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Lalive HM, Griffa A, Carlier S, Nasuti M, Di Noto T, Maréchal B, Rouaud O, Allali G. Amnestic Syndrome in Memory Clinics: Similar Morphological Brain Patterns in Older Adults with and without Alzheimer's Disease. J Alzheimers Dis 2024:JAD240026. [PMID: 38875037 DOI: 10.3233/jad-240026] [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: 06/16/2024]
Abstract
Background Amnestic syndrome of the hippocampal type (ASHT) in Memory Clinics is a presentation common to Alzheimer's disease (AD). However, ASHT can be found in other neurodegenerative disorders. Objective To compare brain morphometry including hippocampal volumes between amnestic older adults with and without AD pathology and investigate their relationship with memory performance and cerebrospinal fluid (CSF) biomarkers. Methods Brain morphometry of 92 consecutive patients (72.5±6.8 years old; 39% female) with Free and Cued Selective Recall Reminding Test (FCSRT) total recall < 40/48 was assessed with an automated algorithm and compared between AD and non-AD patients, as defined by CSF biomarkers. Results AD and non-AD patients presented comparable brain morphology. Total recall was associated to hippocampal volume irrespectively from AD pathology. Conclusions Brain morphometry, including hippocampal volumes, is similar between AD and non-AD older adults with ASHT evaluated in a Memory Clinic, underlying the importance of using molecular biomarkers for the diagnosis of AD.
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Affiliation(s)
- Hadrien M Lalive
- Leenaards Memory Centre, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alessandra Griffa
- Leenaards Memory Centre, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Medical Image Processing Laboratory, Neuro-X Institute, École Polytechnique Fédérale De Lausanne (EPFL), Geneva, Switzerland
| | - Sabrina Carlier
- Leenaards Memory Centre, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mirco Nasuti
- Leenaards Memory Centre, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tommaso Di Noto
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland
- Signal Processing Laboratory (LTS5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Bénédicte Maréchal
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland
- Signal Processing Laboratory (LTS5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Rouaud
- Leenaards Memory Centre, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gilles Allali
- Leenaards Memory Centre, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Pacholko A, Iadecola C. Hypertension, Neurodegeneration, and Cognitive Decline. Hypertension 2024; 81:991-1007. [PMID: 38426329 PMCID: PMC11023809 DOI: 10.1161/hypertensionaha.123.21356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Elevated blood pressure is a well-established risk factor for age-related cognitive decline. Long linked to cognitive impairment on vascular bases, increasing evidence suggests a potential association of hypertension with the neurodegenerative pathology underlying Alzheimer disease. Hypertension is well known to disrupt the structural and functional integrity of the cerebral vasculature. However, the mechanisms by which these alterations lead to brain damage, enhance Alzheimer pathology, and promote cognitive impairment remain to be established. Furthermore, critical questions concerning whether lowering blood pressure by antihypertensive medications prevents cognitive impairment have not been answered. Recent developments in neurovascular biology, brain imaging, and epidemiology, as well as new clinical trials, have provided insights into these critical issues. In particular, clinical and basic findings on the link between neurovascular dysfunction and the pathobiology of neurodegeneration have shed new light on the overlap between vascular and Alzheimer pathology. In this review, we will examine the progress made in the relationship between hypertension and cognitive impairment and, after a critical evaluation of the evidence, attempt to identify remaining knowledge gaps and future research directions that may advance our understanding of one of the leading health challenges of our time.
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Affiliation(s)
- Anthony Pacholko
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY
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3
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Toribio-Fernandez R, Ceron C, Tristão-Pereira C, Fernandez-Nueda I, Perez-Castillo A, Fernandez-Ferro J, Moro MA, Ibañez B, Fuster V, Cortes-Canteli M. Oral anticoagulants: A plausible new treatment for Alzheimer's disease? Br J Pharmacol 2024; 181:760-776. [PMID: 36633908 DOI: 10.1111/bph.16032] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023] Open
Abstract
Alzheimer's disease (AD) and cardiovascular disease (CVD) are strongly associated. Both are multifactorial disorders with long asymptomatic phases and similar risk factors. Indeed, CVD signatures such as cerebral microbleeds, micro-infarcts, atherosclerosis, cerebral amyloid angiopathy and a procoagulant state are highly associated with AD. However, AD and CVD co-development and the molecular mechanisms underlying such associations are not understood. Here, we review the evidence regarding the vascular component of AD and clinical studies using anticoagulants that specifically evaluated the development of AD and other dementias. Most studies reported a markedly decreased incidence of composite dementia in anticoagulated patients with atrial fibrillation, with the highest benefit for direct oral anticoagulants. However, sub-analyses by differential dementia diagnosis were scarce and inconclusive. We finally discuss whether anticoagulation could be a plausible preventive/therapeutic approach for AD and, if so, which would be the best drug and strategy to maximize clinical benefit and minimize potential risks. LINKED ARTICLES: This article is part of a themed issue From Alzheimer's Disease to Vascular Dementia: Different Roads Leading to Cognitive Decline. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v181.6/issuetoc.
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Affiliation(s)
- Raquel Toribio-Fernandez
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Carlos Ceron
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | | | - Irene Fernandez-Nueda
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Ana Perez-Castillo
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Instituto de Investigaciones Biomédicas "Alberto Sols" (CSIC-UAM), Madrid, Spain
| | - Jose Fernandez-Ferro
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- Stroke Unit, Neurology Service, Hospital Universitario Rey Juan Carlos (HURJC), Madrid, Spain
| | - Maria Angeles Moro
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Borja Ibañez
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- CIBER de enfermedades cardiovasculares (CIBERCV), ISCIII, Madrid, Spain
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marta Cortes-Canteli
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Huang J, Cheng R, Liu X, Chen L, Luo T. Unraveling the link: white matter damage, gray matter atrophy and memory impairment in patients with subcortical ischemic vascular disease. Front Neurosci 2024; 18:1355207. [PMID: 38362024 PMCID: PMC10867202 DOI: 10.3389/fnins.2024.1355207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/17/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Prior MRI studies have shown that patients with subcortical ischemic vascular disease (SIVD) exhibited white matter damage, gray matter atrophy and memory impairment, but the specific characteristics and interrelationships of these abnormal changes have not been fully elucidated. Materials and methods We collected the MRI data and memory scores from 29 SIVD patients with cognitive impairment (SIVD-CI), 29 SIVD patients with cognitive unimpaired (SIVD-CU) and 32 normal controls (NC). Subsequently, the thicknesses and volumes of the gray matter regions that are closely related to memory function were automatically assessed using FreeSurfer software. Then, the volume, fractional anisotropy (FA), mean diffusivity (MD), amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) values of white matter hyperintensity (WMH) region and normal-appearing white matter (NAWM) were obtained using SPM, DPARSF, and FSL software. Finally, the analysis of covariance, spearman correlation and mediation analysis were used to analyze data. Results Compared with NC group, patients in SIVD-CI and SIVD-CU groups showed significantly abnormal volume, FA, MD, ALFF, and ReHo values of WMH region and NAWM, as well as significantly decreased volume and thickness values of gray matter regions, mainly including thalamus, middle temporal gyrus and hippocampal subfields such as cornu ammonis (CA) 1. These abnormal changes were significantly correlated with decreased visual, auditory and working memory scores. Compared with the SIVD-CU group, the significant reductions of the left CA2/3, right amygdala, right parasubiculum and NAWM volumes and the significant increases of the MD values in the WMH region and NAWM were found in the SIVD-CI group. And the increased MD values were significantly related to working memory scores. Moreover, the decreased CA1 and thalamus volumes mediated the correlations between the abnormal microstructure indicators in WMH region and the decreased memory scores in the SIVD-CI group. Conclusion Patients with SIVD had structural and functional damages in both WMH and NAWM, along with specific gray matter atrophy, which were closely related to memory impairment, especially CA1 atrophy and thalamic atrophy. More importantly, the volumes of some temporomesial regions and the MD values of WMH regions and NAWM may be potentially helpful neuroimaging indicators for distinguishing between SIVD-CI and SIVD-CU patients.
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Affiliation(s)
- Jing Huang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Runtian Cheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoshuang Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Chen
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Tianyou Luo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Zúñiga Salazar G, Zúñiga D, Balasubramanian S, Mehmood KT, Al-Baldawi S. The Relation Between Arterial Hypertension and Cognitive Impairment: A Literature Review. Cureus 2024; 16:e52782. [PMID: 38389623 PMCID: PMC10882260 DOI: 10.7759/cureus.52782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
The global increase in dementia cases, driven by improved life expectancy and reduced elderly mortality rates, presents a significant public health challenge. Dementia, characterized by a gradual and irreversible decline in cognitive abilities, affects individuals aged 65 and older, disrupting lives and straining healthcare systems. Hypertension significantly influences dementia development. Research consistently links midlife hypertension to cognitive decline, mild cognitive impairment (MCI), and dementia, but findings in older adults vary. While some studies suggest that late-life hypertension accelerates cognitive decline and dementia risk, others propose a protective effect. The impact of hypertension on cognition varies across age groups, spanning from childhood to late life. High blood pressure during midlife and earlier life stages consistently predicts poorer cognitive outcomes. Executive function, attention, and motor speed are the cognitive domains most affected by hypertension, particularly in subcortical diseases. Memory impairments in hypertension-related dementias are complex, often overlapping with other causes. Understanding the inconsistent findings in older adults regarding hypertension, cognitive decline, and dementia risk requires comprehensive exploration of methodological and biological factors. Addressing hypertension and its management may hold the key to reducing the risk of cognitive decline and dementia, especially in midlife and earlier life stages.
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Affiliation(s)
| | - Diego Zúñiga
- Medicine, Universidad Católica de Santiago de Guayaquil, Guayaquil, ECU
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van Gils V, Ramakers I, Jansen WJ, Banning L, Kučikienė D, Costa AS, Schulz JB, Visser PJ, Verhey F, Reetz K, Vos SJ. Contributions of Vascular Burden and Amyloid Abnormality to Cognitive Decline in Memory Clinic Patients. J Alzheimers Dis Rep 2023; 7:1299-1311. [PMID: 38143773 PMCID: PMC10742024 DOI: 10.3233/adr-230040] [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: 05/22/2023] [Accepted: 11/01/2023] [Indexed: 12/26/2023] Open
Abstract
Background Alzheimer's disease pathology and vascular burden are highly prevalent and often co-occur in elderly. It remains unclear how both relate to cognitive decline. Objective To investigate whether amyloid abnormality and vascular burden synergistically contribute to cognitive decline in a memory clinic population. Methods We included 227 patients from Maastricht and Aachen memory clinics. Amyloid abnormality (A+) was defined by CSF Aβ42 using data-driven cut-offs. Vascular burden (V+) was defined as having moderate to severe white matter hyperintensities, or any microbleeds, macrohemorrhage or infarcts on MRI. Longitudinal change in global cognition, memory, processing speed, executive functioning, and verbal fluency was analysed across the A-V-, A-V+, A+V-, A+V+ groups by linear mixed models. Additionally, individual MRI measures, vascular risk and vascular disease were used as V definitions. Results At baseline, the A+V+ group scored worse on global cognition and verbal fluency compared to all other groups, and showed worse memory compared to A-V+ and A-V- groups. Over time (mean 2.7+ - 1.5 years), A+V+ and A+V- groups showed faster global cognition decline than A-V+ and A-V- groups. Only the A+V- group showed decline on memory and verbal fluency. The A-V+ group did not differ from the A-V- group. Individual MRI vascular measures only indicated an independent association of microbleeds with executive functioning decline. Findings were similar using other V definitions. Conclusions Our study demonstrates that amyloid abnormality predicts cognitive decline independent from vascular burden in a memory clinic population. Vascular burden shows a minor contribution to cognitive decline in these patients. This has important prognostic implications.
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Affiliation(s)
- Veerle van Gils
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Inez Ramakers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
- Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
| | - Willemijn J. Jansen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Leonie Banning
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Domantė Kučikienė
- Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
| | - Ana Sofia Costa
- Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
- JARA Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich and RWTH Aachen University, Aachen, Germany
| | - Jörg B. Schulz
- Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
- JARA Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich and RWTH Aachen University, Aachen, Germany
| | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Kathrin Reetz
- Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
- JARA Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich and RWTH Aachen University, Aachen, Germany
| | - Stephanie J.B. Vos
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
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Xiong C, McCue LM, Buckles V, Grant E, Agboola F, Coble D, Bateman RJ, Fagan AM, Benzinger TL, Hassenstab J, Schindler SE, McDade E, Moulder K, Gordon BA, Cruchaga C, Day GS, Ikeuchi T, Suzuki K, Allegri RF, Vöglein J, Levin J, Morris JC. Cross-sectional and longitudinal comparisons of biomarkers and cognition among asymptomatic middle-aged individuals with a parental history of either autosomal dominant or late-onset Alzheimer's disease. Alzheimers Dement 2023; 19:2923-2932. [PMID: 36640138 PMCID: PMC10345163 DOI: 10.1002/alz.12912] [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: 05/05/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Comparisons of late-onset Alzheimer's disease (LOAD) and autosomal dominant AD (ADAD) are confounded by age. METHODS We compared biomarkers from cerebrospinal fluid (CSF), magnetic resonance imaging, and amyloid imaging with Pittsburgh Compound-B (PiB) across four groups of 387 cognitively normal participants, 42 to 65 years of age, in the Dominantly Inherited Alzheimer Network (DIAN) and the Adult Children Study (ACS) of LOAD: DIAN mutation carriers (MCs) and non-carriers (NON-MCs), and ACS participants with a positive (FH+) and negative (FH-) family history of LOAD. RESULTS At baseline, MCs had the lowest age-adjusted level of CSF Aβ42 and the highest levels of total and phosphorylated tau-181, and PiB uptake. Longitudinally, MC had similar increase in PiB uptake to FH+, but drastically faster decline in hippocampal volume than others, and was the only group showing cognitive decline. DISCUSSION Preclinical ADAD and LOAD share many biomarker signatures, but cross-sectional and longitudinal differences may exist.
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Affiliation(s)
- Chengjie Xiong
- Knight Alzheimer Disease Research Center, Washington University, St. Louis, Missouri, USA
- The Dominantly Inherited Alzheimer Network, Washington University, St. Louis, Missouri, USA
- Department of Neurology, Washington University, St. Louis, Missouri, USA
- Division of Biostatistics, Washington University, St. Louis, Missouri, USA
| | - Lena M. McCue
- Division of Biostatistics, Washington University, St. Louis, Missouri, USA
| | - Virginia Buckles
- Knight Alzheimer Disease Research Center, Washington University, St. Louis, Missouri, USA
- The Dominantly Inherited Alzheimer Network, Washington University, St. Louis, Missouri, USA
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Elizabeth Grant
- Division of Biostatistics, Washington University, St. Louis, Missouri, USA
| | - Folasade Agboola
- Division of Biostatistics, Washington University, St. Louis, Missouri, USA
| | - Dean Coble
- Division of Biostatistics, Washington University, St. Louis, Missouri, USA
| | - Randall J. Bateman
- Knight Alzheimer Disease Research Center, Washington University, St. Louis, Missouri, USA
- The Dominantly Inherited Alzheimer Network, Washington University, St. Louis, Missouri, USA
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Anne M Fagan
- Knight Alzheimer Disease Research Center, Washington University, St. Louis, Missouri, USA
- The Dominantly Inherited Alzheimer Network, Washington University, St. Louis, Missouri, USA
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Tammie L.S. Benzinger
- Knight Alzheimer Disease Research Center, Washington University, St. Louis, Missouri, USA
- The Dominantly Inherited Alzheimer Network, Washington University, St. Louis, Missouri, USA
- Department of Radiology, Washington University, St. Louis, Missouri, USA
- Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA
| | - Jason Hassenstab
- Knight Alzheimer Disease Research Center, Washington University, St. Louis, Missouri, USA
- The Dominantly Inherited Alzheimer Network, Washington University, St. Louis, Missouri, USA
- Department of Neurology, Washington University, St. Louis, Missouri, USA
- Department of Psychology, Washington University, St. Louis, Missouri, USA
| | - Suzanne E. Schindler
- Knight Alzheimer Disease Research Center, Washington University, St. Louis, Missouri, USA
- The Dominantly Inherited Alzheimer Network, Washington University, St. Louis, Missouri, USA
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Eric McDade
- Knight Alzheimer Disease Research Center, Washington University, St. Louis, Missouri, USA
- The Dominantly Inherited Alzheimer Network, Washington University, St. Louis, Missouri, USA
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Krista Moulder
- Knight Alzheimer Disease Research Center, Washington University, St. Louis, Missouri, USA
- The Dominantly Inherited Alzheimer Network, Washington University, St. Louis, Missouri, USA
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Brian A. Gordon
- Knight Alzheimer Disease Research Center, Washington University, St. Louis, Missouri, USA
- The Dominantly Inherited Alzheimer Network, Washington University, St. Louis, Missouri, USA
- Department of Psychology, Washington University, St. Louis, Missouri, USA
- Department of Radiology, Washington University, St. Louis, Missouri, USA
| | - Carlos Cruchaga
- Knight Alzheimer Disease Research Center, Washington University, St. Louis, Missouri, USA
- Department of Psychiatry, Washington University, St. Louis, Missouri, USA
| | - Gregory S. Day
- Department of Neurology, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Niigata, JAPAN
| | | | | | - Jonathan Vöglein
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - John C. Morris
- Knight Alzheimer Disease Research Center, Washington University, St. Louis, Missouri, USA
- The Dominantly Inherited Alzheimer Network, Washington University, St. Louis, Missouri, USA
- Department of Neurology, Washington University, St. Louis, Missouri, USA
- Department of Pathology and Immunology, Washington University, St. Louis, Missouri, USA
- Department of Physical Therapy, Washington University, St. Louis, Missouri, USA
- Department of Occupational Therapy, Washington University, St. Louis, Missouri, USA
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Tan KP, Ang JK, Koh EBY, Pang NTP, Mat Saher Z. Relationship of Psychological Flexibility and Mindfulness to Caregiver Burden, and Depressive and Anxiety Symptoms in Caregivers of People with Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4232. [PMID: 36901243 PMCID: PMC10002240 DOI: 10.3390/ijerph20054232] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
Caregivers of People with dementia (PwD) commonly experience burdens and other mental health issues, e.g., depression and anxiety. At present, there are limited studies that examine the relationships between caregiver psychological factors and caregiver burden, and depressive and anxiety symptoms. Therefore, this study's objectives were to examine the relationships between psychological flexibility and mindfulness in caregivers of PwD, and to determine the predictors of these three outcomes. This was a cross-sectional study conducted in the geriatric psychiatry clinic of Kuala Lumpur Hospital, Malaysia, and the sample (n = 82) was recruited via a universal sampling method over three months. The participants completed a questionnaire that consisted of the sociodemographics of the PwD and caregivers, illness characteristics of the PwD, Acceptance and Action Questionnaire-II (AAQ-II), Mindful Attention Awareness Scale (MAAS), Zarit Burden Interview Scale (ZBI), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). The results show that despite significant relationships between psychological flexibility and mindfulness and lower levels of caregiver burden, and depressive and anxiety symptoms (p < 0.01), only psychological inflexibility (p < 0.01) remained as a significant predictor of the three outcomes. Therefore, in conclusion, intervention programs that target the awareness of the caregiver's psychological inflexibility should be implemented to alleviate these adverse outcomes in dementia caregivers.
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Affiliation(s)
- Khai Pin Tan
- Department of Psychiatry and Mental Health, Hospital Tengku Ampuan Afzan, Kuantan 25100, Pahang, Malaysia
| | - Jin Kiat Ang
- Department of Psychiatry, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Eugene Boon Yau Koh
- Department of Psychiatry, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Nicholas Tze Ping Pang
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Sabah, Malaysia
| | - Zanariah Mat Saher
- Department of Psychiatry and Mental Health, Kuala Lumpur General Hospital, Kuala Lumpur 50586, Federal Territory of Kuala Lumpur, Malaysia
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Reiländer A, Pilatus U, Schüre JR, Shrestha M, Deichmann R, Nöth U, Hattingen E, Gracien RM, Wagner M, Seiler A. Impaired oxygen extraction and adaptation of intracellular energy metabolism in cerebral small vessel disease. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 4:100162. [PMID: 36851996 PMCID: PMC9957754 DOI: 10.1016/j.cccb.2023.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/25/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND We aimed to investigate whether combined phosphorous (31P) magnetic resonance spectroscopic imaging (MRSI) and quantitative T 2 ' mapping are able to detect alterations of the cerebral oxygen extraction fraction (OEF) and intracellular pH (pHi) as markers the of cellular energy metabolism in cerebral small vessel disease (SVD). MATERIALS AND METHODS 32 patients with SVD and 17 age-matched healthy control subjects were examined with 3-dimensional 31P MRSI and oxygenation-sensitive quantitative T 2 ' mapping (1/ T 2 ' = 1/T2* - 1/T2) at 3 Tesla (T). PHi was measured within the white matter hyperintensities (WMH) in SVD patients. Quantitative T 2 ' values were averaged across the entire white matter (WM). Furthermore, T 2 ' values were extracted from normal-appearing WM (NAWM) and the WMH and compared between patients and controls. RESULTS Quantitative T 2 ' values were significantly increased across the entire WM and in the NAWM in patients compared to control subjects (149.51 ± 16.94 vs. 138.19 ± 12.66 ms and 147.45 ± 18.14 vs. 137.99 ± 12.19 ms, p < 0.05). WM T 2 ' values correlated significantly with the WMH load (ρ=0.441, p = 0.006). Increased T 2 ' was significantly associated with more alkaline pHi (ρ=0.299, p < 0.05). Both T 2 ' and pHi were significantly positively correlated with vascular pulsatility in the distal carotid arteries (ρ=0.596, p = 0.001 and ρ=0.452, p = 0.016). CONCLUSIONS This exploratory study found evidence of impaired cerebral OEF in SVD, which is associated with intracellular alkalosis as an adaptive mechanism. The employed techniques provide new insights into the pathophysiology of SVD with regard to disease-related consequences on the cellular metabolic state.
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Key Words
- BBB, blood-brain barrier
- CBF, cerebral blood flow
- CBV, cerebral blood volume
- CMRO2, Cerebral metabolic rate of oxygen
- Cellular energy metabolism
- DTI, diffusion tensor imaging
- GE, gradient echo
- Hb, hemoglobin
- ICA, internal carotid artery
- MR spectroscopy
- MRI, magnetic resonance imaging
- MRS, magnetic resonance spectroscopy
- MRSI, magnetic resonance spectroscopic imaging
- Microstructural impairment
- NAWM, normal-appearing white matter
- OEF, oxygen extraction fraction
- Oxygen extraction fraction
- PI, Pulsatility index
- RF, radio frequency
- SVD, cerebral small vessel disease
- Small vessel disease
- TR, repetition time
- WM, white matter
- WMH, white matter hyperintensities
- pHi, intracellular pH
- quantitative MRI
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Affiliation(s)
- Annemarie Reiländer
- Department of Neurology, Goethe University Hospital Frankfurt, Schleusenweg 2-16, Frankfurt 60528, Germany
- Brain Imaging Center, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Ulrich Pilatus
- Institute of Neuroradiology, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Jan-Rüdiger Schüre
- Institute of Neuroradiology, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Manoj Shrestha
- Brain Imaging Center, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Ulrike Nöth
- Brain Imaging Center, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Elke Hattingen
- Institute of Neuroradiology, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - René-Maxime Gracien
- Department of Neurology, Goethe University Hospital Frankfurt, Schleusenweg 2-16, Frankfurt 60528, Germany
- Brain Imaging Center, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Marlies Wagner
- Brain Imaging Center, Goethe University Hospital Frankfurt, Frankfurt Germany
- Institute of Neuroradiology, Goethe University Hospital Frankfurt, Frankfurt Germany
| | - Alexander Seiler
- Department of Neurology, Goethe University Hospital Frankfurt, Schleusenweg 2-16, Frankfurt 60528, Germany
- Brain Imaging Center, Goethe University Hospital Frankfurt, Frankfurt Germany
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10
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Beneath the Top of the Iceberg: Financial Capacity Deficits in Mixed Dementia with and without Depression. Healthcare (Basel) 2023; 11:healthcare11040505. [PMID: 36833039 PMCID: PMC9956589 DOI: 10.3390/healthcare11040505] [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: 12/24/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Nowadays, controversy exists regarding the influence of comorbid depression on cognition in old age. Additionally, we still know little about the influence of depression in mixed dementia (MD), that is, in cases where there is the co-existence of Alzheimer's disease and vascular dementia (VaD). Given that the assessment of financial capacity is pivotal for independent living as well as in the prevention of financial exploitation and abuse in old age, in this pilot study, we aimed to examine whether comorbid depression in MD patients can influence financial capacity performance. A total of 115 participants were recruited. They were divided into four groups: MD patients with and without depressive symptoms and healthy elderly without depression as well as older adults suffering from depression. Participants were examined with a number of neuropsychological tests, including the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), and Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). The results of this study suggested that financial capacity as measured with LCPLTAS in MD patients was severely impaired when depression co-existed compared to patients suffering only from depression and healthy controls. Deficits in financial capacity in MD and comorbid depression should be a point on which healthcare professionals should focus during neuropsychological assessment in order to prevent financial exploitation.
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11
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Pérez Palmer N, Trejo Ortega B, Joshi P. Cognitive Impairment in Older Adults: Epidemiology, Diagnosis, and Treatment. Psychiatr Clin North Am 2022; 45:639-661. [PMID: 36396270 DOI: 10.1016/j.psc.2022.07.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cognitive impairment and dementia affect dozens of millions of people worldwide and cause significant distress to patients and caregivers and a financial burden to families and health care systems. Careful history-taking, cognitive and physical examination, and supplemental neuroimaging and fluid-based biomarkers can accurately diagnose neurocognitive disorders. Management includes non-pharmacological and pharmacological treatments tailored to the etiology and to the individual.
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Affiliation(s)
- Nicolás Pérez Palmer
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, USA.
| | - Barbara Trejo Ortega
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, USA
| | - Pallavi Joshi
- Banner Alzheimer's Institute, 901 East Willeta Street, Phoenix, AZ 85006, USA; Department of Psychiatry, University of Arizona College of Medicine-Phoenix, 475 North 5th, Phoenix, AZ 85004, USA
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12
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Chino B, Cuesta P, Pacios J, de Frutos-Lucas J, Torres-Simón L, Doval S, Marcos A, Bruña R, Maestú F. Episodic memory dysfunction and hypersynchrony in brain functional networks in cognitively intact subjects and MCI: a study of 379 individuals. GeroScience 2022; 45:477-489. [PMID: 36109436 PMCID: PMC9886758 DOI: 10.1007/s11357-022-00656-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/01/2022] [Indexed: 02/03/2023] Open
Abstract
Delayed recall (DR) impairment is one of the most significant predictive factors in defining the progression to Alzheimer's disease (AD). Changes in brain functional connectivity (FC) could accompany this decline in the DR performance even in a resting state condition from the preclinical stages to the diagnosis of AD itself, so the characterization of the relationship between the two phenomena has attracted increasing interest. Another aspect to contemplate is the potential moderator role of the APOE genotype in this association, considering the evidence about their implication for the disease. 379 subjects (118 mild cognitive impairment (MCI) and 261 cognitively intact (CI) individuals) underwent an extensive evaluation, including MEG recording. Applying cluster-based permutation test, we identified a cluster of differences in FC and studied which connections drove such an effect in DR. The moderation effect of APOE genotype between FC results and delayed recall was evaluated too. Higher FC in beta band in the right occipital region is associated with lower DR scores in both groups. A significant anteroposterior link emerged in the seed-based analysis with higher values in MCI. Moreover, APOE genotype appeared as a moderator between beta FC and DR performance only in the CI group. An increased beta FC in the anteroposterior brain region appears to be associated with lower memory performance in MCI. This finding could help discriminate the pattern of the progression of healthy aging to MCI and the relation between resting state and memory performance.
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Affiliation(s)
- Brenda Chino
- Institute of Neuroscience, Autonomous University of Barcelona, Barcelona, Spain. .,Center for Cognitive and Computational Neuroscience, Complutense University of Madrid, Madrid, Spain.
| | - Pablo Cuesta
- Center for Cognitive and Computational Neuroscience, Complutense University of Madrid, Madrid, Spain ,Department of Radiology, Rehabilitation, and Physiotherapy, Complutense University of Madrid, Madrid, Spain ,Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Javier Pacios
- Center for Cognitive and Computational Neuroscience, Complutense University of Madrid, Madrid, Spain ,Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain ,Department of Experimental Psychology, Complutense University of Madrid, Madrid, Spain
| | - Jaisalmer de Frutos-Lucas
- Center for Cognitive and Computational Neuroscience, Complutense University of Madrid, Madrid, Spain ,Department of Experimental Psychology, Complutense University of Madrid, Madrid, Spain ,Centre for Precision Health, Edith Cowan University, Joondalup, WA 6027 Australia ,Centro de Investigación Nebrija en Cognición (CINC), Universidad de Nebrija, Madrid, Spain
| | - Lucía Torres-Simón
- Center for Cognitive and Computational Neuroscience, Complutense University of Madrid, Madrid, Spain ,Department of Experimental Psychology, Complutense University of Madrid, Madrid, Spain
| | - Sandra Doval
- Center for Cognitive and Computational Neuroscience, Complutense University of Madrid, Madrid, Spain ,Department of Experimental Psychology, Complutense University of Madrid, Madrid, Spain
| | - Alberto Marcos
- Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain ,Neurology Department, Hospital Clinico San Carlos, Madrid, Spain
| | - Ricardo Bruña
- Center for Cognitive and Computational Neuroscience, Complutense University of Madrid, Madrid, Spain ,Department of Radiology, Rehabilitation, and Physiotherapy, Complutense University of Madrid, Madrid, Spain ,Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Fernando Maestú
- Center for Cognitive and Computational Neuroscience, Complutense University of Madrid, Madrid, Spain ,Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain ,Department of Experimental Psychology, Complutense University of Madrid, Madrid, Spain
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13
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Smirnov DS, Salmon DP, Galasko D, Edland SD, Pizzo DP, Goodwill V, Hiniker A. TDP-43 Pathology Exacerbates Cognitive Decline in Primary Age-Related Tauopathy. Ann Neurol 2022; 92:425-438. [PMID: 35696592 PMCID: PMC9391297 DOI: 10.1002/ana.26438] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Primary age-related tauopathy (PART) refers to tau neurofibrillary tangles restricted largely to the medial temporal lobe in the absence of significant beta-amyloid plaques. PART has been associated with cognitive impairment, but contributions from concomitant limbic age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) are underappreciated. METHODS We compare prevalence of LATE-NC and vascular copathologies in age- and Braak-matched patients with PART (n = 45, Braak stage I-IV, Thal phase 0-2) or early stage Alzheimer disease neuropathologic change (ADNC; n = 51, Braak I-IV, Thal 3-5), and examine their influence on clinical and cognitive decline. RESULTS Concomitant LATE-NC and vascular pathology were equally common, and cognition was equally impaired, in PART (Mini-Mental State Examination [MMSE] = 24.8 ± 6.9) and ADNC (MMSE = 24.2 ± 6.0). Patients with LATE-NC were more impaired than those without LATE-NC on the MMSE (by 5.8 points, 95% confidence interval [CI] = 3.0-8.6), Mattis Dementia Rating Scale (DRS; 17.5 points, 95% CI = 7.1-27.9), Clinical Dementia Rating, sum of boxes scale (CDR-sob; 5.2 points, 95% CI = 2.1-8.2), memory composite (0.8 standard deviations [SD], 95% CI = 0.1-1.6), and language composite (1.1 SD, 95% CI = 0.2-2.0), and more likely to receive a dementia diagnosis (odds ratio = 4.8, 95% CI = 1.5-18.0). Those with vascular pathology performed worse than those without on the DRS (by 10.2 points, 95% CI = 0.1-20.3) and executive composite (1.3 SD, 95% CI = 0.3-2.3). Cognition declined similarly in PART and ADNC over the 5 years preceding death; however, LATE-NC was associated with more rapid decline on the MMSE (β = 1.9, 95% CI = 0.9-3.0), DRS (β = 7.8, 95% CI = 3.4-12.7), CDR-sob (β = 1.9, 95% CI = 0.4-3.7), language composite (β = 0.5 SD, 95% CI = 0.1-0.8), and vascular pathology with more rapid decline on the DRS (β = 5.2, 95% CI = 0.6-10.2). INTERPRETATION LATE-NC, and to a lesser extent vascular copathology, exacerbate cognitive impairment and decline in PART and early stage ADNC. ANN NEUROL 2022;92:425-438.
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Affiliation(s)
- Denis S. Smirnov
- Department of Neurosciences, University of California, San Diego
| | - David P. Salmon
- Department of Neurosciences, University of California, San Diego
| | - Douglas Galasko
- Department of Neurosciences, University of California, San Diego
- Veterans Affairs San Diego Healthcare System
| | - Steven D. Edland
- Department of Neurosciences, University of California, San Diego
- School of Public Health, University of California, San Diego
| | - Donald P. Pizzo
- Department of Pathology, University of California, San Diego
| | | | - Annie Hiniker
- Department of Pathology, University of California, San Diego
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14
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Liampas I, Hatzimanolis A, Siokas V, Yannakoulia M, Kosmidis MH, Sakka P, Hadjigeorgiou GM, Scarmeas N, Dardiotis E. Antihypertensive Medication Class and the Risk of Dementia and Cognitive Decline in Older Adults: A Secondary Analysis of the Prospective HELIAD Cohort. J Alzheimers Dis 2022; 89:709-719. [PMID: 35912747 DOI: 10.3233/jad-220439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND It is unclear whether the main antihypertensive medication classes (diuretics, calcium channel blockers, beta-blockers, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers (ARBs)) are associated with different risks of cognitive decline. Published evidence is conflicting and stems mainly from observational studies. OBJECTIVE To investigate the differential effects of antihypertensives on the risks of developing dementia and cognitive decline, with a specific focus on the vascular component of the mechanisms underlying these interactions. METHODS Older adults with a history of hypertension and without dementia were drawn from the population-based HELIAD cohort. Age-, gender-, education-, and antihypertensive medication- (five dichotomous exposures) adjusted Cox proportional-hazards models and generalized estimating equations were performed to appraise the associations of baseline antihypertensive therapy with dementia incidence and cognitive decline (quantified using a comprehensive neuropsychological battery). Analyses were subsequently adjusted for clinical vascular risk (dyslipidemia, diabetes mellitus, smoking, cardiovascular, and cerebrovascular history) and genetic susceptibility to stroke (using polygenic risk scores generated according to the MEGASTROKE consortium GWAS findings). RESULTS A total of 776 predominantly female participants (73.61±4.94 years) with hypertension and a mean follow-up of 3.02±0.82 years were analyzed. Baseline treatment was not associated with the risk of incident dementia. ARB users experienced a slower yearly global cognitive [2.5% of a SD, 95% CI = (0.1, 4.9)] and language [4.4% of a SD, 95% CI = (1.4, 7.4)] decline compared to non-users. The fully adjusted model reproduced similar associations for both global cognitive [β= 0.027, 95% CI = (-0.003, 0.057)], and language decline [β= 0.063, 95% CI = (0.023, 0.104)]. CONCLUSION ARBs may be superior to other antihypertensive agents in the preservation of cognition, an association probably mediated by vascular-independent mechanisms.
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Affiliation(s)
- Ioannis Liampas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Alex Hatzimanolis
- Department of Psychiatry, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Vasileios Siokas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paraskevi Sakka
- Athens Association of Alzheimer's Disease and Related Disorders, Marousi, Athens, Greece
| | - Georgios M Hadjigeorgiou
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece.,Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.,Taub Institute for Research in Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY, USA
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
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15
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Zhang Y, Song S, Li H, Wang X, Song L, Xue J. Polysaccharide from Ganoderma lucidum alleviates cognitive impairment in a mouse model of chronic cerebral hypoperfusion by regulating CD4 +CD25 +Foxp3 + regulatory T cells. Food Funct 2022; 13:1941-1952. [PMID: 35088782 DOI: 10.1039/d1fo03698j] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Ganoderma lucidum (G. lucidum) is a kind of edible and medicinal mushroom. G. lucidum polysaccharide-1 (GLP-1) is one of the polysaccharides purified from crude GLP. Chronic cerebral hypoperfusion (CCH) as the common pathological basis of various forms of dementia is an important cause of cognitive impairment. In this study, a step-down test was used to evaluate the cognitive ability of CCH mice. Flow cytometry was used to detect the proportion of CD4+CD25+Foxp3+ regulatory T (Foxp3+Treg) cells. ELISA analysis and western blot analysis were used to detect the transforming growth factor-β1 (TGF-β1) and Interleukin-10 (IL-10) levels that Foxp3+Treg cells secreted. Metabolomic analysis based on gas chromatography-mass spectrometry (GC-MS) was used to evaluate the effect of GLP-1 on dysfunctional metabolism caused by inflammation. Results indicate that GLP-1 exhibited an alleviating cognitive impairment effect on CCH mice. The mechanism was related to GLP-1 by increasing Foxp3+Treg cell levels to increase levels of IL-10 and TGF-β1 and regulate abnormal energy metabolism. These findings could provide preliminary results to exploit G. lucidum as a health care product or functional food for the adjuvant therapy of cognitive impairment of CCH.
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Affiliation(s)
- Yan Zhang
- School of Chemical and Pharmaceutical Engineering, Jilin Institute of Chemical Technology, Jilin 132022, PR China.
| | - Shuang Song
- Graduate School, Jilin Institute of Chemical Technology, Jilin 132022, PR China
| | - Haitao Li
- Department of Pathology, Traditional Chinese Medicine Academy of Sciences of Jilin Province, Changchun 130021, PR China
| | - Xinyan Wang
- Graduate School, Jilin Institute of Chemical Technology, Jilin 132022, PR China
| | - Lianlian Song
- Department of Pathology, Traditional Chinese Medicine Academy of Sciences of Jilin Province, Changchun 130021, PR China
| | - Jianfei Xue
- School of Chemical and Pharmaceutical Engineering, Jilin Institute of Chemical Technology, Jilin 132022, PR China.
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16
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Duara R, Barker W. Heterogeneity in Alzheimer's Disease Diagnosis and Progression Rates: Implications for Therapeutic Trials. Neurotherapeutics 2022; 19:8-25. [PMID: 35084721 PMCID: PMC9130395 DOI: 10.1007/s13311-022-01185-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 01/03/2023] Open
Abstract
The clinical presentation and the pathological processes underlying Alzheimer's disease (AD) can be very heterogeneous in severity, location, and composition including the amount and distribution of AB deposition and spread of neurofibrillary tangles in different brain regions resulting in atypical clinical patterns and the existence of distinct AD variants. Heterogeneity in AD may be related to demographic factors (such as age, sex, educational and socioeconomic level) and genetic factors, which influence underlying pathology, the cognitive and behavioral phenotype, rate of progression, the occurrence of neuropsychiatric features, and the presence of comorbidities (e.g., vascular disease, neuroinflammation). Heterogeneity is also manifest in the individual resilience to the development of neuropathology (brain reserve) and the ability to compensate for its cognitive and functional impact (cognitive and functional reserve). The variability in specific cognitive profiles and types of functional impairment may be associated with different progression rates, and standard measures assessing progression may not be equivalent for individual cognitive and functional profiles. Other factors, which may govern the presence, rate, and type of progression of AD, include the individuals' general medical health, the presence of specific systemic conditions, and lifestyle factors, including physical exercise, cognitive and social stimulation, amount of leisure activities, environmental stressors, such as toxins and pollution, and the effects of medications used to treat medical and behavioral conditions. These factors that affect progression are important to consider while designing a clinical trial to ensure, as far as possible, well-balanced treatment and control groups.
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Affiliation(s)
- Ranjan Duara
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
- Departments of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Warren Barker
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA.
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17
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Dobrynina L, Gadzhieva Z, Shamtieva K, Kremneva E, Filatov A, Bitsieva E, Mirokova E, Krotenkova M. Predictors and integrative index of severity of cognitive disorders in cerebral microangiopathy. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:52-60. [DOI: 10.17116/jnevro202212204152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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18
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Seshadri S, Caunca MR, Rundek T. Vascular Dementia and Cognitive Impairment. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Jung NY, Shin JH, Kim HJ, Jang H, Moon SH, Kim SJ, Kim Y, Cho SH, Kim KW, Kim JP, Jung YH, Kim ST, Kim EJ, Na DL, Vogel JW, Lee S, Seong JK, Seo SW. Distinctive Mediating Effects of Subcortical Structure Changes on the Relationships Between Amyloid or Vascular Changes and Cognitive Decline. Front Neurol 2021; 12:762251. [PMID: 34950100 PMCID: PMC8688398 DOI: 10.3389/fneur.2021.762251] [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: 08/21/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: We investigated the mediation effects of subcortical volume change in the relationship of amyloid beta (Aβ) and lacune with cognitive function in patients with mild cognitive impairment (MCI). Methods: We prospectively recruited 101 patients with MCI who were followed up with neuropsychological tests, MRI, or Pittsburgh compound B (PiB) PET for 3 years. The mediation effect of subcortical structure on the association of PiB or lacunes with cognitive function was analyzed using mixed effects models. Results: Volume changes in the amygdala and hippocampus partially mediated the effect of PiB changes on memory function (direct effect = -0.168/-0.175, indirect effect = -0.081/-0.077 for amygdala/hippocampus) and completely mediated the effect of PiB changes on clinical dementia rating scale sum of the box (CDR-SOB) (indirect effect = 0.082/0.116 for amygdala/hippocampus). Volume changes in the thalamus completely mediated the effect of lacune on memory, frontal executive functions, and CDR-SOB (indirect effect = -0.037, -0.056, and 0.047, respectively). Conclusions: Our findings provide a better understanding of the distinct role of subcortical structures in the mediation of the relationships of amyloid or vascular changes with a decline in specific cognitive domains.
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Affiliation(s)
- Na-Yeon Jung
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Yangsan, South Korea
| | - Jeong-Hyeon Shin
- School of Biomedical Engineering, Korea University, Seoul, South Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Seung Hwan Moon
- Department of Nuclear Medicine, Samsung Medical Center, Seoul, South Korea
| | - Seung Joo Kim
- Department of Neurology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Yeshin Kim
- Department of Neurology, Kangwon National University College of Medicine, Chuncheon-si, South Korea
| | - Soo Hyun Cho
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Ko Woon Kim
- Department of Neurology, Chonbuk National University Medical School and Hospital, Jeonju, South Korea
| | - Jun Pyo Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Young Hee Jung
- Department of Neurology, Myongji Hospital, College of Medicine, Hanyang University, Goyang, South Korea
| | - Sung Tae Kim
- Department of Radiology, Samsung Medical Center, Seoul, South Korea
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine, Pusan, South Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Jacob W Vogel
- Montreal Neurological Institute, McGill University, Montrèal, QC, Canada
| | - Sangjin Lee
- Graduate School, Department of Statistics, Pusan National University, Busan, South Korea
| | - Joon-Kyung Seong
- School of Biomedical Engineering, Korea University, Seoul, South Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Neuroscience Center, Samsung Medical Center, Seoul, South Korea
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Association between Self-Reported Pain, Cognition, and Neuropathology in Older Adults Admitted to an Outpatient Memory Clinic-A Cross-Sectional Study. Brain Sci 2021; 11:brainsci11091156. [PMID: 34573177 PMCID: PMC8465123 DOI: 10.3390/brainsci11091156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/19/2021] [Accepted: 08/27/2021] [Indexed: 12/14/2022] Open
Abstract
Cognitive impairment has been linked to reduced self-reporting of pain. However, it is unclear whether the various cognitive functions are similarly and/or independently associated with such pain report measures. In the present study, we explored how executive functioning (EF), memory, and global cognition relate to self-reported pain and investigated whether underlying neuropathology partially accounts for these results. We used Lasso categorical regression to analyze data from 179 individuals visiting a memory clinic. The data included the self-reported pain occurrence, intensity, severity and frequency, clinical diagnoses, neuropsychological scores, white matter hyperintensities, medial temporal lobe atrophy, depressive symptoms, and demographics. Our results showed that worse memory and EF performance predicted a lower pain occurrence. In those individuals who did report pain, worse memory predicted lower pain intensity, severity, and frequency levels, but for EF reversed effects were found, with worse EF predicting higher pain scores. These relationships were only partially explained by reductions in white matter and medial temporal lobe integrity. Similar effects were found for depressive symptoms. Our findings highlight the distinct associations of EF and memory with self-reported pain. A similar pattern of relationships found for both self-reported pain and depressive symptoms may reflect shared latent affective components.
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21
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Ellis RJ, Paolillo E, Saloner R, Heaton RK. Higher comorbidity burden predicts worsening neurocognitive trajectories in people with HIV. Clin Infect Dis 2021; 74:1323-1328. [PMID: 34329400 DOI: 10.1093/cid/ciab655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Age-related comorbidities accumulate faster in people with HIV (PWH) than in those without (PWoH). We evaluated whether a validated multimorbidity scale, the Charlson Index, predicted neurocognitive trajectories in PWH. METHODS Scaled scores a comprehensive neuropsychological battery were averaged across all visits. Multilevel modeling examined between- and within-person predictors of global neurocognition. At the between-person level, averaged Charlson scores were examined as a predictor of neurocognitive change rate, covarying for HIV disease characteristics. Within-persons, visit-specific Charlson Index was used to predict fluctuations in global neurocognition at the same and next visit, covarying for disease measures. RESULTS Participants were 1195 PWH (mean baseline age 43·0; SD 9·7 years) followed for a mean of 7·1 years (range 0·5-20·5). At the between-person level, more rapid neurocognitive worsening correlated with higher (worse) average Charlson scores (standardized β -0·062, SE 0·015; p=0·001) and lower CD4 nadir (standardized β 0·055, SE 0·021; p=0·011), but not viral suppression or average CD4+ lymphocytes (ps > 0·05). At the within-person level, poorer visit-specific neurocognition was related to worse concurrent, but not preceding, Charlson scores (standardized β-0·046, SE 0·015; p = 0·003), detectable HIV viral load (standardized β0·018, SE 0·006; p = 0·001) and higher CD4+ (standardized β0·043, SE 0·009; p < 0·001). CONCLUSION The impact of comorbidities on neurocognitive decline exceeded that of HIV disease factors. Although correlative, the temporal relationships suggested that treatment of comorbidities might improve neurocognitive prognosis for PWH.
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Affiliation(s)
- Ronald J Ellis
- Department of Neurosciences, University of California, San Diego, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Emily Paolillo
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Rowan Saloner
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
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22
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Vecchio F, Miraglia F, Alú F, Orticoni A, Judica E, Cotelli M, Rossini PM. Contribution of Graph Theory Applied to EEG Data Analysis for Alzheimer's Disease Versus Vascular Dementia Diagnosis. J Alzheimers Dis 2021; 82:871-879. [PMID: 34092648 DOI: 10.3233/jad-210394] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Most common progressive brain diseases in the elderly are Alzheimer's disease (AD) and vascular dementia (VaD). They present with relatively similar clinical symptoms of cognitive decline, but the underlying pathophysiological mechanisms are different. OBJECTIVE The aim is to explore the brain connectivity differences between AD and VaD patients compared to mild cognitive impairment (MCI) and normal elderly (Nold) subjects applying graph theory, in particular the Small World (SW) analysis. METHODS 274 resting state EEGs were analyzed in 100 AD, 80 MCI, 40 VaD, and 54 Nold subjects. Graph theory analyses were applied to undirected and weighted networks obtained by lagged linear coherence evaluated by eLORETA tool. RESULTS VaD and AD patients presented more ordered low frequency structure (lower value of SW) than Nold and MCI subjects, and more random organization (higher value of SW) in low and high frequency alpha rhythms. Differences between patients have been found in high frequency alpha rhythms in VaD (higher value of SW) with respect to AD, and in theta band with a trend which is more similar to MCI and Nold than to AD. MCI subjects presented a network organization which is intermediate, in low frequency bands, between Nold and patients. CONCLUSION Graph theory applied to EEG data has proved very useful in identifying differences in brain network patterns in subjects with dementia, proving to be a valid tool for differential diagnosis. Future studies will aim to validate this method to diagnose especially in the early stages of the disease and at single subject level.
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Affiliation(s)
- Fabrizio Vecchio
- Brain Connectivity Laboratory, Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele Roma, Rome, Italy
| | - Francesca Miraglia
- Brain Connectivity Laboratory, Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele Roma, Rome, Italy
| | - Francesca Alú
- Brain Connectivity Laboratory, Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele Roma, Rome, Italy
| | - Alessandro Orticoni
- Brain Connectivity Laboratory, Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele Roma, Rome, Italy
| | - Elda Judica
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico, Milano, Italy
| | - Maria Cotelli
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Paolo Maria Rossini
- Brain Connectivity Laboratory, Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele Roma, Rome, Italy
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23
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Feng M, Zhang Y, Liu Y, Wu Z, Song Z, Ma M, Wang Y, Dai H. White Matter Structural Network Analysis to Differentiate Alzheimer's Disease and Subcortical Ischemic Vascular Dementia. Front Aging Neurosci 2021; 13:650377. [PMID: 33867969 PMCID: PMC8044349 DOI: 10.3389/fnagi.2021.650377] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/25/2021] [Indexed: 12/16/2022] Open
Abstract
To explore the evaluation of white matter structural network analysis in the differentiation of Alzheimer’s disease (AD) and subcortical ischemic vascular dementia (SIVD), 67 participants [31 AD patients, 19 SIVD patients, and 19 normal control (NC)] were enrolled in this study. Each participant underwent 3.0T MRI scanning. Diffusion tensor imaging (DTI) data were analyzed by graph theory (GRETNA toolbox). Statistical analyses of global parameters [gamma, sigma, lambda, global shortest path length (Lp), global efficiency (Eg), and local efficiency (Eloc)] and nodal parameters [betweenness centrality (BC)] were obtained. Network-based statistical analysis (NBS) was employed to analyze the group differences of structural connections. The diagnosis efficiency of nodal BC in identifying different types of dementia was assessed by receiver operating characteristic (ROC) analysis. There were no significant differences of gender and years of education among the groups. There were no significant differences of sigma and gamma in AD vs. NC and SIVD vs. NC, whereas the Eg values of AD and SIVD were statistically decreased, and the lambda values were increased. The BC of the frontal cortex, left superior parietal gyrus, and left precuneus in AD patients were obviously reduced, while the BC of the prefrontal and subcortical regions were decreased in SIVD patients, compared with NC. SIVD patients had decreased structural connections in the frontal, prefrontal, and subcortical regions, while AD patients had decreased structural connections in the temporal and occipital regions and increased structural connections in the frontal and prefrontal regions. The highest area under curve (AUC) of BC was 0.946 in the right putamen for AD vs. SIVD. White matter structural network analysis may be a potential and promising method, and the topological changes of the network, especially the BC change in the right putamen, were valuable in differentiating AD and SIVD patients.
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Affiliation(s)
- Mengmeng Feng
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou City, China
| | - Yue Zhang
- Department of Geratology, The First Affiliated Hospital of Soochow University, Suzhou City, China
| | - Yuanqing Liu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou City, China
| | - Zhiwei Wu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou City, China
| | - Ziyang Song
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou City, China
| | - Mengya Ma
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou City, China
| | - Yueju Wang
- Department of Geratology, The First Affiliated Hospital of Soochow University, Suzhou City, China
| | - Hui Dai
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou City, China.,Institute of Medical Imaging, Soochow University, Suzhou City, China
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24
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Ouk M, Wu CY, Rabin JS, Jackson A, Edwards JD, Ramirez J, Masellis M, Swartz RH, Herrmann N, Lanctôt KL, Black SE, Swardfager W. The use of angiotensin-converting enzyme inhibitors vs. angiotensin receptor blockers and cognitive decline in Alzheimer's disease: the importance of blood-brain barrier penetration and APOE ε4 carrier status. ALZHEIMERS RESEARCH & THERAPY 2021; 13:43. [PMID: 33573702 PMCID: PMC7876820 DOI: 10.1186/s13195-021-00778-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022]
Abstract
Background The antihypertensive angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACE-Is) have similar indications and mechanisms of action, but prior work suggests divergence in their effects on cognition. Methods Participants in the National Alzheimer’s Coordinating Center database with a clinical diagnosis of dementia due to Alzheimer’s disease (AD) using an ACE-I or an ARB at any visit were selected. The primary outcome was delayed recall memory on the Wechsler Memory Scale Revised – Logical Memory IIA. Other cognitive domains were explored, including attention and psychomotor processing speed (Trail Making Test [TMT]-A and Digit Symbol Substitution Test [DSST]), executive function (TMT-B), and language and semantic verbal fluency (Animal Naming, Vegetable Naming, and Boston Naming Tests). Random slopes mixed-effects models with inverse probability of treatment weighting were used, yielding rate ratios (RR) or regression coefficients (B), as appropriate to the distribution of the data. Apolipoprotein (APOE) ε4 status and blood-brain barrier (BBB) penetrance were investigated as effect modifiers. Results Among 1689 participants with AD, ARB use (n = 578) was associated with 9.4% slower decline in delayed recall performance over a mean follow-up of 2.28 years compared with ACE-I use (n = 1111) [RR = 1.094, p = 0.0327]; specifically, users of BBB-crossing ARBs (RR = 1.25, p = 0.002), BBB-crossing ACE-Is (RR = 1.16, p = 0.010), and non-BBB-crossing ARBs (RR = 1.20, p = 0.005) had better delayed recall performance over time compared with non-BBB-crossing ACE-I users. An interaction with APOE ε4 status (drug × APOE × time RR = 1.196, p = 0.033) emerged; ARBs were associated with better delayed recall scores over time than ACE-Is in non-carriers (RR = 1.200, p = 0.003), but not in carriers (RR = 1.003, p = 0.957). ARB use was also associated with better performance over time on the TMT-A (B = 2.023 s, p = 0.0004) and the DSST (B = 0.573 symbols, p = 0.0485), and these differences were significant among APOE ε4 non-carriers (B = 4.066 s, p = 0.0004; and B = 0.982 symbols, p = 0.0230; respectively). Some differences were seen also in language and verbal fluency among APOE ε4 non-carriers. Conclusions Among APOE ε4 non-carriers with AD, ARB use was associated with greater preservation of memory and attention/psychomotor processing speed, particularly compared to ACE-Is that do not cross the blood-brain-barrier. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-021-00778-8.
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Affiliation(s)
- Michael Ouk
- Department of Pharmacology & Toxicology Room 4207, University of Toronto, Medical Sciences Building 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Che-Yuan Wu
- Department of Pharmacology & Toxicology Room 4207, University of Toronto, Medical Sciences Building 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Jennifer S Rabin
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, M4N 3M5, Canada.,Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Aaron Jackson
- Department of Pharmacology & Toxicology Room 4207, University of Toronto, Medical Sciences Building 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Jodi D Edwards
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,ICES, Ottawa, ON, Canada
| | - Joel Ramirez
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Canadian Partnership for Stroke Recovery, Toronto, ON, Canada
| | - Mario Masellis
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Richard H Swartz
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Canadian Partnership for Stroke Recovery, Toronto, ON, Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Krista L Lanctôt
- Department of Pharmacology & Toxicology Room 4207, University of Toronto, Medical Sciences Building 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,KITE UHN Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Canadian Partnership for Stroke Recovery, Toronto, ON, Canada.,KITE UHN Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Walter Swardfager
- Department of Pharmacology & Toxicology Room 4207, University of Toronto, Medical Sciences Building 1 King's College Circle, Toronto, ON, M5S 1A8, Canada. .,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada. .,Canadian Partnership for Stroke Recovery, Toronto, ON, Canada. .,KITE UHN Toronto Rehabilitation Institute, Toronto, ON, Canada.
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25
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Tu MC, Huang SM, Hsu YH, Yang JJ, Lin CY, Kuo LW. Discriminating subcortical ischemic vascular disease and Alzheimer's disease by diffusion kurtosis imaging in segregated thalamic regions. Hum Brain Mapp 2021; 42:2018-2031. [PMID: 33416206 PMCID: PMC8046043 DOI: 10.1002/hbm.25342] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/02/2020] [Accepted: 12/29/2020] [Indexed: 12/14/2022] Open
Abstract
Differentiating between subcortical ischemic vascular disease (SIVD), Alzheimer's disease (AD), and normal cognition (NC) remains a challenge, and reliable neuroimaging biomarkers are needed. The current study, therefore, investigated the discriminative ability of diffusion kurtosis imaging (DKI) metrics in segregated thalamic regions and compare with diffusion tensor imaging (DTI) metrics. Twenty‐three SIVD patients, 30 AD patients, and 24 NC participants underwent brain magnetic resonance imaging. The DKI metrics including mean kurtosis (MK), axial kurtosis (Kaxial) and radial kurtosis (Kradial) and the DTI metrics including diffusivity and fractional anisotropy (FA) were measured within the whole thalamus and segregated thalamic subregions. Strategic correlations by group, thalamo‐frontal connectivity, and canonical discriminant analysis (CDA) were used to demonstrate the discriminative ability of DKI for SIVD, AD, and NC. Whole and segregated thalamus analysis suggested that DKI metrics are less affected by white matter hyperintensities compared to DTI metrics. Segregated thalamic analysis showed that MK and Kradial were notably different between SIVD and AD/NC. The correlation analysis between Kaxial and MK showed a nonsignificant relationship in SIVD group, a trend of negative relationship in AD group, and a significant positive relationship in NC group. A wider spatial distribution of thalamo‐frontal connectivity differences across groups was shown by MK compared to FA. CDA showed a discriminant power of 97.4% correct classification using all DKI metrics. Our findings support that DKI metrics could be more sensitive than DTI metrics to reflect microstructural changes within the gray matter, hence providing complementary information for currently outlined pathogenesis of SIVD and AD.
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Affiliation(s)
- Min-Chien Tu
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.,Department of Neurology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Sheng-Min Huang
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Miaoli, Taiwan
| | - Yen-Hsuan Hsu
- Department of Psychology, National Chung Cheng University, Chiayi, Taiwan.,Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, Chiayi, Taiwan
| | - Jir-Jei Yang
- Department of Radiology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | | | - Li-Wei Kuo
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Miaoli, Taiwan.,Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
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26
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Yang D, Masurkar AV. Clinical Profiles of Arteriolosclerosis and Alzheimer Disease at Mild Cognitive Impairment and Mild Dementia in a National Neuropathology Cohort. Alzheimer Dis Assoc Disord 2021; 35:14-22. [PMID: 32925200 PMCID: PMC7904566 DOI: 10.1097/wad.0000000000000411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/21/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to evaluate early clinical differences between cerebral arteriolosclerosis (pARTE), Alzheimer disease (pAD), and AD with arteriolosclerosis (ADARTE). METHODS Using National Alzheimer's Coordinating Center neuropathology diagnoses, we defined pARTE (n=21), pAD (n=203), and ADARTE (n=158) groups. We compared demographics, medical history, psychometrics, neuropsychiatric symptoms, and apolipoprotein E (APOE) allele variants across neuropathology groups. Retrospective timepoints were first evaluation with Global Clinical Dementia Rating (CDR) score of 0.5 and 1.0, via the CDR Dementia Staging Instrument, corresponding to mild cognitive impairment (MCI) and mild dementia, respectively. RESULTS In MCI, clinical differences were minimal but pARTE subjects were older, had later onset cognitive decline, and progressed less severely than pAD. In mild dementia, pAD subjects were younger and had earlier onset of decline. Neuropsychiatric (depression) and psychometric (Logical Memory Delayed Recall, Trails B) differences also emerged between the groups. In MCI, APOE4 associated with worse Logical Memory Delayed Recall in pAD and ADARTE. In mild dementia, APOE4 associated with better animal fluency in pAD, but with better Trails A performance and more neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire) in ADARTE. CONCLUSIONS Differences between pARTE, pAD, and ADARTE emerge at mild dementia rather than MCI. APOE4 has varied cognitive and psychiatric impact dependent on neuropathology group and stage.
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Affiliation(s)
| | - Arjun V Masurkar
- Department of Neurology, New York University School of Medicine, Center for Cognitive Neurology, New York, NY
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27
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Dridan BA, Ong B, Lloyd S, Evans L, Crowe SF. The Simple Copy Task: Detecting Higher Order Visual Processing Deficits in Schizophrenia, Dementia, and Movement Disorder Groups. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/j.1742-9544.2012.00067.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Ben Ong
- School of Psychology, La Trobe University
| | - Susan Lloyd
- Psychology Department, John Lindell Rehabilitation Unit
| | - Loretta Evans
- Psychology Department, John Lindell Rehabilitation Unit
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28
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Dobrynina LA, Gadzhieva ZS, Shamtieva KV, Kremneva EI, Akhmetzyanov BM, Kalashnikova LA, Krotenkova MV. Microstructural Predictors of Cognitive Impairment in Cerebral Small Vessel Disease and the Conditions of Their Formation. Diagnostics (Basel) 2020; 10:diagnostics10090720. [PMID: 32961692 PMCID: PMC7554972 DOI: 10.3390/diagnostics10090720] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/08/2020] [Accepted: 09/17/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction: Cerebral small vessel disease (CSVD) is the leading cause of vascular and mixed degenerative cognitive impairment (CI). The variability in the rate of progression of CSVD justifies the search for sensitive predictors of CI. Materials: A total of 74 patients (48 women, average age 60.6 ± 6.9 years) with CSVD and CI of varying severity were examined using 3T MRI. The results of diffusion tensor imaging with a region of interest (ROI) analysis were used to construct a predictive model of CI using binary logistic regression, while phase-contrast magnetic resonance imaging and voxel-based morphometry were used to clarify the conditions for the formation of CI predictors. Results: According to the constructed model, the predictors of CI are axial diffusivity (AD) of the posterior frontal periventricular normal-appearing white matter (pvNAWM), right middle cingulum bundle (CB), and mid-posterior corpus callosum (CC). These predictors showed a significant correlation with the volume of white matter hyperintensity; arterial and venous blood flow, pulsatility index, and aqueduct cerebrospinal fluid (CSF) flow; and surface area of the aqueduct, volume of the lateral ventricles and CSF, and gray matter volume. Conclusion: Disturbances in the AD of pvNAWM, CB, and CC, associated with axonal damage, are a predominant factor in the development of CI in CSVD. The relationship between AD predictors and both blood flow and CSF flow indicates a disturbance in their relationship, while their location near the floor of the lateral ventricle and their link with indicators of internal atrophy, CSF volume, and aqueduct CSF flow suggest the importance of transependymal CSF transudation when these regions are damaged.
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29
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Vinters HV. The 'ACCIDENTAL NEUROPATHOLOGIST'-PERSPECTIVES on 40 years in Neuropathology. FREE NEUROPATHOLOGY 2020; 1. [PMID: 34291231 DOI: 10.17879/freeneuropathology-2020-2956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Harry V Vinters
- Distinguished Professor Emeritus, Depts. of Pathology & Laboratory Medicine & Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA; formerly Chief of Neuropathology, David Geffen School of Medicine at UCLA (1993-2016)
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30
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Bertoux M, Cassagnaud P, Lebouvier T, Lebert F, Sarazin M, Le Ber I, Dubois B, Auriacombe S, Hannequin D, Wallon D, Ceccaldi M, Maurage CA, Deramecourt V, Pasquier F. Does amnesia specifically predict Alzheimer's pathology? A neuropathological study. Neurobiol Aging 2020; 95:123-130. [PMID: 32795849 DOI: 10.1016/j.neurobiolaging.2020.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 12/14/2022]
Abstract
Amnesia is a key component of Alzheimer's disease (AD) and the most important feature of its clinical diagnosis but its specificity has recently been challenged. This study investigated the ability of amnesia to predict AD in a clinicopathological dementia series. Ninety-one patients to which free and cued verbal memory assessment was administered during early cognitive decline, were followed until autopsy. Patients' histological diagnoses were classified as pure AD, mixed AD, and non-AD pathologies. Data-driven automated classification procedures explored the correspondence between memory performance and pathological diagnoses. Classifications revealed 3 clusters of performance reflecting different levels of amnesia. Little correspondence between these clusters and the presence of AD pathology was retrieved. A third of patients with pure/mixed AD pathology were non-amnesic at presentation and ≈45% of patients without AD pathology were amnesic. Data-driven prediction of AD pathology based on memory also had a poor accuracy. Free and cued memory assessments are fair tools to diagnose an amnesic syndrome but lack accuracy to predict AD pathology.
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Affiliation(s)
- Maxime Bertoux
- Univ Lille, Lille Neuroscience & Cognition (Inserm UMRS1172) Degenerative and Vascular Cognitive Disorders, CHU Lille, Laboratory of Excellence Distalz (Development of Innovative Strategies for a Transdisciplinary approach to ALZheimer's disease), Lille, France.
| | - Pascaline Cassagnaud
- Univ Lille, CHU Lille, Laboratory of Excellence Distalz (Development of Innovative Strategies for a Transdisciplinary approach to ALZheimer's disease), Lille, France
| | - Thibaud Lebouvier
- Univ Lille, Lille Neuroscience & Cognition (Inserm UMRS1172) Alzheimer & Tauopathies, CHU Lille, Laboratory of Excellence Distalz (Development of Innovative Strategies for a Transdisciplinary approach to ALZheimer's disease), Lille, France
| | - Florence Lebert
- Univ Lille, Lille Neuroscience & Cognition (Inserm UMRS1172) Degenerative and Vascular Cognitive Disorders, CHU Lille, Laboratory of Excellence Distalz (Development of Innovative Strategies for a Transdisciplinary approach to ALZheimer's disease), Lille, France
| | - Marie Sarazin
- Unit of Neurology of Memory and Language, GHU-Paris Psychiatrie et Neurosciences, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; UMR 1023 IMIV, Service Hospitalier Frédéric Joliot, CEA, Inserm, Université Paris Sud, CNRS, Université Paris-Saclay, Orsay, France
| | - Isabelle Le Ber
- Brain & Spine Institute, UMR 975, Paris, France; Neurology Department, CHU Pitié-Salpêtrière, IM2A, Paris, France
| | - Bruno Dubois
- Brain & Spine Institute, UMR 975, Paris, France; Neurology Department, CHU Pitié-Salpêtrière, IM2A, Paris, France
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- Brain & Spine Institute, UMR 975, Paris, France
| | | | - Didier Hannequin
- Neurology Department, Univ Rouen, CHU Charles Nicolle, Rouen, France
| | - David Wallon
- Neurology Department, Univ Rouen, CHU Charles Nicolle, Rouen, France
| | - Mathieu Ceccaldi
- Neurology and Neuropsychology Department, CHU La Timone, Marseille, France
| | - Claude-Alain Maurage
- Univ Lille, Lille Neuroscience & Cognition (Inserm UMRS1172), Development and Plasticity of the Neuroendocrine Brain, Lille, France; Department of Neuropathology, Univ Lille, CHU Lille, Lille, France
| | - Vincent Deramecourt
- Univ Lille, Lille Neuroscience & Cognition (Inserm UMRS1172) Alzheimer & Tauopathies, CHU Lille, Laboratory of Excellence Distalz (Development of Innovative Strategies for a Transdisciplinary approach to ALZheimer's disease), Lille, France; Department of Neuropathology, Univ Lille, CHU Lille, Lille, France
| | - Florence Pasquier
- Univ Lille, Lille Neuroscience & Cognition (Inserm UMRS1172) Degenerative and Vascular Cognitive Disorders, CHU Lille, Laboratory of Excellence Distalz (Development of Innovative Strategies for a Transdisciplinary approach to ALZheimer's disease), Lille, France
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31
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Clarens MF, Crivelli L, Calandri I, Chrem Méndez P, Martin ME, Russo MJ, Campos J, Surace E, Vázquez S, Sevlever G, Allegri RF. Neuropsychological profile of Alzheimer's disease based on amyloid biomarker findings results from a South American cohort. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:345-350. [PMID: 32349554 DOI: 10.1080/23279095.2020.1756816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: Increased life expectancy and exponential growth of adults suffering from Alzheimer's disease (AD) worldwide, has led to biomarkers incorporation for diagnosis in early stages. Use of neuropsychological testing remains limited. This study aimed to identify which neuropsychological tests best indicated underlying AD pathophysiology.Methods: One hundred and forty-one patients with MCI (Mild Cognitive Impairment) were studied. A neuropsychological test battery based on the Uniform Data Set (UDS) from the Alzheimer's Disease Centers program of the National Institute on Aging (NIA) was performed and amyloid markers recorded; according to presence or absence of amyloid identified by positive PIB-PET findings, or low CSF Aβ42 levels, patients were separated into MCI amyloid-(n:58) and MCI amyloid + (n = 83) cases.Results: Statistical differences were found in all memory tests between groups. Delayed recall score at thirty minutes on the Rey Auditory Verbal Learning Test (AVLT) was the best predictor of amyloid pathology presence (AUC 0.68), followed by AVLT total learning (AUC 0.66) and AVLT Recognition (AUC 0.59) scores, providing useful cut off values in the clinical setting.Conclusions: Use of neuropsychological testing, specifically AVLT scores with cutoff values, contributed to the correct diagnosis of MCI due to AD in this SouthAmerican cohort.
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Affiliation(s)
| | | | | | | | | | | | - Jorge Campos
- Memory and Aging Centre, Fleni, Buenos Aires, Argentina
| | | | | | | | - Ricardo Francisco Allegri
- Memory and Aging Centre, Fleni, Buenos Aires, Argentina.,Neurosciences Department, Universidad de la Costa (CUC), Barranquilla, Colombia
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Cognitive and neuropsychological examination of the elderly. HANDBOOK OF CLINICAL NEUROLOGY 2020. [PMID: 31753159 DOI: 10.1016/b978-0-12-804766-8.00006-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Neuropsychological assessment plays a prominent role in the evaluation and care of patients with neurodegenerative diseases throughout the dynamic course of disease. As a biomarker of disease, neuropsychological measurement can distinguish normal from pathologic aging processes. Further, neuropsychological data can help distinguish and classify underlying pathologies in dementing diseases, augmenting imaging and biofluid markers in this area. Neuropsychological data can predict increased or reduced risk for dementia conferred by multiple factors, and describe disease trajectory in affected individuals. Cognitive evaluation can also estimate and address functional outcomes that are most important to patients and their loved ones and that are clinically relevant to diagnostic staging. In informing intervention and patient care needs, areas of cognitive weakness highlight targets for support/intervention, while areas of cognitive strength can be capitalized upon to modify the clinical course of disease. These functions can be accomplished through the complementary use of brief screening tools and comprehensive test batteries. However, for neuropsychological data to serve these functions, it is critical to understand neuropsychological test properties and nondisease factors that can account for variance in test performance. This chapter concludes with directions for future research.
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33
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Portnova GV. Lack of a Sense of Threat and Higher Emotional Lability in Patients With Chronic Microvascular Ischemia as Measured by Non-linear EEG Parameters. Front Neurol 2020; 11:122. [PMID: 32226407 PMCID: PMC7080963 DOI: 10.3389/fneur.2020.00122] [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] [Received: 07/10/2019] [Accepted: 02/03/2020] [Indexed: 01/10/2023] Open
Abstract
We aimed to investigate the non-linear features of the electroencephalogram (EEG) findings in patients with chronic microvascular ischemia (CMI) in order to determine the brain correlates of emotional impairment that could impact the risk of developing acute ischemia. We compared the EEG responses of patients with CMI and age-matched healthy volunteers to non-verbal emotionally charged sounds. We analyzed the EEG data, the psychological assessment of the stimuli, and the results of neuropsychological and behavioral testing. We assessed the (in)stability of the envelope's amplitude by calculating its average frequency and the ratio of its standard deviation to its mean. The non-linear features were lower in the patient group in the resting state. The emotional stimulation induced a decrease in the frequency of the envelope's amplitude in all subjects. Changes in the fractal dimension during stimulation were only seen in the patient group, and they correlated with symptoms of emotional lability. The lower ratio of the alpha-rhythm envelope's standard deviation to its mean in the right hemisphere correlated with a higher sense of threat. The EEG and behavioral correlates of emotional impairment in patients with CMI were found.
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Affiliation(s)
- Galina V Portnova
- Human Higher Nervous Activity Lab, Institute of Higher Nervous Activity and Neurophysiology of RAS, Moscow, Russia
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34
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Weissberger GH, Gollan TH, Bondi MW, Nation DA, Hansen LA, Galasko D, Salmon DP. Neuropsychological Deficit Profiles, Vascular Risk Factors, and Neuropathological Findings in Hispanic Older Adults with Autopsy-Confirmed Alzheimer's Disease. J Alzheimers Dis 2020; 67:291-302. [PMID: 30636736 DOI: 10.3233/jad-180351] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This study aimed to determine if patterns of neuropsychological deficits, vascular risk factors, and neuropathology differ in Hispanic and Non-Hispanic patients with autopsy-confirmed Alzheimer's disease (AD). Participants were enrolled in a longitudinal study at the Shiley-Marcos AD Research Center at the University of California, San Diego. Hispanic (n = 14) and Non-Hispanic (n = 20) patients with autopsy-confirmed AD who scored ≥95 on the Dementia Rating Scale (DRS) were included. Patient groups were matched on age, education, global mental status, and severity of functional decline; they were compared to Hispanic (n = 14) or Non-Hispanic (n = 20) cognitively-normal controls of similar age and education. Ethnicity (Hispanic, Non-Hispanic) by disease state (autopsy-confirmed AD or cognitively normal) comparisons were made for cognitive test performance and vascular risk factors. Patient groups were further compared on measures of AD (Braak stage, neuritic plaques, neurofibrillary tangles), vascular neuropathology, and performance across cognitive domains of memory, language, attention, executive functions, and visuospatial abilities after scores were z-transformed based on respective culturally-appropriate control groups. Patient groups had similar overall AD pathology burden, whereas Hispanics with AD had more small parenchymal arteriolar disease and amyloid angiopathy than Non-Hispanics with AD. Despite largely similar pathology, Hispanics with AD were less cognitively impaired (relative to respective NC groups) than Non-Hispanics with AD, and exhibited a different pattern of deficits across cognitive domains. Findings suggest that cognitive deficits that are usually prominent in AD may be less salient in Hispanic patients and this may adversely impact the ability to clinically detect the disease in mild to moderate stages.
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Affiliation(s)
- Gali H Weissberger
- Department of Family Medicine, USC Keck School of Medicine, Alhambra, CA, USA
| | - Tamar H Gollan
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.,Department of Psychology, University of California, San Diego, La Jolla, CA, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.,Neurology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Daniel A Nation
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Lawrence A Hansen
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Department of Neuropathology, University of California, San Diego, La Jolla, CA, USA
| | - Douglas Galasko
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Neurology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - David P Salmon
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
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Abstract
Hypertension has emerged as a leading cause of age-related cognitive impairment. Long known to be associated with dementia caused by vascular factors, hypertension has more recently been linked also to Alzheimer disease-the major cause of dementia in older people. Thus, although midlife hypertension is a risk factor for late-life dementia, hypertension may also promote the neurodegenerative pathology underlying Alzheimer disease. The mechanistic bases of these harmful effects remain to be established. Hypertension is well known to alter in the structure and function of cerebral blood vessels, but how these cerebrovascular effects lead to cognitive impairment and promote Alzheimer disease pathology is not well understood. Furthermore, critical questions also concern whether treatment of hypertension prevents cognitive impairment, the blood pressure threshold for treatment, and the antihypertensive agents to be used. Recent advances in neurovascular biology, epidemiology, brain imaging, and biomarker development have started to provide new insights into these critical issues. In this review, we will examine the progress made to date, and, after a critical evaluation of the evidence, we will highlight questions still outstanding and seek to provide a path forward for future studies.
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Affiliation(s)
- Costantino Iadecola
- From the Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York (C.I.)
| | - Rebecca F Gottesman
- Departments of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD.,Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
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Abstract
PURPOSE OF REVIEW This article provides an overview of vascular cognitive impairment; discusses its epidemiology, subtypes, and associations with other neurodegenerative diseases; and reviews the diagnostic evaluation and management of these disorders. RECENT FINDINGS Cerebrovascular disease is a common cause of dementia and frequently coexists with neurodegenerative causes. The heterogeneity of mechanisms leading to vascular cognitive impairment makes developing unifying clinical and research criteria difficult. Recognizing the neuroimaging hallmarks of different forms of vascular cognitive impairment can allow for individualized treatment and management. In individuals with mild vascular cognitive impairment, aerobic exercise appears to be a promising treatment but requires further investigation. SUMMARY Vascular cognitive impairment can be caused by several mechanisms. While treating vascular risk factors is rational to prevent worsening of cognitive impairment, well-designed studies are needed to demonstrate efficacy.
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37
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Mixed dementia: Neglected clinical entity or nosographic artifice? J Neurol Sci 2019; 410:116662. [PMID: 31911281 DOI: 10.1016/j.jns.2019.116662] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/02/2019] [Accepted: 12/27/2019] [Indexed: 11/20/2022]
Abstract
Clinical and pathological data show that Alzheimer's disease (AD) and vascular dementia (VaD) are the most prevalent types of dementia in the elderly. Medically speaking, mixed dementia (MxD) is a heterogenous disorder mostly referred to the coexistence of AD and VaD. The weight of vascular contribution to AD phenotype is nowadays matter of debate. Despite great efforts in the field of neurodegeneration and cerebrovascular disease, controversy over the exact nature of their relation still remains, hampering progress in the specialty and raising doubts about the MxD concept validity. Is MxD a neglected clinical entity or a nosographic artifice? Starting from the assumption that recent advances in dementia classification and diagnostic criteria make this a propitious time to set up preventive and therapeutic strategies, this narrative review and opinion paper summarizes the literature concerning the questioned etiopathogenic overlap between AD and VaD and challenges the traditional view of MxD as the mere co-occurrence of different pure forms of dementia.
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38
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Lin ZY, Huang TW, Huang JS, Zheng GY. Tiaobu Xinshen Recipe () Improved Mild Cognitive Impairment of Alzheimer's Disease Patients with Xin (Heart) and Shen (Kidney) Deficiency. Chin J Integr Med 2019; 26:54-58. [PMID: 31776960 DOI: 10.1007/s11655-019-3073-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To observe the intervention effects of Tiaobu Xinshen Recipe (, TXR) on patients with mild cognitive impairment caused by Alzheimer's disease (MCI-AD). METHODS Totally 88 MCI-AD patients with syndrome of Xin (Heart) and Shen (Kidney) deficiency were assigned to the experimental group (47 cases, treated with TXR) and the control group (41 cases, treated with donepezil hydrochloride) using a random number table. Final recruited qualified patients were 44 cases in the experimental group and 39 cases in the control group. The therapeutic course was 12 weeks. Neuropsychological scales [mini mental state examination (MMSE) and Montreal cognitive assessment (MoCA)], and Chinese medicine (CM) dementia syndromes scales were performed in all patients, and results were compared between groups or intra-group before and after treatment. RESULTS MMSE and MoCA scores of the two groups were increased after treatment compared with those before treatment (P<0.05). But there was no statistical difference in MMSE or MOCA scores after treatment between the two groups (P>0.05). CM dementia syndrome score was significantly decreased after treatment in the experimental group compared with the control group (P<0.01). Visual spatial and executive function scores and delayed recall scores of the two groups were increased compared with those before treatment (P<0.01). CONCLUSION TXR could effectively improve cognitive impairment of MCI-AD patients with syndrome of Xin and Shen deficiency.
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Affiliation(s)
- Zhi-Ying Lin
- Department of Traditional Chinese Medicine, The Affiliated Union Hospital of Fujian Medical University, Fuzhou, 350001, China.
| | - Tian-Wen Huang
- Department of Neurology, The Affiliated Union Hospital of Fujian Medical University, Fuzhou, 350001, China
| | - Jun-Shang Huang
- Key Laboratory of Traditional Chinese Medicine for the Treatment of Brain Dysfunction, Fujian Academy of Traditional Chinese Medicine, Fuzhou, 350001, China
| | - Guan-Yi Zheng
- Department of Traditional Chinese Medicine, The Affiliated Union Hospital of Fujian Medical University, Fuzhou, 350001, China
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39
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Parietal low beta rhythm provides a dynamical substrate for a working memory buffer. Proc Natl Acad Sci U S A 2019; 116:16613-16620. [PMID: 31371513 PMCID: PMC6697799 DOI: 10.1073/pnas.1902305116] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Working memory (WM) is a component of the brain's memory systems vital for interpretation of sequential sensory inputs and consequent decision making. Anatomically, WM is highly distributed over the prefrontal cortex (PFC) and the parietal cortex (PC). Here we present a biophysically detailed dynamical systems model for a WM buffer situated in the PC, making use of dynamical properties believed to be unique to this area. We show that the natural beta1 rhythm (12 to 20 Hz) of the PC provides a substrate for an episodic buffer that can synergistically combine executive commands (e.g., from PFC) and multimodal information into a flexible and updatable representation of recent sensory inputs. This representation is sensitive to distractors, it allows for a readout mechanism, and it can be readily terminated by executive input. The model provides a demonstration of how information can be usefully stored in the temporal patterns of activity in a neuronal network rather than just synaptic weights between the neurons in that network.
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40
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Lee S, Parekh T, King SM, Reed B, Chui HC, Krauss RM, Yassine HN. Low-Density Lipoprotein Particle Size Subfractions and Cerebral Amyloidosis. J Alzheimers Dis 2019; 68:983-990. [DOI: 10.3233/jad-181252] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sung Lee
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Trusha Parekh
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sarah M. King
- Children’s Hospital Oakland Research Institute and University of California San Francisco, San Francisco, CA, USA
| | - Bruce Reed
- Center for Scientific Review, National Institutes of Health, Bethesda, MD, USA
| | - Helena C. Chui
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ronald M. Krauss
- Children’s Hospital Oakland Research Institute and University of California San Francisco, San Francisco, CA, USA
| | - Hussein N. Yassine
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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41
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Dobrynina LA, Gadzhieva ZS, Akhmetzyanov BM, Kalashnikova LA, Krotenkova MV. [The role of arterial, venous blood and cerebrospinal fluid flow disturbances in forming cognitive impairment types in age-related cerebral microangiophathy]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:81-88. [PMID: 32207722 DOI: 10.17116/jnevro201911912281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Age-related cerebral microangiopathy (small vessel disease, SVD) is the main cause of vascular and mixed cognitive impairment (CI) with a complex neuropsychological profile. AIM To investigate the role of arterial and venous blood flow and cerebrospinal fluid (CSF) flow, as well as their interrelation, in the forming of CI types in patients with SVD. MATERIAL AND METHODS Fifty patients (31 f., mean age 61.2±6,2) with SVD (STRIVE, 2013), including 37 with mild CI and 13 with dementia, were examined. A type of CI was determined based on combination of standard deviations from normal results on memory and executive function tests: isolated dysexecutive (13) and predominantly dysexecutive (6), predominantly amnestic (12), mixed, equal impairment of EF and memory, (19). In the statistical analysis, groups of the isolated and predominantly dysexecutive types were merged according to the dominance of deviations in the EF into the dysexecutive type of CI (19). Phase contrast MRI (PhC-MRI) was used to assess characteristics of arterial and venous blood flow and CSF flow on different levels. Indexes of pulse and intracranial compliance and surface of the cerebral aqueduct were calculated. RESULTS Patients with all CI types had a CSF flow systolic peak delay at the cervical level. Mixed and dysexecutive CI types as compared with predominantly amnestic type and control were defined by blood flow reduction in the sinus rectus, and mixed type by the additional decrease in its pulse wave width, blood flow reduction in an internal jugular artery and maximal blood flow velocity in the inner carotid artery, the increase in the intracranial compliance index and surface of the cerebral aqueduct. CONCLUSION The neuropsychological CI type in SVD is defined by features of pathophysiological mechanisms conditioned on differences in blood flow and CSF flow impairment severity and formed hydrodynamic interaction between them. Differential features of CI types in SVD defined by PhC-MRI might become important predictive indicators of potential interaction between SVD and degeneration, improve understanding of risk factors, pathogenesis, prevention and treatment of age-related brain damage.
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Katsumata Y, Fardo DW, Kukull WA, Nelson PT. Dichotomous scoring of TDP-43 proteinopathy from specific brain regions in 27 academic research centers: associations with Alzheimer's disease and cerebrovascular disease pathologies. Acta Neuropathol Commun 2018; 6:142. [PMID: 30567576 PMCID: PMC6299605 DOI: 10.1186/s40478-018-0641-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 12/27/2022] Open
Abstract
TAR-DNA binding protein 43 (TDP-43) proteinopathy is a common brain pathology in elderly persons, but much remains to be learned about this high-morbidity condition. Published stage-based systems for operationalizing disease severity rely on the involvement (presence/absence) of pathology in specific anatomic regions. To examine the comorbidities associated with TDP-43 pathology in aged individuals, we studied data from the National Alzheimer's Coordinating Center (NACC) Neuropathology Data Set. Data were analyzed from 929 included subjects with available TDP-43 pathology information, sourced from 27 different American Alzheimer's Disease Centers (ADCs). Cases with relatively unusual diseases including autopsy-proven frontotemporal lobar degeneration (FTLD-TDP or FTLD-tau) were excluded from the study. Our data provide new information about pathologic features that are and are not associated with TDP-43 pathologies in different brain areas-spinal cord, amygdala, hippocampus, entorhinal cortex/inferior temporal cortex, and frontal neocortex. Different research centers used cite-specific methods including different TDP-43 antibodies. TDP-43 pathology in at least one brain region was common (31.4%) but the pathology was rarely observed in spinal cord (1.8%) and also unusual in frontal cortex (5.3%). As expected, TDP-43 pathology was positively associated with comorbid hippocampal sclerosis pathology and with severe AD pathology. TDP-43 pathology was also associated with comorbid moderate-to-severe brain arteriolosclerosis. The association between TDP-43 pathology and brain arteriolosclerosis appears relatively specific since there was no detected association between TDP-43 pathology and microinfarcts, lacunar infarcts, large infarcts, cerebral amyloid angiopathy (CAA), or circle of Willis atherosclerosis. Together, these observations provide support for the hypothesis that many aged brains are affected by a TDP-43 proteinopathy that is more likely to be seen in brains with AD pathology, arteriolosclerosis pathology, or both.
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Affiliation(s)
- Yuriko Katsumata
- 0000 0004 1936 8438grid.266539.dDepartment of Biostatistics, University of Kentucky, 725 Rose Street, Lexington, KY 40536 USA
- 0000 0004 1936 8438grid.266539.dSanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40536 USA
| | - David W. Fardo
- 0000 0004 1936 8438grid.266539.dDepartment of Biostatistics, University of Kentucky, 725 Rose Street, Lexington, KY 40536 USA
- 0000 0004 1936 8438grid.266539.dSanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40536 USA
| | - Walter A. Kukull
- 0000000122986657grid.34477.33National Alzheimer’s Coordinating Center, Department of Epidemiology, University of Washington, Seattle, WA 98105 USA
| | - Peter T. Nelson
- 0000 0004 1936 8438grid.266539.dSanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40536 USA
- 0000 0004 1936 8438grid.266539.dDepartment of Pathology, Division of Neuropathology, University of Kentucky, Lexington, KY 40536 USA
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Freitas MID, Porto CS, Oliveira MO, Brucki SMD, Mansur LL, Nitrini R, Radanovic M. Linguistic abilities in major vascular cognitive impairment: a comparative study with Alzheimer's disease. Acta Neurol Belg 2018; 118:465-473. [PMID: 30027378 DOI: 10.1007/s13760-018-0977-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/05/2018] [Indexed: 11/28/2022]
Abstract
We assessed the linguistic abilities of multi-infarct (cortical) dementia and subcortical ischemic vascular dementia (VaD) patients and compared the linguistic performance of VaD and Alzheimer's Disease (AD) patients. A total of 23 VaD patients, 20 mild AD patients, and 31 controls participated in the study. All were evaluated using the Arizona Battery for Communication Disorders of Dementia (ABCD). Neuropsychological testing was performed to ascertain that VaD and AD patients had comparable cognitive performance. Both dementia groups performed more poorly than controls in the ABCD measures, except for the comparative question subtest. Comparison between VaD and AD patients showed statistically significant differences only in the confrontation naming subtest (p < 0.05), where paraphasias and visual errors were the most prevalent. AD patients showed a trend towards more circumlocution errors than VaD patients (p = 0.0483). When compared to controls, linguistic abilities of VaD patients were impaired in all measures of linguistic expression and linguistic comprehension, except for the comparative question subtest. Linguistic differences between VaD and AD patients were observed only in the confrontation naming subtest.
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Affiliation(s)
- Maria Isabel D'Avila Freitas
- Behavioral and Cognitive Neurology Unit, Department of Neurology, Faculty of Medicine, Cognitive Disorders Reference Center (CEREDIC), Hospital das Clinicas, University of São Paulo, Rua Dr. Eneas de Carvalho Aguiar, 255, 5th floor, São Paulo, SP, 05403-000, Brazil.
- Department of Speech, Language and Hearing Sciences, Federal University of Santa Catarina (UFSC), Trindade Campus, Florianopolis, SC, 88040-970, Brazil.
| | - Claudia S Porto
- Behavioral and Cognitive Neurology Unit, Department of Neurology, Faculty of Medicine, Cognitive Disorders Reference Center (CEREDIC), Hospital das Clinicas, University of São Paulo, Rua Dr. Eneas de Carvalho Aguiar, 255, 5th floor, São Paulo, SP, 05403-000, Brazil
| | - Maira O Oliveira
- Behavioral and Cognitive Neurology Unit, Department of Neurology, Faculty of Medicine, Cognitive Disorders Reference Center (CEREDIC), Hospital das Clinicas, University of São Paulo, Rua Dr. Eneas de Carvalho Aguiar, 255, 5th floor, São Paulo, SP, 05403-000, Brazil
| | - Sonia M D Brucki
- Behavioral and Cognitive Neurology Unit, Department of Neurology, Faculty of Medicine, Cognitive Disorders Reference Center (CEREDIC), Hospital das Clinicas, University of São Paulo, Rua Dr. Eneas de Carvalho Aguiar, 255, 5th floor, São Paulo, SP, 05403-000, Brazil
| | - Leticia L Mansur
- Behavioral and Cognitive Neurology Unit, Department of Neurology, Faculty of Medicine, Cognitive Disorders Reference Center (CEREDIC), Hospital das Clinicas, University of São Paulo, Rua Dr. Eneas de Carvalho Aguiar, 255, 5th floor, São Paulo, SP, 05403-000, Brazil
- Department of Physiotherapy, Speech Therapy and Occupational Therapy, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Ricardo Nitrini
- Behavioral and Cognitive Neurology Unit, Department of Neurology, Faculty of Medicine, Cognitive Disorders Reference Center (CEREDIC), Hospital das Clinicas, University of São Paulo, Rua Dr. Eneas de Carvalho Aguiar, 255, 5th floor, São Paulo, SP, 05403-000, Brazil
| | - Marcia Radanovic
- Behavioral and Cognitive Neurology Unit, Department of Neurology, Faculty of Medicine, Cognitive Disorders Reference Center (CEREDIC), Hospital das Clinicas, University of São Paulo, Rua Dr. Eneas de Carvalho Aguiar, 255, 5th floor, São Paulo, SP, 05403-000, Brazil
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Weekman EM, Woolums AE, Sudduth TL, Wilcock DM. Hyperhomocysteinemia-Induced Gene Expression Changes in the Cell Types of the Brain. ASN Neuro 2018; 9:1759091417742296. [PMID: 29198136 PMCID: PMC5718317 DOI: 10.1177/1759091417742296] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
High plasma levels of homocysteine, termed hyperhomocysteinemia, are a risk factor for vascular cognitive impairment and dementia, which is the second leading cause of dementia. While hyperhomocysteinemia induces microhemorrhages and cognitive decline in mice, the specific effect of hyperhomocysteinemia on each cell type remains unknown. We took separate cultures of astrocytes, microglia, endothelial cells, and neuronal cells and treated each with moderate levels of homocysteine for 24, 48, 72, and 96 hr. We then determined the gene expression changes for cell-specific markers and neuroinflammatory markers including the matrix metalloproteinase 9 system. Astrocytes had decreased levels of several astrocytic end feet genes, such as aquaporin 4 and an adenosine triphosphate (ATP)-sensitive inward rectifier potassium channel at 72 hr, as well as an increase in matrix metalloproteinase 9 at 48 hr. Gene changes in microglia indicated a peak in proinflammatory markers at 48 hr followed by a peak in the anti-inflammatory marker, interleukin 1 receptor antagonist, at 72 hr. Endothelial cells had reduced occludin expression at 72 hr, while kinases and phosphatases known to alter tau phosphorylation states were increased in neuronal cells. This suggests that hyperhomocysteinemia induces early proinflammatory changes in microglia and astrocytic changes relevant to their interaction with the vasculature. Overall, the data show how hyperhomocysteinemia could impact Alzheimer’s disease and vascular cognitive impairment and dementia.
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Affiliation(s)
- Erica M Weekman
- 1 Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA.,2 Department of Physiology, University of Kentucky, Lexington, KY, USA
| | - Abigail E Woolums
- 1 Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Tiffany L Sudduth
- 1 Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Donna M Wilcock
- 1 Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA.,2 Department of Physiology, University of Kentucky, Lexington, KY, USA
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Association of Induced Hyperhomocysteinemia with Alzheimer's Disease-Like Neurodegeneration in Rat Cortical Neurons After Global Ischemia-Reperfusion Injury. Neurochem Res 2018; 43:1766-1778. [PMID: 30003389 DOI: 10.1007/s11064-018-2592-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/25/2018] [Accepted: 07/05/2018] [Indexed: 12/23/2022]
Abstract
Alzheimer's disease (AD) is a progressive and irreversible neurodegenerative disorder that results in massive hippocampal and neocortical neuronal loss leading to dementia and eventual death. The exact cause of Alzheimer's disease is not fully explored, although a number of risk factors have been recognized, including high plasma concentration of homocysteine (Hcy). Hyperhomocysteinemia (hHcy) is considered a strong, independent risk factor for stroke and dementia. However, the molecular background underlying these mechanisms linked with hHcy and ischemic stroke is not fully understood. Paper describes rat model of global forebrain ischemia combined with the experimentally induced hHcy. Global ischemia-reperfusion injury (IRI) was developed by 4-vessels occlusion lasting for 15 min followed by reperfusion period of 72 h. hHcy was induced by subcutaneous injection of 0.45 µmol/g of Hcy in duration of 14 days. The results showed remarkable neural cell death induced by hHcy in the brain cortex and neurodegeneration is further aggravated by global IRI. We demonstrated degeneration of cortical neurons, alterations in number and morphology of tissue astrocytes and dysregulation of oxidative balance with increased membrane protein oxidation. Complementary to, an immunohistochemical analysis of tau protein and β-amyloid peptide showed that combination of hHcy with the IRI might lead to the progression of AD-like pathological features. Conclusively, these findings suggest that combination of risk factor hHcy with IRI aggravates neurodegeneration processes and leads to development of AD-like pathology in cerebral cortex.
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Lambert C, Zeestraten E, Williams O, Benjamin P, Lawrence AJ, Morris RG, Mackinnon AD, Barrick TR, Markus HS. Identifying preclinical vascular dementia in symptomatic small vessel disease using MRI. Neuroimage Clin 2018; 19:925-938. [PMID: 30003030 PMCID: PMC6039843 DOI: 10.1016/j.nicl.2018.06.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/23/2018] [Accepted: 06/17/2018] [Indexed: 11/21/2022]
Abstract
Sporadic cerebral small vessel disease is an important cause of vascular dementia, a syndrome of cognitive impairment together with vascular brain damage. At post-mortem pure vascular dementia is rare, with evidence of co-existing Alzheimer's disease pathology in 95% of cases. This work used MRI to characterize structural abnormalities during the preclinical phase of vascular dementia in symptomatic small vessel disease. 121 subjects were recruited into the St George's Cognition and Neuroimaging in Stroke study and followed up longitudinally for five years. Over this period 22 individuals converted to dementia. Using voxel-based morphometry, we found structural abnormalities present at baseline in those with preclinical dementia, with reduced grey matter density in the left striatum and hippocampus, and more white matter hyperintensities in the frontal white-matter. The lacunar data revealed that some of these abnormalities may be due to lesions within the striatum and centrum semiovale. Using support vector machines, future dementia could be best predicted using hippocampal and striatal Jacobian determinant data, achieving a balanced classification accuracy of 73%. Using cluster ward linkage we identified four anatomical subtypes. Successful predictions were restricted to groups with lower levels of vascular damage. The subgroup that could not be predicted were younger, further from conversion, had the highest levels of vascular damage, with milder cognitive impairment at baseline but more rapid deterioration in processing speed and executive function, consistent with a primary vascular dementia. In contrast, the remaining groups had decreasing levels of vascular damage and increasing memory impairment consistent with progressively more Alzheimer's-like pathology. Voxel-wise rates of hippocampal atrophy supported these distinctions, with the vascular group closely resembling the non-dementing cohort, whereas the Alzheimer's like group demonstrated global hippocampal atrophy. This work reveals distinct anatomical endophenotypes in preclinical vascular dementia, forming a spectrum between vascular and Alzheimer's like pathology. The latter group can be identified using baseline MRI, with 73% converting within 5 years. It was not possible to predict the vascular dominant dementia subgroup, however 19% of negative predictions with high levels of vascular disease would ultimately develop dementia. It may be that techniques more sensitive to white matter damage, such as diffusion weighted imaging, may prove more useful for this vascular dominant subgroup in the future. This work provides a way to accurately stratify patients using a baseline MRI scan, and has utility in future clinical trials designed to slow or prevent the onset of dementia in these high-risk cohorts.
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Affiliation(s)
- Christian Lambert
- Wellcome Centre for Human Neuroimaging, 12 Queen Square, WC1N 3BG London, UK; Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, SW17 0RE, UK.
| | - Eva Zeestraten
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, SW17 0RE, UK
| | - Owen Williams
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, SW17 0RE, UK
| | - Philip Benjamin
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, SW17 0RE, UK
| | - Andrew J Lawrence
- Stroke Research Group, Clinical Neurosciences, University of Cambridge, CB2 0QQ, UK
| | - Robin G Morris
- Department of Psychology, King's College Institute of Psychiatry, Psychology, and Neuroscience, London, UK
| | - Andrew D Mackinnon
- St George's NHS Healthcare Trust, Atkinson Morley Regional Neuroscience Centre, London, UK
| | - Thomas R Barrick
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, SW17 0RE, UK
| | - Hugh S Markus
- Stroke Research Group, Clinical Neurosciences, University of Cambridge, CB2 0QQ, UK
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Montgomery V, Harris K, Stabler A, Lu LH. Effects of Delay Duration on the WMS Logical Memory Performance of Older Adults with Probable Alzheimer's Disease, Probable Vascular Dementia, and Normal Cognition. Arch Clin Neuropsychol 2018; 32:375-380. [PMID: 28431036 DOI: 10.1093/arclin/acx005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 01/16/2017] [Indexed: 11/14/2022] Open
Abstract
Objective To examine how the duration of time delay between Wechsler Memory Scale (WMS) Logical Memory I and Logical Memory II (LM) affected participants' recall performance. Method There are 46,146 total Logical Memory administrations to participants diagnosed with either Alzheimer's disease (AD), vascular dementia (VaD), or normal cognition in the National Alzheimer's Disease Coordinating Center's Uniform Data Set. Results Only 50% of the sample was administered the standard 20-35 min of delay as specified by WMS-R and WMS-III. We found a significant effect of delay time duration on proportion of information retained for the VaD group compared to its control group, which remained after adding LMI raw score as a covariate. There was poorer retention of information with longer delay for this group. This association was not as strong for the AD and cognitively normal groups. A 24.5-min delay was most optimal for differentiating AD from VaD participants (47.7% classification accuracy), an 18.5-min delay was most optimal for differentiating AD versus normal participants (51.7% classification accuracy), and a 22.5-min delay was most optimal for differentiating VaD versus normal participants (52.9% classification accuracy). Conclusions Considering diagnostic implications, our findings suggest that test administration should incorporate precise tracking of delay periods. We recommend a 20-min delay with 18-25-min range. Poor classification accuracy based on LM data alone is a reminder that story memory performance is only one piece of data that contributes to complex clinical decisions. However, strict adherence to the recommended range yields optimal data for diagnostic decisions.
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Affiliation(s)
| | - Katie Harris
- Roosevelt University, Department of Psychology, Chicago, IL 60603, USA
| | - Anthony Stabler
- Roosevelt University, Department of Psychology, Chicago, IL 60603, USA
| | - Lisa H Lu
- Roosevelt University, Department of Psychology, Chicago, IL 60603, USA
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48
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Palesi F, De Rinaldis A, Vitali P, Castellazzi G, Casiraghi L, Germani G, Bernini S, Anzalone N, Ramusino MC, Denaro FM, Sinforiani E, Costa A, Magenes G, D'Angelo E, Gandini Wheeler-Kingshott CAM, Micieli G. Specific Patterns of White Matter Alterations Help Distinguishing Alzheimer's and Vascular Dementia. Front Neurosci 2018; 12:274. [PMID: 29922120 PMCID: PMC5996902 DOI: 10.3389/fnins.2018.00274] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/09/2018] [Indexed: 12/19/2022] Open
Abstract
Alzheimer disease (AD) and vascular dementia (VaD) together represent the majority of dementia cases. Since their neuropsychological profiles often overlap and white matter lesions are observed in elderly subjects including AD, differentiating between VaD and AD can be difficult. Characterization of these different forms of dementia would benefit by identification of quantitative imaging biomarkers specifically sensitive to AD or VaD. Parameters of microstructural abnormalities derived from diffusion tensor imaging (DTI) have been reported to be helpful in differentiating between dementias, but only few studies have used them to compare AD and VaD with a voxelwise approach. Therefore, in this study a whole brain statistical analysis was performed on DTI data of 93 subjects (31 AD, 27 VaD, and 35 healthy controls—HC) to identify specific white matter patterns of alteration in patients affected by VaD and AD with respect to HC. Parahippocampal tracts were found to be mainly affected in AD, while VaD showed more spread white matter damages associated with thalamic radiations involvement. The genu of the corpus callosum was predominantly affected in VaD, while the splenium was predominantly affected in AD revealing the existence of specific patterns of alteration useful in distinguishing between VaD and AD. Therefore, DTI parameters of these regions could be informative to understand the pathogenesis and support the etiological diagnosis of dementia. Further studies on larger cohorts of subjects, characterized for brain amyloidosis, will allow to confirm and to integrate the present findings and, furthermore, to elucidate the mechanisms of mixed dementia. These steps will be essential to translate these advances to clinical practice.
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Affiliation(s)
- Fulvia Palesi
- Department of Physics, University of Pavia, Pavia, Italy.,Brain Connectivity Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Andrea De Rinaldis
- Brain Connectivity Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Paolo Vitali
- Brain MRI 3T Mondino Research Center, IRCCS Mondino Foundation, Pavia, Italy.,Neuroradiology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Gloria Castellazzi
- Brain Connectivity Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Letizia Casiraghi
- Brain Connectivity Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Giancarlo Germani
- Brain MRI 3T Mondino Research Center, IRCCS Mondino Foundation, Pavia, Italy.,Neuroradiology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Sara Bernini
- Alzheimer's Disease Assessment Unit, Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Matteo Cotta Ramusino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Alzheimer's Disease Assessment Unit, Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy
| | - Federica M Denaro
- Department of Emergency Neurology, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Sinforiani
- Alzheimer's Disease Assessment Unit, Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy
| | - Alfredo Costa
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Alzheimer's Disease Assessment Unit, Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy
| | - Giovanni Magenes
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Egidio D'Angelo
- Brain Connectivity Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Claudia A M Gandini Wheeler-Kingshott
- Brain MRI 3T Mondino Research Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Giuseppe Micieli
- Department of Emergency Neurology, IRCCS Mondino Foundation, Pavia, Italy
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Suridjan I, Herrmann N, Adibfar A, Saleem M, Andreazza A, Oh PI, Lanctôt KL. Lipid Peroxidation Markers in Coronary Artery Disease Patients with Possible Vascular Mild Cognitive Impairment. J Alzheimers Dis 2018; 58:885-896. [PMID: 28505971 PMCID: PMC5467720 DOI: 10.3233/jad-161248] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This study examined associations between lipid peroxidation markers and cognition, and associations between these markers and cognitive response to an exercise intervention program, in adults with coronary artery disease at risk of dementia. Lipid peroxidation products were measured in serum in 118 patients (29 possible vascular mild cognitive impairment and 89 controls). Ratios of early- (lipid hydroperoxides, LPH) to late-stage (8-isoprostane, 8-ISO; 4-hydroxy-2-nonenal, 4-HNE) lipid peroxidation products were calculated. Cognitive performance was assessed before and at completion of a 24-week exercise intervention program. A global effect of group on lipid peroxidation markers was observed, adjusting for sex, years of education, and cardiopulmonary fitness (main effect of group F (3,102) = 2.957, p = 0.036). Lower lipid peroxidation at baseline, as determined by lower 8-ISO concentration, was associated with greater improvement in verbal memory (F (1, 64) = 4.738, p = 0.03) and executive function (F (1, 64) = 5.219, p = 0.026) performance. Similarly, higher ratios of 8-ISO/LPH (F (1, 65) = 6.592, p = 0.013) and (8-ISO+4-HNE) to LPH (F (1, 65) = 3.857, p = 0.054), were associated with less improvement in executive function performance over a 24-week exercise intervention. Lipid peroxidation may be a biomarker of early vascular cognitive impairment, and elevated lipid peroxidation might limit the cognitive benefits of exercise in this high-risk population.
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Affiliation(s)
- Ivonne Suridjan
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Alex Adibfar
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mahwesh Saleem
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ana Andreazza
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Paul I Oh
- University Health Network at Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Krista L Lanctôt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute and Departments of Psychiatry and Pharmacology/Toxicology, University of Toronto, Toronto, ON, Canada
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50
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Vinters HV, Zarow C, Borys E, Whitman JD, Tung S, Ellis WG, Zheng L, Chui HC. Review: Vascular dementia: clinicopathologic and genetic considerations. Neuropathol Appl Neurobiol 2018; 44:247-266. [DOI: 10.1111/nan.12472] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/13/2018] [Indexed: 12/21/2022]
Affiliation(s)
- H. V. Vinters
- Departments of Pathology & Laboratory Medicine (Neuropathology) and Neurology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
| | - C. Zarow
- Department of Neurology; Keck School of Medicine at University of Southern California; Los Angeles CA USA
| | - E. Borys
- Department of Pathology; University of California Davis School of Medicine; Sacramento CA USA
- Department of Pathology; Loyola University Medical Center; Maywood IL USA
| | - J. D. Whitman
- Departments of Pathology & Laboratory Medicine (Neuropathology) and Neurology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
- Departments of Pathology & Laboratory Medicine; UC San Francisco Medical Center; San Francisco CA USA
| | - S. Tung
- Departments of Pathology & Laboratory Medicine (Neuropathology) and Neurology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
| | - W. G. Ellis
- Department of Pathology; University of California Davis School of Medicine; Sacramento CA USA
| | - L. Zheng
- Department of Neurology; Keck School of Medicine at University of Southern California; Los Angeles CA USA
| | - H. C. Chui
- Department of Neurology; Keck School of Medicine at University of Southern California; Los Angeles CA USA
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