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Li X, Wei C, Gao X, Sun J, Yang J. Global trends in the research on older population dizziness/vertigo: a 20-year bibliometric and visualization analysis. Braz J Otorhinolaryngol 2024; 90:101441. [PMID: 38834014 PMCID: PMC11178979 DOI: 10.1016/j.bjorl.2024.101441] [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: 01/21/2024] [Revised: 04/20/2024] [Accepted: 04/29/2024] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVE Dizziness or vertigo in older population frequently presents in clinical settings, yet its etiology remains elusive. The objective of this study was to delineate global trends and identify frontiers in research concerning dizziness or vertigo among older population. METHODS We searched the research literature published from 2003 to 2022 on older population with dizziness or vertigo using two databases from the Web of Science Core Collection. A bibliometric and visualization analysis was conducted. Bibliometric tools facilitated co-authorship, co-citation, and keyword co-occurrence analyses, encompassing countries or regions, institutions, authors, journals, and references. RESULTS The analysis included 1322 publications authored by 6524 individuals from 2244 institutions across 67 countries or regions, spanning 92 subject categories. A steady increase in publications was noted from 2003 to 2022. The University of Munich, Harvard University, and the University of California System emerged as leading institutions with the highest publication outputs. The United States, Germany, and China were predominant in publication counts. Eva Grill was identified as the most prolific author. Otology & Neurotology and Geriatrics & Gerontology emerged as the most prolific journal and subject category, respectively. The most prevalent keywords were "dizziness", "vertigo", "falls", and "geriatric", with "management", "gait", and "association" recognized as the principal research hotspots. CONCLUSION This study provides a systematic analysis of global scientific research on older population dizziness/vertigo, revealing significant advancements in understanding over the past two decades. Management, gait, and association have emerged as the primary research focuses on recent years. These findings offer valuable insights for directing current research efforts to capture prevailing trends and explore new frontiers in this field.
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Affiliation(s)
- Xiang Li
- The First Affiliated Hospital of Ningbo University, Department of Neurology, Ningbo, China
| | - Chao Wei
- The First Affiliated Hospital of Ningbo University, Department of Neurology, Ningbo, China
| | - Xiang Gao
- The First Affiliated Hospital of Ningbo University, Department of Neurosurgery, Ningbo, China
| | - Jie Sun
- The First Affiliated Hospital of Ningbo University, Department of Neurosurgery, Ningbo, China
| | - Jianhong Yang
- The First Affiliated Hospital of Ningbo University, Department of Neurology, Ningbo, China.
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2
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Bucci M, Iozzo P, Merisaari H, Huovinen V, Lipponen H, Räikkönen K, Parkkola R, Salonen M, Sandboge S, Eriksson JG, Nummenmaa L, Nuutila P. Resistance Training Increases White Matter Density in Frail Elderly Women. J Clin Med 2023; 12:jcm12072684. [PMID: 37048767 PMCID: PMC10094827 DOI: 10.3390/jcm12072684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/23/2023] [Accepted: 04/01/2023] [Indexed: 04/07/2023] Open
Abstract
We aimed to investigate the effects of maternal obesity on brain structure and metabolism in frail women, and their reversibility in response to exercise. We recruited 37 frail elderly women (20 offspring of lean/normal-weight mothers (OLM) and 17 offspring of obese/overweight mothers (OOM)) and nine non-frail controls to undergo magnetic resonance and diffusion tensor imaging (DTI), positron emission tomography with Fluorine-18-fluorodeoxyglucose (PET), and cognitive function tests (CERAD). Frail women were studied before and after a 4-month resistance training, and controls were studied once. White matter (WM) density (voxel-based morphometry) was higher in OLM than in OOM subjects. Exercise increased WM density in both OLM and OOM in the cerebellum in superior parietal regions in OLM and in cuneal and precuneal regions in OOM. OLM gained more WM density than OOM in response to intervention. No significant results were found from the Freesurfer analysis, nor from PET or DTI images. Exercise has an impact on brain morphology and cognition in elderly frail women.
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Affiliation(s)
- Marco Bucci
- Turku PET Centre, University of Turku, 20520 Turku, Finland
- Theme Inflammation and Aging, Karolinska University Hospital, 141 86 Huddinge, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska University, 171 77 Stockholm, Sweden
| | - Patricia Iozzo
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy
| | - Harri Merisaari
- Department of Radiology, Turku University Hospital, University of Turku, 20014 Turku, Finland
- Turku Brain and Mind Center, University of Turku, 20014 Turku, Finland
| | - Ville Huovinen
- Turku PET Centre, University of Turku, 20520 Turku, Finland
- Department of Radiology, Turku University Hospital, University of Turku, 20014 Turku, Finland
| | - Heta Lipponen
- Turku PET Centre, University of Turku, 20520 Turku, Finland
| | - Katri Räikkönen
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland
| | - Riitta Parkkola
- Department of Radiology, Turku University Hospital, University of Turku, 20014 Turku, Finland
| | | | - Samuel Sandboge
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
- Psychology/Welfare Sciences, Faculty of Social Sciences, University of Tampere, 33014 Tampere, Finland
| | - Johan Gunnar Eriksson
- Folkhälsan Research Centre, 00250 Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki University Hospital, 00290 Helsinki, Finland
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore 138632, Singapore
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | | | - Pirjo Nuutila
- Turku PET Centre, University of Turku, 20520 Turku, Finland
- Department of Endocrinology, Turku University Hospital, 20520 Turku, Finland
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3
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Laera G, Joly-Burra E, Zuber S, Ballhausen N, Künzi M, Ihle A, da Silva Coelho C, Haas M, Mikneviciute G, Tinello D, Kliegel M, Hering A. Do executive functions explain older adults' health-related quality of life beyond event-based prospective memory? NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2023; 30:135-149. [PMID: 34665685 DOI: 10.1080/13825585.2021.1989368] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Previous work has shown that event-based prospective memory (EBPM) predicted health-related quality of life (HrQoL). In the present study, we aimed to examine whether the relationship between EBPM and HrQoL extended to life satisfaction, and whether it persisted after controlling for other cognitive functions related to EBPM, namely executive functions and retrospective memory. We tested two models using structural equation modeling with latent variables in a sample of older adults. In the first model, we assessed whether EBPM predicted life satisfaction and HrQoL; in the second model, we controlled for retrospective memory and executive functions. The first model indicated that EBPM was related to HrQoL. However, in the second model, this relationship was eliminated by executive functions; life satisfaction was not related to any of the cognitive variables. Findings corroborated the link between HrQoL and EBPM, suggesting that such relationship stems from executive functions rather than retrospective memory.
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Affiliation(s)
- G Laera
- Cognitive Aging Lab (Cal), Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland.,LIVES, Overcoming Vulnerability: Life Course Perspective, Swiss National Centre of Competence in Research, Lausanne and Geneva, Switzerland
| | - E Joly-Burra
- Cognitive Aging Lab (Cal), Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland.,LIVES, Overcoming Vulnerability: Life Course Perspective, Swiss National Centre of Competence in Research, Lausanne and Geneva, Switzerland
| | - S Zuber
- Cognitive Aging Lab (Cal), Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland.,LIVES, Overcoming Vulnerability: Life Course Perspective, Swiss National Centre of Competence in Research, Lausanne and Geneva, Switzerland
| | - N Ballhausen
- Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland.,Department of Developmental Psychology, Tilburg School for Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - M Künzi
- Cognitive Aging Lab (Cal), Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland.,LIVES, Overcoming Vulnerability: Life Course Perspective, Swiss National Centre of Competence in Research, Lausanne and Geneva, Switzerland
| | - A Ihle
- Cognitive Aging Lab (Cal), Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland.,LIVES, Overcoming Vulnerability: Life Course Perspective, Swiss National Centre of Competence in Research, Lausanne and Geneva, Switzerland
| | - C da Silva Coelho
- Cognitive Aging Lab (Cal), Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland.,LIVES, Overcoming Vulnerability: Life Course Perspective, Swiss National Centre of Competence in Research, Lausanne and Geneva, Switzerland
| | - M Haas
- Cognitive Aging Lab (Cal), Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland
| | - G Mikneviciute
- Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland.,LIVES, Overcoming Vulnerability: Life Course Perspective, Swiss National Centre of Competence in Research, Lausanne and Geneva, Switzerland
| | - D Tinello
- Cognitive Aging Lab (Cal), Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland
| | - M Kliegel
- Cognitive Aging Lab (Cal), Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland.,LIVES, Overcoming Vulnerability: Life Course Perspective, Swiss National Centre of Competence in Research, Lausanne and Geneva, Switzerland
| | - A Hering
- Cognitive Aging Lab (Cal), Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland.,Department of Developmental Psychology, Tilburg School for Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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4
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Abstract
Delirium and frailty are prevalent geriatric syndromes and important public health issues among older adults. The prevalence of delirium among hospitalized older adults ranges from 15% to 75%, while that of frailty ranges from 12% to 24%. The exact pathophysiology of these two conditions has not been clearly identified, although several hypotheses have been proposed. However, these conditions are considered to be multifactorial in etiology and are associated with inflammation related to aging, alterations in vascular systems, genetics, and nutritional deficiency. Furthermore, clinically, they are significantly associated with frailty, which increases the risk of delirium by almost two- to three-fold among hospitalized older adults. With their multifactorial etiology and unknown pathophysiology, current evidence supports more practical multicomponent patient-centered approaches to prevent and manage delirium with frailty among hospitalized older adults. These comprehensive and organized bundled approaches can identify high-risk patients with frailty and more effectively manage their delirium.
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Affiliation(s)
- Min Ji Kwak
- Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Corresponding author: Min Ji Kwak, MD, MS, DrPH Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin St MSB 5.126, Houston, TX 77030, USA E-mail:
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5
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Peultier-Celli L, Lion A, Buatois S, Watfa G, Gueguen R, Benetos A, Perrin PP. Relation of arterial stiffness with postural control in older people. Eur Geriatr Med 2021; 12:871-879. [PMID: 33687696 DOI: 10.1007/s41999-021-00468-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/04/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Arterial stiffness generates vascular alterations that may cause balance disorders and falls. This study aimed to investigate the possible link between arterial stiffness and postural control under different sensorial conditions in patients over 65 years. METHODS Carotid-femoral pulse wave velocity (PWV) was measured in 47 participants aged over 65 years to evaluate their arterial stiffness (high PWV). Twenty-seven participants (mean age = 70.52 ± 4.02 years, 22 females) had a normal PWV (< 10 m s-1) and 20 participants (mean age = 75.93 ± 6.11 years; 15 females) had a high PWV (≥ 10 m s-1). Postural control was evaluated using a force platform in four postural conditions: eyes open (EO) 1, eyes closed (EC), eyes open with a dual task (DT) and eyes open again (EO2). Using sway path traveled and surface covered by the center of foot pressure, we calculate the length function of surface (LFS). This ratio provides information about the precision (surface) of postural control and the effort made (length) by the subjects. RESULTS After an age-adjustment, LFS was lower in EO than in EC and DT in both groups (p ≤ 0.001). LFS was higher in participants with high PWV both in eyes open and eyes closed conditions (p < 0.05). LFS increased when PWV increased in EO (p < 0.01) and EC conditions (p < 0.001) but not when a dual task was performed. CONCLUSION Difficulties in maintaining equilibrium under a dual-task condition are more pronounced in people with increased arterial stiffness. These data suggest that understanding of the influence of the arterial stiffness level on specific balance control parameters could contribute to propose better balance-oriented rehabilitation programs in older adults in an attempt to prevent fall.
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Affiliation(s)
- Laetitia Peultier-Celli
- Faculté de Médecine de Nancy, EA 3450 DevAH, Développement, Adaptation et Handicap, Université de Lorraine, 54500, Vandoeuvre-lès-Nancy, France
- Laboratory for the Analysis of Posture, Equilibrium and Motor Function (LAPEM), University Hospital of Nancy, 54500, Vandoeuvre-lès-Nancy, France
| | - Alexis Lion
- Faculté de Médecine de Nancy, EA 3450 DevAH, Développement, Adaptation et Handicap, Université de Lorraine, 54500, Vandoeuvre-lès-Nancy, France
- Laboratory for the Analysis of Posture, Equilibrium and Motor Function (LAPEM), University Hospital of Nancy, 54500, Vandoeuvre-lès-Nancy, France
- Fédération Luxembourgeoise des Associations de Sport de Santé, 1445, Strassen, Luxembourg
- Luxembourg Institute of Research in Orthopedics Sports Medicine and Science, 1460, Luxembourg, Luxembourg
| | - Séverine Buatois
- Faculté de Médecine de Nancy, EA 3450 DevAH, Développement, Adaptation et Handicap, Université de Lorraine, 54500, Vandoeuvre-lès-Nancy, France
- Laboratory for the Analysis of Posture, Equilibrium and Motor Function (LAPEM), University Hospital of Nancy, 54500, Vandoeuvre-lès-Nancy, France
| | - Ghassan Watfa
- University of Lorraine, Inserm, DCAC, 54000, Nancy, France
| | - René Gueguen
- Faculté de Médecine de Nancy, EA 3450 DevAH, Développement, Adaptation et Handicap, Université de Lorraine, 54500, Vandoeuvre-lès-Nancy, France
- Laboratory for the Analysis of Posture, Equilibrium and Motor Function (LAPEM), University Hospital of Nancy, 54500, Vandoeuvre-lès-Nancy, France
| | - Athanase Benetos
- University of Lorraine, Inserm, DCAC, 54000, Nancy, France
- University of Lorraine, University Hospital of Nancy, Pôle « Maladie du Vieillissement, Gérontologie et Soins Palliatifs », 54000, Nancy, France
| | - Philippe P Perrin
- Faculté de Médecine de Nancy, EA 3450 DevAH, Développement, Adaptation et Handicap, Université de Lorraine, 54500, Vandoeuvre-lès-Nancy, France.
- Laboratory for the Analysis of Posture, Equilibrium and Motor Function (LAPEM), University Hospital of Nancy, 54500, Vandoeuvre-lès-Nancy, France.
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6
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Ata Korkmaz HA. Relationship between androgenic alopecia and white matter hyperintensities in apparently healthy subjects. Brain Imaging Behav 2021; 14:527-533. [PMID: 31250269 DOI: 10.1007/s11682-019-00147-y] [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: 11/28/2022]
Abstract
A healthy brain is essential for living a longer and fuller life. Detecting asymptomatic white matter hyperintensities (WMHs) may be clinically important in terms of treatment and prognostic evaluation. WMHs in brain may reflect brain aging. Androgenic alopecia (AGA) is associated with significant cardiovascular risk factors that also have a negative impact on brain aging. The main purpose of present study was to know whether alopecia might provide predictive information of WMHs that may be considered as a surrogate marker of cerebral small vessel disease which is related to arteriolosclerosis and vascular risk factors. From January 2017 to March 2018, 256 cases were enrolled consecutively. Patients under 18 years old, older than 90 years old, known to be affected by neurodegenerative diseases, demyelinating disorders or stroke and/or a brain tumor, were excluded from the study. A 4-point cerebral white matter Magnetic Resonance Imaging (MRI) hyperintensities scoring system, the Fazekas scale, was used to evaluate brain aging. Presence of AGA was evaluated with inspection according to Hamilton-Norwood classification system (grade I to VII). Two hundred eleven (82%) of individuals had mild alopecia (grade I, II, III), 28 (11%) had moderate alopecia (grade IV, V) and 17 (7%) had severe alopecia (grade VI, VII). Frequency of abnormal WMHs was significantly higher in patients with AGA compared to the without AGA. Hypertension (HT) (95% confidence interval [CI]: 1.873-9.487, p < 0.001) and the AGA (95% CI: 2.989-12.916, p < 0.0001) were independent determinants of abnormal WMHs. AGA may be regarded as a surrogate marker of asymptomatic WMHs which is related to arteriolosclerosis and vascular risk factors that has a significant impact on people's life.
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Affiliation(s)
- Hatice Ayca Ata Korkmaz
- Department of Radiology, University of Health Science, Kanuni Research and Education Hospital, Trabzon, Turkey.
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7
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Gibson W, Makhani A, Hunter KF, Wagg A. Do Older Adults with Overactive Bladder Demonstrate Impaired Executive Function Compared to Their Peers Without OAB? Can Geriatr J 2020; 23:329-334. [PMID: 33282051 PMCID: PMC7704076 DOI: 10.5770/cgj.23.423] [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] [Indexed: 01/22/2023]
Abstract
Background Maintaining urinary continence is not an automatic process, but relies on continuous processing of sensory signals from the bladder and suppression of the desire to void. Urinary incontinence (UI) and lower urinary tract symptoms (LUTS), including urinary urgency, frequency, and nocturia are highly prevalent among the general population. This prevalence rises in association with increasing age, and this may be in part due to changes in the central nervous system rather than the urinary tract. The aim of this study was to assess if older adults with overactive bladder (OAB) had demonstrable impairment in executive function. Methods This was a cross-sectional study comparing the performance of adults aged 65 and over with and without OAB on two cognitive tests, the Trail Making Test B (TMT-B) and simple reaction time (SRT). OAB was defined as urgency, with at least weekly urgency incontinence and a daytime urinary frequency of 8 or more. The control group were defined as a Bladder control Self-Assessment Questionnaire (B-SAQ) score of ≤4. Results 56 participants were recruited, of whom 35 met criteria for OAB. The OAB group took significantly longer to complete the TMT-B than the control group (103s vs. 77s, p = .003). There was no difference in the SRT. Conclusions In this sample of older adults, OAB was associated with measurable slower performance on the TMT-B, suggesting that impaired executive function is associated with OAB.
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Affiliation(s)
- William Gibson
- Division of Geriatric Medicine, University of Alberta, Edmonton, AB
| | - Asad Makhani
- Division of Geriatric Medicine, University of Alberta, Edmonton, AB
| | | | - Adrian Wagg
- Division of Geriatric Medicine, University of Alberta, Edmonton, AB
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8
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Abstract
Overactive bladder (OAB) and frailty are multidimensional syndromes, and the prevalence of both increases with age. Little evidence exists for a direct association between OAB and frailty, but urinary urgency may well be a precursor of frailty in older people. Frail older adults are no less deserving of treatment than fit older adults, and lifestyle, behavioral, and pharmacological interventions remain the primary options for treatment, with some evidence for efficacy. Data on onabotulinumtoxinA therapy or percutaneous tibial nerve stimulation in frail older adults are sparse. Frail older adults are often excluded from drug trials, but evidence is accumulating that antimuscarinics and, to a lesser extent, beta-adrenergic agonists are safe, well-tolerated, and effective in older adults. Cognitive impairment associated with frailty should not be used as justification for avoiding the use of antimuscarinics. More studies are required to better understand the association between OAB and frailty, as both are associated with poor outcomes and may be amenable to intervention. Drug trials for OAB treatments should be encouraged to include frail older adults, as this population is highly affected yet often excluded.
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9
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Rao A, Shi SM, Afilalo J, Popma JJ, Khabbaz KR, Laham RJ, Guibone K, Marcantonio ER, Kim DH. Physical Performance and Risk of Postoperative Delirium in Older Adults Undergoing Aortic Valve Replacement. Clin Interv Aging 2020; 15:1471-1479. [PMID: 32921993 PMCID: PMC7455771 DOI: 10.2147/cia.s257079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/01/2020] [Indexed: 12/15/2022] Open
Abstract
Background Delirium is a major risk factor for poor recovery after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). It is unclear whether preoperative physical performance tests improve delirium prediction. Objective To examine whether physical performance tests can predict delirium after SAVR and TAVR, and adapt an existing delirium prediction rule for cardiac surgery, which includes Mini-Mental State Examination (MMSE), depression, prior stroke, and albumin level. Design Prospective cohort, 2014-2017. Setting Single academic center. Subjects A total of 187 patients undergoing SAVR (n=77) or TAVR (n=110). Methods The Short Physical Performance Battery (SPPB) score was calculated based on gait speed, balance, and chair stands (range: 0-12 points, lower scores indicate poor performance). Delirium was assessed using the Confusion Assessment Method. We fitted logistic regression to predict delirium using SPPB components and risk factors of delirium. Results Delirium occurred in 35.8% (50.7% in SAVR and 25.5% in TAVR). The risk of delirium increased for lower SPPB scores: 10-12 (28.2%), 7-9 (34.5%), 4-6 (37.5%) and 0-3 (44.1%) (p-for-trend=0.001). A model that included gait speed <0.46 meter/second (OR, 2.7; 95% CI, 1.2-6.4), chair stands time ≥11.2 seconds (OR, 3.5; 95% CI, 1.0-12.4), MMSE <24 points (OR, 2.9; 95% CI, 1.3-6.4), isolated SAVR (OR, 5.4; 95% CI, 2.1-13.8), and SAVR and coronary artery bypass grafting (OR, 15.8; 95% CI, 5.5-45.7) predicted delirium better than the existing prediction rule (C statistics: 0.71 vs 0.61; p=0.035). Conclusion Assessing physical performance, in addition to cognitive function, can help identify high-risk patients for delirium after SAVR and TAVR.
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Affiliation(s)
- Aarti Rao
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sandra M Shi
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Jonathan Afilalo
- Division of Cardiology and Centre for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Jeffrey J Popma
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kamal R Khabbaz
- Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Roger J Laham
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kimberly Guibone
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Edward R Marcantonio
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Dae Hyun Kim
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
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10
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Moon S, Chung HS, Yu JM, Na HR, Kim SJ, Ko KJ, Choi DK, Kwon O, Lee YG, Cho ST. Impact of urinary incontinence on falls in the older population: 2017 national survey of older Koreans. Arch Gerontol Geriatr 2020; 90:104158. [DOI: 10.1016/j.archger.2020.104158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 12/27/2022]
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11
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Volumetric Carotid Flow Characteristics in Doppler Ultrasonography in Healthy Population Over 65 Years Old. J Clin Med 2020; 9:jcm9051375. [PMID: 32392788 PMCID: PMC7291321 DOI: 10.3390/jcm9051375] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Carotid flow velocity criteria are well established, with age being a factor influencing measurements. However, there are no volumetric standards for the flow in extracranial arteries. The aim of the study was related to volumetric flow assessment of extracranial arteries in a healthy population >65 years old. Methods: Doppler volumetric measurements of internal carotid (ICA), external carotid (ECA) and vertebral arteries (VA) were performed in 123 healthy volunteers >65 years old and compared with 56 healthy volunteers <65 years old. Results: The continuous decline in cerebral blood flow (CBF) volume was observed (p < 0.00001). Volumetric reference values were established in study groups: 1., 65–69 years: 898.5 ± 119.1; 2., 70–74 years: 838.5 ± 148.9; 3., 75–79 years: 805.1 ± 99.3; 4., >80 years: 685.7 ± 112.3 (mL/min). Significant differences were observed between groups: 1 and 3.4, as well as 3 and 4 (p = 0.0295, < 0.000001, 0.00446 respectively). CBF volume decreases gradually with age: 28–64 years—6.2 mL/year (p = 0.0019), 65–75 years—11.4 mL/year (p = 0.0121) and >75 years—14.3 mL/year (p = 0.0074). This is a consequence of flow volume decline in ICA (p = 0.00001) and to lesser extent ECA (p = 0.0011). The decrease of peak systolic (p = 0.002) and end diastolic (p = < 0.00001) velocities in ICA and peak systolic velocity in ECA (p = 0.0017) were observed. Conclusions: CBF decreases with ageing. Volumetric assessment of CBF may play an important additional role in diagnostics of patients with carotid stenosis. Doppler assessment of cerebral flow volume may create an interesting tool for identifying patients with diminished cerebrovascular reserve and higher risk of ischemic symptoms occurrence.
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Morris R, Lewis A. Falls and Cancer. Clin Oncol (R Coll Radiol) 2020; 32:569-578. [PMID: 32291190 DOI: 10.1016/j.clon.2020.03.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/04/2020] [Accepted: 03/26/2020] [Indexed: 11/26/2022]
Abstract
Falls among older people are common and are associated with substantial morbidity, mortality and healthcare costs. Increasingly cancer is becoming a disease of older people and fall rates are higher in elders living with cancer. Cancer and its treatments potentiate important risk factors for falls, including muscle weakness, poor balance, proprioception, cognitive impairment and functional disability. Sarcopenia refers to the progressive deterioration in muscle strength, mass and quality with ageing. Chronic conditions and cancer amplify this decline and are associated with a greater negative effect on function. Age-related impairments of lower limb neurological function are commonly exacerbated by neurotoxic chemotherapy, resulting in gait and balance deficits. Postural instability and falls erode confidence and result in a negative cycle of diminishing activity levels, further deconditioning and a higher risk of further falls. Cancer-related fatigue, sleep and mood disturbances compound this progressive frailty, further worsening treatment tolerance and outcomes. Cognitive impairment is a potent risk factor for falling and is frequently associated with gait abnormalities. The well-recognised effects of cancer treatment on working memory, attention, processing speed and executive function are often apparent (when their presence is sought) before treatment and may be as much the result of the cancer itself as they are 'chemo brain'. Structured exercise programmes focusing on progressively challenging strength and balance training are of proven benefit in falls prevention. Regular aerobic exercise accrues additional benefits in improved cardiorespiratory resilience and concomitant positive effects on treatment tolerance. Increased activity levels positively influence cognition, mood and foster an improved sense of well-being. Simple, practicable clinic-based tests of physical functioning, cognition and neurological function can help to identify those at high risk of falls and functional decline. The use of such instruments can aid judicious treatment planning and identify those most likely to benefit from more detailed specialist comprehensive geriatric assessment.
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Affiliation(s)
- R Morris
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK.
| | - A Lewis
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
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Ryu WS, Schellingerhout D, Hong KS, Jeong SW, Jang MU, Park MS, Choi KH, Kim JT, Kim BJ, Lee J, Cha JK, Kim DH, Nah HW, Lee SJ, Kim JG, Cho YJ, Lee BC, Yu KH, Oh MS, Park JM, Kang K, Lee KB, Park TH, Park SS, Lee J, Bae HJ, Kim DE. White matter hyperintensity load on stroke recurrence and mortality at 1 year after ischemic stroke. Neurology 2019; 93:e578-e589. [DOI: 10.1212/wnl.0000000000007896] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 03/18/2019] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo define the role and risks associated with white matter hyperintensity (WMH) load in a stroke population with respect to recurrent stroke and mortality after ischemic stroke.MethodsA total of 7,101 patients at a network of university hospitals presenting with ischemic strokes were followed up for 1 year. Multivariable Cox proportional hazards model and competing risk analysis were used to examine the independent association between quartiles of WMH load and stroke recurrence and mortality at 1 year.ResultsOverall recurrent stroke risk at 1 year was 6.7%/y, divided between 5.6%/y for recurrent ischemic and 0.5%/y for recurrent hemorrhagic strokes. There was a stronger association between WMH volume and recurrent hemorrhagic stroke by quartile (hazard ratio [HR] 7.32, 14.12, and 33.52, respectively) than for ischemic recurrence (HR 1.03, 1.37, and 1.61, respectively), but the absolute incidence of ischemic recurrence by quartile was higher (3.8%/y, 4.5%/y, 6.3%/y, and 8.2%/y by quartiles) vs hemorrhagic recurrence (0.1%/y, 0.4%/y, 0.6%/y, and 1.3%/y). All-cause mortality (10.5%) showed a marked association with WMH volume (HR 1.06, 1.46, and 1.60), but this was attributable to nonvascular rather than vascular causes.ConclusionsThere is an association between WMH volume load and stroke recurrence, and this association is stronger for hemorrhagic than for ischemic stroke, although the absolute risk of ischemic recurrence remains higher. These data should be helpful to practitioners seeking to find the optimal preventive/treatment regimen for poststroke patients and to individualize risk-benefit ratios.
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Dolui S, Tisdall D, Vidorreta M, Jacobs DR, Nasrallah IM, Bryan RN, Wolk DA, Detre JA. Characterizing a perfusion-based periventricular small vessel region of interest. NEUROIMAGE-CLINICAL 2019; 23:101897. [PMID: 31233954 PMCID: PMC6595083 DOI: 10.1016/j.nicl.2019.101897] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 06/04/2019] [Accepted: 06/11/2019] [Indexed: 10/27/2022]
Abstract
The periventricular white matter (PVWM) is supplied by terminal distributions of small vessels and is particularly susceptible to developing white matter lesions (WML) associated with cerebral small vessel disease (CSVD). We obtained group-averaged cerebral blood flow (CBF) maps from Arterial Spin Labeled (ASL) perfusion MRI data obtained in 436 middle-aged (50.4 ± 3.5 years) subjects in the NHLBI CARDIA study and in 61 elderly (73.3 ± 6.9 years) cognitively normal subjects recruited from the Penn Alzheimer's Disease Center (ADC) and found that the lowest perfused brain voxels are located within the PVWM. We constructed a white matter periventricular small vessel (PSV) region of interest (ROI) by empirically thresholding the group averaged CARDIA CBF map at CBF < 15 ml/100 g/min. Thereafter we compared CBF in the PSV ROI and in the remaining white matter (RWM) with the location and volume of WML measured with Fluid Attenuated Inversion Recovery (FLAIR) MRI. WM CBF was lower within WML than outside WML voxels (p < <0.0001) in both the PSV and RWM ROIs, however this difference was much smaller (p < <0.0001) in the PSV ROI than in the RWM suggesting a more homogenous reduction of CBF in the PSV region. Normalized WML volumes were significantly higher in the PSV ROI than in the RWM and in the elderly cohort as compared to the middle-aged cohort (p < <0.0001). Additionally, the PSV ROI showed a significantly (p = .001) greater increase in lesion volume than the RWM in the elderly ADC cohort than the younger CARDIA cohort. Considerable intersubject variability in PSV CBF observed in both study cohorts likely represents biological variability that may be predictive of future WML and/or cognitive decline. In conclusion, a data-driven PSV ROI defined by voxels with low perfusion in middle age defines a region with homogeneously reduced CBF that is particularly susceptible to progressive ischemic injury in elderly controls. PSV CBF may provide a mechanistically specific biomarker of CSVD.
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Affiliation(s)
- Sudipto Dolui
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Dylan Tisdall
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Marta Vidorreta
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA; Siemens Healthcare S.L.U., Madrid, Spain
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Ilya M Nasrallah
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - R Nick Bryan
- Department of Diagnostic Medicine, University of Texas, Austin, Austin, TX, USA
| | - David A Wolk
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - John A Detre
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
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Giorgio A, Di Donato I, De Leucio A, Zhang J, Salvadori E, Poggesi A, Diciotti S, Cosottini M, Ciulli S, Inzitari D, Pantoni L, Mascalchi M, Federico A, Dotti MT, De Stefano N. Relevance of brain lesion location for cognition in vascular mild cognitive impairment. NEUROIMAGE-CLINICAL 2019; 22:101789. [PMID: 30927600 PMCID: PMC6439281 DOI: 10.1016/j.nicl.2019.101789] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/27/2019] [Accepted: 03/22/2019] [Indexed: 12/03/2022]
Abstract
Background Vascular mild cognitive impairment (VMCI) is a potentially transitional state between normal aging and vascular dementia. The presence of macroscopic white matter lesions (WML) of moderate or severe extension on brain MRI is the hallmark of the VMCI. Objective To assess the clinical relevance of the frequency of WML in patients with VMCI independently of total lesion volume (LV). Methods In this multicenter study, we included 110 patients with VMCI (age: 74.3 ± 6.6 years; sex: 60 women). Cognitive assessment was performed with the VMCI-Tuscany Neuropsychological Battery, which allowed to identify four VMCI groups: amnestic single (n = 9) and multi-domain (n = 76), non-amnestic single- (n = 10) and multi-domain (n = 15). Distribution and frequency of WML on MRI FLAIR images were evaluated with lesion probability map (LPM). Voxelwise statistics was performed with nonparametric permutation tests, controlling for age, sex, slice thickness, center, magnetic field strength, total LV and head size (p < .01, family-wise error-corrected for multiple comparisons across space). Results LPM of the WML had a fairly symmetric and widespread distribution across brain. A higher frequency of WML along association tracts of the WM such as inferior longitudinal fascicle, inferior fronto-occipital fascicle and superior longitudinal fascicle, was correlated with worst cognitive scores at the Trail Making Test Part A and Copy of the Rey–Osterrieth Complex Figure. The non-amnestic groups showed a higher frequency of WML in the anterior cingulum and superior longitudinal fascicle close to the frontal gyrus. Conclusions Our study showed that in patients with VMCI, independently of total LV, the higher frequency of lesions along association tracts of the WM, which mediate intrahemispheric long-range connectivity, is related with psychomotor speed and constructional praxis. Moreover, a prevalence of lesions in the frontal WM seems to characterize VMCI patients with involvement of non-amnestic domains. Vascular mild cognitive impairment (VMCI) has moderate-to-severe white matter lesions (WML). 110 VMCI patients were assessed by a full neuropsychological battery and a lesion mapping approach on MRI images. Higher WML frequency along association tracts correlated with worst psychomotor speed and constructional praxis. Non-amnestic groups of VMCI had higher WML frequency in the frontal WM.
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Affiliation(s)
- Antonio Giorgio
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
| | - Ilaria Di Donato
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Alessandro De Leucio
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Jian Zhang
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Emilia Salvadori
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy.
| | - Anna Poggesi
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy.
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy.
| | - Mirco Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Stefano Ciulli
- Department of Clinical and Experimental Biomedical Sciences -"Mario Serio", University of Florence, Florence, Italy
| | - Domenico Inzitari
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy.
| | - Leonardo Pantoni
- "L. Sacco" Department of Biomedical and Clinical Sciences, University of Milano, Italy.
| | - Mario Mascalchi
- Department of Clinical and Experimental Biomedical Sciences -"Mario Serio", University of Florence, Florence, Italy.
| | - Antonio Federico
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
| | - Maria Teresa Dotti
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
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Hasan TF, Barrett KM, Brott TG, Badi MK, Lesser ER, Hodge DO, Meschia JF. Severity of White Matter Hyperintensities and Effects on All-Cause Mortality in the Mayo Clinic Florida Familial Cerebrovascular Diseases Registry. Mayo Clin Proc 2019; 94:408-416. [PMID: 30832790 DOI: 10.1016/j.mayocp.2018.10.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/07/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare all-cause mortality rates across the severity range of white matter hyperintensities (WMH). PATIENTS AND METHODS Between October 26, 2010, and October 5, 2017, the ongoing Mayo Clinic Florida Familial Cerebrovascular Diseases Registry prospectively enrolled 1011 diverse participants with and without cerebrovascular disease. T2-weighted magnetic resonance imaging of the brain was used to evaluate WMH in 455 participants using the Fazekas scale. Fazekas deep WMH (FD) and periventricular WMH (FPV) scores (0-3 points) were assigned on the basis of WMH severity. Kaplan-Meier survival analyses, Cox proportional hazards models, and estimated hazard ratios compared survival rates across FD and FPV categories. The Fisher exact and χ2 tests evaluated the relationship of categorical variables, and the Kruskal-Wallis test measured the relationship of continuous variables across FD and FPV categories. All tests were performed at a P<.05 significance level. RESULTS Over a median follow-up of 3.06 years (range, 0.00-6.96 years), 96 deaths occurred. Higher FD scores corresponded to a higher likelihood of mortality (P<.001). Participants with an FD score of 3 were 4.69 (95% CI, 2.60-8.46) times more likely to die compared with those with an FD score of 0. Participants with higher FPV scores had a higher likelihood of mortality (P<.001). Participants with an FPV score of 3 were 7.04 (95% CI, 3.39-14.62) times more likely to die compared with those with an FPV score of 0. Once adjusted, age and baseline functional status explained most of the survival differences among the FD scores. CONCLUSION Associations between all-cause mortality rates across the severity range of WMH were observed in the Registry. Further studies are warranted to understand the clinical importance of WMH in other clinical populations.
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Affiliation(s)
- Tasneem F Hasan
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL
| | | | | | | | | | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
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Farhat NS, Theiss R, Santini T, Ibrahim TS, Aizenstein HJ. Neuroimaging of Small Vessel Disease in Late-Life Depression. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1192:95-115. [PMID: 31705491 PMCID: PMC6939470 DOI: 10.1007/978-981-32-9721-0_5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cerebral small vessel disease is associated with late-life depression, cognitive impairment, executive dysfunction, distress, and loss of life for older adults. Late-life depression is becoming a substantial public health burden, and a considerable number of older adults presenting to primary care have significant clinical depression. Even though white matter hyperintensities are linked with small vessel disease, white matter hyperintensities are nonspecific to small vessel disease and can co-occur with other brain diseases. Advanced neuroimaging techniques at the ultrahigh field magnetic resonance imaging are enabling improved characterization, identification of cerebral small vessel disease and are elucidating some of the mechanisms that associate small vessel disease with late-life depression.
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Affiliation(s)
- Nadim S Farhat
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert Theiss
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tales Santini
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tamer S Ibrahim
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Radiology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Howard J Aizenstein
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.
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Shaaban CE, Jorgensen DR, Gianaros PJ, Mettenburg J, Rosano C. Cerebrovascular disease: Neuroimaging of cerebral small vessel disease. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 165:225-255. [DOI: 10.1016/bs.pmbts.2019.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Grajauskas LA, Siu W, Medvedev G, Guo H, D’Arcy RC, Song X. MRI-based evaluation of structural degeneration in the ageing brain: Pathophysiology and assessment. Ageing Res Rev 2019; 49:67-82. [PMID: 30472216 DOI: 10.1016/j.arr.2018.11.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 11/08/2018] [Accepted: 11/21/2018] [Indexed: 12/13/2022]
Abstract
Advances in MRI technology have significantly contributed to our ability to understand the process of brain ageing, allowing us to track and assess changes that occur during normal ageing and neurological conditions. This paper focuses on reviewing structural changes of the ageing brain that are commonly seen using MRI, summarizing the pathophysiology, prevalence, and neuroanatomical distribution of changes including atrophy, lacunes, white matter lesions, and dilated perivascular spaces. We also review the clinically accessible methodology for assessing these MRI-based changes, covering visual rating scales, as well computer-aided and fully automated methods. Subsequently, we consider novel assessment methods designed to evaluate changes across the whole brain, and finally discuss new directions in this field of research.
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Manjón JV, Coupé P, Raniga P, Xia Y, Desmond P, Fripp J, Salvado O. MRI white matter lesion segmentation using an ensemble of neural networks and overcomplete patch-based voting. Comput Med Imaging Graph 2018; 69:43-51. [DOI: 10.1016/j.compmedimag.2018.05.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/21/2018] [Accepted: 05/01/2018] [Indexed: 12/11/2022]
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21
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Aarabi G, Thomalla G, Heydecke G, Seedorf U. Chronic oral infection: An emerging risk factor of cerebral small vessel disease. Oral Dis 2018; 25:710-719. [DOI: 10.1111/odi.12912] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 05/31/2018] [Accepted: 06/04/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Ghazal Aarabi
- Department of Prosthetic DentistryCenter for Dental and Oral MedicineUniversity Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Götz Thomalla
- Department of NeurologyHead‐ and NeurocenterUniversity Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Guido Heydecke
- Department of Prosthetic DentistryCenter for Dental and Oral MedicineUniversity Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Udo Seedorf
- Department of Prosthetic DentistryCenter for Dental and Oral MedicineUniversity Medical Center Hamburg‐Eppendorf Hamburg Germany
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Ciliz M, Sartor J, Lindig T, Pilotto A, Schäffer E, Weiss M, Scheltens P, Becker S, Hobert MA, Berg D, Liepelt-Scarfone I, Maetzler W. Brain-Area Specific White Matter Hyperintensities: Associations to Falls in Parkinson’s Disease. JOURNAL OF PARKINSONS DISEASE 2018; 8:455-462. [DOI: 10.3233/jpd-181351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Meltem Ciliz
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Jennifer Sartor
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Tobias Lindig
- Department of Diagnostic and Interventional Neuroradiology, University of Tuebingen, Tuebingen, Germany
| | - Andrea Pilotto
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Eva Schäffer
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Michael Weiss
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Sara Becker
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Markus A. Hobert
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Daniela Berg
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Walter Maetzler
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
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Compromised prefrontal structure and function are associated with slower walking in older adults. NEUROIMAGE-CLINICAL 2018; 20:620-626. [PMID: 30191124 PMCID: PMC6125763 DOI: 10.1016/j.nicl.2018.08.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 07/13/2018] [Accepted: 08/09/2018] [Indexed: 12/12/2022]
Abstract
Our previous work demonstrates that reduced activation of the executive network is associated with slow walking speed in a cohort of older adults from the MOBILIZE Boston Study. However, the influence of underlying white matter integrity on the activation of this network and walking speed is unknown. Thus, we used diffusion-weighted imaging and fMRI during an n-back task to assess associations between executive network structure, function, and walking speed. Whole-brain tract-based spatial statistics (TBSS) were used to identify regions of white matter microstructural integrity that were associated with walking speed. The integrity of these regions was then entered into multiple regression models to predict task performance and executive network activation during the n-back task. Among the significant associations of FA with walking speed, we observed the anterior thalamic radiation and superior longitudinal fasciculus were further associated with both n-back response speed and executive network activation. These findings suggest that subtle damage to frontal white matter may contribute to altered executive network activation and slower walking in older adults. Older adult walking speed was not associated with white matter lesion burden. Walking speed was associated with microstructural white matter integrity. The integrity of prefrontal areas was associated with executive network activation. Low executive network activation also corresponded to slower walking. Interventions targeting the executive network may preserve older adult mobility.
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C-reactive protein levels and cognitive functions in patients with bipolar I disorder. MIDDLE EAST CURRENT PSYCHIATRY 2018. [DOI: 10.1097/01.xme.0000534677.38455.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Jorgensen DR, Shaaban CE, Wiley CA, Gianaros PJ, Mettenburg J, Rosano C. A population neuroscience approach to the study of cerebral small vessel disease in midlife and late life: an invited review. Am J Physiol Heart Circ Physiol 2018; 314:H1117-H1136. [PMID: 29393657 PMCID: PMC6032084 DOI: 10.1152/ajpheart.00535.2017] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 01/09/2018] [Accepted: 01/22/2018] [Indexed: 12/28/2022]
Abstract
Aging in later life engenders numerous changes to the cerebral microvasculature. Such changes can remain clinically silent but are associated with greater risk for negative health outcomes over time. Knowledge is limited about the pathogenesis, prevention, and treatment of potentially detrimental changes in the cerebral microvasculature that occur with advancing age. In this review, we summarize literature on aging of the cerebral microvasculature, and we propose a conceptual framework to fill existing research gaps and advance future work on this heterogeneous phenomenon. We propose that the major gaps in this area are attributable to an incomplete characterization of cerebrovascular pathology, the populations being studied, and the temporality of exposure to risk factors. Specifically, currently available measures of age-related cerebral microvasculature changes are indirect, primarily related to parenchymal damage rather than direct quantification of small vessel damage, limiting the understanding of cerebral small vessel disease (cSVD) itself. Moreover, studies seldom account for variability in the health-related conditions or interactions with risk factors, which are likely determinants of cSVD pathogenesis. Finally, study designs are predominantly cross-sectional and/or have relied on single time point measures, leaving no clear evidence of time trajectories of risk factors or of change in cerebral microvasculature. We argue that more resources should be invested in 1) developing methodological approaches and basic science models to better understand the pathogenic and etiological nature of age-related brain microvascular diseases and 2) implementing state-of-the-science population study designs that account for the temporal evolution of cerebral microvascular changes in diverse populations across the lifespan.
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Affiliation(s)
- Dana R Jorgensen
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - C Elizabeth Shaaban
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Clayton A Wiley
- Department of Pathology, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Peter J Gianaros
- Departments of Psychology and Psychiatry, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Joseph Mettenburg
- Department of Radiology, University of Pittsburgh, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania
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Nowak KL, Fried L, Jovanovich A, Ix J, Yaffe K, You Z, Chonchol M. Dietary Sodium/Potassium Intake Does Not Affect Cognitive Function or Brain Imaging Indices. Am J Nephrol 2018; 47:57-65. [PMID: 29393090 DOI: 10.1159/000486580] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/02/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Dietary sodium may influence cognitive function through its effects on cerebrovascular function and cerebral blood flow. METHODS The aim of this study was to evaluate the association of dietary sodium intake with cognitive decline in community-dwelling older adults. We also evaluated the associations of dietary potassium and sodium:potassium intake with cognitive decline, and associations of these nutrients with micro- and macro-structural brain magnetic resonance imaging (MRI) indices. In all, 1,194 participants in the Health Aging and Body Composition study with measurements of dietary sodium intake (food frequency questionnaire [FFQ]) and change in the modified Mini Mental State Exam (3MS) were included. RESULTS The age of participants was 74 ± 3 years with a mean dietary sodium intake of 2,677 ± 1,060 mg/day. During follow-up (6.9 ± 0.1 years), 340 (28%) had a clinically significant decline in 3MS score (≥1.5 SD of mean decline). After adjustment, dietary sodium intake was not associated with odds of cognitive decline (OR 0.96, 95% CI 0.50-1.84 per doubling of sodium). Similarly, potassium was not associated with cognitive decline; however, higher sodium:potassium intake was associated with increased odds of cognitive decline (OR 2.02 [95% CI 1.01-4.03] per unit increase). Neither sodium or potassium alone nor sodium:potassium were associated with micro- or macro-structural brain MRI indices. These results are limited by the use of FFQ. CONCLUSIONS In community-dwelling older adults, higher sodium:potassium, but not sodium or potassium intake alone, was associated with decline in cognitive function, with no associations observed with micro- and macro-structural brain MRI indices. These findings do not support reduction dietary sodium/increased potassium intake to prevent cognitive decline with aging.
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Affiliation(s)
- Kristen L Nowak
- Division of Renal Diseases and Hypertension, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
| | - Linda Fried
- Division of Renal-Electrolyte, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Renal Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Anna Jovanovich
- Division of Renal Diseases and Hypertension, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
- Renal Section, Medical Service, Denver Veterans Affairs Medical Center, Denver, Colorado, USA
| | - Joachim Ix
- Division of Nephrology, University of California San Diego, San Diego, California, USA
| | - Kristine Yaffe
- Departments of Psychiatry, Neurology, and Epidemiology, University of California San Francisco, San Francisco, California, USA
| | - Zhiying You
- Division of Renal Diseases and Hypertension, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
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Hsu CL, Best JR, Wang S, Voss MW, Hsiung RGY, Munkacsy M, Cheung W, Handy TC, Liu-Ambrose T. The Impact of Aerobic Exercise on Fronto-Parietal Network Connectivity and Its Relation to Mobility: An Exploratory Analysis of a 6-Month Randomized Controlled Trial. Front Hum Neurosci 2017; 11:344. [PMID: 28713255 PMCID: PMC5492161 DOI: 10.3389/fnhum.2017.00344] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 06/14/2017] [Indexed: 12/12/2022] Open
Abstract
Impaired mobility is a major concern for older adults and has significant consequences. While the widely accepted belief is that improved physical function underlies the effectiveness of targeted exercise training in improving mobility and reducing falls, recent evidence suggests cognitive and neural benefits gained through exercise may also play an important role in promoting mobility. However, the underlying neural mechanisms of this relationship are currently unclear. Thus, we hypothesize that 6 months of progressive aerobic exercise training would alter frontoparietal network (FPN) connectivity during a motor task among older adults with mild subcortical ischemic vascular cognitive impairment (SIVCI)—and exercise-induced changes in FPN connectivity would correlate with changes in mobility. We focused on the FPN as it is involved in top-down attentional control as well as motor planning and motor execution. Participants were randomized either to usual-care (CON), which included monthly educational materials about VCI and healthy diet; or thrice-weekly aerobic training (AT), which was walking outdoors with progressive intensity. Functional magnetic resonance imaging was acquired at baseline and trial completion, where the participants were instructed to perform bilateral finger tapping task. At trial completion, compared with AT, CON showed significantly increased FPN connectivity strength during right finger tapping (p < 0.05). Across the participants, reduced FPN connectivity was associated with greater cardiovascular capacity (p = 0.05). In the AT group, reduced FPN connectivity was significantly associated with improved mobility performance, as measured by the Timed-Up-and-Go test (r = 0.67, p = 0.02). These results suggest progressive AT may improve mobility in older adults with SIVCI via maintaining intra-network connectivity of the FPN.
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Affiliation(s)
- Chun L Hsu
- Aging, Mobility, and Cognitive Neuroscience Lab, University of British Columbia, VancouverBC, Canada.,Department of Physical Therapy, University of British Columbia, VancouverBC, Canada.,Djavad Mowafaghian Center for Brain Health, University of British Columbia, VancouverBC, Canada.,Center for Hip Health and Mobility, VancouverBC, Canada
| | - John R Best
- Aging, Mobility, and Cognitive Neuroscience Lab, University of British Columbia, VancouverBC, Canada.,Department of Physical Therapy, University of British Columbia, VancouverBC, Canada.,Djavad Mowafaghian Center for Brain Health, University of British Columbia, VancouverBC, Canada.,Center for Hip Health and Mobility, VancouverBC, Canada
| | - Shirley Wang
- Aging, Mobility, and Cognitive Neuroscience Lab, University of British Columbia, VancouverBC, Canada.,Department of Physical Therapy, University of British Columbia, VancouverBC, Canada.,Djavad Mowafaghian Center for Brain Health, University of British Columbia, VancouverBC, Canada.,Center for Hip Health and Mobility, VancouverBC, Canada
| | - Michelle W Voss
- Health, Brain, and Cognition Lab, University of Iowa, Iowa CityIA, United States.,Department of Psychology, University of Iowa, Iowa CityIA, United States
| | - Robin G Y Hsiung
- Department of Medicine, University of British Columbia, VancouverBC, Canada
| | - Michelle Munkacsy
- Aging, Mobility, and Cognitive Neuroscience Lab, University of British Columbia, VancouverBC, Canada.,Department of Physical Therapy, University of British Columbia, VancouverBC, Canada.,Djavad Mowafaghian Center for Brain Health, University of British Columbia, VancouverBC, Canada.,Center for Hip Health and Mobility, VancouverBC, Canada
| | - Winnie Cheung
- Aging, Mobility, and Cognitive Neuroscience Lab, University of British Columbia, VancouverBC, Canada.,Department of Physical Therapy, University of British Columbia, VancouverBC, Canada.,Djavad Mowafaghian Center for Brain Health, University of British Columbia, VancouverBC, Canada.,Center for Hip Health and Mobility, VancouverBC, Canada
| | - Todd C Handy
- Department of Psychology, University of British Columbia, VancouverBC, Canada
| | - Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Lab, University of British Columbia, VancouverBC, Canada.,Department of Physical Therapy, University of British Columbia, VancouverBC, Canada.,Djavad Mowafaghian Center for Brain Health, University of British Columbia, VancouverBC, Canada.,Center for Hip Health and Mobility, VancouverBC, Canada
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Cerchiai N, Mancuso M, Navari E, Giannini N, Casani AP. Aging with Cerebral Small Vessel Disease and Dizziness: The Importance of Undiagnosed Peripheral Vestibular Disorders. Front Neurol 2017. [PMID: 28626444 PMCID: PMC5454069 DOI: 10.3389/fneur.2017.00241] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Recent studies showed a link between cerebral small vessel white matter disease (SVD) and dizziness: patients whose dizziness cannot be explained by vestibular disease show severe SVD and gait abnormalities; however, little is still known about how SVD can cause this symptom. The primary aim of this study is to examine the possible underlying causes of dizziness in neurovascular patients; this is in order to assess whether treatable causes could be routinely disregarded. A secondary aim is to possibly define a central oculomotor pattern induced per se by SVD. This could help the diagnosis of SVD-related dizziness. In this single-blind prospective study, 60 patients referred to a neurovascular clinic because of dizziness and SVD on imaging were divided into an L-SVD and a H-SVD group (low and high SVD burden, respectively), and then blindly examined with vestibulometric tests. In H-SVD group, the percentage of unexplained dizziness reached 82.8%. There was a higher prevalence of peripheral vestibular abnormalities in the L-SVD patient group (51.6%) than in the H-SVD (17.2%; p = 0.012). We found no differences in central oculomotor findings between the two groups. Although oculomotricity does not show any consistent pattern, a severe SVD can directly represent a cause of dizziness. However, a patient with mild SVD is more likely to suffer by a peripheral vestibular disorder. Therefore, given the high incidence of vestibular disease in neurovascular or geriatric clinics, clinicians should be cautious when ascribing dizziness solely to the presence of SVD as easily treatable peripheral vestibular causes may be missed.
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Affiliation(s)
- Niccolò Cerchiai
- Department of Medical and Surgical Pathology, Otorhinolaryngology Section, Pisa University, Pisa, Italy
| | - Michelangelo Mancuso
- Department of Experimental and Clinical Medicine, Neurological Institute, Pisa University, Pisa, Italy
| | - Elena Navari
- Department of Medical and Surgical Pathology, Otorhinolaryngology Section, Pisa University, Pisa, Italy
| | - Nicola Giannini
- Department of Experimental and Clinical Medicine, Neurological Institute, Pisa University, Pisa, Italy
| | - Augusto Pietro Casani
- Department of Medical and Surgical Pathology, Otorhinolaryngology Section, Pisa University, Pisa, Italy
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Gibson W, Hunter KF, Camicioli R, Booth J, Skelton DA, Dumoulin C, Paul L, Wagg A. The association between lower urinary tract symptoms and falls: Forming a theoretical model for a research agenda. Neurourol Urodyn 2017; 37:501-509. [PMID: 28471525 DOI: 10.1002/nau.23295] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/31/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is a well-recognised association between falls and lower urinary tract symptoms (LUTS) in older adults, with estimates of odd ratios for falls in the presence of LUTS ranging between 1.5 and 2.3. Falls and LUTS are both highly prevalent among older people and both are markers of frailty, with significant associated morbidity, mortality, and healthcare resource cost. This association is not well examined or explained in the literature. AIMS We aimed to outline current knowledge of the association between falls and lower urinary tract symptoms and suggest a research program to further investigate this. MATERIALS AND METHODS A consensus conference of experts in the field was convened to review the current literature and brainstorm potential future investigative avenues. RESULTS AND DISCUSSION Despite the recognition of this association, there has been little research to examine its potential causes, and no intervention trial has established if reducing LUTS or urinary incontinence can reduce the risk of falls. The commonly held assumption that urgency causes falls through rushing to the toilet is likely incorrect. Falls and LUTS are both symptoms of frailty and have many common causes. Gait, balance, and continence are all processes requiring cognitive input, and the concept of dual tasking may be a further link. CONCLUSION The significant association between lower urinary tract symptoms and falls is currently unexplained, and further research into the potential causes of this association is needed.
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Affiliation(s)
- William Gibson
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Richard Camicioli
- Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Joanne Booth
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Lorna Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Adrian Wagg
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
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McHugh JE, Lawlor BA. Executive functioning independently predicts self-rated health and improvement in self-rated health over time among community-dwelling older adults. Aging Ment Health 2016; 20:415-22. [PMID: 25774986 DOI: 10.1080/13607863.2015.1018866] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Self-rated health, as distinct from objective measures of health, is a clinically informative metric among older adults. The purpose of our study was to examine the cognitive and psychosocial factors associated with self-rated health. METHODS 624 participants over the age of 60 were assessed at baseline, and of these, 510 were contacted for a follow-up two years later. Measures of executive function and self-rated health were assessed at baseline, and self-rated health was assessed at follow-up. We employed multiple linear regression analyses to investigate the relationship between executive functioning and self-rated health, while controlling for demographic, psychosocial and biological variables. RESULTS Controlling for other relevant variables, executive functioning independently and solely predicted self-rated health, both at a cross-sectional level, and also over time. Loneliness was also found to cross-sectionally predict self-rated health, although this relationship was not present at a longitudinal level. CONCLUSION Older adults' self-rated health may be related to their executive functioning and to their loneliness. Self-rated health appeared to improve over time, and the extent of this improvement was also related to executive functioning at baseline. Self-rated health may be a judgement made of one's functioning, especially executive functioning, which changes with age and therefore may be particularly salient in the reflections of older adults.
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Affiliation(s)
- Joanna Edel McHugh
- a TRIL Centre, Trinity College Institute of Neuroscience , Trinity College Dublin , Dublin , Ireland
| | - Brian A Lawlor
- a TRIL Centre, Trinity College Institute of Neuroscience , Trinity College Dublin , Dublin , Ireland
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Saji N, Ogama N, Toba K, Sakurai T. White matter hyperintensities and geriatric syndrome: An important role of arterial stiffness. Geriatr Gerontol Int 2016; 15 Suppl 1:17-25. [PMID: 26671153 DOI: 10.1111/ggi.12673] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2015] [Indexed: 12/16/2022]
Abstract
White matter hyperintensities (WMH) are defined as cerebral white matter changes presumed to be of vascular origin, bilateral and mostly symmetrical. They can appear as hyperintense on T2-weighted and fluid-attenuated inversion recovery sequences, and as isointense or hypointense on T1-weighted magnetic resonance imaging of the brain. WMH have been focused on because of their clinical importance as a risk factor for cerebrovascular diseases and cognitive impairment. WMH are associated with geriatric syndrome, which is defined by clinical symptoms characteristic of older adults, including cognitive and functional impairment and falls. Cerebral small vessel diseases, such as WMH, might play an important role as risk factors for cerebrovascular diseases, cognitive impairment and geriatric syndrome through the mechanism of arterial stiffness. However, the vascular, physiological and metabolic roles of arterial stiffness remain unclear. Basically, arterial stiffness indicates microvessel arteriosclerosis presenting with vascular endothelial dysfunction. These changes might arise from hemodynamic stress as a result of a "tsunami effect" on cerebral parenchyma. In the present article, we review the clinical characteristics of WMH, focusing particularly on two associations: (i) those between cerebral small vessel diseases including WMH and arterial stiffness; and (ii) those between WMH and geriatric syndrome.
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Affiliation(s)
- Naoki Saji
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Noriko Ogama
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.,Biobank, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kenji Toba
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
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Rosano C, Perera S, Inzitari M, Newman AB, Longstreth WT, Studenski S. Digit Symbol Substitution test and future clinical and subclinical disorders of cognition, mobility and mood in older adults. Age Ageing 2016; 45:688-95. [PMID: 27496932 PMCID: PMC5027641 DOI: 10.1093/ageing/afw116] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/11/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE to examine whether psychomotor speed predicts individual and combined disorders in cognition, mobility and mood and if white matter hyperintensities explain these associations. DESIGN AND SETTING longitudinal; Cardiovascular Health Study. SUBJECTS 5,888 participants (57.6% women, 15.7% black, 75.1 (5.5), mean years (SD)). METHODS psychomotor speed (Digit Symbol Substitution Test (DSST)) and small vessel disease (white matter hyperintensities (WMH)) were measured in 1992-94. Global cognition (Modified Mini-Mental State (3MS) examination), mobility (gait speed (GS)) and mood (Center for Epidemiologic Studies Depression (CES-D) scale) were measured annually over 5 years and classified as clinical, subclinical or no disorders based on established values (3MS: 80 and 85 points; GS: 0.6 and 1.0 m/s; CES-D: 10 and 5 points). Analyses were adjusted for demographics, baseline status, education, diabetes, hypertension, ankle-arm index. RESULTS among those with no disorder in cognition, mobility and mood (N = 619) in 1992-94, being in the lowest DSST quartile compared to the highest was associated with nearly twice the odds of developing 1+ clinical or subclinical disorders (N = 413) during follow-up. Associations were stronger for incident clinical disorders in cognition (OR: 8.44, p < 0.01) or mobility (OR: 9.09, p < 0.05) than for mood (OR: 1.88, p < 0.10). Results were similar after adjustment for WMH. CONCLUSIONS slower psychomotor speed may serve as a biomarker of risk of clinical disorders of cognition, mobility and mood. While in part attributable to vascular brain disease, other potentially modifiable contributors may be present. Further studying the causes of psychomotor slowing with ageing might provide novel insights into age-related brain disorders.
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Affiliation(s)
- Caterina Rosano
- University of Pittsburgh - Epidemiology, 130 N. Bellefield Ave., Pittsburgh, PA 15213, USA
| | - Subashan Perera
- University of Pittsburgh - Geriatric Medicine, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Marco Inzitari
- Universitat Autonoma de Barcelona Facultat de Biociencies Ringgold standard institution Bellaterra, Catalunya, Spain
| | - Anne B Newman
- University of Pittsburgh - Graduate School of Public Health, Pittsburgh, PA, USA
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Rosario BL, Rosso AL, Aizenstein HJ, Harris T, Newman AB, Satterfield S, Studenski SA, Yaffe K, Rosano C. Cerebral White Matter and Slow Gait: Contribution of Hyperintensities and Normal-appearing Parenchyma. J Gerontol A Biol Sci Med Sci 2016; 71:968-73. [PMID: 26755683 PMCID: PMC4906323 DOI: 10.1093/gerona/glv224] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 11/30/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND White matter hyperintensities (WMH), a common marker of cerebral small vessel disease, and lower microstructural integrity of normal-appearing white matter are associated with slower gait. How these cerebral measures interact in relation to slower gait is unknown. We assessed whether microstructural integrity of normal-appearing white matter, measured by fractional anisotropy (FA), moderates the association of higher WMH with slower gait. METHODS WMH, FA, and gait speed were acquired for 265 community-dwelling older adults (average age = 82.9 years). RESULTS The inverse association between WMH and gait was robust to adjustment for age, gender, muscle strength, obesity, stroke, and hypertension (fully adjusted model: βs = -0.19, p = .001). The interaction between WMH and FA was significant; analyses stratified by FA showed that the inverse association between WMH and gait speed was significant only for those with low FA (FA < median, fully adjusted model: βs = -0.28, p = .001). Voxel-based results were similar for participants with FA less than median, there was an inverse association between gait speed and WMH which extended throughout the white matter (genu and body of corpus callosum, anterior limb of internal capsule, corona radiata, and superior longitudinal and fronto-occipital fasciculus). In contrast, for participants with FA ≥ median, the association was limited to the genu of corpus callosum, the cingulum, and the inferior longitudinal fasciculus. CONCLUSIONS Microstructural integrity is a moderating factor in the association between WMH and gait. Future studies should examine whether higher microstructural integrity represents a source of compensation in those with greater WMH burden to maintain function in late life.
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Affiliation(s)
| | | | - Howard J Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tamara Harris
- Laboratory of Epidemiology, Demography, and Biometry, National Institute of Health, Bethesda, Maryland
| | | | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | | | - Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco
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Chang KJ, Lee S, Lee Y, Lee KS, Back JH, Jung YK, Lim KY, Noh JS, Kim HC, Roh HW, Choi SH, Kim SY, Joon Son S, Hong CH. Severity of White Matter Hyperintensities and Length of Hospital Stay in Patients with Cognitive Impairment: A CREDOS (Clinical Research Center for Dementia of South Korea) Study. J Alzheimers Dis 2016; 46:719-26. [PMID: 25854927 DOI: 10.3233/jad-142823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND & OBJECTIVE White matter hyperintensities (WMHs) contribute to aggravation of dementia or geriatric syndrome, thereby resulting in functional impairment. However, evidence of direct association between WMHs and medical resource utilization indicated by length of hospital stay (LOS) is scarce in patients with cognitive impairment. This study aimed to examine the relationship between the severity of WMHs and LOS in patients with cognitive impairment. METHODS 4,253 older adults with cognitive impairment were enrolled in this study. We defined LOS as the total sum of days from January 1, 2008 to December 31, 2012. The severity of periventricular (PVWMHs), deep (DWMHs), and overall white matter hyperintensities (Overall WMHs) was evaluated by a visual rating scale. We conducted multinomial logistic regression to demonstrate the relationship between LOS and severity of PVWHMs, DWHMs, and Overall WMHs, respectively. RESULTS The median LOS was 20 days. Severe PVWMHs had a higher likelihood of longer LOS (Q3: odd ratio/OR = 1.32, 95% confidence interval/CI = 1.06-1.64; Q4: OR = 1.33, 95% CI = 1.07-1.65; Q5: OR = 1.55, 95% CI = 1.26-1.91). As for DWMHs, moderate DWMHs were related to longer LOS (Q4: OR = 1.33, 95% CI = 1.03-1.71; Q5: OR = 1.63, 95% CI = 1.26-2.11). Finally, severity of overall WMHs was independently associated with LOS, which was similar to the results of DWMHs. CONCLUSION These findings would advocate for prevention of WMHs to stave off excess medical resource utilization in patients with cognitive impairment.
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Affiliation(s)
- Ki Jung Chang
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Soojin Lee
- Department of Medicare Administration, Backseok Arts University, Seoul, Republic Korea
| | - Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea.,Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea
| | - Kang Soo Lee
- Department of Psychiatry, CHA University School of Medicine, CHA Hospital, Gangnam, Republic of Korea
| | - Joung Hwan Back
- Health Insurance Policy Research Institute, National Health Insurance Service, Seoul, Republic of Korea
| | - Young Ki Jung
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ki Young Lim
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jai Sung Noh
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyun Chung Kim
- Department of Psychiatry, National Medical Center, Seoul, Republic of Korea
| | - Hyun Woong Roh
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University College of Medicine, Incheon, Republic of Korea
| | - Seong Yoon Kim
- Department of Psychiatry, Asan Medical Center, Seoul, Republic of Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea.,Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea.,Memory impairment center, Ajou University Hospital, Suwon, Republic of Korea
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Rosso AL, Flatt JD, Carlson MC, Lovasi GS, Rosano C, Brown AF, Matthews KA, Gianaros PJ. Neighborhood Socioeconomic Status and Cognitive Function in Late Life. Am J Epidemiol 2016; 183:1088-97. [PMID: 27257114 DOI: 10.1093/aje/kwv337] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 12/02/2015] [Indexed: 11/12/2022] Open
Abstract
Neighborhood socioeconomic status (NSES) is associated with cognitive function, independently of individual demographic, health, and socioeconomic characteristics. However, research has been largely cross-sectional, and mechanisms of the association are unknown. In 1992-1993, Cardiovascular Health Study participants (n = 3,595; mean age = 74.8 years; 15.7% black) underwent cognitive testing and magnetic resonance imaging of white matter hyperintensities (WMH), and their addresses were geocoded. NSES was calculated using 1990 US Census data (block groups; 6 measures of wealth, education, and occupation). The Modified Mini-Mental State Examination (3MS) was used to assess general cognition, and the Digit Symbol Substitution Test (DSST) was used to assess speed of processing annually for 6 years. Associations of race-specific NSES tertiles with 3MS, DSST, and WMH were estimated using linear mixed-effects models accounting for geographic clustering, stratified by race, and adjusted for demographic, health, and individual socioeconomic status (education, income, lifetime occupational status) variables. In fully adjusted models, higher NSES was associated with higher 3MS scores in blacks (mean difference between highest and lowest NSES = 2.4 points; P = 0.004) and whites (mean difference = 0.7 points; P = 0.02) at baseline but not with changes in 3MS over time. NSES was marginally associated with DSST and was not associated with WMH. Adjustment for WMH did not attenuate NSES-3MS associations. Associations of NSES with cognition in late adulthood differ by race, are not explained by WMH, and are evident only at baseline.
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Netson KL, Ashford JM, Skinner T, Carty L, Wu S, Merchant TE, Conklin HM. Executive dysfunction is associated with poorer health-related quality of life in pediatric brain tumor survivors. J Neurooncol 2016; 128:313-21. [PMID: 27033060 DOI: 10.1007/s11060-016-2113-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/22/2016] [Indexed: 11/29/2022]
Abstract
Children with a brain tumor (BT) are at risk for a number of physical and cognitive problems that may lower their health-related quality of life (HRQoL). Executive functioning (EF) and intellectual ability are hypothesized to associate with HRQoL and deficits in these areas may be amenable to interventions. This study aimed to investigate intellectual function, EF, and HRQoL following conformal radiation therapy (CRT) for pediatric BT. Forty-five BT survivors (age 12.68 ± 2.56) treated with CRT participated. Thirty-six siblings of BT patients (age 12.36 ± 2.13) and 33 survivors of non-CNS solid tumors (ST; age 12.18 ± 2.88) were comparison groups. IQ estimate (Wechsler Abbreviated Scale of Intelligence; WASI), EF ratings (Behavior Rating Inventory of Executive Function; BRIEF), and HRQoL ratings (KINDL-R) were obtained. BT survivors reported lower overall HRQoL than ST survivors (p = .012). Parents reported lower overall HRQoL for BT survivors than siblings (p = .014). Parent-report on individual areas of HRQoL was higher than self-report for most subscales. IQ and HRQoL ratings were not related (Parent r = .17, p = .27; Child r = .11, p = .49). EF ratings correlated with Parent (r = -.15 to -.73) but not Child HRQoL ratings. Children with BT experienced poorer HRQoL than controls. Children's HRQoL was consistently rated higher by parent- than self-report across all domains. HRQoL was associated with EF, but not with IQ. These findings identify interventions targeting EF (e.g., cognitive rehabilitation, medication) as a possible avenue for improving HRQoL in childhood BT survivors.
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Affiliation(s)
- Kelli L Netson
- Department of Psychiatry & Behavioral Sciences, KU School of Medicine-Wichita, Wichita, KS, USA
| | - Jason M Ashford
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | - Shengjie Wu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Heather M Conklin
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.
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van Overbeek EC, Staals J, Knottnerus ILH, ten Cate H, van Oostenbrugge RJ. Plasma tPA-Activity and Progression of Cerebral White Matter Hyperintensities in Lacunar Stroke Patients. PLoS One 2016; 11:e0150740. [PMID: 26942412 PMCID: PMC4778794 DOI: 10.1371/journal.pone.0150740] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 02/18/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction Tissue plasminogen activator (tPA)-activity and plasminogen activator inhibitor type 1 (PAI-1) antigen are considered to be haemostasis-related markers of endothelial activation and relate to presence of cerebral white matter hyperintensities (WMH) as was earlier shown in a cross-sectional study. We investigated whether tPA-activity and PAI-1 levels are associated with WMH progression in a longitudinal study. Methods In 127 first-ever lacunar stroke patients in whom baseline brain MRI and plasma levels of tPA-activity and PAI-1-antigen were available, we obtained a 2-year follow-up MRI. We assessed WMH progression by a visual WMH change scale. We determined the relationship between levels of tPA-activity and PAI-1 and WMH progression, by logistic regression analysis. Results Plasma tPA-activity was associated with periventricular WMH progression (OR 2.36, 95% CI 1.01–5.49, with correction for age and sex and baseline presence of WMH), but not with deep or any (periventricular and/or deep) WMH progression. PAI-1 levels were lower in patients with WMH progression, but these results were not significant. Conclusion We found a relationship between plasma tPA-activity and progression of periventricular WMH. More research is needed to determine whether there is a (direct) role of tPA in the development and progression of WMH.
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Affiliation(s)
- Ellen C. van Overbeek
- Department of Neurology, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands
- * E-mail:
| | - Julie Staals
- Department of Neurology, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, MUMC, Maastricht, the Netherlands
| | | | - Hugo ten Cate
- Cardiovascular Research Institute Maastricht, MUMC, Maastricht, the Netherlands
- Department of Internal Medicine, MUMC, Maastricht, the Netherlands
| | - Robert J. van Oostenbrugge
- Department of Neurology, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, MUMC, Maastricht, the Netherlands
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Watts A, Honea RA, Billinger SA, Rhyner KT, Hutfles L, Vidoni ED, Burns JM. A combined measure of vascular risk for white matter lesions. J Alzheimers Dis 2016; 45:187-93. [PMID: 25690663 DOI: 10.3233/jad-142085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Though hypertension is a commonly studied risk factor for white matter lesions (WMLs), measures of blood pressure may fluctuate depending on external conditions resulting in measurement error. Indicators of arterial stiffening and reduced elasticity may be more sensitive indicators of risk for WMLs in aging; however the interdependent nature of vascular indicators creates statistical complications. OBJECTIVE The purpose of the study was to determine whether a factor score comprised of multiple vascular indicators would be a stronger predictor of WMLs than traditional measures of blood pressure. METHODS In a sample of well-characterized nondemented older adults, we used a factor analytic approach to account for variance common across multiple vascular measures while reducing measurement error. The result was a single factor score reflecting arterial stiffness and reduced elasticity. We used this factor score to predict white matter lesion volumes acquired via fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging. RESULTS The combined vascular factor score was a stronger predictor of deep WML (β = 0.42, p < 0.001) and periventricular WML volumes (β = 0.49, p < 0.001). After accounting for the vascular factor, systolic and diastolic blood pressure measurements were not significant predictors. CONCLUSIONS This suggests that a combined measure of arterial elasticity and stiffening may be a stronger predictor of WMLs than systolic and diastolic blood pressure accounting for the multicollinearity associated with a variety of interrelated vascular measures.
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Affiliation(s)
- Amber Watts
- Department of Clinical Psychology, University of Kansas, Lawrence, KS, USA
| | - Robyn A Honea
- Alzheimer's Disease Center, University of Kansas, Fairway, KS, USA
| | - Sandra A Billinger
- Department of Physical Therapy & Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kathleen T Rhyner
- Department of Clinical Psychology, University of Kansas, Lawrence, KS, USA
| | - Lewis Hutfles
- Alzheimer's Disease Center, University of Kansas, Fairway, KS, USA
| | - Eric D Vidoni
- Alzheimer's Disease Center, University of Kansas, Fairway, KS, USA
| | - Jeffrey M Burns
- Alzheimer's Disease Center, University of Kansas, Fairway, KS, USA
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Tannenbaum C, van den Heuvel E, Fritel X, Southall K, Jutai J, Rajabali S, Wagg A. Continence Across Continents To Upend Stigma and Dependency (CACTUS-D): study protocol for a cluster randomized controlled trial. Trials 2015; 16:565. [PMID: 26652168 PMCID: PMC4676178 DOI: 10.1186/s13063-015-1099-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/02/2015] [Indexed: 12/01/2022] Open
Abstract
Background Urinary incontinence occurs in 40 % of women aged 65 years and over; however, only 15 % seek care and many delay healthcare seeking for years. Incontinence is associated with depression, social isolation, reduced quality of life, falls and other comorbidities. It is accompanied by an enormous cost to the individual and society. Despite the substantial implications of urinary incontinence on social, psychological and physical well-being of older women, the impact of continence promotion on urinary symptom improvement and subsequent effects on falls, quality of life, stigma, social participation and the cost of care remains unknown. Methods This study is a mixed methods multi-national open-label 2-arm parallel cluster randomized controlled trial aiming to recruit 1000 community-dwelling incontinent women aged 65 years and older across Quebec, Western Canada, France and United Kingdom. Participants will be recruited through community organizations. Data will be collected at 6 time points: baseline and 1 week, 3 months, 6 months, 9 months and 12 months after baseline. One of the primary objectives is to evaluate whether the continence promotion intervention improves incontinence symptoms (measured with the Patient Global Impression of Improvement questionnaire, PGI-I) at 12 months post intervention compared to the control group. Other co-primary outcomes include changes in incontinence-related stigma, fall reduction, and incremental cost-effectiveness ratio and quality-adjusted life years. Data analysis will account for correlation of outcomes (clustering) within community organizations. A qualitative sub-study will explore stigma reduction. Discussion Community-based continence promotion programs may be a cost-effective strategy to reduce urinary incontinence, stigma and falls among older women with untreated incontinence, and simultaneously improve quality of life and healthy active life expectancy. Trial registration ClinicalTrials.gov: NCT01858493, registered 13 May 2013
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Affiliation(s)
- Cara Tannenbaum
- Institut Universitaire de Gériatrie de Montréal, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada.
| | | | - Xavier Fritel
- Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers, France.
| | - Kenneth Southall
- École d'Orthophonie et d'Audiologie, Université de Montréal, Montréal, QC, Canada.
| | - Jeffrey Jutai
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
| | - Saima Rajabali
- Division of Geriatric Medicine, University of Alberta, Edmonton, AB, Canada.
| | - Adrian Wagg
- Division of Geriatric Medicine, University of Alberta, Edmonton, AB, Canada.
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Tian Q, Resnick SM, Ferrucci L, Studenski SA. Intra-individual lap time variation of the 400-m walk, an early mobility indicator of executive function decline in high-functioning older adults? AGE (DORDRECHT, NETHERLANDS) 2015; 37:115. [PMID: 26561401 PMCID: PMC5005853 DOI: 10.1007/s11357-015-9855-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 11/05/2015] [Indexed: 06/02/2023]
Abstract
Higher intra-individual lap time variation (LTV) of the 400-m walk is cross-sectionally associated with poorer attention in older adults. Whether higher LTV predicts decline in executive function and whether the relationship is accounted for by slower walking remain unanswered. The main objective of this study was to examine the relationship between baseline LTV and longitudinal change in executive function. We used data from 347 participants aged 60 years and older (50.7% female) from the Baltimore Longitudinal Study of Aging. Longitudinal assessments of executive function were conducted between 2007 and 2013, including attention (Trails A, Digit Span Forward Test), cognitive flexibility and set shifting (Trails B, Delta TMT: Trials B minus Trials A), visuoperceptual speed (Digit Symbol Substitution Test), and working memory (Digit Span Backward Test). LTV and mean lap time (MLT) were obtained from the 400-m walk test concurrent with the baseline executive function assessment. LTV was computed as variability of lap time across ten 40-m laps based on individual trajectories. A linear mixed-effects model was used to examine LTV in relation to changes in executive function, adjusted for age, sex, education, and MLT. Higher LTV was associated with greater decline in performance on Trails B (β = 4.322, p < 0.001) and delta TMT (β = 4.230, p < 0.001), independent of covariates. Findings remained largely unchanged after further adjustment for MLT. LTV was not associated with changes in other executive function measures (all p > 0.05). In high-functioning older adults, higher LTV in the 400-m walk predicts executive function decline involving cognitive flexibility and set shifting over a long period of time. High LTV may be an early indicator of executive function decline independent of MLT.
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Affiliation(s)
- Qu Tian
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, 21224, MD, USA.
- , 251 Bayview Blvd., Suite 100, Rm 04B316, Baltimore, MD, 21224, USA.
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, 21224, MD, USA
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, 21224, MD, USA
| | - Stephanie A Studenski
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, 21224, MD, USA
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Veselý B, Antonini A, Rektor I. The contribution of white matter lesions to Parkinson's disease motor and gait symptoms: a critical review of the literature. J Neural Transm (Vienna) 2015; 123:241-50. [PMID: 26483133 DOI: 10.1007/s00702-015-1470-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 10/08/2015] [Indexed: 11/29/2022]
Abstract
White matter lesions (WML) associated with cerebrovascular disease (CVD) may be observed on magnetic resonance imaging in Parkinson's disease (PD) patients. WML are an important factor contributing to postural, gait, and cognitive impairment in the elderly without PD and worsening the course of Alzheimer's disease (AD). Numerous articles are available on this topic. Whether WML modify and negatively influence the clinical symptoms, and course of PD is a subject of debate. The aim of this review is to examine the available literature on the contribution of WML to PD motor symptoms in relation to clinical characteristics and methods of assessing WML on MRI. After reviewing the database, we identified 19 studies reporting the relationship between WML and PD; ten studies focusing on the impact of WML on the cognitive status in PD were excluded. We analysed altogether nine studies reporting the relationship between WML and motor signs of PD. The review found association between WML severity and freezing of gait, less significant to responsiveness to dopaminergic treatment and postural instability; no negative impact on tremor and falls was observed. The impact of WML on bradykinesia and rigidity was inconsistent. Comorbid WML is associated with worsening axial motor performance, probably independently from the degree of nigrostriatal dopaminergic denervation in PD. Reducing the vascular risk factors that cause WML may be helpful in preventing the development of axial symptoms and ultimately in improving the quality of life of patients with PD. Given the lack of systematic studies, additional research in this field is needed.
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Affiliation(s)
- Branislav Veselý
- Department of Neurology, Faculty Hospital Nitra, Špitálska 6, 949 01, Nitra, Slovak Republic.
| | - Angelo Antonini
- Parkinson's Disease and Movement Disorders Unit, IRCCS Fondazione Ospedale San Camillo, Venice, Italy
| | - Ivan Rektor
- First Department of Neurology, Center of Neuroscience and Movement Disorders Centre, Central European Institute of Technology (CEITEC), St. Anne's University Hospital, School of Medicine, Masaryk University, Pekařská 664/53, 656 91, Brno, Czech Republic.
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42
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Bolandzadeh N, Tam R, Handy TC, Nagamatsu LS, Hsu CL, Davis JC, Dao E, Beattie BL, Liu-Ambrose T. Resistance Training and White Matter Lesion Progression in Older Women: Exploratory Analysis of a 12-Month Randomized Controlled Trial. J Am Geriatr Soc 2015; 63:2052-60. [DOI: 10.1111/jgs.13644] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Niousha Bolandzadeh
- Aging, Mobility and Cognitive Neuroscience Laboratory; University of British Columbia; Vancouver British Columbia Canada
- Experimental Medicine Program; University of British Columbia; Vancouver British Columbia Canada
- Djavad Mowafaghian Centre for Brain Health; University of British Columbia; Vancouver British Columbia Canada
- Centre for Hip Health and Mobility; University of British Columbia; Vancouver British Columbia Canada
- Vancouver Coastal Health Research Institute; Vancouver British Columbia Canada
| | - Roger Tam
- Department of Radiology; University of British Columbia; Vancouver British Columbia Canada
| | - Todd C. Handy
- Department of Psychology; University of British Columbia; Vancouver British Columbia Canada
| | - Lindsay S. Nagamatsu
- Beckman Institute for Advanced Science and Technology; University of Illinois at Urbana-Champaign; Urbana Illinois
| | - Chun Liang Hsu
- Aging, Mobility and Cognitive Neuroscience Laboratory; University of British Columbia; Vancouver British Columbia Canada
- Djavad Mowafaghian Centre for Brain Health; University of British Columbia; Vancouver British Columbia Canada
- Centre for Hip Health and Mobility; University of British Columbia; Vancouver British Columbia Canada
- Vancouver Coastal Health Research Institute; Vancouver British Columbia Canada
| | - Jennifer C. Davis
- Aging, Mobility and Cognitive Neuroscience Laboratory; University of British Columbia; Vancouver British Columbia Canada
- Vancouver Coastal Health Research Institute; Vancouver British Columbia Canada
- School of Population and Public Health; University of British Columbia; Vancouver British Columbia Canada
- Centre for Clinical Epidemiology and Evaluation; Vancouver Coastal Health Research Institute; Vancouver British Columbia Canada
| | - Elizabeth Dao
- Aging, Mobility and Cognitive Neuroscience Laboratory; University of British Columbia; Vancouver British Columbia Canada
- Djavad Mowafaghian Centre for Brain Health; University of British Columbia; Vancouver British Columbia Canada
- Centre for Hip Health and Mobility; University of British Columbia; Vancouver British Columbia Canada
- Vancouver Coastal Health Research Institute; Vancouver British Columbia Canada
| | - B. Lynn Beattie
- Vancouver Coastal Health Research Institute; Vancouver British Columbia Canada
- Division of Geriatric Medicine; Faculty of Medicine; University of British Columbia; Vancouver Canada
| | - Teresa Liu-Ambrose
- Aging, Mobility and Cognitive Neuroscience Laboratory; University of British Columbia; Vancouver British Columbia Canada
- Experimental Medicine Program; University of British Columbia; Vancouver British Columbia Canada
- Djavad Mowafaghian Centre for Brain Health; University of British Columbia; Vancouver British Columbia Canada
- Centre for Hip Health and Mobility; University of British Columbia; Vancouver British Columbia Canada
- Vancouver Coastal Health Research Institute; Vancouver British Columbia Canada
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Davis JC, Bryan S, Li LC, Best JR, Hsu CL, Gomez C, Vertes KA, Liu-Ambrose T. Mobility and cognition are associated with wellbeing and health related quality of life among older adults: a cross-sectional analysis of the Vancouver Falls Prevention Cohort. BMC Geriatr 2015; 15:75. [PMID: 26142897 PMCID: PMC4491415 DOI: 10.1186/s12877-015-0076-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 06/23/2015] [Indexed: 12/22/2022] Open
Abstract
Background Ascertaining individuals’ quality of life and wellbeing is essential in public health and clinical research. The impact of these two pressing geriatric syndromes – impaired mobility and cognitive function -- on wellbeing and quality of life is not well examined. Hence, our objective was to identify key clinically relevant outcome measures of mobility and cognitive function that explain variation in wellbeing and health related quality of life (HRQoL) among community dwelling older adults. Methods We conducted a cross-sectional analysis of 229 participants presenting to the Vancouver Falls Prevention Clinic from June 2010 through October 2013. The linear regression models included two dependent variables: the ICECAP-O assessing wellbeing and the EQ-5D-3L assessing HRQoL. Key independent variables included the Short Performance Physical Battery (SPPB) and the Montreal Cognitive Assessment (MoCA). Covariates included Functional Comorbidity Index (FCI), sex and age. In the two multiple linear regression models, age was statistically controlled. Other covariates (i.e., sex and FCI) were included based on statistical significance (i.e., p < 0.05). Results The SPPB was significantly associated with HRQoL and with wellbeing after adjusting for known covariates (p < 0.05, Unstandardized ß (Standard Error) 0.023 (0.006) for HRQoL and 0.016 (0.003) for wellbeing). The MoCA was significantly associated with wellbeing after adjusting for known covariates (p = 0.006), Unstandardized ß (Standard Error) 0.005 (0.002) but not with health related quality of life (p > 0.05). Conclusion We found that a measure of mobility and balance was associated with HRQoL and wellbeing. However, cognitive function was associated with wellbeing only. This study highlights the potential importance of considering wellbeing as an outcome measure if interventions are intended to have a broader impact than health alone.
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Affiliation(s)
- Jennifer C Davis
- Centre for Clinical Epidemiology and Evaluation, 828 West 10th Avenue, Vancouver, Canada. .,Vancouver Coastal Health Research Institute (VCHRI), Vancouver, BC, V6T 2B5, Canada. .,University of British Columbia, Vancouver, BC, V6T 2B5, Canada.
| | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation, 828 West 10th Avenue, Vancouver, Canada. .,Vancouver Coastal Health Research Institute (VCHRI), Vancouver, BC, V6T 2B5, Canada. .,University of British Columbia, Vancouver, BC, V6T 2B5, Canada.
| | - Linda C Li
- Department of Physical Therapy, 2177 Wesbrook Mall, Vancouver, Canada. .,University of British Columbia, Vancouver, BC, V6T 2B5, Canada. .,Arthritis Research Centre of Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada.
| | - John R Best
- Department of Physical Therapy, 2177 Wesbrook Mall, Vancouver, Canada. .,University of British Columbia, Vancouver, BC, V6T 2B5, Canada. .,Aging, Mobility, and Cognitive Neuroscience Lab, 2211 Wesbrook Mall, Vancouver, Canada. .,Djavad Mowafaghian Centre for Brain Health, University of British Columbia & VCHRI, 2215 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada. .,Center for Hip Health and Mobility, 311-2647 Willow Street, Vancouver, BC, V5Z 1 M9, Canada.
| | - Chun Liang Hsu
- Department of Physical Therapy, 2177 Wesbrook Mall, Vancouver, Canada. .,University of British Columbia, Vancouver, BC, V6T 2B5, Canada. .,Aging, Mobility, and Cognitive Neuroscience Lab, 2211 Wesbrook Mall, Vancouver, Canada. .,Djavad Mowafaghian Centre for Brain Health, University of British Columbia & VCHRI, 2215 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada. .,Center for Hip Health and Mobility, 311-2647 Willow Street, Vancouver, BC, V5Z 1 M9, Canada.
| | - Caitlin Gomez
- University of British Columbia, Vancouver, BC, V6T 2B5, Canada. .,Aging, Mobility, and Cognitive Neuroscience Lab, 2211 Wesbrook Mall, Vancouver, Canada.
| | - Kelly A Vertes
- University of British Columbia, Vancouver, BC, V6T 2B5, Canada. .,Aging, Mobility, and Cognitive Neuroscience Lab, 2211 Wesbrook Mall, Vancouver, Canada.
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, 2177 Wesbrook Mall, Vancouver, Canada. .,University of British Columbia, Vancouver, BC, V6T 2B5, Canada. .,Aging, Mobility, and Cognitive Neuroscience Lab, 2211 Wesbrook Mall, Vancouver, Canada. .,Djavad Mowafaghian Centre for Brain Health, University of British Columbia & VCHRI, 2215 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada. .,Center for Hip Health and Mobility, 311-2647 Willow Street, Vancouver, BC, V5Z 1 M9, Canada.
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Godmaire GC, Grenier S, Tannenbaum C. An Independent Association Between Urinary Incontinence and Falls in Chronic Benzodiazepine Users. J Am Geriatr Soc 2015; 63:1035-7. [DOI: 10.1111/jgs.13424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Geneviève Courteau Godmaire
- Faculty of Medicine; Université de Montréal; Institut Universitaire de Gériatrie de Montréal; Montréal QC Canada
| | | | - Cara Tannenbaum
- Faculty of Medicine; Université de Montréal; Institut Universitaire de Gériatrie de Montréal; Montréal QC Canada
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45
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Brickman AM, Guzman VA, Gonzalez-Castellon M, Razlighi Q, Gu Y, Narkhede A, Janicki S, Ichise M, Stern Y, Manly JJ, Schupf N, Marshall RS. Cerebral autoregulation, beta amyloid, and white matter hyperintensities are interrelated. Neurosci Lett 2015; 592:54-8. [PMID: 25748319 PMCID: PMC4430835 DOI: 10.1016/j.neulet.2015.03.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/25/2015] [Accepted: 03/01/2015] [Indexed: 12/12/2022]
Abstract
Emerging studies link vascular risk factors and cerebrovascular health to the prevalence and rates of progression in Alzheimer's disease (AD). The brain's ability to maintain constant blood flow across a range of cerebral perfusion pressures, or autoregulation, may both promote and result from small vessel cerebrovascular disease and AD-related amyloid pathology. Here, we examined the relationship among cerebral autoregulation, small vessel cerebrovascular disease, and amyloid deposition in 14 non-demented older adults. Reduced cerebral autoregulation, was associated with increased amyloid deposition and increased white matter hyperintensity volume, which, in turn were positively associated with each other. For the first time in humans, we demonstrate an interrelationship among AD pathology, small vessel cerebrovascular disease, and cerebral autoregulation. Vascular factors and AD pathology are not independent but rather appear to interact.
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Affiliation(s)
- Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, USA; G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, USA.
| | - Vanessa A Guzman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, USA
| | | | - Qolamreza Razlighi
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, USA
| | - Yian Gu
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, USA
| | - Atul Narkhede
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, USA
| | - Sarah Janicki
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, USA; G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, USA
| | - Masanori Ichise
- Department of Radiology, College of Physicians and Surgeons, Columbia University, USA
| | - Yaakov Stern
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, USA; G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, USA
| | - Jennifer J Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, USA; G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, USA
| | - Nicole Schupf
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, USA; G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, USA
| | - Randolph S Marshall
- Department of Neurology, College of Physicians and Surgeons, Columbia University, USA
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Bolandzadeh N, Kording K, Salowitz N, Davis JC, Hsu L, Chan A, Sharma D, Blohm G, Liu-Ambrose T. Predicting cognitive function from clinical measures of physical function and health status in older adults. PLoS One 2015; 10:e0119075. [PMID: 25734446 PMCID: PMC4348544 DOI: 10.1371/journal.pone.0119075] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 01/16/2015] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Current research suggests that the neuropathology of dementia-including brain changes leading to memory impairment and cognitive decline-is evident years before the onset of this disease. Older adults with cognitive decline have reduced functional independence and quality of life, and are at greater risk for developing dementia. Therefore, identifying biomarkers that can be easily assessed within the clinical setting and predict cognitive decline is important. Early recognition of cognitive decline could promote timely implementation of preventive strategies. METHODS We included 89 community-dwelling adults aged 70 years and older in our study, and collected 32 measures of physical function, health status and cognitive function at baseline. We utilized an L1-L2 regularized regression model (elastic net) to identify which of the 32 baseline measures were strongly predictive of cognitive function after one year. We built three linear regression models: 1) based on baseline cognitive function, 2) based on variables consistently selected in every cross-validation loop, and 3) a full model based on all the 32 variables. Each of these models was carefully tested with nested cross-validation. RESULTS Our model with the six variables consistently selected in every cross-validation loop had a mean squared prediction error of 7.47. This number was smaller than that of the full model (115.33) and the model with baseline cognitive function (7.98). Our model explained 47% of the variance in cognitive function after one year. DISCUSSION We built a parsimonious model based on a selected set of six physical function and health status measures strongly predictive of cognitive function after one year. In addition to reducing the complexity of the model without changing the model significantly, our model with the top variables improved the mean prediction error and R-squared. These six physical function and health status measures can be easily implemented in a clinical setting.
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Affiliation(s)
- Niousha Bolandzadeh
- Experimental Medicine Program, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Konrad Kording
- Rehabilitation Institute of Chicago, Northwestern University, Chicago, Illinois, United States of America
| | - Nicole Salowitz
- Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin, United States of America
| | - Jennifer C. Davis
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada
| | - Liang Hsu
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison Chan
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Devika Sharma
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gunnar Blohm
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingstone, Ontario, Canada
| | - Teresa Liu-Ambrose
- Experimental Medicine Program, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
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Rosano C, Abebe KZ, Aizenstein HJ, Boudreau R, Jennings JR, Venkatraman V, Harris TB, Yaffe K, Satterfield S, Newman AB. Longitudinal systolic blood pressure characteristics and integrity of white matter tracts in a cohort of very old black and white adults. Am J Hypertens 2015; 28:326-34. [PMID: 25159083 PMCID: PMC4325666 DOI: 10.1093/ajh/hpu134] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND We sought to determine which systolic blood pressure (SBP) characteristics are associated with reduced brain integrity and whether these associations are stronger for white or gray matter. We hypothesized that exposure to higher and variable SBP will be associated with lower structural integrity of both gray and white matter. METHODS Neuroimaging, SBP, and cognition were obtained in 311 community-dwelling adults in 2006–2008 (average age = 83 years; 58% women; 40% black). Antihypertensive medications, SBP, and health-related factors were collected from 1997 to 1998 to time of neuroimaging. SBP values obtained from 1997 to 1998 to time of neuroimaging were used to compute mean; pulse pressure; coefficient of variation; and peak, load, and group-based trajectories. RESULTS Higher mean SBP was associated with lower white matter integrity in uncinate and superior lateral fasciculi bilaterally, independent of age, stroke history, antihypertensive medication use (odds ratio of having white matter hyperintensities greater than or equal to the median for 10mm Hg of SBP = 10.4, 95% confidence interval = 10.2–10.6, P = 0.0001; standardized beta for fractional anisotropy = −13.54, SE = 4.58, P = 0.003). These neuroimaging markers attenuated the association between higher SBP and lower digit symbol substitution test. Results were similar for trajectories of SBP and stronger for those with previously higher and variable SBP even if SBP was normal at neuroimaging. Results were similar for those without stroke. Associations with gray matter measures were not significant. CONCLUSIONS If confirmed, these data suggest a history of higher and variable SBP for very old adults may be useful to alert clinicians to potential lower integrity in selected tracts, whereas cross-sectional SBP measurements may obscure the risk of underlying white matter hyperintensities. Whether lowering and/or stabilizing SBP levels in very old adults without a remarkable cardiovascular history would have neuroprotective effects and reduce dementia risk needs further study.
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Affiliation(s)
- Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kaleab Z. Abebe
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Robert Boudreau
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - J. Richard Jennings
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vijay Venkatraman
- Department of Bioengineeringm University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tamara B. Harris
- National Institutes of Health, National Institute on Aging, National Institutes of Health, Bethesda, MD
| | - Kristine Yaffe
- Department of Psychiatry, University of California–San Francisco, San Francisco, California
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Anne B. Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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48
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Winge K. Lower urinary tract dysfunction in patients with parkinsonism and other neurodegenerative disorders. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:335-56. [DOI: 10.1016/b978-0-444-63247-0.00019-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Salak Djokić B, Spitznagel MB, Pavlović D, Janković N, Parojčić A, Ilić V, Nikolić Djurović M. Diabetes mellitus and cognitive functioning in a Serbian sample. J Clin Exp Neuropsychol 2014; 37:37-48. [DOI: 10.1080/13803395.2014.985190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Bolandzadeh N, Liu-Ambrose T, Aizenstein H, Harris T, Launer L, Yaffe K, Kritchevsky SB, Newman A, Rosano C. Pathways linking regional hyperintensities in the brain and slower gait. Neuroimage 2014; 99:7-13. [PMID: 24841418 DOI: 10.1016/j.neuroimage.2014.05.017] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 04/28/2014] [Accepted: 05/09/2014] [Indexed: 10/25/2022] Open
Abstract
IMPORTANCE Cerebral white matter hyperintensities (WMHs) are involved in the evolution of impaired mobility and executive functions. Executive functions and mobility are also associated. Thus, WMHs may impair mobility directly, by disrupting mobility-related circuits, or indirectly, by disrupting circuits responsible for executive functions. Understanding the mechanisms underlying impaired mobility in late life will increase our capacity to develop effective interventions. OBJECTIVE To identify regional WMHs most related to slower gait and to examine whether these regional WMHs directly impact mobility, or indirectly by executive functions. DESIGN Cross-sectional study. Twenty-one WMH variables (i.e., total WMH volume and WMHs in 20 tracts), gait speed, global cognition (Modified Mini-Mental State Examination; 3MS), and executive functions and processing speed (Digit-Symbol Substitution Test; DSST) were assessed. An L1-L2 regularized regression (i.e., Elastic Net model) identified the WMH variables most related to slower gait. Multivariable linear regression models quantified the association between these WMH variables and gait speed. Formal tests of mediation were also conducted. SETTING Community-based sample. PARTICIPANTS Two hundred fifty-three adults (mean age: 83years, 58% women, 41% black). MAIN OUTCOME MEASURE Gait speed. RESULTS In older adults with an average gait speed of 0.91m/sec, total WMH volume, WMHs located in the right anterior thalamic radiation (ATRR) and frontal corpuscallosum (CCF) were most associated with slower gait. There was a >10% slower gait for each standard deviation of WMH in CCF, ATRR or total brain (standardized beta in m/sec [p value]: -0.11 [p=0.046], -0.15 [p=0.007] and -0.14 [p=0.010], respectively). These associations were substantially and significantly attenuated after adjustment for DSST. This effect was stronger for WMH in CCF than for ATRR or total WMH (standardized beta in m/sec [p value]: -0.07 [p=0.190], -0.12 [p=0.024] and -0.10 [p=0.049], respectively). Adjustment for 3MS did not change these associations. The mediation analyses also found that DSST significantly mediated the associations between WMHs and gait speed. Our models were adjusted for age, sex, BMI, quadriceps strength, years of education, standing height, and prevalent hypertension. CONCLUSION The impact, direct or indirect, of WMHs on gait speed depended on their location and was mediated by executive function. Thus, multi-faceted interventions targeting executive control functions as well as motor functions, such as balance and strength training, are candidates to the maintenance of mobility across the lifespan.
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Affiliation(s)
- Niousha Bolandzadeh
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Brain Research Centre, University of British Columbia, Vancouver, BC, Canada; Experimental Medicine Graduate Program, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Brain Research Centre, University of British Columbia, Vancouver, BC, Canada
| | - Howard Aizenstein
- Geriatric Psychiatry Neuroimaging Laboratory, Faculty of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tamara Harris
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD, USA
| | - Lenore Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD, USA
| | - Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | | | - Anne Newman
- Center for Aging and Population Health, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Caterina Rosano
- Center for Aging and Population Health, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
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