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Margetts TJ, Wang HS, Karnik SJ, Plotkin LI, Movila A, Oblak AL, Fehrenbacher JC, Kacena MA. From the Mind to the Spine: The Intersecting World of Alzheimer's and Osteoporosis. Curr Osteoporos Rep 2024; 22:152-164. [PMID: 38334917 PMCID: PMC10912148 DOI: 10.1007/s11914-023-00848-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 02/10/2024]
Abstract
PURPOSE OF REVIEW This comprehensive review delves into the intricate interplay between Alzheimer's disease (AD) and osteoporosis, two prevalent conditions with significant implications for individuals' quality of life. The purpose is to explore their bidirectional association, underpinned by common pathological processes such as aging, genetic factors, inflammation, and estrogen deficiency. RECENT FINDINGS Recent advances have shown promise in treating both Alzheimer's disease (AD) and osteoporosis by targeting disease-specific proteins and bone metabolism regulators. Monoclonal antibodies against beta-amyloid and tau for AD, as well as RANKL and sclerostin for osteoporosis, have displayed therapeutic potential. Additionally, ongoing research has identified neuroinflammatory genes shared between AD and osteoporosis, offering insight into the interconnected inflammatory mechanisms. This knowledge opens avenues for innovative dual-purpose therapies that could address both conditions, potentially revolutionizing treatment approaches for AD and osteoporosis simultaneously. This review underscores the potential for groundbreaking advancements in early diagnosis and treatment by unraveling the intricate connection between AD and bone health. It advocates for a holistic, patient-centered approach to medical care that considers both cognitive and bone health, ultimately aiming to enhance the overall well-being of individuals affected by these conditions. This review article is part of a series of multiple manuscripts designed to determine the utility of using artificial intelligence for writing scientific reviews.
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Affiliation(s)
- Tyler J Margetts
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Hannah S Wang
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Sonali J Karnik
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Lilian I Plotkin
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, 46202, USA
| | - Alexandru Movila
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, IN, 46202, USA
| | - Adrian L Oblak
- Department of Radiology & Imaging Sciences, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Jill C Fehrenbacher
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA.
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
| | - Melissa A Kacena
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA.
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, 46202, USA.
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Wang HS, Karnik SJ, Margetts TJ, Plotkin LI, Movila A, Fehrenbacher JC, Kacena MA, Oblak AL. Mind Gaps and Bone Snaps: Exploring the Connection Between Alzheimer's Disease and Osteoporosis. Curr Osteoporos Rep 2024:10.1007/s11914-023-00851-1. [PMID: 38236512 DOI: 10.1007/s11914-023-00851-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE OF REVIEW This comprehensive review discusses the complex relationship between Alzheimer's disease (AD) and osteoporosis, two conditions that are prevalent in the aging population and result in adverse complications on quality of life. The purpose of this review is to succinctly elucidate the many commonalities between the two conditions, including shared pathways, inflammatory and oxidative mechanisms, and hormonal deficiencies. RECENT FINDINGS AD and osteoporosis share many aspects of their respective disease-defining pathophysiology. These commonalities include amyloid beta deposition, the Wnt/β-catenin signaling pathway, and estrogen deficiency. The shared mechanisms and risk factors associated with AD and osteoporosis result in a large percentage of patients that develop both diseases. Previous literature has established that the progression of AD increases the risk of sustaining a fracture. Recent findings demonstrate that the reverse may also be true, suggesting that a fracture early in the life course can predispose one to developing AD due to the activation of these shared mechanisms. The discovery of these commonalities further guides the development of novel therapeutics in which both conditions are targeted. This detailed review delves into the commonalities between AD and osteoporosis to uncover the shared players that bring these two seemingly unrelated conditions together. The discussion throughout this review ultimately posits that the occurrence of fractures and the mechanism behind fracture healing can predispose one to developing AD later on in life, similar to how AD patients are at an increased risk of developing fractures. By focusing on the shared mechanisms between AD and osteoporosis, one can better understand the conditions individually and as a unit, thus informing therapeutic approaches and further research. This review article is part of a series of multiple manuscripts designed to determine the utility of using artificial intelligence for writing scientific reviews.
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Affiliation(s)
- Hannah S Wang
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Sonali J Karnik
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Tyler J Margetts
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Lilian I Plotkin
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, 46202, USA
| | - Alexandru Movila
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, IN, 46202, USA
| | - Jill C Fehrenbacher
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Melissa A Kacena
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, 46202, USA.
| | - Adrian L Oblak
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
- Department of Radiology & Imaging Sciences, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
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Lary CW, Ghatan S, Gerety M, Hinton A, Nagarajan A, Rosen C, Ross RD, Bennett DA, DeStefano AL, Ikram MA, Rivadeneira F, Kiel DP, Seshadri S, Beiser A. Bone mineral density and the risk of incident dementia: A meta-analysis. J Am Geriatr Soc 2024; 72:194-200. [PMID: 37933827 PMCID: PMC10829515 DOI: 10.1111/jgs.18638] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/22/2023] [Accepted: 09/17/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND It is not known whether bone mineral density (BMD) measured at baseline or as the rate of decline prior to baseline (prior bone loss) is a stronger predictor of incident dementia or Alzheimer's disease (AD). METHODS We performed a meta-analysis of three longitudinal studies, the Framingham Heart Study (FHS), the Rotterdam Study (RS), and the Rush Memory and Aging Project (MAP), modeling the time to diagnosis of dementia as a function of BMD measures accounting for covariates. We included individuals with one or two BMD assessments, aged ≥60 years, and free of dementia at baseline with follow-up available. BMD was measured at the hip femoral neck using dual-energy X-ray absorptiometry (DXA), or at the heel calcaneus using quantitative ultrasound to calculate estimated BMD (eBMD). BMD at study baseline ("baseline BMD") and annualized percentage change in BMD prior to baseline ("prior bone loss") were included as continuous measures. The primary outcome was incident dementia diagnosis within 10 years of baseline, and incident AD was a secondary outcome. Baseline covariates included age, sex, body mass index, ApoE4 genotype, and education. RESULTS The combined sample size across all three studies was 4431 with 606 incident dementia diagnoses, 498 of which were AD. A meta-analysis of baseline BMD across three studies showed higher BMD to have a significant protective association with incident dementia with a hazard ratio of 0.47 (95% CI: 0.23-0.96; p = 0.038) per increase in g/cm2 , or 0.91 (95% CI: 0.84-0.995) per standard deviation increase. We observed a significant association between prior bone loss and incident dementia with a hazard ratio of 1.30 (95% CI: 1.12-1.51; p < 0.001) per percent increase in prior bone loss only in the FHS cohort. CONCLUSIONS Baseline BMD but not prior bone loss was associated with incident dementia in a meta-analysis across three studies.
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Affiliation(s)
- Christine W. Lary
- Roux Institute at Northeastern University, Portland, ME
- MaineHealth Institute for Research, Scarborough, ME
| | | | | | | | - Archana Nagarajan
- Roux Institute at Northeastern University, Portland, ME
- MaineHealth Institute for Research, Scarborough, ME
- Tufts University Graduate School of Biomedical Sciences, Boston, MA
| | | | - Ryan D. Ross
- Department of Anatomy & Cell Biology, Rush University Medical Center
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL
| | | | | | | | - Douglas P. Kiel
- Hinda and Arthur Marcus Institute for Aging Research and Department of Medicine, Hebrew SeniorLife, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, UT Health, San Antonio, TX
- Boston University School of Medicine, Boston, MA
| | - Alexa Beiser
- Boston University School of Public Health, Boston, MA
- Boston University School of Medicine, Boston, MA
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Serna J, Su F, Lansdown DA, Feeley BT, Ma CB, Zhang AL. Total shoulder arthroplasty in patients with dementia or mild cognitive impairment. JSES Int 2024; 8:159-166. [PMID: 38312270 PMCID: PMC10837705 DOI: 10.1016/j.jseint.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background Anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA) reliably alleviate pain and restore shoulder function for a variety of indications. However, these procedures are not well-studied in patients with neurocognitive impairment. Therefore, the purpose of this study was to investigate whether patients with dementia or mild cognitive impairment (MCI) have increased odds of surgical or medical complications following arthroplasty. Methods The PearlDiver database was queried from 2010 through October 2021 to identify a cohort of patients who underwent either ATSA or RTSA and had a minimum 2-year follow-up. Current Procedural Terminology and International Classification of Diseases codes were used to stratify this cohort into three groups: (1) patients with dementia, (2) patients with MCI, and (3) patients with neither condition. Surgical and medical complication rates were compared among these three groups. Results The overall prevalence of neurocognitive impairment among patients undergoing total shoulder arthroplasty was 3.0% in a cohort of 92,022 patients. Patients with dementia had increased odds of sustaining a periprosthetic humerus fracture (odds ratio [OR] = 1.46, P < .001), developing prosthesis instability (OR = 1.72, P < .001), and undergoing revision arthroplasty (OR = 1.55, P = .003) after RTSA compared to patients with normal cognition. ATSA patients with dementia did not have an elevated risk of surgical complications or revision. Conversely, RTSA patients with MCI did not have an elevated risk of complications or revision, although ATSA patients with MCI had greater odds of prosthesis instability (OR = 2.51, P = .008). Additionally, patients with neurocognitive impairment had elevated odds of medical complications compared to patients with normal cognition, including acute myocardial infarction and cerebrovascular accident. Conclusion Compared to patients with normal cognition, RTSA patients with preoperative dementia and ATSA patients with preoperative MCI are at increased risk for surgical complications. Moreover, both ATSA and RTSA patients with either preoperative MCI or dementia are at increased risk for medical complications. As the mean age in the U.S. continues to rise, special attention should be directed towards patients with neurocognitive impairment to minimize postoperative complications aftertotal shoulder arthroplasty, and the risks of this surgery more carefully discussed with patients and their families and caretakers.
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Affiliation(s)
- Juan Serna
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Favian Su
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Drew A. Lansdown
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Brian T. Feeley
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - C. Benjamin Ma
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Alan L. Zhang
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
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Ruggiero C, Baroni M, Xenos D, Parretti L, Macchione IG, Bubba V, Laudisio A, Pedone C, Ferracci M, Magierski R, Boccardi V, Antonelli-Incalzi R, Mecocci P. Dementia, osteoporosis and fragility fractures: Intricate epidemiological relationships, plausible biological connections, and twisted clinical practices. Ageing Res Rev 2024; 93:102130. [PMID: 38030092 DOI: 10.1016/j.arr.2023.102130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
Dementia, osteoporosis, and fragility fractures are chronic diseases, often co-existing in older adults. These conditions pose severe morbidity, long-term disability, and mortality, with relevant socioeconomic implications. While in the research arena, the discussion remains on whether dementia is the cause or the consequence of fragility fractures, healthcare professionals need a better understanding of the interplay between such conditions from epidemiological and physiological standpoints. With this review, we summarized the available literature surrounding the relationship between cognitive impairment, dementia, and both low bone mineral density (BMD) and fragility fractures. Given the strength of the bi-directional associations and their impact on the quality of life, we shed light on the biological connections between brain and bone systems, presenting the main mediators, including gut microbioma, and pathological pathways leading to the dysregulation of bone and brain metabolism. Ultimately, we synthesized the evidence about the impact of available pharmacological treatments for the prevention of fragility fractures on cognitive functions and individuals' outcomes when dementia coexists. Vice versa, the effects of symptomatic treatments for dementia on the risk of falls and fragility fractures are explored. Combining evidence alongside clinical practice, we discuss challenges and opportunities related to the management of older adults affected by cognitive impairment or dementia and at high risk for fragility fracture prevention, which leads to not only an improvement in patient health-related outcomes and survival but also a reduction in healthcare cost and socio-economic burden.
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Affiliation(s)
- C Ruggiero
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy.
| | - M Baroni
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - D Xenos
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - L Parretti
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - I G Macchione
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - V Bubba
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - A Laudisio
- Department of Medicine, Unit of Geriatrics, Campus Bio-Medico di Roma University, Rome, Italy
| | - C Pedone
- Department of Medicine, Unit of Geriatrics, Campus Bio-Medico di Roma University, Rome, Italy
| | - M Ferracci
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - R Magierski
- Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
| | - V Boccardi
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - R Antonelli-Incalzi
- Department of Medicine, Unit of Geriatrics, Campus Bio-Medico di Roma University, Rome, Italy
| | - P Mecocci
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
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6
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Feng L, Bian L, Ning C, Zhang P, Zhao Y, Gao Z, Ping P, Fu S. Positive associations between sex hormones, bone metabolism and cognitive impairment in Chinese oldest-old females. BMC Psychiatry 2023; 23:562. [PMID: 37542223 PMCID: PMC10403843 DOI: 10.1186/s12888-023-04957-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/13/2023] [Indexed: 08/06/2023] Open
Abstract
PURPOSE With a rapid increase in older adults, progressive impairment in cognitive function has become an increasing concern owing to high social and economic burdens. The current study was designed to investigate the associations of sex hormones and bone metabolism with cognitive impairment (CI) in Chinese oldest-old females. METHODS There were 396 oldest-old females from the China Hainan Oldest-old Cohort Study (CHOCS). Following standardized procedures, Mini Mental State Examination was effectively completed, and sex hormones and bone metabolism were assessed in these females. RESULTS The median age of all females was 101 years (range: from 80 to 116). There were 340 females (86%) with CI. Participants with CI had significantly higher levels of age, progesterone, prolactin and estradiol than those without CI (P < 0.05 for all). Total type I collagen N-terminal elongation peptide [hazard ratio (HR): 1.018, 95%CI: 1.001-1.035] and prolactin (HR: 1.065, 95%CI: 1.005-1.129) levels were positively and significantly associated with CI (P < 0.05 for all). CONCLUSIONS Prolactin and total type I collagen N-terminal elongation peptide had positive associations with CI in Chinese oldest-old females. Thus, a balance in sex hormones and bone metabolism may have significant effects on cognitive function during the aging process.
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Affiliation(s)
- Long Feng
- Department of Anesthesia, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
| | - Lihua Bian
- Department of Obstetrics and Gynecology, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
| | - Chaoxue Ning
- Central Laboratory, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
| | - Pei Zhang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Yali Zhao
- Central Laboratory, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China.
| | - Zhitao Gao
- School of Laboratory Medicine, Xinxiang Medical University, Xinxiang, China.
| | - Ping Ping
- General Station for Drug and Instrument Supervision and Control, Joint Logistic Support Force of Chinese People's Liberation Army, Beijing, China.
| | - Shihui Fu
- Department of Cardiology, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China.
- Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China.
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7
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Zhao Y, Chen H, Qiu F, He J, Chen J. Cognitive impairment and risks of osteoporosis: A systematic review and meta-analysis. Arch Gerontol Geriatr 2023; 106:104879. [PMID: 36462246 DOI: 10.1016/j.archger.2022.104879] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/19/2022] [Accepted: 11/24/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To systematically assess the association between osteoporosis and cognitive impairment, and to provide new light on the prevention of cognitive impairment in patients with osteoporosis. METHOD A comprehensive research of Embase, Cochrane Library, PubMed, Web of Science, CNKI, Wangfang Data and VIP was performed from inception to January 2022, using the search term 'osteoporosis' and 'cognitive impairment'. Literature screening, data extraction and quality evaluation were conducted by two reviewers independently, and meta-analysis was performed by RevMan 5.4 software. RESULTS A total of 8 studies (136222 participants) were included. Meta-analysis showed that patients with osteoporosis had an increased risk of cognitive impairment [OR=2.01, 95% CI(1.63-2.48), P<0.01]. This initial meta-analysis had significant heterogeneity, and subgroup analysis suggested that potential heterogeneity in different study types, age and outcome indicators. CONCLUSION Patients with osteoporosis are at increased risk of cognitive impairment, and osteoporosis intervention could prevent or delay the onset of cognitive impairment for those at risk.
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Affiliation(s)
- Yangyang Zhao
- School of Medicine, Xiamen University, Xiamen, Fujian 361000, China
| | - Heqing Chen
- Department of Rehabilitation, Zhongshan Hospital of Xiamen University, Xiamen, Fujian 361000, China
| | - Fei Qiu
- Department of Rehabilitation, Zhongshan Hospital of Xiamen University, Xiamen, Fujian 361000, China
| | - Jianquan He
- Department of Rehabilitation, Zhongshan Hospital of Xiamen University, Xiamen, Fujian 361000, China
| | - Jian Chen
- Department of Rehabilitation, Zhongshan Hospital of Xiamen University, Xiamen, Fujian 361000, China.
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8
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LLabre JE, Gil C, Amatya N, Lagalwar S, Possidente B, Vashishth D. Degradation of Bone Quality in a Transgenic Mouse Model of Alzheimer's Disease. J Bone Miner Res 2022; 37:2548-2565. [PMID: 36250342 PMCID: PMC9772191 DOI: 10.1002/jbmr.4723] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 10/03/2022] [Accepted: 10/14/2022] [Indexed: 12/31/2022]
Abstract
Alzheimer's disease (AD) patients present with symptoms such as impairment of insulin signaling, chronic inflammation, and oxidative stress. Furthermore, there are comorbidities associated with AD progression. For example, osteoporosis is common with AD wherein patients exhibit reduced mineralization and a risk for fragility fractures. However, there is a lack of understanding on the effects of AD on bone beyond loss of bone density. To this end, we investigated the effects of AD on bone quality using the 5XFAD transgenic mouse model in which 12-month-old 5XFAD mice showed accumulation of amyloid-beta (Aβ42) compared with wild-type (WT) littermates (n = 10/group; 50% female, 50% male). Here, we observed changes in cortical bone but not in cancellous bone quality. Both bone mass and bone quality, measured in femoral samples using imaging (micro-CT, confocal Raman spectroscopy, X-ray diffraction [XRD]), mechanical (fracture tests), and chemical analyses (biochemical assays), were altered in the 5XFAD mice compared with WT. Micro-CT results showed 5XFAD mice had lower volumetric bone mineral density (BMD) and increased endocortical bone loss. XRD results showed decreased mineralization with smaller mineral crystals. Bone matrix compositional properties, from Raman, showed decreased crystallinity along with higher accumulation of glycoxidation products and glycation products, measured biochemically. 5XFAD mice also demonstrated loss of initiation and maximum toughness. We observed that carboxymethyl-lysine (CML) and mineralization correlated with initiation toughness, whereas crystal size and pentosidine (PEN) correlated with maximum toughness, suggesting bone matrix changes predominated by advanced glycation end products (AGEs) and altered/poor mineral quality explained loss of fracture toughness. Our findings highlight two pathways to skeletal fragility in AD through alteration of bone quality: (i) accumulation of AGEs; and (ii) loss of crystallinity, decreased crystal size, and loss of mineralization. We observed that the accumulation of amyloidosis in brain correlated with an increase in several AGEs, consistent with a mechanistic link between elevated Aβ42 levels in the brain and AGE accumulation in bone. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Joan E. LLabre
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
- Shirley Ann Jackson, Ph.D. Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Cristianel Gil
- Department of Biology, Skidmore College, Saratoga Springs, NY, USA
| | - Neha Amatya
- Department of Biology, Skidmore College, Saratoga Springs, NY, USA
| | - Sarita Lagalwar
- Neuroscience Program, Skidmore College, Saratoga Springs, NY, USA
| | | | - Deepak Vashishth
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
- Shirley Ann Jackson, Ph.D. Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY, USA
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9
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Pan H, Cao J, Wu C, Huang F, Wu P, Lang J, Liu Y. Osteoporosis is associated with elevated baseline cerebrospinal fluid biomarkers and accelerated brain structural atrophy among older people. Front Aging Neurosci 2022; 14:958050. [PMID: 36185490 PMCID: PMC9523506 DOI: 10.3389/fnagi.2022.958050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Abstract
Objective The aim of this study was to examine whether osteoporosis (OP) is associated with Alzheimer’s disease-related cerebrospinal fluid (CSF) biomarkers and brain structures among older people. Methods From the Alzheimer’s disease Neuroimaging Initiative database, we grouped participants according to the OP status (OP+/OP−) and compared the Alzheimer’s disease (AD)-related CSF biomarker levels and the regional brain structural volumes between the two groups using multivariable models. These models were adjusted for covariates including age, education, gender, diagnosis of Alzheimer’s disease, and apolipoprotein E4 carrier status. Results In the cross-sectional analyses at baseline, OP was related to higher CSF t-tau (total tau) and p-tau181 (tau phosphorylated at threonine-181) but not to CSF amyloid-beta (1–42) or the volumes of entorhinal cortex and hippocampus. In the longitudinal analyses, OP was not associated with the change in the three CSF biomarkers over time but was linked to a faster decline in the size of the entorhinal cortex and hippocampus. Conclusion OP was associated with elevated levels of CSF t-tau and p-tau181 at baseline, and accelerated entorhinal cortex and hippocampal atrophies over time among older people.
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Affiliation(s)
- Hao Pan
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiali Cao
- Department of Outpatient, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Congcong Wu
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Furong Huang
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peng Wu
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Junzhe Lang
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yangbo Liu
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Yangbo Liu,,
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10
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Fehsel K, Christl J. Comorbidity of osteoporosis and Alzheimer's disease: Is `AKT `-ing on cellular glucose uptake the missing link? Ageing Res Rev 2022; 76:101592. [PMID: 35192961 DOI: 10.1016/j.arr.2022.101592] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 02/08/2023]
Abstract
Osteoporosis and Alzheimer's disease (AD) are both degenerative diseases. Osteoporosis often proceeds cognitive deficits, and multiple studies have revealed common triggers that lead to energy deficits in brain and bone. Risk factors for osteoporosis and AD, such as obesity, type 2 diabetes, aging, chemotherapy, vitamin deficiency, alcohol abuse, and apolipoprotein Eε4 and/or Il-6 gene variants, reduce cellular glucose uptake, and protective factors, such as estrogen, insulin, exercise, mammalian target of rapamycin inhibitors, hydrogen sulfide, and most phytochemicals, increase uptake. Glucose uptake is a fine-tuned process that depends on an abundance of glucose transporters (Gluts) on the cell surface. Gluts are stored in vesicles under the plasma membrane, and protective factors cause these vesicles to fuse with the membrane, resulting in presentation of Gluts on the cell surface. This translocation depends mainly on AKT kinase signaling and can be affected by a range of factors. Reduced AKT kinase signaling results in intracellular glucose deprivation, which causes endoplasmic reticulum stress and iron depletion, leading to activation of HIF-1α, the transcription factor necessary for higher Glut expression. The link between diseases and aging is a topic of growing interest. Here, we show that diseases that affect the same biochemical pathways tend to co-occur, which may explain why osteoporosis and/or diabetes are often associated with AD.
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11
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Depression and bone loss as risk factors for cognitive decline: A systematic review and meta-analysis. Ageing Res Rev 2022; 76:101575. [PMID: 35093615 DOI: 10.1016/j.arr.2022.101575] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/24/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Depression is linked to Alzheimer's disease (AD) but it is unclear whether depression is also associated with cognitive decline in the preclinical phase and mild cognitive impairment (MCI). Previous meta-analyses have only investigated AD as an outcome without accounting for individuals showing cognitive decline that does not meet the diagnostic criteria for AD. Other potentially modifiable risk factors such as bone loss have also been less explored and there remains uncertainty around their temporal relationship with cognitive decline. AIMS To conduct a systematic review and meta-analysis investigating depression and bone loss as risk factors for subsequent cognitive decline. METHODS A comprehensive search strategy was developed and applied using four databases; MEDLINE Complete, Embase, PsycINFO and CINAHL Complete. The pooled summary effects were estimated as odds ratios with 95% confidence intervals using a random-effects model. The study protocol was registered with PROSPERO (ID: CRD42020159369). RESULTS A total of 75 longitudinal cohort studies were identified for meta-analysis, of which 70 examined the impact of depression on cognitive decline and five examined the impact of bone loss. Prior exposure to depression was found to be associated with cognitive score reduction (OR 1.33 95% CI 1.17, 1.51), MCI incidence (OR 1.52 95% CI 1.28, 1.79) and AD incidence (OR 1.79 95% CI 1.46, 2.2). Bone loss was also associated with the incidence of AD (OR=1.81 95% CI 1.28, 2.55). CONCLUSIONS Overall, the results support the hypothesis that depression is associated with subsequent cognitive decline. Bone loss was also found to be associated with AD incidence; however, due to the small number of studies, the results should be viewed with caution.
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12
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Trivedi T, Guise TA. Systemic effects of abnormal bone resorption on muscle, metabolism, and cognition. Bone 2022; 154:116245. [PMID: 34718221 DOI: 10.1016/j.bone.2021.116245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 12/11/2022]
Abstract
Skeletal tissue is dynamic, undergoing constant remodeling to maintain musculoskeletal integrity and balance in the human body. Recent evidence shows that apart from maintaining homeostasis in the local microenvironment, the skeleton systemically affects other tissues. Several cancer-associated and noncancer-associated bone disorders can disrupt the physiological homeostasis locally in the bone microenvironment and indirectly contribute to dysregulation of systemic body function. The systemic effects of bone on the regulation of distant organ function have not been widely explored. Recent evidence suggests that bone can interact with skeletal muscle, pancreas, and brain by releasing factors from mineralized bone matrix. Currently available bone-targeting therapies such as bisphosphonates and denosumab inhibit bone resorption, decrease morbidity associated with bone destruction, and improve survival. Bisphosphonates have been a standard treatment for bone metastases, osteoporosis, and cancer treatment-induced bone diseases. The extraskeletal effects of bisphosphonates on inhibition of tumor growth are known. However, our knowledge of the effects of bisphosphonates on muscle weakness, hyperglycemia, and cognitive defects is currently evolving. To be able to identify the molecular link between bone and distant organs during abnormal bone resorption and then treat these abnormalities and prevent their systemic effects could improve survival benefits. The current review highlights the link between bone resorption and its systemic effects on muscle, pancreas, and brain.
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Affiliation(s)
- Trupti Trivedi
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Theresa A Guise
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
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13
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Kwon MJ, Kim JH, Kim JH, Cho SJ, Nam ES, Choi HG. The Occurrence of Alzheimer's Disease and Parkinson's Disease in Individuals With Osteoporosis: A Longitudinal Follow-Up Study Using a National Health Screening Database in Korea. Front Aging Neurosci 2021; 13:786337. [PMID: 34955816 PMCID: PMC8692765 DOI: 10.3389/fnagi.2021.786337] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/18/2021] [Indexed: 01/18/2023] Open
Abstract
Background: Public health concerns regarding the potential link between osteoporosis and the increased occurrence of Alzheimer’s disease (AD) and Parkinson’s disease (PD) have been raised, but the results remain inconsistent and require further validation. Here, we investigated the long-term relationship of osteoporosis with the occurrence of AD/PD using data from a large-scale nationwide cohort. Methods: This longitudinal follow-up study included 78,994 patients with osteoporosis and 78,994 controls from the Korean National Health Insurance Service-Health Screening Cohort database (2002–2015) who were matched using propensity score matching at a 1:1 ratio based on age, sex, income, and residential area. A Cox proportional hazard model was used to assess the association between osteoporosis and the occurrence of AD/PD after adjusting for multiple covariates. Results: During the follow-up period, AD occurred in 5,856 patients with osteoporosis and 3,761 controls (incidence rates: 10.4 and 6.8 per 1,000 person-years, respectively), and PD occurred in 1,397 patients and 790 controls (incidence rates: 2.4 and 1.4 per 1,000 person-years, respectively). The incidences of AD and PD were significantly higher in the osteoporosis group than in the matched control group. After adjustment, the osteoporosis group exhibited 1.27-fold and 1.49-fold higher occurrences of AD (95% confidence interval (CI) = 1.22–1.32) and PD (95% CI = 1.36–1.63) than the controls, respectively. The results of subgroup analyses supported the increased occurrence of AD and PD in patients with osteoporosis, independent of income, residential area, obesity, smoking, alcohol consumption, hyperlipidemia, hypertension, or blood glucose level. Conclusion: Our results indicate that the presence of osteoporosis may increase the likelihood of developing two common neurodegenerative diseases in adults aged ≥40 years.
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Affiliation(s)
- Mi Jung Kwon
- Division of Neuropathology, Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Seong Jin Cho
- Department of Pathology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Eun Sook Nam
- Department of Pathology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
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14
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Ebrahimpur M, Sharifi F, Shadman Z, Payab M, Mehraban S, Shafiee G, Heshmat R, Fahimfar N, Mehrdad N, Khashayar P, Nabipour I, Larijani B, Ostovar A. Osteoporosis and cognitive impairment interwoven warning signs: community-based study on older adults-Bushehr Elderly Health (BEH) Program. Arch Osteoporos 2020; 15:140. [PMID: 32910343 DOI: 10.1007/s11657-020-00817-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/01/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Cognitive impairment and osteoporosis are frequently seen to coincide in clinical practice. Osteoporosis was higher in elderly populations with cognitive impairment, especially in postmenopausal women. Thus, prophylaxis for osteoporosis, falls, and fractures should be considered as part of the treatment of patients with cognitive impairment. INTRODUCTION Cognitive impairment and osteoporosis are two important health concerns among older adults that their possible relationship, concurrent occurrence, and linking mechanism have recently been highlighted. The purpose of this study was to assess the sex-independent association of these two conditions. MATERIALS AND METHODS From among 2331 individuals aged ≥ 60 years selected in Bushehr Elderly Health (BEH) Program, Iran; data of 1508 participants were analyzed. Cognitive status was assessed using Category Fluency Test and Mini-cog assessment instrument. Association between osteopenia-osteoporosis and cognitive impairment were assessed using uni- and multivariable logistic regression models. RESULTS Osteoporosis was diagnosed in 598 (39.6%) of the participants (58.3% female and 21.9% male, P < 0.001). From among them, 677 (44.9%) had evidence of cognitive impairment (64.5% female and 31.0% male, P < 0.001). Multivariate logistic regressions showed spinal and total hip osteoporosis was associated with 1.83 (CI 95% 1.13-2.96) and 2.24-fold (CI 95% 1.28-3.89) increase in the risk of cognitive impairment among female subjects, respectively. Ordinal logistic regression, on the other hand, revealed cognitive impairment to be associated with 1.42-fold (CI 95% 1.04-1.92) increase in the risk of spinal osteopenia-osteoporosis, 1.5-fold increase in total hip osteoporosis (CI 95% 1.09-2.05), and 1.48-fold increase in general osteoporosis (CI 95% 1.06-2.0). CONCLUSION Different degrees of bone loss and cognitive impairment may be a risk factor for each other among women but not in men. It is suggested that the screening, adopting preventive measures for the other condition and regular follow-ups, if needed, could be of utmost importance.
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Affiliation(s)
- Mahbube Ebrahimpur
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Sharifi
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zhaleh Shadman
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Moloud Payab
- Metabolomics and genomics research center, endocrinology and metabolism molecular- cellular sciences institute, Tehran university of medical sciences, Tehran, Iran
| | - Saghar Mehraban
- Medical Student, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Gita Shafiee
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Fahimfar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Mehrdad
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Patricia Khashayar
- Center for Microsystems Technology, Imec and Ghent University, Ghent, Belgium
| | - Iraj Nabipour
- The Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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15
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Takano Y, Tatewaki Y, Mutoh T, Morota N, Matsudaira I, Thyreau B, Nagasaka T, Odagiri H, Yamamoto S, Arai H, Taki Y. Voxel-Based Morphometry Reveals a Correlation Between Bone Mineral Density Loss and Reduced Cortical Gray Matter Volume in Alzheimer's Disease. Front Aging Neurosci 2020; 12:178. [PMID: 32625080 PMCID: PMC7311782 DOI: 10.3389/fnagi.2020.00178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 05/25/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Decreased bone mineral density (BMD) was associated with poorer cognitive function and increased risk of Alzheimer's disease (AD). However, objective evidence for the relationship between osteoporosis and AD in humans has not been extensively described. Objectives: We aimed to evaluate the relationships between BMD and the cortical volumes of brain regions vulnerable to AD; hippocampus, parahippocampal gyrus, precuneus, posterior cingulate, and angular gyrus, using voxel-based morphometry (VBM), to investigate the association between bone loss and AD. Methods: A cohort of 149 consecutive elderly participants who complained of memory disturbance underwent high-resolution structural brain magnetic resonance imaging (MRI) and dual-energy X-ray absorptiometry (DXA). We used SPM12 software to conduct a voxel-based multiple regression analysis to examine the association between femoral neck BMD values and regional gray matter volume (rGMV) on structural T1-weighted MRI. Results: After adjusting for subject age, gender, total brain volume (TBV), and mini-mental state examination (MMSE) scores, the multiple regression analysis showed significant correlations between BMD loss and rGMV decline in the left precuneus, which is an important neural network hub vulnerable to AD. Conclusion: These data suggest that the bone and brain communicate with each other, as in "bone-brain crosstalk," and that control of BMD factors could contribute to cognitive function and help prevent AD.
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Affiliation(s)
- Yumi Takano
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Japan
| | - Yasuko Tatewaki
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Japan
| | - Tatsushi Mutoh
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Japan
| | - Naoya Morota
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Izumi Matsudaira
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Benjamin Thyreau
- Smart-Aging International Research Center, Tohoku University, Sendai, Japan
| | - Tatsuo Nagasaka
- Division of Radiology, Tohoku University Hospital, Sendai, Japan
| | - Hayato Odagiri
- Division of Radiology, Tohoku University Hospital, Sendai, Japan
| | - Shuzo Yamamoto
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Japan
| | - Hiroyuki Arai
- Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Japan.,Department of Geriatrics and Gerontology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Yasuyuki Taki
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai, Japan.,Smart-Aging International Research Center, Tohoku University, Sendai, Japan
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16
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Başgöz B, İnce S, Safer U, Naharcı Mİ, Taşçı İ. Low bone density and osteoporosis among older adults with Alzheimer's disease, vascular dementia, and mixed dementia: A Cross-sectional Study With Prospective Enrollment. Turk J Phys Med Rehabil 2020; 66:193-200. [PMID: 32760897 PMCID: PMC7401688 DOI: 10.5606/tftrd.2020.3803] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/27/2019] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES This study aims to examine bone mineral density (BMD) and osteoporosis in older adults with dementia compared to those with a normal cognitive status and to evaluate the type, severity, and duration of dementia. PATIENTS AND METHODS Between May 2013 and May 2017, a total of 363 participants aged ≥65 years (136 males, 227 females; mean age 78.4±5.4 years; range 66 to 99 years) with and without Alzheimer's disease (AD), vascular dementia (VaD), or mixed dementia (AD-VaD) were included in this single-center, prospective, cross-sectional study. The dementia group included 93 patients with dementia and the control group included 270 age- and sex-matched healthy individuals. We used dual-energy X-ray absorptiometry (DXA) to measure BMD of the lumbar spine, total hip, and femoral neck. RESULTS Controlled for age and sex, demented and non-demented participants had a similar BMD (g/cm2) at lumbar spine [F (1, 358):0.83, p=363], but lower BMD values of total hip [F (1, 359):10.26, p=0.001] and femoral neck [F (1, 359):15.21, p<0.001] in the patients with dementia. Adjusted percentage of osteoporosis and low bone mass based on total hip and femoral neck T-scores were also significantly higher in the patient group. The mean BMD values, frequency of osteoporosis, and low bone mass did not significantly differ according to the subtype of dementia, sex, and disease duration or severity. CONCLUSION Our study results show that demented elders have a lower BMD and higher frequency of osteoporosis at the hip, but not at the lumbar spine, irrespective of sex and type of dementia. Based on these results, we can speculate that not only AD, but also VaD and AD-VaD may be associated with bone loss at the hip.
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Affiliation(s)
- Bilgin Başgöz
- Department of Internal Medicine, University of Health Sciences, Gülhane School of Medicine, Ankara, Turkey
| | - Semra İnce
- Department of Nuclear Medicine, University of Health Sciences, Gülhane School of Medicine, Ankara, Turkey
| | - Umut Safer
- Department of Geriatrics, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Mehmet İlkin Naharcı
- Department of Geriatrics, University of Health Sciences, Gülhane School of Medicine, Ankara, Turkey
| | - İlker Taşçı
- Department of Geriatrics, University of Health Sciences, Gülhane School of Medicine, Ankara, Turkey
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17
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Wu PH, Lin YT, Chen CS, Chiu YW, Tsai JC, Kuo PL, Hsu YL, Ljunggren Ö, Fellström B, Kuo MC. Associations of Bone Turnover Markers with Cognitive Function in Patients Undergoing Hemodialysis. DISEASE MARKERS 2020; 2020:8641749. [PMID: 32377274 PMCID: PMC7196142 DOI: 10.1155/2020/8641749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/16/2020] [Accepted: 01/17/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients undergoing hemodialysis experience a greater risk of cognitive impairment than the general population, but limited data elucidates the biomarkers on this. We evaluated the association of bone turnover markers on cognitive function among 251 prevalent hemodialysis enrollees in a cross-sectional study. METHODS 251 hemodialysis patients (median age = 57.8, 55% men) and 37 control subjects (mean age = 61.2, 56% men) without a prior stroke or dementia diagnosis were enrolled. Serum concentrations of 8 bone markers were analyzed as the association of cognitive function (Montreal Cognitive Assessment (MoCA) and Cognitive Abilities Screening Instrument (CASI)) using linear regression analysis. RESULTS A lower cognitive function was noted in hemodialysis patients compared to control subjects. The receptor activator of nuclear factor kappa-B ligand (RANKL) was the only bone marker found to be associated with cognitive function (MoCA and CASI tests) in hemodialysis patients without a prior stroke or dementia diagnosis. In stepwise multiple linear regression analysis, the association remained significant in MoCA (β = 1.14, 95% CI 0.17 to 2.11) and CASI (β = 3.06, 95% CI 0.24 to 5.88). Short-term memory (β = 0.52, 95% CI 0.01 to 1.02), mental manipulation (β = 0.51, 95% CI 0.05 to 0.96), and abstract thinking (β = 0.57, 95% CI 0.06 to 1.09) were the significant subdomains in the CASI score related to RANKL. CONCLUSIONS Serum RANKL levels were potentially associated with better cognitive function in hemodialysis patients. Further large-scale and prospective studies are needed to confirm our findings.
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Affiliation(s)
- Ping-Hsun Wu
- Graduate Institute of Clinical Medicine, College of Medicines, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Yi-Ting Lin
- Graduate Institute of Clinical Medicine, College of Medicines, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Cheng-Sheng Chen
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jer-Chia Tsai
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Lin Kuo
- Graduate Institute of Clinical Medicine, College of Medicines, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ya-Ling Hsu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Östen Ljunggren
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Bengt Fellström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Mei-Chuan Kuo
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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18
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Gu Y, Wu Z, Zeng F, Jiang M, Teeling JL, Ni J, Takahashi I. Systemic Exposure to Lipopolysaccharide from Porphyromonas gingivalis Induces Bone Loss-Correlated Alzheimer's Disease-Like Pathologies in Middle-Aged Mice. J Alzheimers Dis 2020; 78:61-74. [PMID: 32925065 DOI: 10.3233/jad-200689] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) and bone loss are clinically exacerbated. However, the mechanism of exacerbation remains understood. OBJECTIVE We tested our hypothesis that periodontitis is involved in the exacerbation, contributing to AD pathologies. METHODS The bone, memory, and inflammation in bone and brain were examined in 12-month-old mice after systemic exposure to lipopolysaccharide from Porphyromonas gingivalis (P gLPS) for 3 consecutive weeks. RESULTS Compared with control mice, bone loss in tibia (26% decrease) and memory decline (47% decrease) were induced in mice with a positive correlation after exposure to P gLPS (r = 0.7378, p = 0.0011). The IL-6 and IL-17 expression in tibia was negatively correlated with the bone volume/total tissue volume (r = -0.6619, p = 0.0052; r = -0.7129, p = 0.0019), while that in the cortex was negatively correlated with the memory test latency (r = -0.7198, p = 0.0017; p = 0.0351, r = -0.5291). Furthermore, the IL-17 expression in microglia was positively correlated with Aβ42 accumulation in neurons (r = 0.8635, p < 0.0001). In cultured MG6 microglia, the P gLPS-increased IL-6 expression was inhibited by a PI3K-specific inhibitor (68% decrease), and that of IL-17 was inhibited by IL-6 antibody (41% decrease). In cultured N2a neurons, conditioned medium from P gLPS-stimulated microglia (MCM) but not P gLPS increased the productions of AβPP, CatB, and Aβ42, which were significantly inhibited by pre-treatment with IL-17 antibody (67%, 51%, and 41% decrease). CONCLUSION These findings demonstrated that chronic systemic exposure to P gLPS simultaneously induces inflammation-dependent bone loss and AD-like pathologies by elevating IL-6 and IL-17 from middle age, suggesting that periodontal bacteria induce exacerbation of bone loss and memory decline, resulting in AD progression.
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Affiliation(s)
- Yebo Gu
- Section of Orthodontics and Dentofacial Orthopedics, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Zhou Wu
- Department of Aging Science and Pharmacology, Faculty of Dental Sciences, Kyushu University, Fukuoka, Japan
- OBT Research Center, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Fan Zeng
- Department of Aging Science and Pharmacology, Faculty of Dental Sciences, Kyushu University, Fukuoka, Japan
| | - Muzhou Jiang
- Department of Aging Science and Pharmacology, Faculty of Dental Sciences, Kyushu University, Fukuoka, Japan
| | - Jessica L Teeling
- Biological Sciences, Faculty of Natural and Environmental Sciences, University of Southampton, United Kingdom
| | - Junjun Ni
- Department of Aging Science and Pharmacology, Faculty of Dental Sciences, Kyushu University, Fukuoka, Japan
- Key Laboratory of Molecular Medicine, Department of Biology, School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Ichiro Takahashi
- Section of Orthodontics and Dentofacial Orthopedics, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
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19
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Polenick CA, Min L, Kales HC. Medical Comorbidities of Dementia: Links to Caregivers' Emotional Difficulties and Gains. J Am Geriatr Soc 2019; 68:609-613. [PMID: 31746461 DOI: 10.1111/jgs.16244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/18/2019] [Accepted: 10/04/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate how eight major medical comorbidities of dementia (arthritis, cancer, diabetes, heart disease, hypertension, lung disease, osteoporosis, and stroke) are associated with caregivers' perceptions of emotional caregiving difficulties and caregiving gains (ie, benefits or rewards from the care role). DESIGN Nationally representative cross-sectional surveys of community-dwelling persons living with dementia (PLWDs) and their co-resident family caregivers in the United States. SETTING The 2011 National Health and Aging Trends Study and National Study of Caregiving. PARTICIPANTS Total of 356 co-resident family caregivers of community-dwelling PLWDs. MEASUREMENTS Caregivers' sociodemographic and health characteristics, caregiving stressors, emotional caregiving difficulties, caregiving gains, and chronic health conditions of PLWDs. RESULTS Caregivers most commonly cared for a PLWD with arthritis (65.5%), followed by hypertension (64.9%), diabetes (30.1%), stroke (28.8%), osteoporosis (27.1%), heart disease (23.3%), cancer (21.5%), and lung disease (17.2%). Logistic regressions revealed that caregivers were 2.63 and 2.32 times more likely to report higher than median emotional caregiving difficulties when PLWDs had diagnoses of diabetes and osteoporosis, respectively, controlling for caregiver sex, relationship to the PLWD (spouse vs non-spouse), educational attainment, self-rated health, and assistance with activities of daily living and medical care activities. Caregivers were also 2.10 times more likely to report lower than median caregiving gains when PLWDs had a diagnosis of osteoporosis. CONCLUSION Comorbid health conditions among PLWDs have distinct implications for caregiving outcomes. Clinical care and interventions to improve the well-being of both care dyad members should support caregivers in managing medical comorbidities of dementia. J Am Geriatr Soc 68:609-613, 2020.
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Affiliation(s)
- Courtney A Polenick
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Institute for Social Research, University of Michigan, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Lillian Min
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.,Geriatric, Research, Education, and Clinical Center (GRECC), Ann Arbor, Michigan
| | - Helen C Kales
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, California
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20
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Ross RD, Shah RC, Leurgans S, Bottiglieri T, Wilson RS, Sumner DR. Circulating Dkk1 and TRAIL Are Associated With Cognitive Decline in Community-Dwelling, Older Adults With Cognitive Concerns. J Gerontol A Biol Sci Med Sci 2019; 73:1688-1694. [PMID: 29432613 DOI: 10.1093/gerona/glx252] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Indexed: 12/22/2022] Open
Abstract
Background Osteoporosis and Alzheimer's disease are common diseases of aging that would seem to be unrelated, but may be linked through the influence of bone-derived signals on brain function. The aim of the current study is to investigate the relationship between circulating levels of bone-related biomarkers and cognition. Methods The population included 103 community-dwelling older individuals with memory concerns but without cognitive impairment. A global cognition summary measure was collected at baseline and 6, 12, and 18 months post-enrollment by converting raw scores from 19 cognitive function tests to z-scores and averaging. Baseline plasma concentrations of bone-related biomarkers, including undercarboxylated, carboxylated, and total osteocalcin, parathyroid hormone, C-terminal telopeptide of collagen 1 (CTX-1), procollagen type 1 amino-terminal propeptide, osteoprotegrin, osteopontin, Dickkopf WNT signaling pathway inhibitor 1 (Dkk1), sclerostin, and amyloid β peptides (Aβ40 and Aβ42), were measured. Results Using sex, age, and education-adjusted mixed-effects models, we found that baseline levels of TNF-related apoptosis-inducing ligand (TRAIL; p < .001), Dkk1 (p = .014), and CTX-1 (p = .046) were related to the annual rate of change of global cognition over the 18 month follow-up. In cognitive domain-specific analysis, baseline TRAIL was found to be positively related to the annual rate of change in episodic (p < .001) and working memory (p = .016), and baseline Dkk1 was positively related to semantic memory (p = .027) and negatively related to working memory (p = .016). Conclusions These results further confirm the link between bone and brain health and suggest that circulating levels of bone-related biomarkers may have diagnostic potential to predict worsening cognition.
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Affiliation(s)
- Ryan D Ross
- Department of Cell and Molecular Medicine, Rush University Medical Center, Chicago, Illinois
| | - Raj C Shah
- Department of Family Medicine, Rush University Medical Center, Chicago, Illinois.,Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Sue Leurgans
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | | | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Dale Rick Sumner
- Department of Cell and Molecular Medicine, Rush University Medical Center, Chicago, Illinois.,Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
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21
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Osteoporose und Multimorbidität. Z Gerontol Geriatr 2019; 52:433-439. [DOI: 10.1007/s00391-019-01569-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 05/24/2019] [Indexed: 12/18/2022]
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22
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Loskutova N, Watts AS, Burns JM. The cause-effect relationship between bone loss and Alzheimer's disease using statistical modeling. Med Hypotheses 2019; 122:92-97. [PMID: 30593432 PMCID: PMC6318806 DOI: 10.1016/j.mehy.2018.10.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/29/2018] [Accepted: 10/21/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Animal studies provide strong evidence that the CNS directly regulates bone remodeling through the actions of the hypothalamus via two distinct pathways, the neural (mediated by leptin) arm and neurohumoral (mediated by neurohormones and growth factors) arm. The impact of AD on central regulatory mechanisms of bone mass is not known. OBJECTIVES To test a model that assesses the relationship between hypothalamic atrophy and bone loss in Alzheimer's disease (AD) and potential mediation through neural (leptin) and neurohumoral (insulin-like growth factor -1, IGF-1) mechanisms. HYPOTHESES AD-related hypothalamic structural change alters neural and neurohumoral regulatory systems of bone remodeling and contributes to bone loss in early AD. DESIGN A secondary data analysis of data obtained in a two-year longitudinal study with path analysis and longitudinal mediation modeling. PARTICIPANTS The data were collected as a part of the University of Kansas Brain Aging Project, a two-year observational study of 71 older adults with early stage AD and 69 non-demented controls. MEASUREMENTS Demographic characteristics and measures of bone density, body composition, and hypothalamic volume, serum levels of leptin, growth hormone, and IGF-1 were collected. RESULTS Hypothalamic atrophy and bone loss were observed in AD group and were associated. Data modeling suggests that bone loss may precede measurable changes in the brain. Leptin increased over two years in AD and the increase in leptin was associated with hypothalamic atrophy. However, changes in leptin or IGF-1 levels did not mediate the relationship between hypothalamic atrophy and bone loss. CONCLUSIONS This study extends previous findings by suggesting that bone loss in AD may be related to neurodegenerative changes (atrophy) in the hypothalamus. Further studies are needed to explore the role of brain atrophy and mediating mechanisms in bone loss. Further exploring temporal relationship between bone loss and AD may have an important diagnostic value.
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Affiliation(s)
- Natalia Loskutova
- American Academy of Family Physicians National Research Network, USA.
| | | | - Jeffrey M Burns
- University of Kansas School of Medicine, Kansas City, KS, USA
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23
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Abstract
Low bone mineral density (BMD) is correlated with Alzheimer's disease and its severity, but the association remains unclear in adults (≥50 years) without a history of stroke or dementia.We assessed BMD and cognitive function using the Mini-Mental Status Examination (MMSE) in 650 stroke- and dementia-free subjects (≥50 years) who were recruited for an early health check-up program between January 2009 and December 2010.The mean age was 62.9 ± 8.0 years and mean MMSE score was 27.6 ± 3.6. A total of 361 subjects had reduced BMD: 197 (30.3%) had osteopenia and 154 (23.6%) had osteoporosis, based on criteria of world health organization. A total of 5.4% of the male subjects had osteoporosis, versus 19.8% of the female subjects. After adjusting for age, sex, education, and other possible confounding factors such as hypertension, diabetes mellitus, and smoking, the estimated odds ratio for cognitive impairment was 1.72 for the osteopenia group (95% confidence interval [CI] 1.09-2.14, P = .019) and 2.81 for the osteoporosis group (95% CI 1.78-4.45, P < .001).Low BMD is correlated with cognitive impairment in community-dwelling adults aged 50 years and above without any medical history of stroke or dementia, especially in women. A community-based, early life, preventive osteoporosis education campaign might decrease the incidence of dementia.
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Affiliation(s)
- Hyun Goo Kang
- Department of Neurology, Chonbuk National University Hospital, Jeonju
| | - Hyun Young Park
- Department of Neurology, Wonkwang University School of Medicine, Institute of Wonkwang Medical Science, Iksan
| | - Han Uk Ryu
- Department of Neurology, Chonbuk National University Hospital, Jeonju
| | - Seung-Han Suk
- Department of Neurology, Wonkwang University Ansan Municipal Geriatric Hospital and Center for Prevention of Stroke and Dementia, Ansan, South Korea
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24
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Kostev K, Hadji P, Jacob L. Impact of Osteoporosis on the Risk of Dementia in Almost 60,000 Patients Followed in General Practices in Germany. J Alzheimers Dis 2018; 65:401-407. [DOI: 10.3233/jad-180569] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | | | - Louis Jacob
- Faculty of Medicine, University of Paris 5, Paris, France
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25
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Takahashi S, Hoshino M, Tsujio T, Terai H, Suzuki A, Namikawa T, Kato M, Matsumura A, Takayama K, Nakamura H. Risk factors for cognitive decline following osteoporotic vertebral fractures: A multicenter cohort study. J Orthop Sci 2017; 22:834-839. [PMID: 28501435 DOI: 10.1016/j.jos.2017.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/18/2017] [Accepted: 04/20/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND Osteoporotic vertebral fractures (OVFs) are the most common cause of intractable back pain and reduced activities of daily living (ADL), which may affect cognitive function. However, no previous studies have reported a change in cognitive function after OVFs. The purpose was to reveal cognitive function changes after OVFs and investigate the risk factors for cognitive decline. METHODS Consecutive patients with symptomatic OVFs were enrolled in a prospective multicenter cohort study. The inclusion criteria were age >65 years, diagnosis of acute or subacute OVF, and back pain onset within 2 months prior to presentation. Cognitive function was assessed with the mini-mental state examination. Medical history, radiological findings, and ADL were investigated as risk factors for cognitive decline. RESULTS We recruited a sample of 339 patients (58 men and 281 women) who met the inclusion criteria. Patients underwent examinations and completed questionnaires at both the time of enrollment and at 6-month follow-up. At 6-month follow-up, cognitive decline was observed in 26 (7.7%) patients. Medical history, including comorbidities and sports activities, did not affect odds ratios (ORs). However, elevated ORs were associated with delayed union (OR: 4.67, 95% Confidence interval: 1.22-17.87). In addition, significantly increased ORs were associated with reduced ADL at 6-month follow-up. CONCLUSIONS The current results revealed the incidence of cognitive decline after the onset of OVF. Delayed union and reduced ADL at 6-month follow-up were associated with cognitive decline. Patients with cognitive decline experienced significantly reduced quality of life. These results highlight the importance of preventing cognitive impairment in patients with symptomatic OVF. Physical treatment or early surgical treatment may provide appropriate options, particularly for patients with suspected delayed union.
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Affiliation(s)
- Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
| | - Tadao Tsujio
- Department of Orthopaedic Surgery, Shiraniwa Hospital, 6-10-1, Shiraniwadai, Ikoma City, Nara, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Takashi Namikawa
- Department of Orthopaedic Surgery, Osaka City General Hospital, 2-15-16, Miyakojima Hon-Dori, Miyakojima-ku, Osaka, Japan
| | - Minori Kato
- Department of Orthopaedic Surgery, Osaka City General Hospital, 2-15-16, Miyakojima Hon-Dori, Miyakojima-ku, Osaka, Japan
| | - Akira Matsumura
- Department of Orthopaedic Surgery, Osaka City General Hospital, 2-15-16, Miyakojima Hon-Dori, Miyakojima-ku, Osaka, Japan
| | - Kazushi Takayama
- Department of Orthopaedic Surgery, Seikeikai Hospital, 6-2-11, Koryonakamachi, Sakai-ku, Sakai City, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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26
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Bendayan R, Kuh D, Cooper R, Muthuri S, Muniz-Terrera G, Adams J, Ward K, Richards M. Associations of Childhood and Adulthood Cognition with Bone Mineral Density in Later Adulthood: A Population-Based Longitudinal Study. Front Aging Neurosci 2017; 9:241. [PMID: 28790912 PMCID: PMC5525002 DOI: 10.3389/fnagi.2017.00241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/10/2017] [Indexed: 01/14/2023] Open
Abstract
This study explores the association between cognitive ability in childhood and midlife and bone health outcomes in early old age; and the relationships of these bone measures with contemporaneous and subsequent cognitive ability in the MRC National Survey of Health and Development (NSHD). This British birth cohort assessed areal and volumetric bone mineral density (aBMD and vBMD) at age 60-64, derived from peripheral quantitative computed tomography and dual-energy X-ray absorptiometry, and cognitive performance from childhood to age 69, among 866 women and 792 men. Cognitive performance at age 15 was assessed using tests of verbal and non-verbal ability, and mathematics; and memory and search speed tasks were administered at ages 53, 60-64, and 69. Covariates included body size, pubertal timing, smoking, leisure time physical activity, socioeconomic circumstances and menopause timing. Multiple linear regression analyses showed that higher childhood cognitive ability was associated with higher hip aBMD, in women, and greater cortical and trabecular vBMD, in men. For women, there were positive associations between hip aBMD and total vBMD, and contemporaneous cognitive ability with associations also extending to subsequent cognitive ability for total vBMD. For men, some associations with trabecular and total vBMD emerged at ages 60-64 and 69 but only after adjusting for education, occupational class and health behaviors. Our findings highlight that higher cognitive ability in childhood is associated with BMD in early old age and these associations might be explained by social and behavioral pathways. The results suggest that individuals with greater cognitive ability in early life are more likely to engage in healthy behaviors (e.g., leisure time physical activity) in adulthood, which in turn are associated with greater BMD later in life. Associations between bone health and cognitive performance should be considered within a life course framework; and the potential role of smoking and physical activity should be addressed when advising adults at high future risk of osteoporosis and fracture.
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Affiliation(s)
- Rebecca Bendayan
- MRC Unit for Lifelong Health and Ageing, University College LondonLondon, United Kingdom
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing, University College LondonLondon, United Kingdom
| | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing, University College LondonLondon, United Kingdom
| | - Stella Muthuri
- MRC Unit for Lifelong Health and Ageing, University College LondonLondon, United Kingdom
| | | | - Judith Adams
- Radiology and Manchester Academic Health Science Centre, Manchester Royal Infirmary, Central Manchester University Hospitals, NHS Foundation TrustManchester, United Kingdom
- Centre for Imaging Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchester, United Kingdom
| | - Kate Ward
- Nutrition and Bone Health, MRC Elsie Widdowson LaboratoryCambridge, United Kingdom
- MRC Lifecourse Epidemiology Unit, University of SouthamptonSouthampton, United Kingdom
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing, University College LondonLondon, United Kingdom
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27
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Miller KL, Alfaro-Almagro F, Bangerter NK, Thomas DL, Yacoub E, Xu J, Bartsch AJ, Jbabdi S, Sotiropoulos SN, Andersson JLR, Griffanti L, Douaud G, Okell TW, Weale P, Dragonu I, Garratt S, Hudson S, Collins R, Jenkinson M, Matthews PM, Smith SM. Multimodal population brain imaging in the UK Biobank prospective epidemiological study. Nat Neurosci 2016; 19:1523-1536. [PMID: 27643430 PMCID: PMC5086094 DOI: 10.1038/nn.4393] [Citation(s) in RCA: 985] [Impact Index Per Article: 123.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/25/2016] [Indexed: 01/17/2023]
Abstract
Medical imaging has enormous potential for early disease prediction, but is impeded by the difficulty and expense of acquiring data sets before symptom onset. UK Biobank aims to address this problem directly by acquiring high-quality, consistently acquired imaging data from 100,000 predominantly healthy participants, with health outcomes being tracked over the coming decades. The brain imaging includes structural, diffusion and functional modalities. Along with body and cardiac imaging, genetics, lifestyle measures, biological phenotyping and health records, this imaging is expected to enable discovery of imaging markers of a broad range of diseases at their earliest stages, as well as provide unique insight into disease mechanisms. We describe UK Biobank brain imaging and present results derived from the first 5,000 participants' data release. Although this covers just 5% of the ultimate cohort, it has already yielded a rich range of associations between brain imaging and other measures collected by UK Biobank.
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Affiliation(s)
- Karla L Miller
- Oxford Centre for Functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK
| | - Fidel Alfaro-Almagro
- Oxford Centre for Functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK
| | - Neal K Bangerter
- Department of Electrical Engineering, Brigham Young University, Provo, USA
| | - David L Thomas
- Institute of Neurology, University College London, London, UK
| | - Essa Yacoub
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, USA
| | - Junqian Xu
- Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Saad Jbabdi
- Oxford Centre for Functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK
| | | | - Jesper LR Andersson
- Oxford Centre for Functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK
| | - Ludovica Griffanti
- Oxford Centre for Functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK
| | - Gwenaëlle Douaud
- Oxford Centre for Functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK
| | - Thomas W Okell
- Oxford Centre for Functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK
| | | | | | | | | | - Rory Collins
- UK Biobank, Stockport, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mark Jenkinson
- Oxford Centre for Functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK
| | - Paul M Matthews
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Stephen M Smith
- Oxford Centre for Functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK
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28
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Ishii M, Iadecola C. Metabolic and Non-Cognitive Manifestations of Alzheimer's Disease: The Hypothalamus as Both Culprit and Target of Pathology. Cell Metab 2015; 22:761-76. [PMID: 26365177 PMCID: PMC4654127 DOI: 10.1016/j.cmet.2015.08.016] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Alzheimer's disease (AD) is increasingly recognized as a complex neurodegenerative disease beginning decades prior to the cognitive decline. While cognitive deficits remain the cardinal manifestation of AD, metabolic and non-cognitive abnormalities, such as alterations in body weight and neuroendocrine functions, are also present, often preceding the cognitive decline. Furthermore, hypothalamic dysfunction can also be a driver of AD pathology. Here we offer a brief appraisal of hypothalamic dysfunction in AD and provide insight into an underappreciated dual role of the hypothalamus as both a culprit and target of AD pathology, as well as into new opportunities for therapeutic interventions and biomarker development.
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Affiliation(s)
- Makoto Ishii
- Feil Family Brain and Mind Research Institute, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY 10065, USA.
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY 10065, USA
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29
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Sohrabi HR, Bates KA, Weinborn M, Bucks RS, Rainey-Smith SR, Rodrigues MA, Bird SM, Brown BM, Beilby J, Howard M, Criddle A, Wraith M, Taddei K, Martins G, Paton A, Shah T, Dhaliwal SS, Mehta PD, Foster JK, Martins IJ, Lautenschlager NT, Mastaglia F, Laws SM, Martins RN. Bone mineral density, adiposity, and cognitive functions. Front Aging Neurosci 2015; 7:16. [PMID: 25741279 PMCID: PMC4332358 DOI: 10.3389/fnagi.2015.00016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 02/03/2015] [Indexed: 12/12/2022] Open
Abstract
Cognitive decline and dementia due to Alzheimer's disease (AD) have been associated with genetic, lifestyle, and environmental factors. A number of potentially modifiable risk factors should be taken into account when preventive or ameliorative interventions targeting dementia and its preclinical stages are investigated. Bone mineral density (BMD) and body composition are two such potentially modifiable risk factors, and their association with cognitive decline was investigated in this study. 164 participants, aged 34–87 years old (62.78 ± 9.27), were recruited for this longitudinal study and underwent cognitive and clinical examinations at baseline and after 3 years. Blood samples were collected for apolipoprotein E (APOE) genotyping and dual energy x-ray absorptiometry (DXA) was conducted at the same day as cognitive assessment. Using hierarchical regression analysis, we found that BMD and lean body mass, as measured using DXA were significant predictors of episodic memory. Age, gender, APOE status, and premorbid IQ were controlled for. Specifically, the List A learning from California Verbal Learning Test was significantly associated with BMD and lean mass both at baseline and at follow up assessment. Our findings indicate that there is a significant association between BMD and lean body mass and episodic verbal learning. While the involvement of modifiable lifestyle factors in human cognitive function has been examined in different studies, there is a need for further research to understand the potential underlying mechanisms.
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Affiliation(s)
- Hamid R Sohrabi
- School of Medical Sciences, Edith Cowan University Joondalup, WA, Australia ; The McCusker Alzheimer's Research Foundation Nedlands, WA, Australia ; School of Psychiatry and Clinical Neurosciences, University of Western Australia Crawley, Australia
| | - Kristyn A Bates
- The McCusker Alzheimer's Research Foundation Nedlands, WA, Australia ; The School of Animal Biology, University of Western Australia Crawley, WA, Australia
| | - Michael Weinborn
- The McCusker Alzheimer's Research Foundation Nedlands, WA, Australia ; School of Psychology, University of Western Australia Crawley, WA, Australia
| | - Romola S Bucks
- School of Psychology, University of Western Australia Crawley, WA, Australia
| | - Stephanie R Rainey-Smith
- School of Medical Sciences, Edith Cowan University Joondalup, WA, Australia ; The McCusker Alzheimer's Research Foundation Nedlands, WA, Australia
| | - Mark A Rodrigues
- School of Medical Sciences, Edith Cowan University Joondalup, WA, Australia ; The McCusker Alzheimer's Research Foundation Nedlands, WA, Australia
| | - Sabine M Bird
- The McCusker Alzheimer's Research Foundation Nedlands, WA, Australia ; School of Psychiatry and Clinical Neurosciences, University of Western Australia Crawley, Australia
| | - Belinda M Brown
- School of Medical Sciences, Edith Cowan University Joondalup, WA, Australia ; The McCusker Alzheimer's Research Foundation Nedlands, WA, Australia
| | - John Beilby
- School of Pathology and Laboratory Medicine, University of Western Australia Nedlands, WA, Australia ; PathWest Laboratory Medicine of WA Nedlands, WA, Australia
| | - Matthew Howard
- The McCusker Alzheimer's Research Foundation Nedlands, WA, Australia
| | - Arthur Criddle
- Western Medicine, Hollywood Specialist Centre Nedlands, WA, Australia
| | - Megan Wraith
- Western Medicine, Hollywood Specialist Centre Nedlands, WA, Australia
| | - Kevin Taddei
- School of Medical Sciences, Edith Cowan University Joondalup, WA, Australia ; The McCusker Alzheimer's Research Foundation Nedlands, WA, Australia
| | - Georgia Martins
- School of Medical Sciences, Edith Cowan University Joondalup, WA, Australia ; The McCusker Alzheimer's Research Foundation Nedlands, WA, Australia
| | - Athena Paton
- School of Medical Sciences, Edith Cowan University Joondalup, WA, Australia ; The McCusker Alzheimer's Research Foundation Nedlands, WA, Australia
| | - Tejal Shah
- School of Medical Sciences, Edith Cowan University Joondalup, WA, Australia ; The McCusker Alzheimer's Research Foundation Nedlands, WA, Australia
| | | | - Pankaj D Mehta
- Division of Immunology, Department of Developmental Neurobiolog,Institute for Basic Research in Developmental Disabilities Staten Island, NY, USA
| | - Jonathan K Foster
- Neurosciences Unit, Health Department of WA, School of Psychology and Speech Pathology, Curtin University of Technology Perth, WA, Australia
| | - Ian J Martins
- School of Medical Sciences, Edith Cowan University Joondalup, WA, Australia ; The McCusker Alzheimer's Research Foundation Nedlands, WA, Australia
| | - Nicola T Lautenschlager
- School of Psychiatry and Clinical Neurosciences, University of Western Australia Crawley, Australia ; Academic Unit for Psychiatry of Old Age, St. Vincent's Health, Department of Psychiatry, University of Melbourne Parkville, VIC, Australia ; The WA Centre for Health and Ageing, University of Western Australia Crawley, Australia
| | - Francis Mastaglia
- Institute for Immunology and Infectious Diseases, Murdoch University WA, Australia
| | - Simon M Laws
- School of Medical Sciences, Edith Cowan University Joondalup, WA, Australia ; The McCusker Alzheimer's Research Foundation Nedlands, WA, Australia
| | - Ralph N Martins
- School of Medical Sciences, Edith Cowan University Joondalup, WA, Australia ; The McCusker Alzheimer's Research Foundation Nedlands, WA, Australia ; School of Psychiatry and Clinical Neurosciences, University of Western Australia Crawley, Australia
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30
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Chang KH, Chung CJ, Lin CL, Sung FC, Wu TN, Kao CH. Increased risk of dementia in patients with osteoporosis: a population-based retrospective cohort analysis. AGE (DORDRECHT, NETHERLANDS) 2014; 36:967-75. [PMID: 24347180 PMCID: PMC4039265 DOI: 10.1007/s11357-013-9608-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 12/03/2013] [Indexed: 06/03/2023]
Abstract
Osteoporosis is a common systemic skeletal disease that predominantly affects people older than 50 years and often co-occurs with dementia. The purpose of this study was to evaluate the risk of dementia in osteoporosis patients in Taiwan. Using data from Taiwan's National Health Insurance Research Database (NHIRD), we identified 23,941 patients with osteoporosis from 2000 to 2010 and 47,579 nonosteoporosis control patients, frequency-matched for age, sex, and index year, excluding patients with dementia at the baseline. We conducted univariate and multiple Cox proportional-hazards regression analyses to calculate the hazard ratios (HRs) and 95 % confidence intervals (CIs) of the association between osteoporosis and risk of dementia. After adjustment for potential risk factors, the osteoporosis patients exhibited 1.46-fold and 1.39-fold higher risk of dementia (95 % CI = 1.37-1.56) and Alzheimer's disease (95 % CI = 0.95-2.02), respectively, compared with the matched nonosteoporosis patients. We observed increased risk of dementia in both men and women with osteoporosis. The osteoporosis patients receiving bisphosphonate treatment or estrogen supplementation were associated with significantly lower risk of dementia compared with the osteoporosis patients who did not receive any treatment. Overall, our results suggest higher risks of dementia in osteoporosis patients than in nonosteoporosis patients. Osteoporosis could thus be considered an early risk factor for dementia. Future large-scale double-blind randomized clinical trials are required to clarify the role of medication in osteoporosis-related dementia.
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Affiliation(s)
- Kuang-Hsi Chang
- />Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- />Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chi-Jung Chung
- />Department of Medical Research, China Medical University and Hospital, Taichung, Taiwan
- />Department of Health Risk Management, College of Public Health, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- />Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- />Department of Public Health, China Medical University, Taichung, Taiwan
| | - Trong-Neng Wu
- />Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- />Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- />Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Number 2, Yuh-Der Road, Taichung, 40447 Taiwan
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Alexander JL, Sommer BR, Dennerstein L, Grigorova M, Neylan T, Kotz K, Richardson G, Rosenbaum R. Role of psychiatric comorbidity on cognitive function during and after the menopausal transition. Expert Rev Neurother 2014; 7:S157-80. [DOI: 10.1586/14737175.7.11s.s157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bagger YZ, Tankó LB, Alexandersen P, Qin G, Christiansen C. The Implications of Body Fat Mass and Fat Distribution for Cognitive Function in Elderly Women. ACTA ACUST UNITED AC 2012; 12:1519-26. [PMID: 15483217 DOI: 10.1038/oby.2004.189] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate how body fat mass, an established source of endogenous estrogen after menopause, influences cognitive impairment in elderly women. RESEARCH METHODS AND PROCEDURES Study participants were 5607 generally healthy postmenopausal women with mean age of 63.8 years at baseline followed for an average of 7.3 years. Cognitive function assessed at follow-up using the short Blessed test was related to baseline body weight, the yearly change in weight, and follow-up measures of body fat depots assessed by DXA. Cognitive function was also related to various surrogates of lifetime estrogen exposure. RESULTS Women with the worst cognitive performance (score >or= 9) at follow-up were the ones who lost the most body weight and revealed the lowest central fat mass (CFM). The association of weight loss with worse cognitive performance was apparent across all age groups except for those more than 80 years old. In the multivariate logistic model, the risk of cognitive impairment was 18% lower in women in the second quartile of CFM (p = 0.14), 32% lower in the third (p = 0.01), and 48% lower in the fourth (p < 0.001) compared with those in the first quartile. CFM showed significant correlation with the simultaneously measured serum estradiol (r = 0.25; p < 0.001). Cognitive score showed an inverse linear relationship with the duration of reproductive period and bone mineral density assessed at follow-up. DISCUSSION These findings argue for a protective association of body fat mass with cognitive impairment in elderly women. This association seems to involve a more prominent exposure to endogenous estrogens.
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Affiliation(s)
- Yu Z Bagger
- Center for Clinical and Basic Research A/S, Ballerup Byvej 222, DK-2750 Ballerup, Denmark.
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33
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Association between cognitive impairment and bone mineral density in postmenopausal women. Menopause 2012; 19:636-41. [DOI: 10.1097/gme.0b013e31823dbec7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Colón-Emeric C, O'Connell MB, Haney E. Osteoporosis piece of multi-morbidity puzzle in geriatric care. ACTA ACUST UNITED AC 2011; 78:515-26. [PMID: 21748741 DOI: 10.1002/msj.20269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Osteoporosis frequently coexists with other chronic diseases and syndromes of aging, and therefore multimorbidity interactions can potentially complicate its evaluation and treatment. This article reviews osteoporosis comorbidity interactions with select common diseases of aging including cardiovascular, neurologic, and geriatric syndromes, and select commonly used medications by older adults. Using depression as a case example, we describe the complex relationship between osteoporosis, mood, and antidepressant medications, and the implications of these interactions for patients and clinicians.
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Affiliation(s)
- Cathleen Colón-Emeric
- Duke University Medical Center and the Durham VA Geriatric Research, Education, and Clinical Center, Durham, NC, USA.
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35
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Abstract
The burden of medical comorbidity in individuals with Alzheimer's disease is greater than that observed in matched individuals without dementia. This has important implications for all clinicians and healthcare providers who deal with this common condition. The prevalence of vascular risk factors and vascular disease is particularly high. Additionally, associations with a number of other chronic medical conditions have been described, including thyroid disorders, sleep apnoea, osteoporosis and glaucoma. This review gives an overview of evidenced medical (non-psychiatric) comorbidity associated with Alzheimer's disease and briefly explores the underlying mechanisms that may account for these associations.
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Affiliation(s)
- A Duthie
- Old Age Psychiatry Directorate, Royal Cornhill Hospital, UK
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36
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Henderson V, Popat R. Effects of endogenous and exogenous estrogen exposures in midlife and late-life women on episodic memory and executive functions. Neuroscience 2011; 191:129-38. [DOI: 10.1016/j.neuroscience.2011.05.059] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 04/27/2011] [Accepted: 05/24/2011] [Indexed: 02/06/2023]
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Seitz DP, Adunuri N, Gill SS, Rochon PA. Prevalence of dementia and cognitive impairment among older adults with hip fractures. J Am Med Dir Assoc 2011; 12:556-564. [PMID: 21450227 DOI: 10.1016/j.jamda.2010.12.001] [Citation(s) in RCA: 152] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 11/27/2010] [Accepted: 12/01/2010] [Indexed: 12/26/2022]
Abstract
BACKGROUND Dementia and cognitive impairment are known to be risk factors for hip fractures and are associated with increased postoperative morbidity and mortality. Little is known of the prevalence of dementia and cognitive impairment among older adults with hip fractures. METHODS We completed searches of the electronic databases for observational studies and report the prevalence of either dementia or cognitive impairment among individuals with hip fractures. We included studies that reported the prevalence of dementia using standard diagnostic criteria or cognitive impairment as measured on cognitive screening tests. We used random-effects meta-analysis to arrive at pooled estimates of the prevalence of dementia and cognitive impairment. RESULTS Five studies reported the prevalence of dementia and 34 studies reported the prevalence of cognitive impairment in older adults with hip fractures. The estimated prevalence of dementia among older adults with hip fractures was 19.2% (95% confidence interval [CI]: 11.4% to 30.6%), whereas the prevalence of cognitive impairment was 41.8% (95% CI: 37.0% to 46.8%). In subgroup analyses, individuals admitted from long-term care were more likely to have dementia when compared with individuals admitted from the community, whereas there were no significant differences in the prevalence of cognitive impairment according to gender or study setting. CONCLUSIONS We conclude that dementia and cognitive impairment are common among older adults with hip fractures. Clinicians providing care for individuals with hip fractures should be aware of the high prevalence of cognitive impairment in this population. Effective strategies to prevent hip fractures and improve postoperative outcomes for older adults with dementia are needed.
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Affiliation(s)
- Dallas P Seitz
- Department of Psychiatry, Division of Geriatric Psychiatry, Queen's University, Kingston, Ontario, Canada.
| | | | - Sudeep S Gill
- Division of Geriatric Medicine, Queen's University, Kingston, Ontario, Canada
| | - Paula A Rochon
- Women's College Research Institute, Toronto, Ontario, Canada
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Annweiler C, Montero-Odasso M, Schott AM, Berrut G, Fantino B, Beauchet O. Fall prevention and vitamin D in the elderly: an overview of the key role of the non-bone effects. J Neuroeng Rehabil 2010; 7:50. [PMID: 20937091 PMCID: PMC2959005 DOI: 10.1186/1743-0003-7-50] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Accepted: 10/11/2010] [Indexed: 11/29/2022] Open
Abstract
Preventing falls and fall-related fractures in the elderly is an objective yet to be reached. There is increasing evidence that a supplementation of vitamin D and/or of calcium may reduce the fall and fracture rates. A vitamin D-calcium supplement appears to have a high potential due to its simple application and its low cost. However, published studies have shown conflicting results as some studies failed to show any effect, while others reported a significant decrease of falls and fractures. Through a 15-year literature overview, and after a brief reminder on mechanism of falls in older adults, we reported evidences for a vitamin D action on postural adaptations - i.e., muscles and central nervous system - which may explain the decreased fall and bone fracture rates and we underlined the reasons for differences and controversies between published data. Vitamin D supplementation should thus be integrated into primary and secondary fall prevention strategies in older adults.
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Affiliation(s)
- Cedric Annweiler
- Department of Internal Medicine and Geriatrics, Angers University Hospital; Angers University Memory Center; UPRES EA 2646, University of Angers, UNAM, Angers, France
| | - Manuel Montero-Odasso
- Department of Medicine, Division of Geriatric Medicine, University of Western Ontario, London, Ontario, Canada
| | - Anne M Schott
- Department IMER, Lyon University Hospital; EA 4129, RECIF, University of Lyon; Inserm, U831, Lyon, France
| | - Gilles Berrut
- Department of Geriatrics, Nantes University Hospital; University of Nantes, UNAM, Nantes, France
| | - Bruno Fantino
- Department of Internal Medicine and Geriatrics, Angers University Hospital; Angers University Memory Center; UPRES EA 2646, University of Angers, UNAM, Angers, France
| | - Olivier Beauchet
- Department of Internal Medicine and Geriatrics, Angers University Hospital; Angers University Memory Center; UPRES EA 2646, University of Angers, UNAM, Angers, France
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39
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Loskutova N, Honea RA, Vidoni ED, Brooks WM, Burns JM. Bone density and brain atrophy in early Alzheimer's disease. J Alzheimers Dis 2010; 18:777-85. [PMID: 19661621 DOI: 10.3233/jad-2009-1185] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Studies suggest a link between bone loss and Alzheimer's disease. To examine bone mineral density (BMD) in early Alzheimer's disease (AD) and its relationship to brain structure and cognition, we evaluated 71 patients with early stage AD (Clinical Dementia Rating (CDR) 0.5 and 1) and 69 non-demented elderly control participants (CDR 0). Measures included whole body BMD by dual energy x-ray absorptiometry (DXA) and normalized whole brain volumes computed from structural MRI scans. Cognition was assessed with a standard neuropsychological test battery. Mean BMD was lower in the early AD group (1.11 +/- 0.13) compared to the non-demented control group (1.16 +/- 0.12, p = 0.02), independent of age, gender, habitual physical activity, smoking, depression, estrogen replacement, and apolipoprotein E4 carrier status. In the early AD group, BMD was related to whole brain volume (b = 0.18, p = 0.03). BMD was also associated with cognitive performance, primarily in tests of memory (logical memory [b = 0.15, p = 0.04], delayed logical memory [b = 0.16, p = 0.02], and the selective reminding task - free recall [b = 0.18, p = 0.009]). BMD is reduced in the earliest clinical stages of AD and associated with brain atrophy and memory decline, suggesting that central mechanisms may contribute to bone loss in early AD.
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Affiliation(s)
- Natalia Loskutova
- Department of Physical Therapy and Rehabilitation Sciences, University of Kansas School of Allied Health, Kansas City, KS, USA
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Loskutova N, Honea RA, Brooks WM, Burns JM. Reduced limbic and hypothalamic volumes correlate with bone density in early Alzheimer's disease. J Alzheimers Dis 2010; 20:313-22. [PMID: 20164583 DOI: 10.3233/jad-2010-1364] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Accelerated bone loss is associated with Alzheimer's disease (AD). Although the central nervous system plays a direct role in regulating bone mass, primarily through the actions of the hypothalamus, there is little work investigating the possible role of neurodegeneration in bone loss. In this cross-sectional study, we examined the association between bone mineral density (BMD) and neuroimaging markers of neurodegeneration (i.e., global and regional measures of brain volume) in early AD and non-demented aging. Fifty-five non-demented and 63 early AD participants underwent standard neurological and neuropsychological assessment, structural MRI scanning, and dual energy x-ray absorptiometry. In early AD, voxel-based morphometry analyses demonstrated that low BMD was associated with low volume in limbic grey matter (GM) including the hypothalamus, cingulate, and parahippocampal gyri and in the left superior temporal gyrus and left inferior parietal cortex. No relationship between BMD and regional GM volume was found in non-demented controls. The hypothesis-driven region of interest analysis further isolating the hypothalamus demonstrated a positive relationship between BMD and hypothalamic volume after controlling for age and gender in the early AD group but not in non-demented controls. These results demonstrate that lower BMD is associated with lower hypothalamic volume in early AD, suggesting that central mechanisms of bone remodeling may be disrupted by neurodegeneration.
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Affiliation(s)
- Natalia Loskutova
- Department of Physical Therapy and Rehabilitation Sciences, University of Kansas School of Allied Health, Kansas City, KS 66160, USA
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41
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Hendrie HC, Albert MS, Butters MA, Gao S, Knopman DS, Launer LJ, Yaffe K, Cuthbert BN, Edwards E, Wagster MV. The NIH Cognitive and Emotional Health Project. Report of the Critical Evaluation Study Committee. Alzheimers Dement 2009; 2:12-32. [PMID: 19595852 DOI: 10.1016/j.jalz.2005.11.004] [Citation(s) in RCA: 209] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 11/29/2005] [Indexed: 12/29/2022]
Abstract
BACKGROUND The Cognitive and Emotional Health Project (CEHP) seeks to identify the demographic, social, and biological determinants of cognitive and emotional health in the older adult. As part of the CEHP, a critical evaluation study committee was formed to assess the state of epidemiological research on demographic, social, and biological determinants of cognitive and emotional health. METHODS Criteria for inclusion in the survey were large cohort studies, longitudinal in design, participants predominantly 65 years or older, with measurements of both cognition and emotion, and information on a wide variety of demographic, psychosocial, and biological factors. North American and European studies, which met these criteria, were selected for the review. Outcome measures included cognition, cognitive decline, and cognitive function. For emotion, symptoms included depression and anxiety, positive and negative affect, subjective well being, mastery, and resilience. RESULTS Ninety-six papers were identified that addressed cognitive and emotional outcomes. A large variety of risk factors were consistently identified with cognitive outcomes, particularly those previously associated with increased risk of cardiovascular disease. There was considerable overlap between risk factors for cognitive and emotional outcomes. CONCLUSION This review identifies a large number of lifestyle and health behaviors that alter the risk for maintenance of cognitive and emotional health. Large longitudinal cohort studies are a unique source to explore factors associated with cognitive and emotional health. Secondary analyses of these studies should be encouraged as should the development of standardized questionnaires to measure cognitive and emotional health. Future research in this field should study cognitive and emotional health simultaneously.
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Affiliation(s)
- Hugh C Hendrie
- Indiana University Center for Aging Research, Indianapolis, IN, USA.
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42
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Blood biomarkers of osteoporosis in mild cognitive impairment and Alzheimer’s disease. J Neural Transm (Vienna) 2009; 116:905-11. [DOI: 10.1007/s00702-009-0241-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 05/06/2009] [Indexed: 02/07/2023]
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Barrett-Connor E, Laughlin GA. Endogenous and exogenous estrogen, cognitive function, and dementia in postmenopausal women: evidence from epidemiologic studies and clinical trials. Semin Reprod Med 2009; 27:275-82. [PMID: 19401958 PMCID: PMC2701737 DOI: 10.1055/s-0029-1216280] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There are more than 200 published scientific papers showing that estrogen has favorable effects on brain tissue and physiology in cell culture and animal models including non-human primates. The biological plausibility for a neuroprotective estrogen effect is overwhelming. However, most studies of endogenous estrogen and cognitive decline or dementia in women fail to show protection, and some suggest harm. Failure to find any consistent association might reflect the limitations of a single time of estrogen assay or poor assay sensitivity. More than half of the observational studies of hormone therapy suggest benefit. Nearly all long-term clinical trials fail to show benefit, and the longer trials tend to show harm. Failure to adequately adjust for self-selection of healthier and wealthier women and publication bias could account for some, or all, of the protective effect attributed to estrogen in observational studies. Overall, the evidence does not convincingly support the prescription of early or late postmenopausal estrogen therapy to preserve cognitive function or prevent dementia.
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Affiliation(s)
- Elizabeth Barrett-Connor
- Chief Division of Epidemiology, Departments of Family and Preventive Medicine and Medicine, University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093-0607; ; phone: 858.534.0511; fax: 858.534.8625
| | - Gail A. Laughlin
- Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093-0631-C, ; phone: 858.822.2416; fax: 858.534-0511
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Psychological state, quality of life, and body composition in postmenopausal women with osteoporosis in Lithuania. Arch Osteoporos 2009; 4:85-90. [PMID: 20234863 PMCID: PMC2836755 DOI: 10.1007/s11657-009-0034-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 11/04/2009] [Indexed: 02/03/2023]
Abstract
SUMMARY: The objective of this study was to determine body composition, physical activity, and psychological state in postmenopausal women with osteoporosis. Fat mass, lean mass, water mass, and basal metabolic rate are lower, self-reported physical activity and risk factors of fractures are higher, and cognitive functions were worse in osteoporotic patients than in controls. Significant correlations were found between physical activity and emotional state parameters. INTRODUCTION: This study aims to determine peculiarities of body composition, physical activity, risk factors predicting fractures, psychological state and quality of life, and possible relations between them in postmenopausal women with osteoporosis in Lithuania. METHODS: Thirty-one postmenopausal women with osteoporosis and 29 healthy age- and sex-matched controls were included in the study. Profile of Mood State and Hospital Anxiety and Depression Scale were used for the assessment of emotional state. Trail Making Test and Digit Symbol Test of Wechsler Adult Intelligence Scale were used to evaluate cognitive functioning. Quality of life was evaluated using the World Health Organization Brief Quality of Life Questionnaire. Risk of fractures was assessed by the Risk Factors Predicting Questionnaire. RESULTS: Fat mass (22.4 +/- 4.7 vs. 40.6 +/- 14.2 kg, p < 0.001), lean mass (37.3 +/- 6.0 vs. 48.1 +/- 7.6 kg, p < 0.001), water mass (31.6 +/- 2.9 vs. 38.3 +/- 5.3 kg, p < 0.001), and basal metabolic rate (1,253 +/- 132 vs. 1,456 +/- 126 kcal, p < 0.001) were lower in osteoporotic patients than in controls. Self-reported physical activity (2.35 +/- 0.6 vs. 1.69 +/- 0.5, p < 0.001) and risk factors of fractures (5.9 +/- 2.1 vs. 2.6 +/- 2.4, p < 0.001) were higher in women with osteoporosis than in healthy age- and sex-matched controls (2.35 +/- 0.6 vs. 69 +/- 0.5, p < 0.001). Trail making A and B scores were higher in patients than in age- and sex-matched controls (55.8 +/- 19.9 vs. 45.1 +/- 19.9, p = 0.07 and 118.2 +/- 34.6 vs. 92.8 +/- 48.7, p = 0.006). Some significant correlations were detected between physical activity and emotional state and quality of life parameters. CONCLUSION: In postmenopausal women with osteoporosis, fat body mass, lean body mass, water body mass, basal metabolic rate, and waist-to-hip ratio are lower, physical activity and risk of fractures are higher, and cognitive functions are worse than in age- and sex-matched controls. Some psychological peculiarities could be related to physical activity in women with osteoporosis.
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Successful skeletal aging: a marker of low fracture risk and longevity. The Study of Osteoporotic Fractures (SOF). J Bone Miner Res 2009; 24:134-43. [PMID: 18715137 PMCID: PMC2605163 DOI: 10.1359/jbmr.080813] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Successful aging is multidimensional, and many phenotypes have been proposed. We examined a biomarker of aging based on repeated measures of BMD for up to 15 yr and hypothesized that maintenance of BMD will be associated with low fracture risk and disability and improved survival. We studied 9704 women recruited at four U.S. clinical centers and enrolled in the Study of Osteoporotic Fractures, a longitudinal cohort study. Of these, 8224 women had at least one hip BMD measurement. Hip BMD was measured a maximum of five times over 15 yr. Random effects regression was used to determine a BMD slope for each subject. Three groups were formed-"maintained" BMD: slope >or=0, n = 724 (9%); "expected" BMD loss: slope <0 to <1 SD below mean, n = 6478 (79%); and "accelerated" BMD loss: slope >or=1 SD below mean, n = 1022 (12%). Cox proportional hazards models were used to compare the relative hazard (RH; 95% CI) of fracture, incident mobility disability, and mortality in the maintained and accelerated groups compared with the expected. A 1 SD decrease in the BMD slope was associated with an increased risk of all outcomes. In multivariate models, the RH of nonspine fracture was 0.81 (0.71-0.93) and of hip fracture was 0.36 (0.25-0.53) for women in the maintained compared with the expected group. The incidence of mobility disability was lower in the maintained versus expected group (RH = 0.70; 95% CI = 0.59-0.83), but this was largely explained by other factors. Women who experienced accelerated bone loss were more likely to develop disability (RH = 1.56; 95% CI: 1.33-1.84). Mortality risks were lower in the maintained compared with the expected group (RH = 0.49; 95% CI: 0.42-0.58). In conclusion, a subset of older women maintained their BMD up to 15 yr, suggesting that bone loss is not an inevitable consequence of aging. These women experienced a lower risk of fractures, disability, and mortality, suggesting that this phenotype may be a marker of successful aging.
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Crane PK, Narasimhalu K, Gibbons LE, Mungas DM, Haneuse S, Larson EB, Kuller L, Hall K, van Belle G. Item response theory facilitated cocalibrating cognitive tests and reduced bias in estimated rates of decline. J Clin Epidemiol 2008; 61:1018-27.e9. [PMID: 18455909 DOI: 10.1016/j.jclinepi.2007.11.011] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Revised: 11/14/2007] [Accepted: 11/18/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To cocalibrate the Mini-Mental State Examination, the Modified Mini-Mental State, the Cognitive Abilities Screening Instrument, and the Community Screening Instrument for Dementia using item response theory (IRT) to compare screening cut points used to identify cases of dementia from different studies, to compare measurement properties of the tests, and to explore the implications of these measurement properties on longitudinal studies of cognitive functioning over time. STUDY DESIGN AND SETTING We used cross-sectional data from three large (n>1000) community-based studies of cognitive functioning in the elderly. We used IRT to cocalibrate the scales and performed simulations of longitudinal studies. RESULTS Screening cut points varied quite widely across studies. The four tests have curvilinear scaling and varied levels of measurement precision, with more measurement error at higher levels of cognitive functioning. In longitudinal simulations, IRT scores always performed better than standard scoring, whereas a strategy to account for varying measurement precision had mixed results. CONCLUSION Cocalibration allows direct comparison of cognitive functioning in studies using any of these four tests. Standard scoring appears to be a poor choice for analysis of longitudinal cognitive testing data. More research is needed into the implications of varying levels of measurement precision.
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Affiliation(s)
- Paul K Crane
- Department of Medicine, University of Washington, Seattle, WA, USA.
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Bussières AE, Taylor JA, Peterson C. Diagnostic Imaging Practice Guidelines for Musculoskeletal Complaints in Adults—An Evidence-Based Approach—Part 3: Spinal Disorders. J Manipulative Physiol Ther 2008; 31:33-88. [DOI: 10.1016/j.jmpt.2007.11.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2007] [Revised: 09/28/2007] [Accepted: 10/14/2007] [Indexed: 01/29/2023]
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48
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Suzuki A, Fukuo K, Yasuda O, Taniguchi K, Kitano S, Ogihara T. Different changes of bone mineral density and nutritional status after hospitalization between vascular dementia and Alzheimer's disease in elderly female patients. Geriatr Gerontol Int 2007. [DOI: 10.1111/j.1447-0594.2007.00426.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cukierman T, Gerstein HC, Williamson JD. Cognitive decline and dementia in diabetes--systematic overview of prospective observational studies. Diabetologia 2005; 48:2460-9. [PMID: 16283246 DOI: 10.1007/s00125-005-0023-4] [Citation(s) in RCA: 659] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Accepted: 07/21/2005] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS We systematically reviewed and summarised prospective data relating diabetes status to changes in cognitive function over time. METHODS Published reports of longitudinal studies that described assessment of cognitive function in people with diabetes were sought. Studies were included if they assessed cognitive function in participants with diabetes at the beginning and at follow-up. Studies were excluded if they had (1) a follow-up period of less than 1 year, (2) a rate of loss to follow-up in excess of 30%, or (3) described selected subgroups. Change in cognitive function was recorded as either the mean change in score and/or the proportion of individuals developing various degrees of change in cognitive function. A pooled estimate was calculated for the latter. RESULTS Of 1,165 abstracts and titles initially identified, 25 articles met the inclusion and exclusion criteria. Individuals with diabetes had a 1.2- to 1.5-fold greater change over time in measures of cognitive function than those without diabetes. When assessed by the Mini-Mental State Exam and the Digit Symbol Span tests, a diagnosis of diabetes increased the odds of cognitive decline 1.2-fold (95% CI 1.05-1.4) and 1.7-fold (95% CI 1.3-2.3), respectively . The odds of future dementia increased 1.6-fold (95% CI 1.4-1.8). CONCLUSIONS/INTERPRETATION Compared to people without diabetes, people with diabetes have a greater rate of decline in cognitive function and a greater risk of cognitive decline. Cognitive dysfunction should therefore be added to the list of chronic complications of diabetes.
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Affiliation(s)
- T Cukierman
- Division of Endocrinology & Metabolism and Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
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Rasgon NL, Magnusson C, Johansson ALV, Pedersen NL, Elman S, Gatz M. Endogenous and exogenous hormone exposure and risk of cognitive impairment in Swedish twins: a preliminary study. Psychoneuroendocrinology 2005; 30:558-67. [PMID: 15808925 DOI: 10.1016/j.psyneuen.2005.01.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2004] [Revised: 11/05/2004] [Accepted: 01/12/2005] [Indexed: 11/23/2022]
Abstract
PURPOSE To analyze the risk of cognitive impairment among female Swedish Twins with regard to endogenous and exogenous hormone exposure. DESIGN AND SETTING A cross-sectional analysis of data from the HARMONY Study, a population-based cohort study of cognitive impairment in the Swedish Twin Registry. METHODS Information regarding age at menarche and menopause, parity, and length and type of hormone therapy (HT) was collected via a telephone interview from 6604 women, aged 65-84. Cognitive impairment was assessed with the TELE, a brief telephone cognitive screen. RESULTS Length of reproductive period was inversely associated with risk of cognitive impairment (p<0.01). The OR was 1.15 (CI 95% 0.96-1.36) for women with reproductive periods <35 years and 0.82 (CI 95% 0.66-1.00) for women with reproductive periods >39 years. Age at menopause was inversely associated with risk of cognitive impairment. Use of HT was associated with average 40% decline in the risk of cognitive impairment, independent of type and timing of treatment. CONCLUSION Our results suggest that both increased length of reproductive period and HT are associated with reduced risk of cognitive impairment.
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Affiliation(s)
- Natalie L Rasgon
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Room 2360, Palo Alto, CA 94305-5723, USA.
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