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Munoz E, Filshtein T, Bettcher BM, McLaren D, Hedden T, Tommet D, Mungas D, Therneau T. Cognitive function and neuropathological outcomes: a forward-looking approach. J Neurol 2019; 266:2920-2928. [PMID: 31435771 DOI: 10.1007/s00415-019-09516-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/08/2019] [Accepted: 08/16/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the risk of Alzheimer's disease-related neuropathology burden at autopsy given older adults' current cognitive state. METHOD Participants included 1,303 individuals who enrolled in the Religious Orders Study (ROS) and 1,789 who enrolled in the Rush Memory and Aging Project (MAP). Cognitive status was evaluated via standardized assessments of global cognition and episodic memory. At the time of analyses, about 50% of participants were deceased with the remaining numbers right censored. Using multi-state Cox proportional hazard models, we compared the cognitive status of all subjects alive at a given age and estimated future risk of dying with different AD-related neuropathologies. Endpoints considered were Braak Stages (0-2, 3-4, 5-6), CERAD (0, 1, 2, 3), and TDP-43 (0, 1, 2, 3) level. RESULTS For all three pathological groupings (Braak, CERAD, TDP-43), we found that a cognitive test score one standard deviation below average put individuals at up to three times the risk for being diagnosed with late stage AD at autopsy according to pathological designations. The effect remained significant after adjusting for sex, APOE-e4 status, smoking status, education level, and vascular health scores. CONCLUSION Applying multi-state modeling techniques, we were able to identify those at risk of exhibiting specific levels of neuropathology based on current cognitive test performance. This approach presents new and approachable possibilities in clinical settings for diagnosis and treatment development programs.
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Affiliation(s)
- Elizabeth Munoz
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, TX, 78712, USA.
- University of California, Riverside, CA, 92521, USA.
| | - Teresa Filshtein
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
| | - Brianne M Bettcher
- Rocky Mountain Alzheimer's Disease Center, Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Trey Hedden
- Department of Neurology, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Doug Tommet
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, USA
| | - Dan Mungas
- Department of Neurology, University of California, Davis, CA, USA
| | - Terry Therneau
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
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Jacobs HIL, Hopkins DA, Mayrhofer HC, Bruner E, van Leeuwen FW, Raaijmakers W, Schmahmann JD. The cerebellum in Alzheimer's disease: evaluating its role in cognitive decline. Brain 2019; 141:37-47. [PMID: 29053771 DOI: 10.1093/brain/awx194] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 06/12/2017] [Indexed: 12/12/2022] Open
Abstract
The cerebellum has long been regarded as essential only for the coordination of voluntary motor activity and motor learning. Anatomical, clinical and neuroimaging studies have led to a paradigm shift in the understanding of the cerebellar role in nervous system function, demonstrating that the cerebellum appears integral also to the modulation of cognition and emotion. The search to understand the cerebellar contribution to cognitive processing has increased interest in exploring the role of the cerebellum in neurodegenerative and neuropsychiatric disorders. Principal among these is Alzheimer's disease. Here we review an already sizeable existing literature on the neuropathological, structural and functional neuroimaging studies of the cerebellum in Alzheimer's disease. We consider these observations in the light of the cognitive deficits that characterize Alzheimer's disease and in so doing we introduce a new perspective on its pathophysiology and manifestations. We propose an integrative hypothesis that there is a cerebellar contribution to the cognitive and neuropsychiatric deficits in Alzheimer's disease. We draw on the dysmetria of thought theory to suggest that this cerebellar component manifests as deficits in modulation of the neurobehavioural deficits. We provide suggestions for future studies to investigate this hypothesis and, ultimately, to establish a comprehensive, causal clinicopathological disease model.
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Affiliation(s)
- Heidi I L Jacobs
- School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, PO BOX 616, 6200 MD, AQ220 Maastricht, The Netherlands.,Faculty of Psychology and Neuroscience, Department of Cognitive Neuroscience, Maastricht University, PO BOX 616, 6200 MD Maastricht, The Netherlands.,Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - David A Hopkins
- School for Mental Health and Neuroscience, Department of Neuroscience, Maastricht University, PO BOX 616, 6200 MD Maastricht, The Netherlands.,Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Helen C Mayrhofer
- Faculty of Psychology and Neuroscience, Department of Cognitive Neuroscience, Maastricht University, PO BOX 616, 6200 MD Maastricht, The Netherlands
| | - Emiliano Bruner
- Centro Nacional de Investigación sobre la Evolución Humana, Burgos, Spain
| | - Fred W van Leeuwen
- School for Mental Health and Neuroscience, Department of Neuroscience, Maastricht University, PO BOX 616, 6200 MD Maastricht, The Netherlands
| | - Wijnand Raaijmakers
- Faculty of Psychology and Neuroscience, Department of Cognitive Neuroscience, Maastricht University, PO BOX 616, 6200 MD Maastricht, The Netherlands
| | - Jeremy D Schmahmann
- Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Jacova C, McGrenere J, Lee HS, Wang WW, Le Huray S, Corenblith EF, Brehmer M, Tang C, Hayden S, Beattie BL, Hsiung GYR. C-TOC (Cognitive Testing on Computer): investigating the usability and validity of a novel self-administered cognitive assessment tool in aging and early dementia. Alzheimer Dis Assoc Disord 2016; 29:213-21. [PMID: 25187218 DOI: 10.1097/wad.0000000000000055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Cognitive Testing on Computer (C-TOC) is a novel computer-based test battery developed to improve both usability and validity in the computerized assessment of cognitive function in older adults. METHODS C-TOC's usability was evaluated concurrently with its iterative development to version 4 in subjects with and without cognitive impairment, and health professional advisors representing different ethnocultural groups. C-TOC version 4 was then validated against neuropsychological tests (NPTs), and by comparing performance scores of subjects with normal cognition, Cognitive Impairment Not Dementia (CIND) and Alzheimer disease. C-TOC's language tests were validated in subjects with aphasic disorders. RESULTS The most important usability issue that emerged from consultations with 27 older adults and with 8 cultural advisors was the test-takers' understanding of the task, particularly executive function tasks. User interface features did not pose significant problems. C-TOC version 4 tests correlated with comparator NPT (r=0.4 to 0.7). C-TOC test scores were normal (n=16)>CIND (n=16)>Alzheimer disease (n=6). All normal/CIND NPT performance differences were detected on C-TOC. Low computer knowledge adversely affected test performance, particularly in CIND. C-TOC detected impairments in aphasic disorders (n=11). DISCUSSION In general, C-TOC had good validity in detecting cognitive impairment. Ensuring test-takers' understanding of the tasks, and considering their computer knowledge appear important steps towards C-TOC's implementation.
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Affiliation(s)
- Claudia Jacova
- *Division of Neurology Department of Medicine; ∥Division of Geriatrics, Department of Medicine, University of British Columbia ‡Computer Science, University of British Columbia †Hospital Clinic for Alzheimer Disease and Related Disorders, Vancouver Coastal Health, University of British Columbia, Vancouver, BC, Canada §Department of Computer Science, University of Michigan Flint, Flint Township, MI
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Reynolds CA, Gatz M, Christensen K, Christiansen L, Dahl Aslan AK, Kaprio J, Korhonen T, Kremen WS, Krueger R, McGue M, Neiderhiser JM, Pedersen NL. Gene-Environment Interplay in Physical, Psychological, and Cognitive Domains in Mid to Late Adulthood: Is APOE a Variability Gene? Behav Genet 2016; 46:4-19. [PMID: 26538244 PMCID: PMC4858319 DOI: 10.1007/s10519-015-9761-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
Abstract
Despite emerging interest in gene-environment interaction (GxE) effects, there is a dearth of studies evaluating its potential relevance apart from specific hypothesized environments and biometrical variance trends. Using a monozygotic within-pair approach, we evaluated evidence of G×E for body mass index (BMI), depressive symptoms, and cognition (verbal, spatial, attention, working memory, perceptual speed) in twin studies from four countries. We also evaluated whether APOE is a 'variability gene' across these measures and whether it partly represents the 'G' in G×E effects. In all three domains, G×E effects were pervasive across country and gender, with small-to-moderate effects. Age-cohort trends were generally stable for BMI and depressive symptoms; however, they were variable-with both increasing and decreasing age-cohort trends-for different cognitive measures. Results also suggested that APOE may represent a 'variability gene' for depressive symptoms and spatial reasoning, but not for BMI or other cognitive measures. Hence, additional genes are salient beyond APOE.
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Affiliation(s)
- Chandra A Reynolds
- Department of Psychology, University of California Riverside, 900 University Ave., Riverside, CA, 92521, USA.
| | - Margaret Gatz
- Department of Psychology, University of Southern California, Los Angeles, CA, 90089, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, 17177, Stockholm, Sweden
| | - Kaare Christensen
- Epidemiology, Biostatistics and Bio-demography, Institute of Public Health, University of Southern Denmark, 5000, Odense C, Denmark
- Department of Clinical Genetics and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Lene Christiansen
- Epidemiology, Biostatistics and Bio-demography, Institute of Public Health, University of Southern Denmark, 5000, Odense C, Denmark
| | - Anna K Dahl Aslan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, 17177, Stockholm, Sweden
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Jaakko Kaprio
- Department of Public Health & Institute for Molecular Medicine FIMM, University of Helsinki, 00014, Helsinki, Finland
| | - Tellervo Korhonen
- Department of Public Health, University of Helsinki, 00014, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland
| | - William S Kremen
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA
| | - Robert Krueger
- Department of Psychology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Matt McGue
- Epidemiology, Biostatistics and Bio-demography, Institute of Public Health, University of Southern Denmark, 5000, Odense C, Denmark
- Department of Psychology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Jenae M Neiderhiser
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Nancy L Pedersen
- Department of Psychology, University of Southern California, Los Angeles, CA, 90089, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, 17177, Stockholm, Sweden
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Herrmann N, Harimoto T, Balshaw R, Lanctôt KL. Risk Factors for Progression of Alzheimer Disease in a Canadian Population: The Canadian Outcomes Study in Dementia (COSID). CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:189-99. [PMID: 26174219 PMCID: PMC4459246 DOI: 10.1177/070674371506000406] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 05/01/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine risk factors for clinically significant progression during 12 months in patients with mild-to-moderate Alzheimer disease. METHOD Community-dwelling patients with mild-to-moderate Alzheimer disease were enrolled in a 3-year prospective study, the Canadian Outcomes Study in Dementia (commonly referred to as COSID), at 32 Canadian sites. Assessments included the Global Deterioration Scale (GDS) for disease severity, the Mini-Mental State Examination (MMSE) for cognition, the Functional Autonomy Measurement System (SMAF) for daily functioning, and the NeuroPsychiatric Inventory (NPI) for behaviour, measured at baseline and at 12 months. Logistic regression identified factors associated with GDS decline, and subsequent stepwise regression identified key independent predictors. Area under the curve (AUC) was then calculated for the model. RESULTS Among 488 patients (mean age 76.5 years [SD 6.4], MMSE 22.1 [SD4.6], 44.1% male), 225 (46%) showed GDS decline. After adjusting for age, baseline risk factors for deterioration included the following: poorer cognition (lower MMSE score, OR 0.55; 95% CI 0.4 to 0.72 per 5 points, P ≤ 0.001), greater dependence (lower SMAF, OR 0.72; 95% CI 0.63 to 0.83 per 5 points, P ≤ 0.001), and more neuropsychiatric symptoms (higher NPI, OR 1.11; 95% CI 1.02 to 1.2 per 5 points, P = 0.02), with a protective effect of male sex (OR 0.59; 95% CI 0.39 to 0.9, P = 0.02), and higher (worse) GDS score (very mild, compared with mild OR 0.25; 95% CI 0.09 to 0.70, P ≤ 0.01; compared with moderate, OR 0.08; 95% CI 0.03 to 0.23, P < 0.001; compared with moderately severe, OR 0.03; 95% CI 0.01 to 0.11, P < 0.001). The AUC was 73% (P < 0.001) (sensitivity 90% and specificity 33%). CONCLUSION The progression of Alzheimer disease in Canada can be predicted using readily available clinical information.
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Affiliation(s)
- Nathan Herrmann
- Head, Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario; Professor, Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Tetsuhiro Harimoto
- Research Assistant, Medical Outcome and Research in Economics Group (MORE), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario
| | - Robert Balshaw
- Senior Scientist, Statistician, BC Centre for Disease Control, Vancouver, British Columbia
| | - Krista L Lanctôt
- Executive Director, Medical Outcome and Research in Economics Group (MORE), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario; Professor, Department of Psychiatry and Pharmacology and Toxicology, University of Toronto, Toronto, Ontario
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Gatz M, Fiske A, Reynolds CA, Johansson B, Fratiglioni L, Pedersen NL. Performance on neurocognitive tests by co-twins to dementia cases compared to normal control twins. J Geriatr Psychiatry Neurol 2005; 18:202-7. [PMID: 16306240 DOI: 10.1177/0891988705281865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nondemented co-twins of twins who were diagnosed as demented were compared to randomly selected members of normal control twin pairs in which both members of the pair were nondemented. Nondemented co-twins included 23 monozygotic and 62 dizygotic twins; there were 27 normal control twins. Both monozygotic and dizygotic nondemented co-twins of dementia cases scored significantly lower than normal control twins on 5 of 10 cognitive tests. Moreover, monozygotic co-twins of dementia cases had a generally lower score profile than dizygotic co-twins of dementia cases did. These findings show that being at greater genetic risk for dementia is reflected in cognitive performance even in the absence of a diagnosis of dementia.
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Affiliation(s)
- Margaret Gatz
- Department of Psychology, University of Southern California, Los Angeles 90089-1061, USA.
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Salmon* E, Lespagnard* S, Marique P, Peeters F, Herholz K, Perani D, Holthoff V, Kalbe E, Anchisi D, Adam S, Collette F, Garraux G. Cerebral metabolic correlates of four dementia scales in Alzheimer’s disease. J Neurol 2005. [DOI: 10.1007/s00415-005-0961-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Salmon E, Lespagnard S, Marique P, Peeters F, Herholz K, Perani D, Holthoff V, Kalbe E, Anchisi D, Adam S, Collette F, Garraux G. Cerebral metabolic correlates of four dementia scales in Alzheimer's disease. J Neurol 2005; 252:283-90. [PMID: 16189724 DOI: 10.1007/s00415-005-0551-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2003] [Revised: 03/09/2004] [Accepted: 05/10/2004] [Indexed: 10/25/2022]
Abstract
Different scales can be used to evaluate dementia severity in Alzheimer's disease (AD). They do assess different cognitive or functional abilities, but their global scores are frequently in mutual correlation. Functional imaging provides an objective method for the staging of dementia severity. Positron emission tomography was used to assess the relationship between brain metabolism and four dementia scales that reflect a patient's global cognitive abilities (mini mental state), caregiver's evaluation of cognitive impairment (newly designed scale), daily living functioning (instrumental activities of daily living) and global dementia (clinical dementia rating). We wondered whether different clinical dementia scales would be related to severity of metabolic impairment in the same brain regions, and might reflect impairment of common cognitive processes. 225 patients with probable AD were recruited in a prospective multicentre European study. All clinical scales were related to brain metabolism in associative temporal, parietal or frontal areas. A factorial analysis demonstrated that all scales could be classified in a single factor. That factor was highly correlated to decrease of cerebral activity in bilateral parietal and temporal cortices, precuneus, and left middle frontal gyrus. This finding suggests that global scores for all scales provided similar information on the neural substrate of dementia severity. Capitalizing on the neuroimaging literature, dementia severity reflected by reduced metabolism in posterior and frontal associative areas in AD might be related to a decrease of controlled processes.
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Affiliation(s)
- E Salmon
- Cyclotron Research Centre, University of Liege, B30 Sart Tilman, 4000 Liege, Belgium.
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Adam S, Van der Linden M, Collette F, Lemauvais L, Salmon E. Further Exploration of Controlled and Automatic Memory Processes in Early Alzheimer's Disease. Neuropsychology 2005; 19:420-7. [PMID: 16060816 DOI: 10.1037/0894-4105.19.4.420] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The authors' aim in this study was to explore automatic and controlled processes in Alzheimer's disease (AD) by using a variant of the word-stem completion task that applies the process-dissociation procedure. Several methodological precautions were taken in order to limit problems observed in previous studies (e.g., poor task sensitivity, ceiling and/or floor effects, no control over comprehension of instructions). Our results (a) confirmed the marked deterioration in controlled processes and (b) showed that when psychometric constraints were limited, automatic memory processes were preserved in AD. These data are in line with those from more global studies in suggesting that AD is characterized by an early deterioration in controlled processes and an initial preservation of automatic processes.
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Affiliation(s)
- Stéphane Adam
- Neuropsychology Unit, University of Liège, Liège, Belgium.
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Bäckman L, Jones S, Small BJ, Agüero-Torres H, Fratiglioni L. Rate of cognitive decline in preclinical Alzheimer's disease: the role of comorbidity. J Gerontol B Psychol Sci Soc Sci 2003; 58:P228-36. [PMID: 12878651 DOI: 10.1093/geronb/58.4.p228] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We investigated the influence of individual-difference variables implicated as risk factors for Alzheimer's disease (AD) or known to be related to cognitive performance in normal aging (e.g., age, sex, years of education, previous and recent diseases, apolipoprotein E status, social network, and substance use) on rate of cognitive change from preclinical to clinical AD. With the use of data from a population-based study, 230 persons who were nondemented at baseline and diagnosed with AD at a 3-year follow-up were examined with the Mini-Mental State Examination (MMSE). Of all predictor variables examined, only number of diseases resulting in hospital admission during the follow-up period made an independent contribution to rate of MMSE change. These results suggest that many variables affecting the onset of the degenerative process as well as cognitive functioning in normal aging exert little influence on rate of cognitive change in preclinical AD. This may reflect the fact that the emerging dementia disease overshadows the role of these variables for cognitive functioning. A possible exception to this pattern is that an increasing number of concomitant health conditions may exacerbate the rate of cognitive decline during the final portion of the preclinical phase in AD.
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Affiliation(s)
- Lars Bäckman
- Aging Research Center at the Karolinska Institute and Stockholm Gerontology Research Center, Stockholm, Sweden.
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