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Chen YS, Kuo CY, Lu CH, Wang YW, Chou KH, Lin WC. Multiscale brain age prediction reveals region-specific accelerated brain aging in Parkinson's disease. Neurobiol Aging 2024; 140:122-129. [PMID: 38776615 DOI: 10.1016/j.neurobiolaging.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/20/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
Brain biological age, which measures the aging process in the brain using neuroimaging data, has been used to assess advanced brain aging in neurodegenerative diseases, including Parkinson disease (PD). However, assuming that whole brain degeneration is uniform may not be sufficient for assessing the complex neurodegenerative processes in PD. In this study we constructed a multiscale brain age prediction models based on structural MRI of 1240 healthy participants. To assess the brain aging patterns using the brain age prediction model, 93 PD patients and 91 healthy controls matching for sex and age were included. We found increased global and regional brain age in PD patients. The advanced aging regions were predominantly noted in the frontal and temporal cortices, limbic system, basal ganglia, thalamus, and cerebellum. Furthermore, region-level rather than global brain age in PD patients was associated with disease severity. Our multiscale brain age prediction model could aid in the development of objective image-based biomarkers to detect advanced brain aging in neurodegenerative diseases.
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Affiliation(s)
- Yueh-Sheng Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen-Yuan Kuo
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yuan-Wei Wang
- The Science & Technology Policy Research and Information Center, National Applied Research Laboratories(NARLabs), Taipei, Taiwan
| | - Kun-Hsien Chou
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan; Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Wang X, Fu S, Yoo K, Wang X, Gan L, Zou T, Gao Q, Han H, Yang Z, Hu X, Chen H, Liu D, Li R. Individualized Structural Perturbations on Normative Brain Connectome Restrict Deep Brain Stimulation Outcomes in Parkinson's Disease. Mov Disord 2024. [PMID: 38894532 DOI: 10.1002/mds.29874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Patients with Parkinson's disease (PD) respond to deep brain stimulation (DBS) variably. However, how brain substrates restrict DBS outcomes remains unclear. OBJECTIVE In this article, we aim to identify prognostic brain signatures for explaining the response variability. METHODS We retrospectively investigated a cohort of patients with PD (n = 141) between 2017 and 2022, and defined DBS outcomes as the improvement ratio of clinical motor scores. We used a deviation index to quantify individual perturbations on a reference structural covariance network acquired with preoperative T1-weighted magnetic resonance imaging. The neurobiological perturbations of patients were represented as z scored indices based on the chronological perturbations measured on a group of normal aging adults. RESULTS After applying stringent statistical tests (z > 2.5) and correcting for false discoveries (P < 0.01), we found that accelerated deviations mainly affected the prefrontal cortex, motor strip, limbic system, and cerebellum in PD. Particularly, a negative network within the accelerated deviations, expressed as "more preoperative deviations, less postoperative improvements," could predict DBS outcomes (mean absolute error = 0.09, R2 = 0.15). Moreover, a fusion of personal brain predictors and medical responses significantly improved traditional evaluations of DBS outcomes. Notably, the most important brain predictor, a pathway connecting the cognitive unit (prefrontal cortex) and motor control unit (cerebellum and motor strip), partially mediates DBS outcomes with the age at surgery. CONCLUSIONS Our findings suggest that individual structural perturbations on the cognitive motor control circuit are critical for modulating DBS outcomes. Interventions toward the circuit have the potential for additional clinical improvements. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Xuyang Wang
- Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Shiyu Fu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Kwangsun Yoo
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
- Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Xiaoyue Wang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Lin Gan
- Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Ting Zou
- Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Qing Gao
- School of Mathematical Sciences, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Honghao Han
- Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Zhenzhe Yang
- Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Xiaofei Hu
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Huafu Chen
- Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Dingyang Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Rong Li
- Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
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3
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Beheshti I, Perron J, Ko JH. Neuroanatomical Signature of the Transition from Normal Cognition to MCI in Parkinson's Disease. Aging Dis 2024:AD.2024.0323. [PMID: 38913040 DOI: 10.14336/ad.2024.0323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/23/2024] [Indexed: 06/25/2024] Open
Abstract
The progression of Parkinson's disease (PD) is often accompanied by cognitive decline. We had previously developed a brain age estimation program utilizing structural MRI data of 949 healthy individuals from publicly available sources. Structural MRI data of 244 PD patients who were cognitively normal at baseline was acquired from the Parkinson Progression Markers Initiative (PPMI). 192 of these showed stable normal cognitive function from baseline out to 5 years (PD-SNC), and the remaining 52 had unstable normal cognition and developed mild cognitive impairment within 5 years (PD-UNC). 105 healthy controls were also included in the analysis as a reference. First, we examined if there were any baseline differences in regional brain structure between PD-UNC and PD-SNC cohorts utilizing the three most widely used atrophy estimation pipelines, i.e., voxel-based morphometry (VBM), deformation-based morphometry and cortical thickness analyses. We then investigated if accelerated brain age estimation with our multivariate regressive machine learning algorithm was different across these groups (HC, PD-SNC, and PD-UNC). As per the VBM analysis, PD-UNC patients demonstrated a noticeable increase in GM volume in the posterior and anterior lobes of the cerebellum, sub-lobar, extra-nuclear, thalamus, and pulvinar regions when compared to PD-SNC at baseline. PD-UNC patients were observed to have significantly older brain age compared to both PD-SNC patients (p=0.009) and healthy controls (p<0.009). The increase in GM volume in the PD-UNC group could potentially indicate an inflammatory or neuronal hypertrophy response, which could serve as a biomarker for future cognitive decline among this population.
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Affiliation(s)
- Iman Beheshti
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- PrairieNeuro Research Centre, Kleysen Institute for Advanced Medicine, Health Science Centre, Winnipeg, MB, Canada
| | - Jarrad Perron
- PrairieNeuro Research Centre, Kleysen Institute for Advanced Medicine, Health Science Centre, Winnipeg, MB, Canada
- Graduate Program in Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Ji Hyun Ko
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- PrairieNeuro Research Centre, Kleysen Institute for Advanced Medicine, Health Science Centre, Winnipeg, MB, Canada
- Graduate Program in Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
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4
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Filip P, Mana J, Lasica A, Keller J, Urgošík D, May J, Mueller K, Jech R, Bezdicek O, Růžička F. Structural and microstructural predictors of cognitive decline in deep brain stimulation of subthalamic nucleus in Parkinson's disease. Neuroimage Clin 2024; 42:103617. [PMID: 38749145 PMCID: PMC11112358 DOI: 10.1016/j.nicl.2024.103617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/22/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND AND OBJECTIVES The intricate relationship between deep brain stimulation (DBS) in Parkinson's disease (PD) and cognitive impairment has lately garnered substantial attention. The presented study evaluated pre-DBS structural and microstructural cerebral patterns as possible predictors of future cognitive decline in PD DBS patients. METHODS Pre-DBS MRI data in 72 PD patients were combined with neuropsychological examinations and follow-up for an average of 2.3 years after DBS implantation procedure using a screening cognitive test validated for diagnosis of mild cognitive impairment in PD in a Czech population - Dementia Rating Scale 2. RESULTS PD patients who would exhibit post-DBS cognitive decline were found to have, already at the pre-DBS stage, significantly lower cortical thickness and lower microstructural complexity than cognitively stable PD patients. Differences in the regions directly related to cognition as bilateral parietal, insular and cingulate cortices, but also occipital and sensorimotor cortex were detected. Furthermore, hippocampi, putamina, cerebellum and upper brainstem were implicated as well, all despite the absence of pre-DBS differences in cognitive performance and in the position of DBS leads or stimulation parameters between the two groups. CONCLUSIONS Our findings indicate that the cognitive decline in the presented PD cohort was not attributable primarily to DBS of the subthalamic nucleus but was associated with a clinically silent structural and microstructural predisposition to future cognitive deterioration present already before the DBS system implantation.
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Affiliation(s)
- Pavel Filip
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic; Department of Cybernetics, Czech Technical University in Prague, Prague, Czech Republic; Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, USA
| | - Josef Mana
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Andrej Lasica
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Jiří Keller
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic; Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Dušan Urgošík
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaromír May
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Karsten Mueller
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic; Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Robert Jech
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic.
| | - Ondrej Bezdicek
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Filip Růžička
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
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Yan S, Lu J, Zhu H, Tian T, Qin Y, Li Y, Zhu W. The influence of accelerated brain aging on coactivation pattern dynamics in Parkinson's disease. J Neurosci Res 2024; 102:e25357. [PMID: 38803227 DOI: 10.1002/jnr.25357] [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: 11/06/2023] [Revised: 04/27/2024] [Accepted: 05/05/2024] [Indexed: 05/29/2024]
Abstract
Aging is widely acknowledged as the primary risk factor for brain degeneration, with Parkinson's disease (PD) tending to follow accelerated aging trajectories. We aim to investigate the impact of structural brain aging on the temporal dynamics of a large-scale functional network in PD. We enrolled 62 PD patients and 32 healthy controls (HCs). The level of brain aging was determined by calculating global and local brain age gap estimates (G-brainAGE and L-brainAGE) from structural images. The neural network activity of the whole brain was captured by identifying coactivation patterns (CAPs) from resting-state functional images. Intergroup differences were assessed using the general linear model. Subsequently, a spatial correlation analysis between the L-brainAGE difference map and CAPs was conducted to uncover the anatomical underpinnings of functional alterations. Compared to HCs (-3.73 years), G-brainAGE was significantly higher in PD patients (+1.93 years), who also exhibited widespread elevation in L-brainAGE. G-brainAGE was correlated with disease severity and duration. PD patients spent less time in CAPs involving activated default mode and the fronto-parietal network (DMN-FPN), as well as the sensorimotor and salience network (SMN-SN), and had a reduced transition frequency from other CAPs to the DMN-FPN and SMN-SN CAPs. Furthermore, the pattern of localized brain age acceleration showed spatial similarities with the SMN-SN CAP. Accelerated structural brain aging in PD adversely affects brain function, manifesting as dysregulated brain network dynamics. These findings provide insights into the neuropathological mechanisms underlying neurodegenerative diseases and imply the possibility of interventions for modifying PD progression by slowing the brain aging process.
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Affiliation(s)
- Su Yan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Lu
- Department of CT & MRI, The First Affiliated Hospital, College of Medicine, Shihezi University, Shihezi, China
| | - Hongquan Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tian Tian
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanyuan Qin
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanhao Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Chen CL, Cheng SY, Montaser-Kouhsari L, Wu WC, Hsu YC, Tai CH, Tseng WYI, Kuo MC, Wu RM. Advanced brain aging in Parkinson's disease with cognitive impairment. NPJ Parkinsons Dis 2024; 10:62. [PMID: 38493188 PMCID: PMC10944471 DOI: 10.1038/s41531-024-00673-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/29/2024] [Indexed: 03/18/2024] Open
Abstract
Patients with Parkinson's disease and cognitive impairment (PD-CI) deteriorate faster than those without cognitive impairment (PD-NCI), suggesting an underlying difference in the neurodegeneration process. We aimed to verify brain age differences in PD-CI and PD-NCI and their clinical significance. A total of 94 participants (PD-CI, n = 27; PD-NCI, n = 34; controls, n = 33) were recruited. Predicted age difference (PAD) based on gray matter (GM) and white matter (WM) features were estimated to represent the degree of brain aging. Patients with PD-CI showed greater GM-PAD (7.08 ± 6.64 years) and WM-PAD (8.82 ± 7.69 years) than those with PD-NCI (GM: 1.97 ± 7.13, Padjusted = 0.011; WM: 4.87 ± 7.88, Padjusted = 0.049) and controls (GM: -0.58 ± 7.04, Padjusted = 0.004; WM: 0.88 ± 7.45, Padjusted = 0.002) after adjusting demographic factors. In patients with PD, GM-PAD was negatively correlated with MMSE (Padjusted = 0.011) and MoCA (Padjusted = 0.013) and positively correlated with UPDRS Part II (Padjusted = 0.036). WM-PAD was negatively correlated with logical memory of immediate and delayed recalls (Padjusted = 0.003 and Padjusted < 0.001). Also, altered brain regions in PD-CI were identified and significantly correlated with brain age measures, implicating the neuroanatomical underpinning of neurodegeneration in PD-CI. Moreover, the brain age metrics can improve the classification between PD-CI and PD-NCI. The findings suggest that patients with PD-CI had advanced brain aging that was associated with poor cognitive functions. The identified neuroimaging features and brain age measures can serve as potential biomarkers of PD-CI.
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Affiliation(s)
- Chang-Le Chen
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shao-Ying Cheng
- Department of Neurology, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan
| | | | - Wen-Chao Wu
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
| | | | - Chun-Hwei Tai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Yih Isaac Tseng
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan.
- Acroviz Inc, Taipei, Taiwan.
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
| | - Ming-Che Kuo
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan.
- Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan.
| | - Ruey-Meei Wu
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
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Kalc P, Dahnke R, Hoffstaedter F, Gaser C. BrainAGE: Revisited and reframed machine learning workflow. Hum Brain Mapp 2024; 45:e26632. [PMID: 38379519 PMCID: PMC10879910 DOI: 10.1002/hbm.26632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/23/2024] [Accepted: 02/05/2024] [Indexed: 02/22/2024] Open
Abstract
Since the introduction of the BrainAGE method, novel machine learning methods for brain age prediction have continued to emerge. The idea of estimating the chronological age from magnetic resonance images proved to be an interesting field of research due to the relative simplicity of its interpretation and its potential use as a biomarker of brain health. We revised our previous BrainAGE approach, originally utilising relevance vector regression (RVR), and substituted it with Gaussian process regression (GPR), which enables more stable processing of larger datasets, such as the UK Biobank (UKB). In addition, we extended the global BrainAGE approach to regional BrainAGE, providing spatially specific scores for five brain lobes per hemisphere. We tested the performance of the new algorithms under several different conditions and investigated their validity on the ADNI and schizophrenia samples, as well as on a synthetic dataset of neocortical thinning. The results show an improved performance of the reframed global model on the UKB sample with a mean absolute error (MAE) of less than 2 years and a significant difference in BrainAGE between healthy participants and patients with Alzheimer's disease and schizophrenia. Moreover, the workings of the algorithm show meaningful effects for a simulated neocortical atrophy dataset. The regional BrainAGE model performed well on two clinical samples, showing disease-specific patterns for different levels of impairment. The results demonstrate that the new improved algorithms provide reliable and valid brain age estimations.
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Affiliation(s)
- Polona Kalc
- Structural Brain Mapping Group, Department of NeurologyJena University HospitalJenaGermany
| | - Robert Dahnke
- Structural Brain Mapping Group, Department of NeurologyJena University HospitalJenaGermany
- Department of Psychiatry and PsychotherapyJena University HospitalJenaGermany
| | - Felix Hoffstaedter
- Forschungszentrum Jülich, Institute of Neuroscience and Medicine, Brain and Behaviour (INM‐7)JülichGermany
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University DüsseldorfDüsseldorfGermany
| | - Christian Gaser
- Structural Brain Mapping Group, Department of NeurologyJena University HospitalJenaGermany
- Department of Psychiatry and PsychotherapyJena University HospitalJenaGermany
- German Center for Mental Health (DZPG)Jena‐Halle‐MagdeburgGermany
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Beheshti I, Booth S, Ko JH. Differences in brain aging between sexes in Parkinson's disease. NPJ Parkinsons Dis 2024; 10:35. [PMID: 38355735 PMCID: PMC10866976 DOI: 10.1038/s41531-024-00646-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
Parkinson's disease (PD) is linked to faster brain aging. Male sex is associated with higher prevalence, severe symptoms, and a faster progression rate in PD. There remains a significant gap in understanding the function of sex in the process of brain aging in PD. The structural T1-weighted MRI-driven brain-predicted age difference (i.e., Brain-PAD: the actual age subtracted from the brain-predicted age) was computed in a group of 373 people with PD (mean age ± SD: 61.37 ± 9.81, age range: 33-85, 34% female) from the Parkinson's Progression Marker Initiative database using a robust brain-age estimation framework that was trained on 949 healthy subjects. Linear regression models were used to investigate the association between Brain-PAD and clinical variables in PD, stratified by sex. Males with Parkinson's disease (PD-M) exhibited a significantly higher mean Brain-PAD than their female counterparts (PD-F) (t(256) = 2.50, p = 0.012). In the propensity score-matched PD-M group (PD-M*), Brain-PAD was found to be associated with a decline in general cognition, a worse degree of sleep behavior disorder, reduced visuospatial acuity, and caudate atrophy. Conversely, no significant links were observed between these factors and Brain-PAD in the PD-F group. Having 'older' looking brains in PD-M than PD-F supports the idea that sex plays a vital function in PD, such that the PD mechanism may be different in males and females. This study has the potential to broaden our understanding of dissimilarities in brain aging between sexes in the context of PD.
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Affiliation(s)
- Iman Beheshti
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, MB, Canada
- Kleysen Institute for Advanced Medicine, Health Science Centre, Winnipeg, MB, Canada
| | - Samuel Booth
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, MB, Canada
- Kleysen Institute for Advanced Medicine, Health Science Centre, Winnipeg, MB, Canada
| | - Ji Hyun Ko
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, MB, Canada.
- Kleysen Institute for Advanced Medicine, Health Science Centre, Winnipeg, MB, Canada.
- Graduate Program in Biomedical Engineering, University of Manitoba, Winnipeg, MB, Canada.
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9
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Brusaferri L, Alshelh Z, Schnieders JH, Sandström A, Mohammadian M, Morrissey EJ, Kim M, Chane CA, Grmek GC, Murphy JP, Bialobrzewski J, DiPietro A, Klinke J, Zhang Y, Torrado-Carvajal A, Mercaldo N, Akeju O, Wu O, Rosen BR, Napadow V, Hadjikhani N, Loggia ML. Neuroimmune activation and increased brain aging in chronic pain patients after the COVID-19 pandemic onset. Brain Behav Immun 2024; 116:259-266. [PMID: 38081435 PMCID: PMC10872439 DOI: 10.1016/j.bbi.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/10/2023] [Accepted: 12/08/2023] [Indexed: 12/22/2023] Open
Abstract
The COVID-19 pandemic has exerted a global impact on both physical and mental health, and clinical populations have been disproportionally affected. To date, however, the mechanisms underlying the deleterious effects of the pandemic on pre-existing clinical conditions remain unclear. Here we investigated whether the onset of the pandemic was associated with an increase in brain/blood levels of inflammatory markers and MRI-estimated brain age in patients with chronic low back pain (cLBP), irrespective of their infection history. A retrospective cohort study was conducted on 56 adult participants with cLBP (28 'Pre-Pandemic', 28 'Pandemic') using integrated Positron Emission Tomography/ Magnetic Resonance Imaging (PET/MRI) and the radioligand [11C]PBR28, which binds to the neuroinflammatory marker 18 kDa Translocator Protein (TSPO). Image data were collected between November 2017 and January 2020 ('Pre-Pandemic' cLBP) or between August 2020 and May 2022 ('Pandemic' cLBP). Compared to the Pre-Pandemic group, the Pandemic patients demonstrated widespread and statistically significant elevations in brain TSPO levels (P =.05, cluster corrected). PET signal elevations in the Pandemic group were also observed when 1) excluding 3 Pandemic subjects with a known history of COVID infection, or 2) using secondary outcome measures (volume of distribution -VT- and VT ratio - DVR) in a smaller subset of participants. Pandemic subjects also exhibited elevated serum levels of inflammatory markers (IL-16; P <.05) and estimated BA (P <.0001), which were positively correlated with [11C]PBR28 SUVR (r's ≥ 0.35; P's < 0.05). The pain interference scores, which were elevated in the Pandemic group (P <.05), were negatively correlated with [11C]PBR28 SUVR in the amygdala (r = -0.46; P<.05). This work suggests that the pandemic outbreak may have been accompanied by neuroinflammation and increased brain age in cLBP patients, as measured by multimodal imaging and serum testing. This study underscores the broad impact of the pandemic on human health, which extends beyond the morbidity solely mediated by the virus itself.
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Affiliation(s)
- Ludovica Brusaferri
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Computer Science and Informatics, School of Engineering, London South Bank University, London, UK
| | - Zeynab Alshelh
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jack H Schnieders
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Angelica Sandström
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mehrbod Mohammadian
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Erin J Morrissey
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Minhae Kim
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Courtney A Chane
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Grace C Grmek
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer P Murphy
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Julia Bialobrzewski
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexa DiPietro
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Julie Klinke
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yi Zhang
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Angel Torrado-Carvajal
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Medical Image Analysis and Biometry Laboratory, Universidad Rey Juan Carlos, Madrid, Spain
| | - Nathaniel Mercaldo
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ona Wu
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Bruce R Rosen
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Nouchine Hadjikhani
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Gillberg Neuropsychiatry Centre, University of Gothenburg, Sweden
| | - Marco L Loggia
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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10
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Stefano GB. Quantum Computing and the Future of Neurodegeneration and Mental Health Research. Brain Sci 2024; 14:93. [PMID: 38248308 PMCID: PMC10813156 DOI: 10.3390/brainsci14010093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
Quantum computing and supercomputing are two distinct approaches that can be used to solve complex computational problems [...].
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Affiliation(s)
- George B Stefano
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Ke Karlovu 11, 120 00 Prague, Czech Republic
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11
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Statsenko Y, Kuznetsov NV, Morozova D, Liaonchyk K, Simiyu GL, Smetanina D, Kashapov A, Meribout S, Gorkom KNV, Hamoudi R, Ismail F, Ansari SA, Emerald BS, Ljubisavljevic M. Reappraisal of the Concept of Accelerated Aging in Neurodegeneration and Beyond. Cells 2023; 12:2451. [PMID: 37887295 PMCID: PMC10605227 DOI: 10.3390/cells12202451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Genetic and epigenetic changes, oxidative stress and inflammation influence the rate of aging, which diseases, lifestyle and environmental factors can further accelerate. In accelerated aging (AA), the biological age exceeds the chronological age. OBJECTIVE The objective of this study is to reappraise the AA concept critically, considering its weaknesses and limitations. METHODS We reviewed more than 300 recent articles dealing with the physiology of brain aging and neurodegeneration pathophysiology. RESULTS (1) Application of the AA concept to individual organs outside the brain is challenging as organs of different systems age at different rates. (2) There is a need to consider the deceleration of aging due to the potential use of the individual structure-functional reserves. The latter can be restored by pharmacological and/or cognitive therapy, environment, etc. (3) The AA concept lacks both standardised terminology and methodology. (4) Changes in specific molecular biomarkers (MBM) reflect aging-related processes; however, numerous MBM candidates should be validated to consolidate the AA theory. (5) The exact nature of many potential causal factors, biological outcomes and interactions between the former and the latter remain largely unclear. CONCLUSIONS Although AA is commonly recognised as a perspective theory, it still suffers from a number of gaps and limitations that assume the necessity for an updated AA concept.
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Affiliation(s)
- Yauhen Statsenko
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates; (Y.S.); (G.L.S.); (D.S.); (A.K.); (S.M.); (K.N.-V.G.)
- ASPIRE Precision Medicine Research Institute Abu Dhabi, United Arab Emirates University, Al Ain 27272, United Arab Emirates; (D.M.); (K.L.); (R.H.); (S.A.A.); (B.S.E.); (M.L.)
- Big Data Analytic Center, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates
| | - Nik V. Kuznetsov
- ASPIRE Precision Medicine Research Institute Abu Dhabi, United Arab Emirates University, Al Ain 27272, United Arab Emirates; (D.M.); (K.L.); (R.H.); (S.A.A.); (B.S.E.); (M.L.)
| | - Daria Morozova
- ASPIRE Precision Medicine Research Institute Abu Dhabi, United Arab Emirates University, Al Ain 27272, United Arab Emirates; (D.M.); (K.L.); (R.H.); (S.A.A.); (B.S.E.); (M.L.)
| | - Katsiaryna Liaonchyk
- ASPIRE Precision Medicine Research Institute Abu Dhabi, United Arab Emirates University, Al Ain 27272, United Arab Emirates; (D.M.); (K.L.); (R.H.); (S.A.A.); (B.S.E.); (M.L.)
| | - Gillian Lylian Simiyu
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates; (Y.S.); (G.L.S.); (D.S.); (A.K.); (S.M.); (K.N.-V.G.)
| | - Darya Smetanina
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates; (Y.S.); (G.L.S.); (D.S.); (A.K.); (S.M.); (K.N.-V.G.)
| | - Aidar Kashapov
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates; (Y.S.); (G.L.S.); (D.S.); (A.K.); (S.M.); (K.N.-V.G.)
| | - Sarah Meribout
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates; (Y.S.); (G.L.S.); (D.S.); (A.K.); (S.M.); (K.N.-V.G.)
| | - Klaus Neidl-Van Gorkom
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates; (Y.S.); (G.L.S.); (D.S.); (A.K.); (S.M.); (K.N.-V.G.)
| | - Rifat Hamoudi
- ASPIRE Precision Medicine Research Institute Abu Dhabi, United Arab Emirates University, Al Ain 27272, United Arab Emirates; (D.M.); (K.L.); (R.H.); (S.A.A.); (B.S.E.); (M.L.)
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
- Division of Surgery and Interventional Science, University College London, London NW3 2PS, UK
| | - Fatima Ismail
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates;
| | - Suraiya Anjum Ansari
- ASPIRE Precision Medicine Research Institute Abu Dhabi, United Arab Emirates University, Al Ain 27272, United Arab Emirates; (D.M.); (K.L.); (R.H.); (S.A.A.); (B.S.E.); (M.L.)
- Department of Biochemistry and Molecular Biology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates
| | - Bright Starling Emerald
- ASPIRE Precision Medicine Research Institute Abu Dhabi, United Arab Emirates University, Al Ain 27272, United Arab Emirates; (D.M.); (K.L.); (R.H.); (S.A.A.); (B.S.E.); (M.L.)
- Department of Anatomy, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates
| | - Milos Ljubisavljevic
- ASPIRE Precision Medicine Research Institute Abu Dhabi, United Arab Emirates University, Al Ain 27272, United Arab Emirates; (D.M.); (K.L.); (R.H.); (S.A.A.); (B.S.E.); (M.L.)
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates
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12
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Antonopoulos G, More S, Raimondo F, Eickhoff SB, Hoffstaedter F, Patil KR. A systematic comparison of VBM pipelines and their application to age prediction. Neuroimage 2023; 279:120292. [PMID: 37572766 PMCID: PMC10529438 DOI: 10.1016/j.neuroimage.2023.120292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/23/2023] [Accepted: 07/21/2023] [Indexed: 08/14/2023] Open
Abstract
Voxel-based morphometry (VBM) analysis is commonly used for localized quantification of gray matter volume (GMV). Several alternatives exist to implement a VBM pipeline. However, how these alternatives compare and their utility in applications, such as the estimation of aging effects, remain largely unclear. This leaves researchers wondering which VBM pipeline they should use for their project. In this study, we took a user-centric perspective and systematically compared five VBM pipelines, together with registration to either a general or a study-specific template, utilizing three large datasets (n>500 each). Considering the known effect of aging on GMV, we first compared the pipelines in their ability of individual-level age prediction and found markedly varied results. To examine whether these results arise from systematic differences between the pipelines, we classified them based on their GMVs, resulting in near-perfect accuracy. To gain deeper insights, we examined the impact of different VBM steps using the region-wise similarity between pipelines. The results revealed marked differences, largely driven by segmentation and registration steps. We observed large variability in subject-identification accuracies, highlighting the interpipeline differences in individual-level quantification of GMV. As a biologically meaningful criterion we correlated regional GMV with age. The results were in line with the age-prediction analysis, and two pipelines, CAT and the combination of fMRIPrep for tissue characterization with FSL for registration, reflected age information better.
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Affiliation(s)
- Georgios Antonopoulos
- Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Research Centre Jülich, Jülich, Germany
| | - Shammi More
- Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Research Centre Jülich, Jülich, Germany
| | - Federico Raimondo
- Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Research Centre Jülich, Jülich, Germany
| | - Simon B Eickhoff
- Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Research Centre Jülich, Jülich, Germany
| | - Felix Hoffstaedter
- Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Research Centre Jülich, Jülich, Germany
| | - Kaustubh R Patil
- Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Research Centre Jülich, Jülich, Germany.
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13
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Leonardsen EH, Vidal-Piñeiro D, Roe JM, Frei O, Shadrin AA, Iakunchykova O, de Lange AMG, Kaufmann T, Taschler B, Smith SM, Andreassen OA, Wolfers T, Westlye LT, Wang Y. Genetic architecture of brain age and its causal relations with brain and mental disorders. Mol Psychiatry 2023; 28:3111-3120. [PMID: 37165155 PMCID: PMC10615751 DOI: 10.1038/s41380-023-02087-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/12/2023]
Abstract
The difference between chronological age and the apparent age of the brain estimated from brain imaging data-the brain age gap (BAG)-is widely considered a general indicator of brain health. Converging evidence supports that BAG is sensitive to an array of genetic and nongenetic traits and diseases, yet few studies have examined the genetic architecture and its corresponding causal relationships with common brain disorders. Here, we estimate BAG using state-of-the-art neural networks trained on brain scans from 53,542 individuals (age range 3-95 years). A genome-wide association analysis across 28,104 individuals (40-84 years) from the UK Biobank revealed eight independent genomic regions significantly associated with BAG (p < 5 × 10-8) implicating neurological, metabolic, and immunological pathways - among which seven are novel. No significant genetic correlations or causal relationships with BAG were found for Parkinson's disease, major depressive disorder, or schizophrenia, but two-sample Mendelian randomization indicated a causal influence of AD (p = 7.9 × 10-4) and bipolar disorder (p = 1.35 × 10-2) on BAG. These results emphasize the polygenic architecture of brain age and provide insights into the causal relationship between selected neurological and neuropsychiatric disorders and BAG.
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Affiliation(s)
- Esten H Leonardsen
- Center for Lifespan Changes in Brain and Cognition (LCBC), Department of Psychology, University of Oslo, 0317, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, 0317, Oslo, Norway
| | - Didac Vidal-Piñeiro
- Center for Lifespan Changes in Brain and Cognition (LCBC), Department of Psychology, University of Oslo, 0317, Oslo, Norway
| | - James M Roe
- Center for Lifespan Changes in Brain and Cognition (LCBC), Department of Psychology, University of Oslo, 0317, Oslo, Norway
| | - Oleksandr Frei
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, 0317, Oslo, Norway
| | - Alexey A Shadrin
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, 0317, Oslo, Norway
- K.G. Jebsen Centre for Neurodevelopmental disorders, University of Oslo, Oslo, Norway
| | - Olena Iakunchykova
- Center for Lifespan Changes in Brain and Cognition (LCBC), Department of Psychology, University of Oslo, 0317, Oslo, Norway
| | - Ann-Marie G de Lange
- Department of Psychology, University of Oslo, 0317, Oslo, Norway
- LREN, Centre for Research in Neurosciences, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, 1015, Lausanne, Switzerland
- Department of Psychiatry, University of Oxford, OX1 2JD, Oxford, UK
| | - Tobias Kaufmann
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, 0317, Oslo, Norway
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, 72074, Tübingen, Germany
| | - Bernd Taschler
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, OX3 9DU, Oxford, United Kingdom
| | - Stephen M Smith
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, OX3 9DU, Oxford, United Kingdom
| | - Ole A Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, 0317, Oslo, Norway
- K.G. Jebsen Centre for Neurodevelopmental disorders, University of Oslo, Oslo, Norway
| | - Thomas Wolfers
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, 0317, Oslo, Norway
- Department of Psychology, University of Oslo, 0317, Oslo, Norway
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, 72074, Tübingen, Germany
| | - Lars T Westlye
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, 0317, Oslo, Norway
- K.G. Jebsen Centre for Neurodevelopmental disorders, University of Oslo, Oslo, Norway
- Department of Psychology, University of Oslo, 0317, Oslo, Norway
| | - Yunpeng Wang
- Center for Lifespan Changes in Brain and Cognition (LCBC), Department of Psychology, University of Oslo, 0317, Oslo, Norway.
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14
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Beheshti I. Cocaine Destroys Gray Matter Brain Cells and Accelerates Brain Aging. BIOLOGY 2023; 12:biology12050752. [PMID: 37237564 DOI: 10.3390/biology12050752] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023]
Abstract
Introduction: Cocaine use disorder (CUD) is a substance use disorder characterized by a strong desire to obtain, consume, and misuse cocaine. Little is known about how cocaine affects the structure of the brain. In this study, we first investigated the anatomical brain changes in individuals with CUD compared to their matched healthy controls, and then explored whether these anatomical brain abnormalities contribute to considerably accelerated brain aging among this population. Methods: At the first stage, we used anatomical magnetic resonance imaging (MRI) data, voxel-based morphometry (VBM), and deformation-based morphometry techniques to uncover the morphological and macroscopic anatomical brain changes in 74 CUD patients compared to 62 age- and sex-matched healthy controls (HCs) obtained from the SUDMEX CONN dataset, the Mexican MRI dataset of patients with CUD. Then, we computed brain-predicted age difference (i.e., brain-PAD: the brain-predicted age minus the actual age) in CUD and HC groups using a robust brain age estimation framework. Using a multiple regression analysis, we also investigated the regional gray matter (GM) and white matter (WM) changes associated with the brain-PAD. Results: Using a whole-brain VBM analysis, we observed widespread gray matter atrophy in CUD patients located in the temporal lobe, frontal lobe, insula, middle frontal gyrus, superior frontal gyrus, rectal gyrus, and limbic lobe regions compared to the HCs. In contrast, we did not observe any swelling in the GM, changes in the WM, or local brain tissue atrophy or expansion between the CUD and HC groups. Furthermore, we found a significantly higher brain-PAD in CUD patients compared to matched HCs (mean difference = 2.62 years, Cohen's d = 0.54; t-test = 3.16, p = 0.002). The regression analysis showed significant negative changes in GM volume associated with brain-PAD in the CUD group, particularly in the limbic lobe, subcallosal gyrus, cingulate gyrus, and anterior cingulate regions. Discussion: The results of our investigation reveal that chronic cocaine use is linked to significant changes in gray matter, which hasten the process of structural brain aging in individuals who use the drug. These findings offer valuable insights into the impact of cocaine on the composition of the brain.
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Affiliation(s)
- Iman Beheshti
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Health Sciences Centre, Winnipeg, MB R3E 3J7, Canada
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15
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More S, Antonopoulos G, Hoffstaedter F, Caspers J, Eickhoff SB, Patil KR. Brain-age prediction: A systematic comparison of machine learning workflows. Neuroimage 2023; 270:119947. [PMID: 36801372 DOI: 10.1016/j.neuroimage.2023.119947] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 02/18/2023] Open
Abstract
The difference between age predicted using anatomical brain scans and chronological age, i.e., the brain-age delta, provides a proxy for atypical aging. Various data representations and machine learning (ML) algorithms have been used for brain-age estimation. However, how these choices compare on performance criteria important for real-world applications, such as; (1) within-dataset accuracy, (2) cross-dataset generalization, (3) test-retest reliability, and (4) longitudinal consistency, remains uncharacterized. We evaluated 128 workflows consisting of 16 feature representations derived from gray matter (GM) images and eight ML algorithms with diverse inductive biases. Using four large neuroimaging databases covering the adult lifespan (total N = 2953, 18-88 years), we followed a systematic model selection procedure by sequentially applying stringent criteria. The 128 workflows showed a within-dataset mean absolute error (MAE) between 4.73-8.38 years, from which 32 broadly sampled workflows showed a cross-dataset MAE between 5.23-8.98 years. The test-retest reliability and longitudinal consistency of the top 10 workflows were comparable. The choice of feature representation and the ML algorithm both affected the performance. Specifically, voxel-wise feature spaces (smoothed and resampled), with and without principal components analysis, with non-linear and kernel-based ML algorithms performed well. Strikingly, the correlation of brain-age delta with behavioral measures disagreed between within-dataset and cross-dataset predictions. Application of the best-performing workflow on the ADNI sample showed a significantly higher brain-age delta in Alzheimer's and mild cognitive impairment patients compared to healthy controls. However, in the presence of age bias, the delta estimates in the patients varied depending on the sample used for bias correction. Taken together, brain-age shows promise, but further evaluation and improvements are needed for its real-world application.
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Affiliation(s)
- Shammi More
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Georgios Antonopoulos
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Felix Hoffstaedter
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Julian Caspers
- Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Kaustubh R Patil
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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16
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Hoenig MC, Dzialas V, Drzezga A, van Eimeren T. The Concept of Motor Reserve in Parkinson's Disease: New Wine in Old Bottles? Mov Disord 2023; 38:16-20. [PMID: 36345092 DOI: 10.1002/mds.29266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/14/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Merle C Hoenig
- Institute for Neuroscience and Medicine II, Molecular Organization of the Brain, Research Center Juelich, Julich, Germany.,Department of Nuclear Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Verena Dzialas
- Department of Nuclear Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Faculty of Mathematics and Natural Sciences, University of Cologne, Cologne, Germany
| | - Alexander Drzezga
- Institute for Neuroscience and Medicine II, Molecular Organization of the Brain, Research Center Juelich, Julich, Germany.,Department of Nuclear Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn/Cologne, Germany
| | - Thilo van Eimeren
- Department of Nuclear Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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17
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Sone D, Beheshti I. Neuroimaging-Based Brain Age Estimation: A Promising Personalized Biomarker in Neuropsychiatry. J Pers Med 2022; 12:jpm12111850. [PMID: 36579560 PMCID: PMC9695293 DOI: 10.3390/jpm12111850] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/10/2022] Open
Abstract
It is now possible to estimate an individual's brain age via brain scans and machine-learning models. This validated technique has opened up new avenues for addressing clinical questions in neurology, and, in this review, we summarize the many clinical applications of brain-age estimation in neuropsychiatry and general populations. We first provide an introduction to typical neuroimaging modalities, feature extraction methods, and machine-learning models that have been used to develop a brain-age estimation framework. We then focus on the significant findings of the brain-age estimation technique in the field of neuropsychiatry as well as the usefulness of the technique for addressing clinical questions in neuropsychiatry. These applications may contribute to more timely and targeted neuropsychiatric therapies. Last, we discuss the practical problems and challenges described in the literature and suggest some future research directions.
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Affiliation(s)
- Daichi Sone
- Department of Psychiatry, Jikei University School of Medicine, Tokyo 105-8461, Japan
- Correspondence: ; Tel.: +81-03-3433
| | - Iman Beheshti
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, MB R3E 3P5, Canada
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18
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Taylor A, Zhang F, Niu X, Heywood A, Stocks J, Feng G, Popuri K, Beg MF, Wang L. Investigating the temporal pattern of neuroimaging-based brain age estimation as a biomarker for Alzheimer's Disease related neurodegeneration. Neuroimage 2022; 263:119621. [PMID: 36089183 PMCID: PMC9995621 DOI: 10.1016/j.neuroimage.2022.119621] [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: 07/18/2022] [Revised: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 11/19/2022] Open
Abstract
Neuroimaging-based brain-age estimation via machine learning has emerged as an important new approach for studying brain aging. The difference between one's estimated brain age and chronological age, the brain age gap (BAG), has been proposed as an Alzheimer's Disease (AD) biomarker. However, most past studies on the BAG have been cross-sectional. Quantifying longitudinal changes in an individual's BAG temporal pattern would likely improve prediction of AD progression and clinical outcome based on neurophysiological changes. To fill this gap, our study conducted predictive modeling using a large neuroimaging dataset with up to 8 years of follow-up to examine the temporal patterns of the BAG's trajectory and how it varies by subject-level characteristics (sex, APOEɛ4 carriership) and disease status. Specifically, we explored the pattern and rate of change in BAG over time in individuals who remain stable with normal cognition or mild cognitive impairment (MCI), as well as individuals who progress to clinical AD. Combining multimodal imaging data in a support vector regression model to estimate brain age yielded improved performance over single modality. Multilevel modeling results showed the BAG followed a linear increasing trajectory with a significantly faster rate in individuals with MCI who progressed to AD compared to cognitively normal or MCI individuals who did not progress. The dynamic changes in the BAG during AD progression were further moderated by sex and APOEɛ4 carriership. Our findings demonstrate the BAG as a potential biomarker for understanding individual specific temporal patterns related to AD progression.
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Affiliation(s)
- Alexei Taylor
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA 19104, USA
| | - Fengqing Zhang
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA 19104, USA.
| | - Xin Niu
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA 19104, USA
| | - Ashley Heywood
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Jane Stocks
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Gangyi Feng
- Department of Linguistics and Modern Languages, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China; Brain and Mind Institute, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Karteek Popuri
- Department of Computer Science, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Mirza Faisal Beg
- School of Engineering Science, Simon Fraser University, Burnaby, V6A1S6 BCE, Canada
| | - Lei Wang
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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19
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Hermann A, Tarakdjian GN, Temp AGM, Kasper E, Machts J, Kaufmann J, Vielhaber S, Prudlo J, Cole JH, Teipel S, Dyrba M. Cognitive and behavioural but not motor impairment increases brain age in amyotrophic lateral sclerosis. Brain Commun 2022; 4:fcac239. [PMID: 36246047 PMCID: PMC9556938 DOI: 10.1093/braincomms/fcac239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/01/2022] [Accepted: 09/21/2022] [Indexed: 11/14/2022] Open
Abstract
Age is the most important single risk factor of sporadic amyotrophic lateral sclerosis. Neuroimaging together with machine-learning algorithms allows estimating individuals' brain age. Deviations from normal brain-ageing trajectories (so called predicted brain age difference) were reported for a number of neuropsychiatric disorders. While all of them showed increased predicted brain-age difference, there is surprisingly few data yet on it in motor neurodegenerative diseases. In this observational study, we made use of previously trained algorithms of 3377 healthy individuals and derived predicted brain age differences from volumetric MRI scans of 112 amyotrophic lateral sclerosis patients and 70 healthy controls. We correlated predicted brain age difference scores with voxel-based morphometry data and multiple different motoric disease characteristics as well as cognitive/behavioural changes categorized according to Strong and Rascovsky. Against our primary hypothesis, there was no higher predicted brain-age difference in the amyotrophic lateral sclerosis patients as a group. None of the motoric phenotypes/characteristics influenced predicted brain-age difference. However, cognitive/behavioural impairment led to significantly increased predicted brain-age difference, while slowly progressive as well as cognitive/behavioural normal amyotrophic lateral sclerosis patients had even younger brain ages than healthy controls. Of note, the cognitive/behavioural normal amyotrophic lateral sclerosis patients were identified to have increased cerebellar brain volume as potential resilience factor. Younger brain age was associated with longer survival. Our results raise the question whether younger brain age in amyotrophic lateral sclerosis with only motor impairment provides a cerebral reserve against cognitive and/or behavioural impairment and faster disease progression. This new conclusion needs to be tested in subsequent samples. In addition, it will be interesting to test whether a potential effect of cerebral reserve is specific for amyotrophic lateral sclerosis or can also be found in other neurodegenerative diseases with primary motor impairment.
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Affiliation(s)
- Andreas Hermann
- Translational Neurodegeneration Section “Albrecht Kossel”, Department of Neurology, University Medical Center Rostock, University of Rostock, 18147 Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock (CTNR), University Medical Center Rostock, University of Rostock, 18147 Rostock, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE)Rostock/Greifswald, 18147 Rostock, Germany
| | - Gaël Nils Tarakdjian
- Translational Neurodegeneration Section “Albrecht Kossel”, Department of Neurology, University Medical Center Rostock, University of Rostock, 18147 Rostock, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE)Rostock/Greifswald, 18147 Rostock, Germany
| | - Anna Gesine Marie Temp
- Translational Neurodegeneration Section “Albrecht Kossel”, Department of Neurology, University Medical Center Rostock, University of Rostock, 18147 Rostock, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE)Rostock/Greifswald, 18147 Rostock, Germany
| | - Elisabeth Kasper
- Department of Neurology, University Medical Center Rostock, University of Rostock, 18147 Rostock, Germany
| | - Judith Machts
- Institute for Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
- Center for Behavioral Brain Sciences CBBS, 39104 Magdeburg, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Magdeburg, 39120 Magdeburg, Germany
| | - Jörn Kaufmann
- Department of Neurology, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Stefan Vielhaber
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Magdeburg, 39120 Magdeburg, Germany
- Department of Neurology, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Johannes Prudlo
- Department of Neurology, University Medical Center Rostock, University of Rostock, 18147 Rostock, Germany
| | - James H Cole
- Centre for Medical Image Computing, Department of Computer Science, UCL, London, UK
- Dementia Research Centre, Queen Square Institute of Neurology, UCL, London, UK
| | - Stefan Teipel
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE)Rostock/Greifswald, 18147 Rostock, Germany
- Department of Psychosomatic Medicine, University Medical Center Rostock, University of Rostock, 18147 Rostock, Germany
| | - Martin Dyrba
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE)Rostock/Greifswald, 18147 Rostock, Germany
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Hu W, Wang W, Wang Y, Chen Y, Shang X, Liao H, Huang Y, Bulloch G, Zhang S, Kiburg K, Zhang X, Tang S, Yu H, Yang X, He M, Zhu Z. Retinal age gap as a predictive biomarker of future risk of Parkinson's disease. Age Ageing 2022; 51:6555657. [PMID: 35352798 PMCID: PMC8966015 DOI: 10.1093/ageing/afac062] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction retinal age derived from fundus images using deep learning has been verified as a novel biomarker of ageing. We aim to investigate the association between retinal age gap (retinal age–chronological age) and incident Parkinson’s disease (PD). Methods a deep learning (DL) model trained on 19,200 fundus images of 11,052 chronic disease-free participants was used to predict retinal age. Retinal age gap was generated by the trained DL model for the remaining 35,834 participants free of PD at the baseline assessment. Cox proportional hazards regression models were utilised to investigate the association between retinal age gap and incident PD. Multivariable logistic model was applied for prediction of 5-year PD risk and area under the receiver operator characteristic curves (AUC) was used to estimate the predictive value. Results a total of 35,834 participants (56.7 ± 8.04 years, 55.7% female) free of PD at baseline were included in the present analysis. After adjustment of confounding factors, 1-year increase in retinal age gap was associated with a 10% increase in risk of PD (hazard ratio [HR] = 1.10, 95% confidence interval [CI]: 1.01–1.20, P = 0.023). Compared with the lowest quartile of the retinal age gap, the risk of PD was significantly increased in the third and fourth quartiles (HR = 2.66, 95% CI: 1.13–6.22, P = 0.024; HR = 4.86, 95% CI: 1.59–14.8, P = 0.005, respectively). The predictive value of retinal age and established risk factors for 5-year PD risk were comparable (AUC = 0.708 and 0.717, P = 0.821). Conclusion retinal age gap demonstrated a potential for identifying individuals at a high risk of developing future PD.
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Affiliation(s)
- Wenyi Hu
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
- Ophthalmology, Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yueye Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yifan Chen
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Xianwen Shang
- Ophthalmology, Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
| | - Huan Liao
- Neural Regeneration Group, Institute of Reconstructive Neurobiology, University of Bonn, Bonn, Germany
| | - Yu Huang
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Gabriella Bulloch
- Ophthalmology, Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
| | - Shiran Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Katerina Kiburg
- Ophthalmology, Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
| | - Xueli Zhang
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Shulin Tang
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Honghua Yu
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Xiaohong Yang
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Mingguang He
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
- Ophthalmology, Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhuoting Zhu
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
- Ophthalmology, Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
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