- Xia Zhao
- School of Medicine, Huzhou University, Huzhou Centre Hospital, Huzhou, China
| | - Lina Wang
- School of Medicine, Huzhou University, Huzhou Centre Hospital, Huzhou, China
| | - Chenxi Ge
- School of Medicine, Huzhou University, Huzhou Centre Hospital, Huzhou, China
| | - Xiaoshen Liu
- School of Medicine, Huzhou University, Huzhou Centre Hospital, Huzhou, China
| | - Mei Chen
- Department of Nursing, Huzhou Rehabilitation Hospital, Huzhou, China
| | - Chen Zhang
- Department of General Medicine, Community Health Service Center of Renhuangshan, Huzhou, China
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27
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Pradeep T, Bray MJC, Arun S, Richey LN, Jahed S, Bryant BR, LoBue C, Lyketsos CG, Kim P, Peters ME. History of traumatic brain injury interferes with accurate diagnosis of Alzheimer's dementia: a nation-wide case-control study. Int Rev Psychiatry 2020; 32:61-70. [PMID: 31707905 PMCID: PMC6952566 DOI: 10.1080/09540261.2019.1682529] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/16/2019] [Indexed: 12/14/2022]
Abstract
Traumatic brain injury (TBI) and Alzheimer's disease (AD) bear a complex relationship, potentially increasing risk of one another reciprocally. However, recent evidence suggests post-TBI dementia exists as a distinct neurodegenerative syndrome, confounding AD diagnostic accuracy in clinical settings. This investigation sought to evaluate TBI's impact on the accuracy of clinician-diagnosed AD using gold standard neuropathological criteria. In this preliminary analysis, data were acquired from the National Alzheimer's Coordinating Centre (NACC), which aggregates clinical and neuropathologic information from Alzheimer's disease centres across the United States. Modified National Institute on Aging-Reagan criteria were applied to confirm AD by neuropathology. Among participants with clinician-diagnosed AD, TBI history was associated with misdiagnosis (false positives) (OR = 1.351 [95% CI: 1.091-1.674], p = 0.006). Among participants without clinician-diagnosed AD, TBI history was not associated with false negatives. TBI moderates AD diagnostic accuracy. Possible AD misdiagnosis can mislead patients, influence treatment decisions, and confound research study designs. Further work examining the influence of TBI on dementia diagnosis is warranted.
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Affiliation(s)
- Tejus Pradeep
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Michael J. C. Bray
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Siddharth Arun
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Lisa N. Richey
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Sahar Jahed
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Barry R. Bryant
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Christian LoBue
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Paul Kim
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Matthew E. Peters
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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28
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POINT/COUNTER-POINT—Beyond the headlines: the actual evidence that traumatic brain injury is a risk factor for later-in-life dementia. Arch Clin Neuropsychol 2019; 35:123-127. [DOI: 10.1093/arclin/acz074] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/23/2019] [Accepted: 11/13/2019] [Indexed: 01/07/2023] Open
Abstract
Abstract
Traumatic brain injury (TBI) as a risk factor for developing dementia later in life has been a subject of debate and controversy. TBI has been found to be associated with an increased likelihood for developing dementia 10–30 years later in several retrospective studies using population records. However, understanding the link between TBI and dementia requires looking beyond calculated risk estimates and delving into the association TBI has with pathological changes seen in Alzheimer’s disease and related conditions, as well as those seen in normal aging. Some individuals with TBI, notably those with more serious injuries, show evidence of AD-related pathological changes, such as tau aggregates, at a much earlier age than healthy older individuals without a history of TBI. This would suggest that some people may be more susceptible to the effects of TBI, accumulating additional pathological changes seen in Alzheimer disease and related conditions, which may synergistically and/or cumulatively interact with factors associated with aging. The strongest support to date suggests that TBI may confer an increased risk for earlier onset of neurodegenerative changes in some individuals, possibly as a function of an accumulation of additional pathological changes. While there appears to be a link between TBI and the development of dementia in group studies, the evidence to date does not suggest an association between TBI and progressive cognitive decline during normal aging nor a greater rate of decline in those with dementia. Thus, there remains much to be learned about the pathophysiology of this apparent relationship.
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29
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Katsumoto A, Takeuchi H, Tanaka F. Tau Pathology in Chronic Traumatic Encephalopathy and Alzheimer's Disease: Similarities and Differences. Front Neurol 2019; 10:980. [PMID: 31551922 PMCID: PMC6748163 DOI: 10.3389/fneur.2019.00980] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/28/2019] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) has been associated with the development of Alzheimer's disease (AD) because these conditions share common pathological hallmarks: amyloid-β and hyperphosphorylated tau accumulation. However, given recent data it is uncertain if a history of TBI leads to the development of AD. Moreover, chronic traumatic encephalopathy (CTE), caused by repetitive mild TBI and characterized by progressive neurodegeneration with hyperphosphorylated tau, has come to be recognized as distinct from AD. Therefore, it is important to elucidate the clinical outcomes and molecular mechanisms underlying tau pathology following TBI. We summarize the histopathological features and clinical course of TBI in CTE, comparing the tau pathology with that in AD. Following brain injury, diffuse axonal injury, and hyperphosphorylated tau aggregates are observed within a shorter period than in AD. Hyperphosphorylated tau deposition usually begins in the perivascular area of the sulci in the cerebral cortex, then spreads unevenly in the cortex in CTE, while AD shows diffuse distribution of hyperphosphorylated tau in the cortical areas. We also highlight the molecular profile of tau and the implications of tau progression throughout the brain in both diseases. Tau contains phosphorylation sites common to both conditions. In particular, phosphorylation at Thr231 triggers a conformational change to the toxic cis form of tau, which is suggested to drive neurodegeneration. Although the mechanism of rapid tau accumulation remains unknown, the structural diversity of tau might result in these different outcomes. Finally, future perspectives on CTE in terms of tau reduction are discussed.
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Affiliation(s)
- Atsuko Katsumoto
- Department of Neurology and Stroke Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Hideyuki Takeuchi
- Department of Neurology and Stroke Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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30
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Das M, Tang X, Han JY, Mayilsamy K, Foran E, Biswal MR, Tzekov R, Mohapatra SS, Mohapatra S. CCL20-CCR6 axis modulated traumatic brain injury-induced visual pathologies. J Neuroinflammation 2019; 16:115. [PMID: 31151410 PMCID: PMC6544928 DOI: 10.1186/s12974-019-1499-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 05/06/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a major cause of death and disability in the USA and the world; it constitutes 30% of injury-related deaths (Taylor et al., MMWR Surveill Summ 66:1-16, 2017). Contact sports athletes often experience repetitive TBI (rTBI), which exerts a cumulative effect later in life. Visual impairment is a common after-effect of TBI. Previously, we have shown that C-C chemokine 20 (CCL20) plays a critical role in neurodegeneration and inflammation following TBI (Das et al., J Neuroinflammation 8:148, 2011). C-C chemokine receptor 6 (CCR6) is the only receptor that CCL20 interacts with. The objective of the present study was to investigate the role of CCL20-CCR6 axis in mediating rTBI-induced visual dysfunction (TVD). METHODS Wild type (WT) or CCR6 knock out (CCR6-/-) mice were subjected to closed head rTBI. Pioglitazone (PG) is a peroxisome proliferator-activated receptor γ (PPARγ) agonist which downregulates CCL20 production. Subsets of WT mice were treated with PG following final rTBI. A subset of mice was also treated with anti-CCL20 antibody to neutralize the CCL20 produced after rTBI. Histopathological assessments were performed to show cerebral pathologies, retinal pathologies, and inflammatory changes induced by rTBI. RESULTS rTBI induced cerebral neurodegeneration, retinal degeneration, microgliosis, astrogliosis, and CCL20 expression. CCR6-/- mice showed reduced retinal degeneration, microgliosis, and inflammation. Treatment with CCL20 neutralization antibody or PG showed reduced CCL20 expression along with reduced retinal degeneration and inflammation. rTBI-induced GFAP-positive glial activation in the optic nerve was not affected by knocking out CCR6. CONCLUSION The present data indicate that rTBI-induced retinal pathology is mediated at least in part by CCL20 in a CCR6-dependent manner.
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Affiliation(s)
- Mahasweta Das
- James A. Haley Veterans Hospital, Tampa, FL, USA.,Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Xiaolan Tang
- James A. Haley Veterans Hospital, Tampa, FL, USA.,Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jung Yeon Han
- James A. Haley Veterans Hospital, Tampa, FL, USA.,Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Karthick Mayilsamy
- James A. Haley Veterans Hospital, Tampa, FL, USA.,Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Elspeth Foran
- James A. Haley Veterans Hospital, Tampa, FL, USA.,Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Manas R Biswal
- Graduate Programs at College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Radouil Tzekov
- James A. Haley Veterans Hospital, Tampa, FL, USA.,Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.,Graduate Programs at College of Pharmacy, University of South Florida, Tampa, FL, USA.,Department of Medical Engineering, University of South Florida, Tampa, FL, USA.,The Roskamp Institute, Sarasota, FL, USA
| | - Shyam S Mohapatra
- James A. Haley Veterans Hospital, Tampa, FL, USA.,Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.,Graduate Programs at College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Subhra Mohapatra
- James A. Haley Veterans Hospital, Tampa, FL, USA. .,Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
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Sugarman MA, McKee AC, Stein TD, Tripodis Y, Besser LM, Martin B, Palmisano JN, Steinberg EG, O'Connor MK, Au R, McClean M, Killiany R, Mez J, Weiner MW, Kowall NW, Stern RA, Alosco ML. Failure to detect an association between self-reported traumatic brain injury and Alzheimer's disease neuropathology and dementia. Alzheimers Dement 2019; 15:686-698. [PMID: 30852157 PMCID: PMC6511462 DOI: 10.1016/j.jalz.2018.12.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/26/2018] [Accepted: 12/29/2018] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Recent research with neuropathologic or biomarker evidence of Alzheimer's disease (AD) casts doubt on traumatic brain injury (TBI) as a risk factor for AD. We leveraged the National Alzheimer's Coordinating Center to examine the association between self-reported TBI with loss of consciousness and AD neuropathologic changes, and with baseline and longitudinal clinical status. METHODS The sample included 4761 autopsy participants (453 with remote TBI with loss of consciousness; 2822 with AD neuropathologic changes) from National Alzheimer's Coordinating Center. RESULTS Self-reported TBI did not predict AD neuropathologic changes (P > .10). Reported TBI was not associated with baseline or change in dementia severity or cognitive function in participants with or without autopsy-confirmed AD. DISCUSSION Self-reported TBI with loss of consciousness may not be an independent risk factor for clinical or pathological AD. Research that evaluates number and severity of TBIs is needed to clarify the neuropathological links between TBI and dementia documented in other large clinical databases.
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Affiliation(s)
- Michael A Sugarman
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Edith Nourse Rogers Memorial Veterans Hospital, Department of Neuropsychology, Bedford, MA, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA; VA Boston Healthcare System, Boston, MA, USA; Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA; VA Boston Healthcare System, Boston, MA, USA; Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Lilah M Besser
- National Alzheimer's Coordinating Center, University of Washington, Seattle, WA, USA
| | - Brett Martin
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Joseph N Palmisano
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Eric G Steinberg
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA
| | - Maureen K O'Connor
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Edith Nourse Rogers Memorial Veterans Hospital, Department of Neuropsychology, Bedford, MA, USA
| | - Rhoda Au
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Framingham Heart Study, National Heart, Lung, and Blood Institute, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Michael McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Ronald Killiany
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA; Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA; Center for Biomedical Imaging, Boston University School of Medicine, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Michael W Weiner
- Department of Veteran Affairs Medical Center, Center for Imaging and Neurodegenerative Diseases, San Francisco, CA, USA; Departments of Radiology and Biomedical Imaging, Medicine, Psychiatry, and Neurology, University of California, San Francisco, CA, USA
| | - Neil W Kowall
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA; Neurology Service, VA Boston Healthcare System, Boston, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA; Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA; Department of Neurosurgery, Boston University School of Medicine, Boston, MA, USA
| | - Michael L Alosco
- Boston University Alzheimer's Disease Center and CTE Center, Boston University School of Medicine, Boston, MA, USA; Department of Neurology, Boston University School of Medicine, Boston, MA, USA.
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Eid A, Mhatre I, Richardson JR. Gene-environment interactions in Alzheimer's disease: A potential path to precision medicine. Pharmacol Ther 2019; 199:173-187. [PMID: 30877021 DOI: 10.1016/j.pharmthera.2019.03.005] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/01/2019] [Indexed: 12/19/2022]
Abstract
Alzheimer's disease (AD) is the leading cause of dementia in the United States and afflicts >5.7 million Americans in 2018. Therapeutic options remain extremely limited to those that are symptom targeting, while no drugs have been approved for the modification or reversal of the disease itself. Risk factors for AD including aging, the female sex, as well as carrying an APOE4 genotype. These risk factors have been extensively examined in the literature, while less attention has been paid to modifiable risk factors, including lifestyle, and environmental risk factors such as exposures to air pollution and pesticides. This review highlights the most recent data on risk factors in AD and identifies gene by environment interactions that have been investigated. It also provides a suggested framework for a personalized therapeutic approach to AD, by combining genetic, environmental and lifestyle risk factors. Understanding modifiable risk factors and their interaction with non-modifiable factors (age, susceptibility alleles, and sex) is paramount for designing personalized therapeutic interventions.
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Affiliation(s)
- Aseel Eid
- Department of Environmental Health, Robert Stempel School of Public Health and Social Work, Florida International University, Miami, FL, United States of America
| | - Isha Mhatre
- Department of Environmental Health, Robert Stempel School of Public Health and Social Work, Florida International University, Miami, FL, United States of America; Department of Neurosciences, School of Biomedical Sciences, Kent State University, Kent, OH
| | - Jason R Richardson
- Department of Environmental Health, Robert Stempel School of Public Health and Social Work, Florida International University, Miami, FL, United States of America.
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