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Chen LJ, Sha S, Brenner H, Schöttker B. Longitudinal associations of polypharmacy and frailty with major cardiovascular events and mortality among more than half a million middle-aged participants of the UK Biobank. Maturitas 2024; 185:107998. [PMID: 38678818 DOI: 10.1016/j.maturitas.2024.107998] [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: 09/25/2023] [Revised: 03/04/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Studies of the associations of polypharmacy and frailty with adverse health outcomes in middle-aged adults are limited. Furthermore, a potentially stronger association of polypharmacy with adverse health outcomes in frail than in non-frail adults is of interest. OBJECTIVE To evaluate associations of frailty (assessed using a frailty index) and polypharmacy (defined as taking five or more drugs) with major cardiovascular events, cancer incidence, all-cause, cardiovascular disease-specific, and cancer-specific mortality. METHODS Cox proportional hazards regression models were used to analyze 501,548 participants of the UK Biobank cohort study aged 40-69 years who were followed up for an average of 12 years. RESULTS The prevalence of pre-frailty and frailty were 43.2 % and 2.3 %, respectively, and that of polypharmacy was 18.3 %. Although strongly associated with each other, frailty and polypharmacy were independently, statistically significantly associated with major cardiovascular events, cardiovascular disease-specific, and all-cause mortality. In addition, the hazard ratios of polypharmacy were stronger among (pre-)frail than non-frail study participants. No profound associations with cancer incidence and cancer mortality were observed. No sex and age differences were observed. CONCLUSIONS This large cohort study showed that polypharmacy and frailty are independent risk factors for major cardiovascular events, cardiovascular disease-specific and all-cause mortality in both middle-aged (40-64 years) and older people (≥ 65 years). In addition, the hazard ratios of polypharmacy were stronger among (pre-)frail than non-frail study participants. This underlines the need to avoid polypharmacy as far as possible not only in older but also in middle-aged subjects (40-64 years), especially if they are pre-frail or frail.
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Affiliation(s)
- Li-Ju Chen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
| | - Sha Sha
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany; Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115 Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany; Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115 Heidelberg, Germany.
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Corney KB, Stuart AL, Pasco JA, Mohebbi M, Kavanagh BE, Sui SX, Williams LJ. Psychiatric symptoms, associated pharmacological treatments and cognitive function: A population-based study of men. J Affect Disord 2024; 356:657-663. [PMID: 38657772 DOI: 10.1016/j.jad.2024.04.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 04/09/2024] [Accepted: 04/21/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Psychiatric symptomatology and medications used in their treatment may be modifiable risk factors associated with cognitive function, although findings from population-based studies spanning the full adult age range are lacking. This study aimed to investigate associations between psychiatric symptomatology, psychotropic medication use and cognitive function in a population-based sample of men. METHODS Data for 537 men were drawn from the Geelong Osteoporosis Study. Cognitive function (psychomotor function, attention, working memory and visual learning) was determined using the Cog-State Brief Battery. Current depressive and anxiety symptomatology was determined using the Hospital Anxiety and Depression Scale, and psychotropic medication use was self-reported. Linear regression models were developed to determine associations between psychiatric symptomatology and psychotropic medication use with each cognitive measure. RESULTS Depressive symptomatology was associated with lower overall cognitive function (b-0.037 ± 0.010, η2 = 0.025, p < 0.001), psychomotor function (b 0.006 ± 0.002, η2 = 0.028 p < 0.001) and attention (b 0.004 ± 0.001, η2 = 0.021, p < 0.001), whereas psychotropic use was associated with lower overall cognitive function (b - 0.174 ± 0.075, η2 = 0.010, p = 0.021), attention (b 0.017 ± 0.008, η2 = 0.008, p = 0.038 and working memory (b 0.031 ± 0.012, η2 = 0.010, p = 0.010). Anticonvulsant use was associated with lower overall cognitive function (b - 0.723 ± 0.172, η2 = 0.032, p < 0.001), attention (b 0.065 ± 0.018, η2 = 0.029, p < 0.001) and working memory (b 0.088 ± 0.026, η2 = 0.022, p < 0.001). All relationships were found to have a small effect. There were no significant associations between anxiety symptomatology and antidepressant and anxiolytic use with any of the cognitive domains. CONCLUSION Depressive symptomatology and anticonvulsant use were associated with lower cognitive function. Understanding the underlying mechanisms involved in these relationships can advance knowledge on the heterogeneity in cognitive ageing and aid in prevention initiatives.
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Affiliation(s)
- Kayla B Corney
- Deakin University, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia.
| | - Amanda L Stuart
- Deakin University, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia
| | - Julie A Pasco
- Deakin University, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia; Barwon Health, Geelong, VIC, Australia; Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mohammadreza Mohebbi
- Deakin University, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia; Deakin University, Faculty of Health, Biostatistics Unit, Melbourne, VIC, Australia
| | - Bianca E Kavanagh
- Deakin University, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia; Deakin University, Deakin Rural Health, School of Medicine, Warrnambool, VIC, Australia
| | - Sophia X Sui
- Deakin University, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia
| | - Lana J Williams
- Deakin University, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia; Barwon Health, Geelong, VIC, Australia
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Ribeiro FJ, Poínhos R. Nootropic supplements for esports. INT J VITAM NUTR RES 2024; 94:275-295. [PMID: 37563907 DOI: 10.1024/0300-9831/a000790] [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] [Indexed: 08/12/2023]
Abstract
Background: esports, or organized video game competitions, have been expanding quickly. The use of dietary supplements by esports players appears vulgarized but lacks supporting evidence. Objectives: To outline studies that tested the effects of dietary supplements on video gaming, summarize their findings, highlight knowledge gaps, and recommend future research. Eligibility criteria: Clinical trials published in English between 1990 and 2023 that assessed the effects of dietary supplements on the cognitive performance of video gamers. Sources of evidence: The Web of Science, PubMed, Scopus, and Google Scholar databases. Charting methods: PRISMA's (2020) flow diagram was used to create the data chart. Results: Sixteen studies were outlined. Thirteen were randomized, thirteen applied acute interventions, ten applied a crossover design and only three weren't placebo-controlled. Of the 10 studies that included caffeine (40-200 mg), four reported significant positive effects on cognition (attention, processing speed, working memory), two on first-person shooter video gaming performance (reaction time, hit accuracy, time to hit 60 targets), and one on Tetris game score. All 3 studies that included arginine silicate (1500 mg) reported significant improvements in one or more aspects of cognition (reaction time, attention, visual representation, and spatial planning). Two studies that tested sucrose (21 and 26.8 g) didn't report significant improvements, while one study that tested 26.1 g of glucose registered significant positive effects on processing speed and sustained attention. Conclusions: The published literature has focused on the effects of caffeine, which may exert both positive and negative effects on esports players. Additional, high-quality research is needed.
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Affiliation(s)
- Fernando J Ribeiro
- Faculty of Nutrition and Food Sciences, University of Porto (FCNAUP), Porto, Portugal
- Faculty of Sciences, University of Porto (FCUP), Porto, Portugal
| | - Rui Poínhos
- Faculty of Nutrition and Food Sciences, University of Porto (FCNAUP), Porto, Portugal
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Ronca F, Blodgett JM, Bruinvels G, Lowery M, Raviraj M, Sandhar G, Symeonides N, Jones C, Loosemore M, Burgess PW. Attentional, anticipatory and spatial cognition fluctuate throughout the menstrual cycle: Potential implications for female sport. Neuropsychologia 2024:108909. [PMID: 38762068 DOI: 10.1016/j.neuropsychologia.2024.108909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/06/2024] [Accepted: 05/15/2024] [Indexed: 05/20/2024]
Abstract
Current research suggests that menstruating female athletes might be at greater risk of musculoskeletal injury in relation to hormonal changes throughout the menstrual cycle. A separate body of work suggests that spatial cognition might also fluctuate in a similar manner. Changes in spatial cognition could, in theory, be a contributing risk factor for injury, especially in fast-paced sports that require precise, millisecond accuracy in interactions with moving objects in the environment. However, existing theories surrounding causes for increased injury risk in menstruating females largely focus on biomechanical mechanisms, with little consideration of possible cognitive determinants of injury risk. Therefore, the aim of this proof-of-principle study was to explore whether menstruating females exhibit fluctuations in cognitive processes throughout their cycle on a novel sport-oriented cognitive test battery, designed to measure some of the mental processes putatively involved in these sporting situations. A total of 394 participants completed an online cognitive battery, a mood scale and a symptom questionnaire twice, 14 days apart. After exclusions, 248 eligible participants were included in the analyses (mean: 28 ± 6 years) (male = 96, female(menstruating) = 105, female(contraception) = 47). Cycle phase for menstruating females was based on self-reported information. The cognitive battery was designed to measure reaction times, attention, visuospatial functions (including 3D mental rotation) and timing anticipation. Three composite scores were generated using factor analysis with varimax rotation (Errors, Reaction Time, Intra-Individual Variability). Mixed model ANOVAs and repeated measures ANOVAs were performed to test for between and within-subject effects. There was no group difference in reaction times and accuracy between males and females (using contraception and not). However, within subject analyses revealed that regularly menstruating females performed better during menstruation compared to being in any other phase, with faster reaction times (10ms c.ca, p < 0.01), fewer errors (p < 0.05) and lower dispersion intra-individual variability (p < 0.05). In contrast they exhibited slower reaction times (10ms c.ca, p < 0.01) and poorer timing anticipation (p < 0.01) in the luteal phase, and more errors in the predicted ovulatory phase (p < 0.01). Self-reported mood, cognitive and physical symptoms were all worst during menstruation (p < 0.01), and a significant proportion of females felt that their symptoms were negatively affecting their cognitive performance during menstruation on testing day, which was incongruent with their actual performance. These findings suggest that visuospatial and anticipatory processes may fluctuate throughout the menstrual cycle in the general population, with better performance during the menstrual phase and poorer performance during the luteal phase. If these extend to associations between phase-specific cognitive performance and injury incidence, they would support a cognitive theory of determinants of injury risk in cycling female athletes, opening an opportunity to develop mitigation strategies where appropriate.
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Affiliation(s)
- F Ronca
- Institute of Sport, Exercise and Health, University College London, London, UK.
| | - J M Blodgett
- Institute of Sport, Exercise and Health, University College London, London, UK; NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - G Bruinvels
- Institute of Sport, Exercise and Health, University College London, London, UK
| | - M Lowery
- Institute of Sport, Exercise and Health, University College London, London, UK; Sport and Wellbeing Analytics Limited, Swansea, UK
| | - M Raviraj
- Institute of Sport, Exercise and Health, University College London, London, UK
| | - G Sandhar
- Institute of Sport, Exercise and Health, University College London, London, UK
| | - N Symeonides
- Institute of Sport, Exercise and Health, University College London, London, UK
| | - C Jones
- Institute of Sport, Exercise and Health, University College London, London, UK; Sport and Wellbeing Analytics Limited, Swansea, UK
| | - M Loosemore
- Institute of Sport, Exercise and Health, University College London, London, UK
| | - P W Burgess
- Institute of Cognitive Neuroscience, University College London, London, UK
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McMurray J, Levy A, Pang W, Holyoke P. Psychometric Evaluation of a Tablet-Based Tool to Detect Mild Cognitive Impairment in Older Adults: Mixed Methods Study. J Med Internet Res 2024; 26:e56883. [PMID: 38640480 PMCID: PMC11069099 DOI: 10.2196/56883] [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: 01/29/2024] [Revised: 03/05/2024] [Accepted: 03/19/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND With the rapid aging of the global population, the prevalence of mild cognitive impairment (MCI) and dementia is anticipated to surge worldwide. MCI serves as an intermediary stage between normal aging and dementia, necessitating more sensitive and effective screening tools for early identification and intervention. The BrainFx SCREEN is a novel digital tool designed to assess cognitive impairment. This study evaluated its efficacy as a screening tool for MCI in primary care settings, particularly in the context of an aging population and the growing integration of digital health solutions. OBJECTIVE The primary objective was to assess the validity, reliability, and applicability of the BrainFx SCREEN (hereafter, the SCREEN) for MCI screening in a primary care context. We conducted an exploratory study comparing the SCREEN with an established screening tool, the Quick Mild Cognitive Impairment (Qmci) screen. METHODS A concurrent mixed methods, prospective study using a quasi-experimental design was conducted with 147 participants from 5 primary care Family Health Teams (FHTs; characterized by multidisciplinary practice and capitated funding) across southwestern Ontario, Canada. Participants included health care practitioners, patients, and FHT administrative executives. Individuals aged ≥55 years with no history of MCI or diagnosis of dementia rostered in a participating FHT were eligible to participate. Participants were screened using both the SCREEN and Qmci. The study also incorporated the Geriatric Anxiety Scale-10 to assess general anxiety levels at each cognitive screening. The SCREEN's scoring was compared against that of the Qmci and the clinical judgment of health care professionals. Statistical analyses included sensitivity, specificity, internal consistency, and test-retest reliability assessments. RESULTS The study found that the SCREEN's longer administration time and complex scoring algorithm, which is proprietary and unavailable for independent analysis, presented challenges. Its internal consistency, indicated by a Cronbach α of 0.63, was below the acceptable threshold. The test-retest reliability also showed limitations, with moderate intraclass correlation coefficient (0.54) and inadequate κ (0.15) values. Sensitivity and specificity were consistent (63.25% and 74.07%, respectively) between cross-tabulation and discrepant analysis. In addition, the study faced limitations due to its demographic skew (96/147, 65.3% female, well-educated participants), the absence of a comprehensive gold standard for MCI diagnosis, and financial constraints limiting the inclusion of confirmatory neuropsychological testing. CONCLUSIONS The SCREEN, in its current form, does not meet the necessary criteria for an optimal MCI screening tool in primary care settings, primarily due to its longer administration time and lower reliability. As the number of digital health technologies increases and evolves, further testing and refinement of tools such as the SCREEN are essential to ensure their efficacy and reliability in real-world clinical settings. This study advocates for continued research in this rapidly advancing field to better serve the aging population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/25520.
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Affiliation(s)
- Josephine McMurray
- Lazaridis School of Business & Economics, Wilfrid Laurier University, Brantford, ON, Canada
- Health Studies, Faculty of Human and Social Sciences, Wilfrid Laurier University, Brantford, ON, Canada
| | - AnneMarie Levy
- Lazaridis School of Business & Economics, Wilfrid Laurier University, Brantford, ON, Canada
| | - Wei Pang
- Lazaridis School of Business & Economics, Wilfrid Laurier University, Brantford, ON, Canada
- Biomedical Informatics & Data Science, Yale University, New Haven, CT, United States
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Yun Z, Shen Y, Yan X, Tian S, Wang J, Teo CS, Zhao H, Xue C, Dong Q, Hou L. Association between 19 medication use and risk of common cancers: A cross-sectional and Mendelian randomisation study. J Glob Health 2024; 14:04057. [PMID: 38487860 PMCID: PMC10940964 DOI: 10.7189/jogh.14.04057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
Background Previous studies have yielded inconsistent results concerning drug use and the risk of cancers. We conducted a large-scale cross-sectional study and a two-sample Mendelian randomisation (MR) study to reveal the causal effect between the use of 19 medications and the risk of four common cancers (breast, lung, colorectal, and prostate). Methods We obtained information on medication use and cancer diagnosis from National Health and Nutrition Examination Survey participants. After propensity score matching, we conducted survey-weighted multivariate logistic regression and restricted cubic spline analysis to assess the observed correlation between medication use and cancer while adjusting for multiple covariates. We also performed MR analysis to investigate causality based on summary data from genome-wide association studies on medication use and cancers. We performed sensitivity analyses, replication analysis, genetic correlation analysis, and reverse MR analysis to improve the reliability of MR findings. Results We found that the use of agents acting on the renin-angiotensin system was associated with reduced risk of prostate cancer (odds ratio (OR) = 0.42; 95% confidence interval (CI) = 0.27-0.63, P < 0.001), and there was a nonlinear association of 'decrease-to-increase-to-decrease' (P < 0.0001). The random-effects inverse variance weighted (IVW) model-based primary MR analysis (OR = 0.94, 95% CI = 0.91-0.97, P = 0.0007) and replication MR analysis (OR = 0.90, 95% CI = 0.85-0.96, P = 0.0006) both provided robust evidence of the causality of genetic liability for the use of agents acting on the renin-angiotensin system on a decreased risk of prostate cancer. Conclusions Our study provides robust evidence that the use of drugs acting on the renin-angiotensin system can reduce prostate cancer risk. Given the high prevalence of prostate cancer, these findings have important implications for drug selection and prostate cancer prevention in patients with cardiovascular disease.
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Affiliation(s)
- Zhangjun Yun
- Department of Oncology and Haematology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- First School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yang Shen
- Department of Oncology and Haematology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiang Yan
- Department of Oncology and Haematology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- First School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Shaodan Tian
- Department of Oncology and Haematology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Wang
- Department of Oncology and Haematology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chiah Shean Teo
- School of Traditional and Complementary Medicine, Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Hongbin Zhao
- Department of Oncology and Haematology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- First School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Chengyuan Xue
- Department of Oncology and Haematology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- First School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Qing Dong
- Department of Oncology and Haematology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Li Hou
- Department of Oncology and Haematology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Ai B, Chen L, Cai M, Fu J, Li H, Lin H, Zhang Z. No Associations Between Glucosamine Supplementation and Dementia or Parkinson's Disease: Findings From a Large Prospective Cohort Study. J Gerontol A Biol Sci Med Sci 2024; 79:glad123. [PMID: 37158699 DOI: 10.1093/gerona/glad123] [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: 09/08/2022] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND We investigated the associations between habitual use of glucosamine and incident dementia and Parkinson's disease in a population-based cohort. METHODS Using the UK Biobank data, we included around 0.29 million middle- to old-aged participants free of dementia or Parkinson's disease at baseline. Glucosamine supplementation was measured by questionnaire at baseline. Some participants additionally answered 1-5 rounds of 24-hour dietary recalls afterwards, particularly 112 243 participants (for dementia) and 112 084 (for Parkinson's disease). Incident cases of dementia and Parkinson's disease were identified through linkage to health administrative data sets. We examined the associations of glucosamine supplementation with incident dementia and Parkinson's disease using Cox proportional-hazards regression models with adjustment for various covariates. RESULTS During the study period (median follow-up: 9.1-10.9 years), 4 404 and 1 637 participants developed dementia and Parkinson's disease, respectively. Glucosamine intake was not associated with incident dementia or Parkinson's disease. In fully adjusted models, the hazard ratios associated with glucosamine intake were 1.06 [95% confidence interval (CI): 0.99, 1.14] for dementia and 0.97(95% CI: 0.86, 1.09) for Parkinson's disease. In the subsample, similar results were found as the frequency of reported glucosamine use over multiple dietary surveys was associated with neither of the 2 conditions. CONCLUSIONS Habitual supplementation of glucosamine was not associated with incident dementia or Parkinson's disease.
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Affiliation(s)
- Baozhuo Ai
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Lan Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Miao Cai
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jiaying Fu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Haitao Li
- Department of Social Medicine and Health Service Management, Shenzhen University, Shenzhen, China
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zilong Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Kamenskikh EM, Krygina AY, Gomboeva SC, Zhailebaeva D, Koval DP, Kicherov NA, Otchurzhap CN, Birulina YG, Alifirova VM. [Biobanking in clinical trials involving multiple sclerosis patients]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:7-15. [PMID: 39175234 DOI: 10.17116/jnevro20241240727] [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] [Indexed: 08/24/2024]
Abstract
Investigation of multiple sclerosis (MS) pathogenesis requires sophisticated analytical tools of precision medicine, such as omics research, which include genomics, microbiomics and metabolomics (proteomics, lipidomics and glycomics). Such sensitive methods are based on careful preanalytical work with biomaterials to maintain quality and obtain objective results. Implementation of biobanking as a universal method for working with biomaterials will help to standardize the stages of research, compare different scientific team's results. Collaboration of MS researchers with large biobanks can also help to conduct multicenter and long-term prospective studies, to include a wide number of patients. In this article, we analyze the experience of biobanking practice technologies in studies of MS patients and share the experience of partnership between the Center for MS of the Tomsk Region and the Bank of Biological Material of the Siberian State Medical University.
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Affiliation(s)
| | - A Yu Krygina
- Siberian State Medical University, Tomsk, Russia
| | | | | | - D P Koval
- Siberian State Medical University, Tomsk, Russia
| | - N A Kicherov
- Siberian State Medical University, Tomsk, Russia
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Liabeuf S, Pešić V, Spasovski G, Maciulaitis R, Bobot M, Farinha A, Wagner CA, Unwin RJ, Capasso G, Bumblyte IA, Hafez G. Drugs with a negative impact on cognitive function (Part 1): chronic kidney disease as a risk factor. Clin Kidney J 2023; 16:2365-2377. [PMID: 38045996 PMCID: PMC10689135 DOI: 10.1093/ckj/sfad241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Indexed: 12/05/2023] Open
Abstract
People living with chronic kidney disease (CKD) frequently suffer from mild cognitive impairment and/or other neurocognitive disorders. This review in two parts will focus on adverse drug reactions resulting in cognitive impairment as a potentially modifiable risk factor in CKD patients. Many patients with CKD have a substantial burden of comorbidities leading to polypharmacy. A recent study found that patients seen by nephrologists were the most complex to treat because of their high number of comorbidities and medications. Due to polypharmacy, these patients may experience a wide range of adverse drug reactions. Along with CKD progression, the accumulation of uremic toxins may lead to blood-brain barrier (BBB) disruption and pharmacokinetic alterations, increasing the risk of adverse reactions affecting the central nervous system (CNS). In patients on dialysis, the excretion of drugs that depend on kidney function is severely reduced such that adverse and toxic levels of a drug or its metabolites may be reached at relatively low doses, unless dosing is adjusted. This first review will discuss how CKD represents a risk factor for adverse drug reactions affecting the CNS via (i) BBB disruption associated with CKD and (ii) the impact of reduced kidney function and dialysis itself on drug pharmacokinetics.
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Affiliation(s)
- Sophie Liabeuf
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens University Medical Center, Amiens, France
- MP3CV Laboratory, EA7517, Jules Verne University of Picardie, Amiens, France
| | - Vesna Pešić
- Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Goce Spasovski
- Department of Nephrology, Clinical Centre “Mother Theresa”, Saints Cyril and Methodius University, Skopje, North Macedonia
| | - Romaldas Maciulaitis
- Department of Nephrology, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Institute of Physiology and Pharmacology, Faculty of Medicines, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mickaël Bobot
- Aix-Marseille University, Department of Nephrology, AP-HM, La Conception Hospital, Marseille, France; C2VN Laboratory, Inserm 1263, INRAE 1260, Aix-Marseille University, Marseille, France
| | - Ana Farinha
- Department of Nephrology, Hospital de Vila Franca de Xira, Lisbon, Portugal
| | - Carsten A Wagner
- Institute of Physiology, University of Zürich, Zurich, Switzerland
| | - Robert J Unwin
- Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
| | - Giovambattista Capasso
- Department of Translantional Medical Sciences, University of Campania Luigi Vanvitelli , Naples, Italy
- Biogem Research Institute , Ariano Irpino, Italy
| | - Inga Arune Bumblyte
- Department of Nephrology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gaye Hafez
- Department of Pharmacology, Faculty of Pharmacy, Altinbas University, Istanbul, Turkey
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Zhou C, Zhang Y, Yang S, Ye Z, Wu Q, Liu M, He P, Zhang Y, Qin X. Habitual glucosamine use, APOE genotypes, and risk of incident cause-specific dementia in the older population. Alzheimers Res Ther 2023; 15:152. [PMID: 37689747 PMCID: PMC10492372 DOI: 10.1186/s13195-023-01295-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 08/24/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND The relationship of glucosamine use with incident dementia in the older population remains uncertain. We aimed to evaluate the longitudinal association between habitual glucosamine supplement and the risk of cause-specific dementia and examine the possible effect modifiers on this association. METHODS The study included 214,945 participants over the age of 60 who had available information on glucosamine use and did not have dementia at baseline in the UK Biobank. The APOE genotypes were determined by a combination variant of rs429358 and rs7412. The primary outcome was incident vascular dementia, incident Alzheimer's disease, and incident frontotemporal dementia, respectively. RESULTS Over a median follow-up duration of 12 years, 1039, 1774, and 122 participants developed vascular dementia, Alzheimer's disease, and frontotemporal dementia, respectively. Overall, habitual glucosamine use was significantly associated with a lower risk of incident vascular dementia (adjusted HR, 0.82; 95%CI, 0.70-0.96), but not significantly associated with incident Alzheimer's disease (adjusted HR, 1.02; 95%CI, 0.92-1.14) and incident frontotemporal dementia (adjusted HR, 0.95; 95%CI, 0.63-1.43). Moreover, the inverse association between habitual glucosamine use and incident vascular dementia was more pronounced in participants with concomitant supplement of calcium (P-interaction = 0.011), and those without concomitant supplement of zinc (P-interaction = 0.018). However, APOE ε4 dosage and baseline cognitive function did not significantly modify the relationships of glucosamine use with incident vascular dementia or Alzheimer's disease (All P-interactions > 0.05). CONCLUSIONS Regardless of APOE genotypes and baseline cognitive function, habitual glucosamine use was significantly inversely associated with incident vascular dementia in the older population.
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Affiliation(s)
- Chun Zhou
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yanjun Zhang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Sisi Yang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Ziliang Ye
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Qimeng Wu
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Mengyi Liu
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Panpan He
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yuanyuan Zhang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xianhui Qin
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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11
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Sinclair LI, Ball HA, Bolea-Alamanac BM. Does depression in mid-life predispose to greater cognitive decline in later life in the Whitehall II cohort? J Affect Disord 2023; 335:111-119. [PMID: 37172658 DOI: 10.1016/j.jad.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Later-life depression appears to have different symptomatology and possibly underlying pathology to younger adults. Depression is linked to dementia but whether it is a risk factor or an early sign of dementia remains unclear. Neuroinflammation is increasingly recognised in both conditions. AIMS To investigate the link between depression, inflammation and dementia. We hypothesised that recurrent depression increases the rate of cognitive decline in older adults and that this effect is modified by anti-inflammatory medication. METHODS We used data from Whitehall II including cognitive test results and reliable measures to assess depression. Depression was defined as a self-reported diagnosis or a score of ≥20 on the CESD. The presence/absence of inflammatory illness was assessed using a standardised list of inflammatory conditions. Individuals with dementia, chronic neurological and psychotic conditions were excluded. Logistic and linear regression was used to examine the effect of depression on cognitive test performance and the effect of chronic inflammation. LIMITATIONS Lack of clinical diagnoses of depression. RESULTS There were 1063 individuals with and 2572 without depression. Depression did not affect deterioration in episodic memory, verbal fluency or the AH4 test at 15-year follow up. We found no evidence of an effect of anti-inflammatory medication. Depressed individuals had worse cross-sectional performance on the Mill Hill test and tests of abstract reasoning and verbal fluency at both baseline and 15-year follow-up. CONCLUSIONS Using a UK based study with a long follow-up interval we have shown that depression in individuals aged >50 is not associated with increased cognitive decline.
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Affiliation(s)
- Lindsey Isla Sinclair
- Department of Clinical Neuroscience, Bristol Medical School, University of Bristol, Learning & Research Building, Southmead Hospital, BS10 5NB, United Kingdom of Great Britain and Northern Ireland.
| | - Harriet Ann Ball
- Department of Clinical Neuroscience, Bristol Medical School, University of Bristol, Learning & Research Building, Southmead Hospital, BS10 5NB, United Kingdom of Great Britain and Northern Ireland
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12
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Zheng J, Ni C, Zhang Y, Huang J, Hukportie DN, Liang B, Tang S. Association of regular glucosamine use with incident dementia: evidence from a longitudinal cohort and Mendelian randomization study. BMC Med 2023; 21:114. [PMID: 36978077 PMCID: PMC10052856 DOI: 10.1186/s12916-023-02816-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Emerging data suggests the neuroprotective and anti-neuroinflammatory effects of glucosamine. We aimed to examine the association between regular glucosamine use and risk of incident dementia, including dementia subtypes. METHODS We conducted large-scale observational and two-sample Mendelian randomization (MR) analyses. Participants in UK Biobank having accessible data for dementia incidence and who did not have dementia at baseline were included in the prospective cohort. Through the Cox proportional hazard model, we examined the risks of incident all-cause dementia, Alzheimer's disease (AD), and vascular dementia among glucosamine users and non-users. To further test the causal association between glucosamine use and dementia, we conducted a 2-sample MR utilizing summary statistics from genome-wide association studies (GWAS). The GWAS data were obtained from observational cohort participants of mostly European ancestry. RESULTS During a median follow-up of 8.9 years, there were 2458 cases of all-cause dementia, 924 cases of AD, and 491 cases of vascular dementia. In multivariable analysis, the hazard ratios (HR) of glucosamine users for all-cause dementia, AD, and vascular dementia were 0.84 (95% CI 0.75-0.93), 0.83 (95% CI 0.71-0.98), and 0.74 (95% CI 0.58-0.95), respectively. The inverse associations between glucosamine use and AD appeared to be stronger among participants aged below 60 years than those aged above 60 years (p = 0.04 for interaction). The APOE genotype did not modify this association (p > 0.05 for interaction). Single-variable MR suggested a causal relationship between glucosamine use and lower dementia risk. Multivariable MR showed that taking glucosamine continued to protect against dementia after controlling for vitamin, chondroitin supplement use and osteoarthritis (all-cause dementia HR 0.88, 95% CI 0.81-0.95; AD HR 0.78, 95% CI 0.72-0.85; vascular dementia HR 0.73, 95% CI 0.57-0.94). Single and multivariable inverse variance weighted (MV-IVW) and MR-Egger sensitivity analyses produced similar results for these estimations. CONCLUSIONS The findings of this large-scale cohort and MR analysis provide evidence for potential causal associations between the glucosamine use and lower risk for dementia. These findings require further validation through randomized controlled trials.
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Affiliation(s)
- Jiazhen Zheng
- Bioscience and Biomedical Engineering Thrust, Systems Hub, The Hong Kong University of Science and Technology (Guangzhou), Guangzhou, Guangdong, China
| | - Can Ni
- Bioscience and Biomedical Engineering Thrust, Systems Hub, The Hong Kong University of Science and Technology (Guangzhou), Guangzhou, Guangdong, China
| | - Yingchai Zhang
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong, SAR, China
| | - Jinghan Huang
- Biomedical Genetics Section, School of Medicine, Boston University, Boston, USA
- Department of Chemical Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Daniel Nyarko Hukportie
- Department of Epidemiology, School of Public Health, (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Buwen Liang
- Bioscience and Biomedical Engineering Thrust, Systems Hub, The Hong Kong University of Science and Technology (Guangzhou), Guangzhou, Guangdong, China
| | - Shaojun Tang
- Bioscience and Biomedical Engineering Thrust, Systems Hub, The Hong Kong University of Science and Technology (Guangzhou), Guangzhou, Guangdong, China.
- Division of Emerging Interdisciplinary Areas, The Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong, SAR, China.
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13
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Eum S, Hill SK, Bishop JR. Considering medication exposure in genomic association studies of cognition in psychotic disorders. Pharmacogenomics 2022; 23:791-806. [PMID: 36102182 DOI: 10.2217/pgs-2022-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cognitive dysfunction is a core feature of psychosis-spectrum illnesses, and the characterization of related genetic mechanisms may provide insights regarding the disease pathophysiology. Substantial efforts have been made to determine the genetic component of cognitive symptoms, without clear success. Illness-related moderators and environmental factors such as medications hinder the detection of genomic association with cognition. Polypharmacy is common in psychotic disorders, and the cumulative effects of medication regimens can confound gene-cognition associations. A review of the relative contributions of important pharmacological and genetic relationships identifies that the effects of medications on cognition in psychotic disorders may be at least, if not more, impactful than individual genes, thus underscoring the importance of accounting for medication exposure in gene-cognition association studies.
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Affiliation(s)
- Seenae Eum
- Department of Pharmacogenomics, School of Pharmacy, Shenandoah University, Fairfax, VA 22031, USA
| | - Scot Kristian Hill
- Department of Psychology, Rosalind Franklin University of Medicine & Science, North Chicago, IL 60064, USA
| | - Jeffrey R Bishop
- Department of Experimental & Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA.,Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN 55455, USA
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14
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Pronk AC, Seppala LJ, Trajanoska K, Stringa N, van de Loo B, de Groot LCPGM, van Schoor NM, Koskeridis F, Markozannes G, Ntzani E, Uitterlinden AG, Rivadeneira F, Stricker BH, van der Velde N. Candidate genetic variants and antidepressant-related fall risk in middle-aged and older adults. PLoS One 2022; 17:e0266590. [PMID: 35421149 PMCID: PMC9009709 DOI: 10.1371/journal.pone.0266590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/23/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Antidepressant use has been associated with increased fall risk. Antidepressant-related adverse drug reactions (e.g. orthostatic hypotension) depend partly on genetic variation. We hypothesized that candidate genetic polymorphisms are associated with fall risk in older antidepressant users. METHODS The association between antidepressant use and falls was cross-sectionally investigated in a cohort of Dutch older adults by logistic regression analyses. In case of significant interaction product term of antidepressant use and candidate polymorphism, the association between the variant genotype and fall risk was assessed within antidepressant users and the association between antidepressant use and fall risk was investigated stratified per genotype. Secondly, a look-up of the candidate genes was performed in an existing genome-wide association study on drug-related falls in antidepressant users within the UK Biobank. In antidepressant users, genetic associations for our candidate polymorphisms for fall history were investigated. RESULTS In antidepressant users(n = 566), for rs28371725 (CYP2D6*41) fall risk was decreased in TC/variant allele carriers compared to CC/non-variant allele carriers (OR = 0.45, 95% CI 0.26-0.80). Concerning rs1057910 (CYP2C9*3), fall risk was increased in CA/variant allele carriers compared to AA/non-variant allele carriers (OR = 1.95, 95% CI 1.17-3.27). Regarding, rs1045642 (ABCB1), fall risk was increased in AG/variant allele carriers compared to GG/non-variant allele carriers (OR = 1.69, 95% CI 1.07-2.69). Concerning the ABCB1-haplotype (rs1045642/rs1128503), fall risk was increased in AA-AA/variant allele carriers compared to GG-GG/non-variant allele carriers (OR = 1.86, 95% CI 1.05-3.29). In the UK Biobank, in antidepressant users(n = 34,000) T/variant-allele of rs28371725 (CYP2D*41) was associated with increased fall risk (OR = 1.06, 95% CI 1.01-1.12). G/non-variant-allele of rs4244285 (CY2C19*2) was associated with decreased risk (OR = 0.96, 95% CI 0.92-1.00). CONCLUSION This is the first study showing that certain genetic variants modify antidepressant-related fall risk. The results were not always consistent across the studies and should be validated in a study with a prospective design. However, pharmacogenetics might have value in antidepressant (de)prescribing in falls prevention.
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Affiliation(s)
- A. C. Pronk
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - L. J. Seppala
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - K. Trajanoska
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - N. Stringa
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - B. van de Loo
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - L. C. P. G. M. de Groot
- Department of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - N. M. van Schoor
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - F. Koskeridis
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - G. Markozannes
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - E. Ntzani
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
- Department of Health Services, Policy and Practice, Center for Research Synthesis in Health, School of Public Health, Brown University, Providence, RI, United States of America
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, United States of America
| | - A. G. Uitterlinden
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - F. Rivadeneira
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - B. H. Stricker
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - N. van der Velde
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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15
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Li Z, Kormilitzin A, Fernandes M, Vaci N, Liu Q, Newby D, Goodday S, Smith T, Nevado-Holgado AJ, Winchester L. Validation of UK Biobank data for mental health outcomes: A pilot study using secondary care electronic health records. Int J Med Inform 2022; 160:104704. [PMID: 35168089 PMCID: PMC8889024 DOI: 10.1016/j.ijmedinf.2022.104704] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 12/20/2021] [Accepted: 01/20/2022] [Indexed: 01/25/2023]
Abstract
UK Biobank (UKB) is widely employed to investigate mental health disorders and related exposures; however, its applicability and relevance in a clinical setting and the assumptions required have not been sufficiently and systematically investigated. Here, we present the first validation study using secondary care mental health data with linkage to UKB from Oxford - Clinical Record Interactive Search (CRIS) focusing on comparison of demographic information, diagnostic outcome, medication record and cognitive test results, with missing data and the implied bias from both resources depicted. We applied a natural language processing model to extract information embedded in unstructured text from clinical notes and attachments. Using a contingency table we compared the demographic information recorded in UKB and CRIS. We calculated the positive predictive value (PPV, proportion of true positives cases detected) for mental health diagnosis and relevant medication. Amongst the cohort of 854 subjects, PPVs for any mental health diagnosis for dementia, depression, bipolar disorder and schizophrenia were 41.6%, and were 59.5%, 12.5%, 50.0% and 52.6%, respectively. Self-reported medication records in UKB had general PPV of 47.0%, with the prevalence of frequently prescribed medicines to each typical mental health disorder considerably different from the information provided by CRIS. UKB is highly multimodal, but with limited follow-up records, whereas CRIS offers a longitudinal high-resolution clinical picture with more than ten years of observations. The linkage of both datasets will reduce the self-report bias and synergistically augment diverse modalities into a unified resource to facilitate more robust research in mental health.
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Affiliation(s)
- Zhenpeng Li
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
| | | | - Marco Fernandes
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
| | - Nemanja Vaci
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
| | - Qiang Liu
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
| | - Danielle Newby
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
| | - Sarah Goodday
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK; 4youandme, Seattle, WA 98121-1031, USA
| | - Tanya Smith
- NIHR Biomedical Research Centre, Oxford Health NHS Foundation Trust, Warneford Hospital, Warneford Lane, Oxford OX3 7JX, UK
| | | | - Laura Winchester
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK.
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16
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Wu C, Xiong LY, Ouk M, Rabin JS, Herrmann N, Lanctôt KL, Kapral MK, Law M, Cogo‐Moreira H, Edwards JD, Swardfager W. Gastric acid suppressants and cognitive decline in people with or without cognitive impairment. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12243. [PMID: 35169610 PMCID: PMC8829893 DOI: 10.1002/trc2.12243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Studies suggest associations between proton pump inhibitors (PPIs) and dementia risk; however, many neither considered histamine-2 receptor antagonists (H2RAs) nor baseline cognitive status. METHODS Participants (National Alzheimer's Coordinating Center Database; 2005-2021) using a PPI or H2RA were compared. Covariate-adjusted Cox regression was used to estimate hazard ratios (HR) for progression from normal cognition to mild cognitive impairment (MCI), and from MCI to dementia over 5 years. In a propensity-score-matched subsample of mild-moderate Alzheimer's disease (AD), mixed-effects negative binomial regression was used to estimate decline in delayed recall memory. RESULTS Compared to PPI, H2RA use was associated with earlier progression from MCI to dementia (HR = 1.40 [1.09-1.81]; n = 1701), and with faster memory decline in AD over time (rate ratio = 0.76 [0.64-0.92]; n = 628), but not with progression from normal cognition to MCI (HR = 0.94 [0.71-1.24]; n = 2784). DISCUSSION Compared to PPIs, H2RAs were associated with cognitive decline, specifically among people with pre-existing cognitive impairment.
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Affiliation(s)
- Che‐Yuan Wu
- Department of Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
- Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Lisa Y. Xiong
- Department of Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
- Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Michael Ouk
- Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Jennifer S. Rabin
- Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Harquail Centre for NeuromodulationSunnybrook Research InstituteTorontoOntarioCanada
- Division of NeurologyDepartment of MedicineSunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
- Rehabilitation Sciences InstituteUniversity of TorontoTorontoOntarioCanada
| | - Nathan Herrmann
- Department of PsychiatrySunnybrook Health Sciences CentreTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Krista L. Lanctôt
- Department of Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
- Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
- KITE University Health Network Toronto Rehabilitation InstituteTorontoOntarioCanada
| | - Moira K. Kapral
- ICESTorontoOntarioCanada
- Institute for Health Policy, Management, and EvaluationUniversity of TorontoTorontoOntarioCanada
- Division of General Internal MedicineDepartment of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Marcus Law
- University Health Network Toronto Rehabilitation InstituteTorontoOntarioCanada
- Department of Family and Community MedicineUniversity of TorontoTorontoOntarioCanada
| | - Hugo Cogo‐Moreira
- Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Faculty of Education, ICT, and LearningØstfold University CollegeHaldenNorway
| | - Jodi D. Edwards
- University of Ottawa Heart InstituteUniversity of OttawaOttawaOntarioCanada
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
- ICESOttawaOntarioCanada
| | - Walter Swardfager
- Department of Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
- Sandra Black Centre for Brain Resilience and RecoveryHurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- KITE University Health Network Toronto Rehabilitation InstituteTorontoOntarioCanada
- Canadian Partnership for Stroke RecoverySunnybrook Research InstituteTorontoOntarioCanada
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17
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Gaastra B, Alexander S, Bakker MK, Bhagat H, Bijlenga P, Blackburn S, Collins MK, Doré S, Griessenauer C, Hendrix P, Hong EP, Hostettler IC, Houlden H, IIhara K, Jeon JP, Kim BJ, Kumar M, Morel S, Nyquist P, Ren D, Ruigrok YM, Werring D, Galea I, Bulters D, Tapper W. Genome-Wide Association Study of Clinical Outcome After Aneurysmal Subarachnoid Haemorrhage: Protocol. Transl Stroke Res 2022; 13:565-576. [PMID: 34988871 PMCID: PMC9232474 DOI: 10.1007/s12975-021-00978-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/26/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
Aneurysmal subarachnoid haemorrhage (aSAH) results in persistent clinical deficits which prevent survivors from returning to normal daily functioning. Only a small fraction of the variation in clinical outcome following aSAH is explained by known clinical, demographic and imaging variables; meaning additional unknown factors must play a key role in clinical outcome. There is a growing body of evidence that genetic variation is important in determining outcome following aSAH. Understanding genetic determinants of outcome will help to improve prognostic modelling, stratify patients in clinical trials and target novel strategies to treat this devastating disease. This protocol details a two-stage genome-wide association study to identify susceptibility loci for clinical outcome after aSAH using individual patient-level data from multiple international cohorts. Clinical outcome will be assessed using the modified Rankin Scale or Glasgow Outcome Scale at 1–24 months. The stage 1 discovery will involve meta-analysis of individual-level genotypes from different cohorts, controlling for key covariates. Based on statistical significance, supplemented by biological relevance, top single nucleotide polymorphisms will be selected for replication at stage 2. The study has national and local ethical approval. The results of this study will be rapidly communicated to clinicians, researchers and patients through open-access publication(s), presentation(s) at international conferences and via our patient and public network.
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Affiliation(s)
- Ben Gaastra
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK.,Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton, SO16 6YD, UK
| | - Sheila Alexander
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA, 15261, USA
| | - Mark K Bakker
- Department of Neurology, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Heidelberlaan 100, 3584, CX, Utrecht, the Netherlands
| | - Hemant Bhagat
- Division of Neuroanaesthesia, Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Philippe Bijlenga
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Spiros Blackburn
- University of Texas Houston Health Science Center, Houston, TX, USA
| | - Malie K Collins
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Sylvain Doré
- Departments of Anesthesiology, Neurology, Psychiatry, Pharmaceutics, and Neuroscience, College of Medicine, Center for Translational Research in Neurodegenerative Disease, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Christoph Griessenauer
- Department of Neurosurgery, Geisinger, Danville, PA, USA.,Department of Neurosurgery, Christian-Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Philipp Hendrix
- Department of Neurosurgery, Geisinger, Danville, PA, USA.,Department of Neurosurgery, Saarland University Medical Center, Homburg, Germany
| | - Eun Pyo Hong
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, South Korea
| | - Isabel C Hostettler
- Stroke Research Centre, University College London, Institute of Neurology, London, UK
| | - Henry Houlden
- Stroke Research Centre, University College London, Institute of Neurology, London, UK
| | - Koji IIhara
- National Cerebral and Cardiovascular Center Hospital, 6-1 Kishibe-Shimmachi, Suita, Osaka, Japan
| | - Jin Pyeong Jeon
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, South Korea.,Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, South Korea
| | - Bong Jun Kim
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, South Korea
| | - Munish Kumar
- Division of Neuroanaesthesia, Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandrine Morel
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.,Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Paul Nyquist
- Departments of Neurology, Anesthesia/Critical Care Medicine, Neurosurgery and General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
| | - Dianxu Ren
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA, 15261, USA
| | - Ynte M Ruigrok
- Department of Neurology, University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Heidelberlaan 100, 3584, CX, Utrecht, the Netherlands
| | - David Werring
- Stroke Research Centre, University College London, Institute of Neurology, London, UK
| | - Ian Galea
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK.
| | - Diederik Bulters
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton, SO16 6YD, UK
| | - Will Tapper
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
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Auditory outcome following aneurysmal subarachnoid haemorrhage. J Neurol Sci 2021; 434:120125. [PMID: 34995980 DOI: 10.1016/j.jns.2021.120125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 01/02/2023]
Abstract
Auditory deficits are increasingly recognised following aneurysmal subarachnoid haemorrhage (aSAH) and are thought to be of central rather than peripheral origin. Central hearing impairment, also known as auditory processing disorder (APD), often coexists with cognitive deficits and it is thought that APD has both auditory and cognitive elements. The aim of this study was to assess auditory outcome following aSAH and its relationship with cognition. A retrospective case-controlled study design was employed with aSAH cases and matched controls identified from the UK Biobank. Auditory and cognitive outcomes were assessed using the digit triplet test (DTT) and a test of psychomotor reaction time, respectively. Best DTT score was compared between cases and controls using the t-test. A regression-based mediation analysis was performed to assess whether cognition mediated auditory outcome. 270 aSAH patients with auditory outcomes were identified with an average follow-up of 106 months. A matched control cohort of 1080 individuals was also identified. The aSAH cohort had significantly impaired best DTT scores compared to matched controls (p = 0.002). Cognition significantly mediated auditory outcome following aSAH, accounting for 9.8% of the hearing impairment after aSAH. In conclusion significant hearing impairment follows aSAH. The deficit is bilateral and non-progressive. There is a link with cognitive deficit, pointing to a central rather than peripheral source, in keeping with an auditory processing disorder. All aSAH patients should be asked about hearing difficulty at follow-up and when present it should be investigated with peripheral and central auditory assessments, as well as cognitive tests.
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Long-Term Cognitive Outcome following Aneurysmal Subarachnoid Haemorrhage. J Stroke Cerebrovasc Dis 2021; 31:106184. [PMID: 34773754 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/05/2021] [Accepted: 10/17/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Survivors of aneurysmal subarachnoid haemorrhage (aSAH) frequently suffer from cognitive dysfunction. The aim of this study was to assess, in a large sample size with long term follow-up, the characteristics of cognitive dysfunction following aSAH and explore whether cognitive deficits mediate employment outcome. MATERIALS AND METHODS In this retrospective case-controlled study, aSAH survivors (n = 884) were identified from the UK Biobank and compared to matched controls (n = 3536). Controls were propensity score matched according to age, sex, Townsend deprivation score, educational status and relevant medications known to influence cognition. Cognitive outcomes and employment status were compared between cases and controls using group comparison and cross-tabulation tests. A regression-based mediation analysis was performed to assess whether cognitive deficits mediate employment status following aSAH. RESULTS Psychomotor reaction time and employment status significantly differed between aSAH cases and controls with slower reaction times (p < 0.001) and more unemployment or inability to work due to illness (p < 0.001) in the aSAH cohort at a mean follow-up of 125 months. Psychomotor slowing was estimated to mediate a significant proportion (6.59%) of the effect of aSAH on employment status. CONCLUSIONS Psychomotor reaction time and employment status differed significantly between aSAH cases and control matched individuals in the UK Biobank. Psychomotor slowing following aSAH had a discernible impact on employment status. Psychomotor reaction time and employment status are practical to acquire and can be used as surrogate measures of outcome in future studies of aSAH survivors.
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Sommerlad A, Werbeloff N, Perera G, Smith T, Costello H, Mueller C, Kormilitzin A, Broadbent M, Nevado-Holgado A, Lovestone S, Stewart R, Livingston G. Effect of trazodone on cognitive decline in people with dementia: Cohort study using UK routinely collected data. Int J Geriatr Psychiatry 2021; 37. [PMID: 34564898 DOI: 10.1002/gps.5625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/20/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Evidence in mouse models has found that the antidepressant trazodone may be protective against neurodegeneration. We therefore aimed to compare cognitive decline of people with dementia taking trazodone with those taking other antidepressants. METHODS Three identical naturalistic cohort studies using UK clinical registers. We included all people with dementia assessed during 2008-16 who were recorded taking trazodone, citalopram or mirtazapine for at least 6 weeks. Linear mixed models examined age, time and sex-adjusted Mini-mental state examination (MMSE) change in people with all-cause dementia taking trazodone compared with those taking citalopram and mirtazapine. In secondary analyses, we examined those with non-vascular dementia; mild dementia; and adjusted results for neuropsychiatric symptoms. We combined results from the three study sites using random-effects meta-analysis. RESULTS We included 2,199 people with dementia, including 406 taking trazodone, with mean 2.2 years follow-up. There was no difference in adjusted cognitive decline in people with all-cause or non-vascular dementia taking trazodone, citalopram or mirtazapine in any of the three study sites. When data from the three sites were combined in meta-analysis, we found greater mean MMSE decline in people with all-cause dementia taking trazodone compared to those taking citalopram (0·26 points per successive MMSE measurement, 95% CI 0·03-0·49; p = 0·03). Results in sensitivity analyses were consistent with primary analyses. CONCLUSIONS There was no evidence of cognitive benefit from trazodone compared to other antidepressants in people with dementia in three naturalistic cohort studies. Despite preclinical evidence, trazodone should not be advocated for cognition in dementia.
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Affiliation(s)
- Andrew Sommerlad
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Nomi Werbeloff
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Gayan Perera
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Tanya Smith
- NIHR Biomedical Research Centre, Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Harry Costello
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Christoph Mueller
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | | | - Alejo Nevado-Holgado
- Mathematical Institute, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Simon Lovestone
- Department of Psychiatry, University of Oxford, Oxford, UK
- Johnson and Johnson Medical Ltd., Janssen-Cilag, High Wycombe, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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21
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Lack of association between proton pump inhibitor use and decline in cognitive performance in the ELSA-Brasil cohort. Eur J Clin Pharmacol 2021; 77:1725-1735. [PMID: 34014336 DOI: 10.1007/s00228-021-03156-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The study aims to investigate the longitudinal association of use and time of use of proton pump inhibitors (PPIs) with decreased performance in three cognitive tests. METHODS Prospective cohort study included 7115 participants with mean age of 58.9 years at baseline (2008-2010) who participated in the second wave (2012-2014) of ELSA-Brasil (average interval between visits = 3.9 years (range: 1.7 to 6.0 years)). Cognitive performance was assessed by tests of memory, phonemic and semantic verbal fluency, and the trail making test, applied to both waves. Associations with the use and time of use of PPIs at baseline were investigated using linear models with mixed effects after adjusting for confounding factors. RESULTS At baseline, 7.4% (529) of the participants used PPIs on a regular basis. After all adjustments, the interaction term use of PPI × age was not statistically significant for the cognitive tests evaluated, indicating that the use of PPI at baseline was not associated with a more accelerated decline in cognitive performance between waves. The interaction term PPI use × age was not statistically significant, in any of the categories of medication use time, any of the cognitive function tests evaluated, indicating that PPI use time is not associated with decrease in cognitive scores as the time interval between visits increases. CONCLUSION In this cohort middle-aged and elderly adults, after average interval of 3.9 years (relatively short time to detect cognitive decline in a young cohort), the use and time of use of PPIs at the beginning of the study were not associated with a decline in cognitive performance in these tests between visits.
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22
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Feng KM, Chien WC, Chen JT, Chen YH, Chung CH, Sun CA, Chen CL. The impact of glucosamine on age-related macular degeneration in patients: A nationwide, population-based cohort study. PLoS One 2021; 16:e0251925. [PMID: 34010361 PMCID: PMC8133402 DOI: 10.1371/journal.pone.0251925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/05/2021] [Indexed: 01/25/2023] Open
Abstract
Purpose To analyze the association between glucosamine (GlcN) use and the risk of age-related macular degeneration (AMD) using claims data from the National Health Insurance Research Database (NHIRD). Methods A retrospective, population-based study was conducted with NHIRD data from a 14-year period (2000–2013). Chi-squared and Student’s t-tests were used to evaluate differences between the study and comparison cohorts for categorical and continuous variables, respectively. Risk factors for disease development were examined by the adjusted hazard ratio (aHR) with 95% confidence interval. Kaplan-Meier analysis was performed to compare the cumulative risk of AMD between the two cohorts. Results In total, 1,344 patients with GlcN treatment were enrolled in the study cohort and 5,376 patients without GlcN use were enrolled in the comparison cohort. The incidence rate of AMD was lower with GlcN use (3.65%) than without GlcN use (5.26%) (P = 0.014). GlcN use was associated with a lower risk of developing AMD among patients with hyperlipidemia, coronary artery disease, chronic obstructive pulmonary disease, stroke, other neurological disorders, or degenerative arthritis. Although the incidence of wet type AMD did not significantly differ (P = 0.91), the incidence of dry type AMD was lower in patients with GlcN use (2.9%) than those without GlcN use (4.84%) (P = 0.003). Kaplan-Meier analysis similarly revealed a lower rate of dry type AMD in patients with GlcN use compared to those without GlcN use (log-rank P = 0.004). Conclusions GlcN treatment can decrease the risk of developing dry type AMD. Further prospective controlled studies are needed to determine the effectiveness of GlcN treatment in patients with AMD and the associated mechanism.
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Affiliation(s)
- Kathy Ming Feng
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Jiann-Torng Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Ching-Long Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- * E-mail:
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Ali SB, Mahmood K, Saeed R, Salman T, Choudhary MI, Haleem DJ. Elevated anxiety, hypoactivity, memory deficits, decreases of brain serotonin and 5-HT-1A receptors expression in rats treated with omeprazole. Toxicol Res 2021; 37:237-248. [PMID: 33868980 DOI: 10.1007/s43188-020-00060-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/11/2020] [Accepted: 07/27/2020] [Indexed: 12/23/2022] Open
Abstract
Omeprazole (OM) is one of the most prescribed drugs worldwide for the treatment of hyperacidity and gastric reflux. However, concerns regarding its safety have emerged recently, and the drug is reported to enhance the risk for anxiety and cognitive deficits, particularly in elderly patients. The present study investigated these adverse effects, if any, in adult male rats. Associated changes in brain serotonin (5-hydroxytryptamine; 5-HT) and dopamine metabolism and the expression of 5-HT-1A receptors in the raphe and hippocampus were also determined. The drug was injected i.p. in doses of 10 and 20 mg/kg for 15 days. Both doses of OM decreased motor activity in an open field and impaired learning and memory in the Morris water maze test. Anxiety monitored in an elevated plus maze test was enhanced in rats treated with 20 mg/kg OM only. The levels of 5-HT and its metabolite 5-hydroxyindoleacetic acid and of homovanillic acid, a metabolite of dopamine, determined by HPLC-EC, were decreased in the brain of OM treated rats. The expression of 5-HT-1A receptor, determined by qRT-PCR, was reduced markedly in the hippocampus and moderately in the raphe. Our results provide evidence that OM use can reduce raphe hippocampal serotonin neurotransmission to lead to anxiety/depression and cognitive impairment. There is a need for increased awareness and prescription guidelines for therapeutic use of OM and possibly also other proton pump inhibitors.
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Affiliation(s)
- Sadia Basharat Ali
- Present Address: Neuroscience Research Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270 Pakistan
| | - Khalid Mahmood
- Present Address: Neuroscience Research Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270 Pakistan
| | - Raheel Saeed
- Present Address: Neuroscience Research Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270 Pakistan
| | - Tabinda Salman
- Present Address: Neuroscience Research Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270 Pakistan
| | - Muhammad Iqbal Choudhary
- Present Address: Neuroscience Research Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270 Pakistan
| | - Darakhshan Jabeen Haleem
- Present Address: Neuroscience Research Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270 Pakistan
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Abramovitch A, Short T, Schweiger A. The C Factor: Cognitive dysfunction as a transdiagnostic dimension in psychopathology. Clin Psychol Rev 2021; 86:102007. [PMID: 33864968 DOI: 10.1016/j.cpr.2021.102007] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 12/19/2022]
Abstract
Research into cognitive functions across psychological disorders suggests that cognitive deficiencies may be present across multiple disorders, potentially pointing to a transdiagnostic phenomenon. More recently, a single dimension model of psychopathology, the p factor, has been proposed, in which cognitive deficits are thought to be an intrinsic construct, assumed to be transdiagnostic. However, no systematic investigation to date tested this hypothesis. The aim of the present study was to systematically review meta-analyses to assess the hypothesis that the C factor (cognitive dysfunction) is transdiagnostic in psychopathology and review potential moderators that may account for such a phenomenon. We conducted a systematic review of meta-analyses examining cognitive function across all disorders for which data were available. Included meta-analyses (n = 82), comprising 97 clinical samples, yielded 1,055 effect sizes. Twelve major disorders/categories (e.g., bipolar disorder, substance use disorders) were included, comprising 29 distinct clinical entities (e.g., euthymic bipolar disorder; alcohol use disorder). Results show that all disorders reviewed are associated with underperformance across cognitive domains, supporting the hypothesis that the C factor (or cognitive dysfunction) is a transdiagnostic factor related to p. To examine moderators that may explain or contribute to c, we first consider important interpretative limitations of neuropsychological data in psychopathology. More crucially, we review oft-neglected motivational and emotional transdiagnostic constructs of p, as prominent contributing constructs to the C factor. These constructs are offered as a roadmap for future research examining these constructs related to p, that contribute, and may account for cognitive dysfunctions in psychopathology.
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Affiliation(s)
| | - Tatiana Short
- Department of Psychology, Texas State University, USA
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25
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Korda AI, Andreou C, Borgwardt S. Pattern classification as decision support tool in antipsychotic treatment algorithms. Exp Neurol 2021; 339:113635. [PMID: 33548218 DOI: 10.1016/j.expneurol.2021.113635] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/20/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
Pattern classification aims to establish a new approach in personalized treatment. The scope is to tailor treatment on individual characteristics during all phases of care including prevention, diagnosis, treatment, and clinical outcome. In psychotic disorders, this need results from the fact that a third of patients with psychotic symptoms do not respond to antipsychotic treatment and are described as having treatment-resistant disorders. This, in addition to the high variability of treatment responses among patients, enhances the need of applying advanced classification algorithms to identify antipsychotic treatment patterns. This review comprehensively summarizes advancements and challenges of pattern classification in antipsychotic treatment response to date and aims to introduce clinicians and researchers to the challenges of including pattern classification into antipsychotic treatment decision algorithms.
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Affiliation(s)
- Alexandra I Korda
- Department of Psychiatry and Psychotherapy, University Hospital Lübeck (UKSH), Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Christina Andreou
- Department of Psychiatry and Psychotherapy, University Hospital Lübeck (UKSH), Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University Hospital Lübeck (UKSH), Ratzeburger Allee 160, 23538 Lübeck, Germany.
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Tapela N, Collister J, Clifton L, Turnbull I, Rahimi K, Hunter DJ. Prevalence and determinants of hypertension control among almost 100 000 treated adults in the UK. Open Heart 2021; 8:e001461. [PMID: 33707223 PMCID: PMC7957140 DOI: 10.1136/openhrt-2020-001461] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/08/2020] [Accepted: 12/21/2020] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To identify factors associated with hypertension control among treated middle-aged UK adults. METHODS A cross-sectional population-based study including 99 468 previously diagnosed, treated hypertensives enrolled in the UK Biobank. Hypertension control was defined as systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg. RESULTS Median age was 62.3 years (IQR 57.3 to 66.0), 45.9% female, 92.0% white, 40.1% obese, 9.3% current smokers and 19.4% had prior cardiovascular disease. 38.1% (95% CI 37.8% to 38.4%) were controlled. In multivariable logistic regression, associations with lack of hypertension control included: older age (OR 0.61, 95% CI 0.58 to 0.64 for 60-69 years compared with age 40-50 years), higher alcohol use (OR 0.61, 95% CI 0.58 to 0.64, for consuming >30 units per week compared with none), black ethnicity (OR 0.73, 95% CI 0.65 to 0.82 compared with white), obesity (OR 0.73, 95% CI 0.71 to 0.76 compared with normal body mass index). The strongest positive association with control was having ≥3 comorbidities (OR 2.09, 95% CI 1.95 to 2.23). Comorbidities associated with control included cardiovascular disease (OR 2.11, 95% CI 2.04 to 2.19), migraines (OR 1.68, 95% CI 1.56 to 1.81), diabetes (OR 1.32, 95% CI 1.27 to 1.36) and depression (OR 1.27, 95% CI 1.20 to 1.34). CONCLUSIONS In one of the largest population-based analyses of middle-aged adults with measured blood pressure, the majority of treated hypertensives were uncontrolled. Risk factors for hypertension were associated with a lower probability of control. Having a comorbidity was associated with higher probability of control, possibly due to more frequent interaction with the healthcare system and/or appropriate management of those at greater cardiovascular risk.
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Affiliation(s)
- Neo Tapela
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Jennifer Collister
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Lei Clifton
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Iain Turnbull
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Kazem Rahimi
- Deep Medicine, Nuffield Department of Reproductive and Women's Health, University of Oxford, Oxford, Oxfordshire, UK
| | - David J Hunter
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
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27
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Newby D, Prieto-Alhambra D, Duarte-Salles T, Ansell D, Pedersen L, van der Lei J, Mosseveld M, Rijnbeek P, James G, Alexander M, Egger P, Podhorna J, Stewart R, Perera G, Avillach P, Grosdidier S, Lovestone S, Nevado-Holgado AJ. Methotrexate and relative risk of dementia amongst patients with rheumatoid arthritis: a multi-national multi-database case-control study. ALZHEIMERS RESEARCH & THERAPY 2020; 12:38. [PMID: 32252806 PMCID: PMC7137292 DOI: 10.1186/s13195-020-00606-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 03/23/2020] [Indexed: 01/04/2023]
Abstract
Background Inflammatory processes have been shown to play a role in dementia. To understand this role, we selected two anti-inflammatory drugs (methotrexate and sulfasalazine) to study their association with dementia risk. Methods A retrospective matched case-control study of patients over 50 with rheumatoid arthritis (486 dementia cases and 641 controls) who were identified from electronic health records in the UK, Spain, Denmark and the Netherlands. Conditional logistic regression models were fitted to estimate the risk of dementia. Results Prior methotrexate use was associated with a lower risk of dementia (OR 0.71, 95% CI 0.52–0.98). Furthermore, methotrexate use with therapy longer than 4 years had the lowest risk of dementia (odds ratio 0.37, 95% CI 0.17–0.79). Sulfasalazine use was not associated with dementia (odds ratio 0.88, 95% CI 0.57–1.37). Conclusions Further studies are still required to clarify the relationship between prior methotrexate use and duration as well as biological treatments with dementia risk.
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Affiliation(s)
- Danielle Newby
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK.,Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | | | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Johan van der Lei
- Department of Medical Informatics, Erasmus Universitair Medisch Centrum, Rotterdam, Netherlands
| | - Mees Mosseveld
- Department of Medical Informatics, Erasmus Universitair Medisch Centrum, Rotterdam, Netherlands
| | - Peter Rijnbeek
- Department of Medical Informatics, Erasmus Universitair Medisch Centrum, Rotterdam, Netherlands
| | - Glen James
- Real World Data, GlaxoSmithKline, Uxbridge, UK
| | | | - Peter Egger
- Real World Data, GlaxoSmithKline, Uxbridge, UK
| | - Jana Podhorna
- Boehringer Ingelheim International GmbH, Medicine CNS & Emerging Areas, Ingelheim am Rhein, Germany
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Gayan Perera
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Paul Avillach
- Department of Biomedical Informatics, Harvard Medical School, Boston, USA.,Department of Medical Informatics, Erasmus Universitair Medisch Centrum, Rotterdam, Netherlands
| | - Solène Grosdidier
- Department of Medical Informatics, Erasmus Universitair Medisch Centrum, Rotterdam, Netherlands
| | - Simon Lovestone
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.,Janssen-Cilag', Beerse, Belgium
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Jones D, Wilkinson R, Jackson C, Drew P. Variation and Interactional Non-Standardization in Neuropsychological Tests: The Case of the Addenbrooke's Cognitive Examination. QUALITATIVE HEALTH RESEARCH 2020; 30:458-470. [PMID: 31550997 PMCID: PMC7322939 DOI: 10.1177/1049732319873052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The Addenbrooke's Cognitive Examination (ACE-111) is a neuropsychological test used in clinical practice to inform a dementia diagnosis. The ACE-111 relies on standardized administration so that patients' scores can be interpreted by comparison with normative scores. The test is delivered and responded to in interaction between clinicians and patients, which places talk-in-interaction at the heart of its administration. In this article, conversation analysis (CA) is used to investigate how the ACE-111 is delivered in clinical practice. Based on analysis of 40 video/audio-recorded memory clinic consultations in which the ACE-111 was used, we have found that administrative standardization is rarely achieved in practice. There was evidence of both (a) interactional variation in the way the clinicians introduce the test and (b) interactional non-standardization during its implementation. We show that variation and interactional non-standardization have implications for patients' understanding and how they might respond to particular questions.
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Affiliation(s)
- Danielle Jones
- University of Bradford, Bradford, UK
- Danielle Jones, Lecturer in Dementia Studies, Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Richmond Road, Bradford BD7 1DP, UK.
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Lusic Kalcina L, Pavlinac Dodig I, Pecotic R, Valic M, Dogas Z. Psychomotor Performance in Patients with Obstructive Sleep Apnea Syndrome. Nat Sci Sleep 2020; 12:183-195. [PMID: 32210650 PMCID: PMC7069561 DOI: 10.2147/nss.s234310] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/09/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Determinants of obstructive sleep apnea (OSA) are hypoxemia and hypercapnia, as well as (micro) arousals from sleep, resulting in chronic sleep fragmentation, sleep deprivation, and excessive daytime sleepiness (EDS). All of the above-mentioned factors might contribute to psychomotor impairment seen in OSA patients. Additionally, this study aimed to assess the contribution of BMI, age, EDS assessed with Epworth sleepiness scale (ESS), and severity of OSA assessed with apnea-hypopnea index (AHI) to the reaction time on chronometric tests in OSA patients and controls. It is hypothesized that moderate and severe OSA have adverse effects on reaction time of perception to visual stimulus, of solving simple arithmetic operations, and of psychomotor limbs coordination assessed by chronometric psychodiagnostic test battery. PATIENTS AND METHODS This study was conducted on 206 male participants; 103 of them had moderate or severe OSA diagnosed by whole-night polysomnography/polygraphy. Control participants (N=103), matched to patients with OSA by age and BMI, had no reported OSA in their medical history, no increased risk for OSA, nor EDS. All participants were assessed with three chronometric psychodiagnostic tests, measuring the reaction time of perception to visual stimulus, of solving simple arithmetic operations, and of psychomotor limbs coordination. RESULTS Participants from the OSA group achieved impaired results compared to control participants in minimum single task solving time in speed of solving simple arithmetic operations (3±0.9 and 2.6±0.6, P<0.001), and in minimum solving time of a single task in complex psychomotor limbs coordination (0.69±0.2 and 0.61±0.1, P=0.007). Regression analysis revealed no significant contribution of daytime sleepiness to the results achieved in each of the tests. CONCLUSION It is concluded that severe OSA impaired speed of perception, convergent, and operative thinking. Moreover, it is suggested that EDS did not contribute to poor psychomotor outcome in patients with OSA in this study, when age was controlled for.
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Affiliation(s)
- Linda Lusic Kalcina
- Department of Neuroscience, Split Sleep Medicine Center, University of Split School of Medicine, Split, Croatia
| | - Ivana Pavlinac Dodig
- Department of Neuroscience, Split Sleep Medicine Center, University of Split School of Medicine, Split, Croatia
| | - Renata Pecotic
- Department of Neuroscience, Split Sleep Medicine Center, University of Split School of Medicine, Split, Croatia
| | - Maja Valic
- Department of Neuroscience, Split Sleep Medicine Center, University of Split School of Medicine, Split, Croatia
| | - Zoran Dogas
- Department of Neuroscience, Split Sleep Medicine Center, University of Split School of Medicine, Split, Croatia
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Surkova EV, Tanashyan MM, Bespalov AI, Naminov AV. [Diabetes mellitus and cognitive impairment]. TERAPEVT ARKH 2019; 91:112-118. [PMID: 32598641 DOI: 10.26442/00403660.2019.10.000362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
The review discusses literature data and the results of our own studies on the effect of diabetes on cognitive functions and cerebrovascular pathology, as well as possible ptogenetic mechanisms for the implementation of this effect. The results of studies on the effects of antidiabetic drugs on cognitive function are presented.
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Barus R, Béné J, Deguil J, Gautier S, Bordet R. Drug interactions with dementia-related pathophysiological pathways worsen or prevent dementia. Br J Pharmacol 2019; 176:3413-3434. [PMID: 30714122 PMCID: PMC6715604 DOI: 10.1111/bph.14607] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/12/2018] [Accepted: 01/07/2019] [Indexed: 12/27/2022] Open
Abstract
Many risk factors are known to induce or precipitate dementia. Drugs acting via different mechanisms can modulate cognitive performance and exert either beneficial or deleterious effects on cognition through functional or neuropathological mechanisms. This review discusses the association between several classes of drugs and cognitive impairment and dementia risk. These drugs can be divided into drugs targeting CNS disorders (e.g., anticholinergic drugs, antiepileptics, antipsychotics, benzodiazepines, and opioids) and drugs targeting non‐CNS disorders (e.g., antidiabetics, antihypertensives, proton pump inhibitors, and statins). Furthermore, we sought to highlight the pharmacological mechanisms underlying their possible detrimental or beneficial effects on cognition. Anticholinergic and antiepileptic drugs were excluded from this review because their effects on cognition are well known. Studies investigating benzodiazepines have revealed an increased risk of dementia. Conclusions on dementia risk or cognitive impairment regarding opioids and antipsychotic drugs are difficult to draw. These different classes appear to impair cognition not by a single clear mechanism of action specific to each class but by several relatively interdependent and interconnected mechanisms (e.g., impaired neurotransmission, neuroinflammation, neuronal death, oxidative stress, or interactions with dementia‐related pathways). The dementia risk initially associated with the use of proton pump inhibitors might have been overestimated. In contrast, statins, antihypertensive medications, and antidiabetics could potentially decrease the risk of dementia and cognitive impairment by acting in ways opposite to the mechanisms cited above.Linked ArticlesThis article is part of a themed section on Therapeutics for Dementia and Alzheimer's Disease: New Directions for Precision Medicine. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.18/issuetoc
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Affiliation(s)
- Romain Barus
- UnivLille, INSERM, CHU LilleDegenerative and Vascular Cognitive DisordersLilleFrance
| | - Johana Béné
- UnivLille, INSERM, CHU LilleDegenerative and Vascular Cognitive DisordersLilleFrance
| | - Julie Deguil
- UnivLille, INSERM, CHU LilleDegenerative and Vascular Cognitive DisordersLilleFrance
| | - Sophie Gautier
- UnivLille, INSERM, CHU LilleDegenerative and Vascular Cognitive DisordersLilleFrance
| | - Régis Bordet
- UnivLille, INSERM, CHU LilleDegenerative and Vascular Cognitive DisordersLilleFrance
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Del Ser T, Zea MA, Valentí M, Olazarán J, López-Álvarez J, Rebollo-Vázquez A, Ávila-Villanueva M, Frades B, Medina M, Fernández-Blázquez MA. Effects of commonly prescribed drugs on cognition and mild cognitive impairment in healthy elderly people. J Psychopharmacol 2019; 33:965-974. [PMID: 31241413 DOI: 10.1177/0269881119857206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Chronic drug intake has been associated with negative and positive cognitive effects in elderly people, although subjacent conditions may be confounding factors. AIM To study the effects on cognitive performance of commonly prescribed medications in a cohort of cognitively normal older adults. METHODS Medication intake was recorded during two years in 1087 individuals 70-85 years old, without neurological or psychiatric conditions. The influence of every drug, drug family and therapeutic group on six cognitive scores and on the conversion to mild cognitive impairment over two years was ascertained by cross-sectional and longitudinal analyses controlling for demographic and clinical variables. RESULTS Small effects of several drugs on information processing were found in cross-sectional analyses but only confirmed for a positive effect of vitamin D in case-control analyses. Longitudinal analyses showed no drug effects on the cognitive slopes. Several hypotensive drugs reduced, whereas bromazepam and glucose lowering drugs increased, the conversion rate to mild cognitive impairment with very small effects (R2=0.3-1%). CONCLUSIONS Cognitively healthy elderly individuals show minimal negative effects on information processing associated with chronic intake of some drugs probably related to the subjacent condition. Some drugs slightly affect the rate of conversion to mild cognitive impairment. Positive effects of vitamin D, chondroitin, atorvastatin and antihypertensive drugs, and negative effects of antidepressants and benzodiazepines, should be further explored in studies with longer follow-up.
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Affiliation(s)
- Teodoro Del Ser
- 1 Alzheimer's Disease Investigation Research Unit, CIEN Foundation, Carlos III Institute of Health, Queen Sofia Foundation, Alzheimer Research Centre, Madrid, Spain
| | - María-Ascensión Zea
- 1 Alzheimer's Disease Investigation Research Unit, CIEN Foundation, Carlos III Institute of Health, Queen Sofia Foundation, Alzheimer Research Centre, Madrid, Spain
| | - Meritxell Valentí
- 1 Alzheimer's Disease Investigation Research Unit, CIEN Foundation, Carlos III Institute of Health, Queen Sofia Foundation, Alzheimer Research Centre, Madrid, Spain
| | - Javier Olazarán
- 1 Alzheimer's Disease Investigation Research Unit, CIEN Foundation, Carlos III Institute of Health, Queen Sofia Foundation, Alzheimer Research Centre, Madrid, Spain.,2 Service of Neurology, University Hospital Gregorio Marañón, Madrid, Spain
| | - Jorge López-Álvarez
- 1 Alzheimer's Disease Investigation Research Unit, CIEN Foundation, Carlos III Institute of Health, Queen Sofia Foundation, Alzheimer Research Centre, Madrid, Spain.,3 Service of Psychiatry, University Hospital 12 de Octubre, Madrid, Spain
| | - Ana Rebollo-Vázquez
- 1 Alzheimer's Disease Investigation Research Unit, CIEN Foundation, Carlos III Institute of Health, Queen Sofia Foundation, Alzheimer Research Centre, Madrid, Spain
| | - Marina Ávila-Villanueva
- 1 Alzheimer's Disease Investigation Research Unit, CIEN Foundation, Carlos III Institute of Health, Queen Sofia Foundation, Alzheimer Research Centre, Madrid, Spain
| | - Belén Frades
- 1 Alzheimer's Disease Investigation Research Unit, CIEN Foundation, Carlos III Institute of Health, Queen Sofia Foundation, Alzheimer Research Centre, Madrid, Spain
| | - Miguel Medina
- 1 Alzheimer's Disease Investigation Research Unit, CIEN Foundation, Carlos III Institute of Health, Queen Sofia Foundation, Alzheimer Research Centre, Madrid, Spain.,4 Centro de Investigación Biomédica en Red sobre Enfermedades Degenerativas (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Miguel A Fernández-Blázquez
- 1 Alzheimer's Disease Investigation Research Unit, CIEN Foundation, Carlos III Institute of Health, Queen Sofia Foundation, Alzheimer Research Centre, Madrid, Spain
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Jack K, Ridley C, Turner S. Effective communication with older people. Nurs Older People 2019; 31:e1126. [PMID: 31468756 DOI: 10.7748/nop.2019.e1126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2018] [Indexed: 11/09/2022]
Abstract
Effective communication with older people is an important aspect of nursing practice. Ineffective communication can lead to older people feeling inadequate, disempowered and helpless. Nurses have a duty to ensure that older people think they are being listened to and that their concerns are being validated in a non-judgemental way. Central to effective communication is the ability of nurses to be self-aware, and monitor their thoughts and feelings about, for example, negative stereotypes associated with the ageing process. Effective communication can sometimes be difficult to achieve due to the effects of ageing, but nurses can overcome some barriers through thoughtful interventions. It is important to treat older people as individuals, and to monitor and adapt communication accordingly. By doing so, nurses can ensure older people feel empowered, respected and able to maintain their independence.
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Affiliation(s)
- Kirsten Jack
- Manchester Metropolitan University, Manchester, England
| | | | - Samuel Turner
- Manchester Metropolitan University, Manchester, England
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Wu Y, Byrne EM, Zheng Z, Kemper KE, Yengo L, Mallett AJ, Yang J, Visscher PM, Wray NR. Genome-wide association study of medication-use and associated disease in the UK Biobank. Nat Commun 2019; 10:1891. [PMID: 31015401 PMCID: PMC6478889 DOI: 10.1038/s41467-019-09572-5] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/11/2019] [Indexed: 12/21/2022] Open
Abstract
Genome-wide association studies (GWASs) of medication use may contribute to understanding of disease etiology, could generate new leads relevant for drug discovery and can be used to quantify future risk of medication taking. Here, we conduct GWASs of self-reported medication use from 23 medication categories in approximately 320,000 individuals from the UK Biobank. A total of 505 independent genetic loci that meet stringent criteria (P < 10−8/23) for statistical significance are identified. We investigate the implications of these GWAS findings in relation to biological mechanism, potential drug target identification and genetic risk stratification of disease. Amongst the medication-associated genes are 16 known therapeutic-effect target genes for medications from 9 categories. Two of the medication classes studied are for disorders that have not previously been subject to large GWAS (hypothyroidism and gastro-oesophageal reflux disease). An understanding of the genetic variants associated with medication use may shed light on the underlying biological pathways of disease, and aid in drug development. Here, Wu and colleagues conduct a GWAS for self-reported medication-use in the UK Biobank, finding more than 500 independent variants and many promising leads for future work.
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Affiliation(s)
- Yeda Wu
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Enda M Byrne
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Zhili Zheng
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia.,Institute for Advanced Research, Wenzhou Medical University, 325027, Wenzhou, Zhejiang, China
| | - Kathryn E Kemper
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Loic Yengo
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Andrew J Mallett
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia.,Department of Renal Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Jian Yang
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia.,Institute for Advanced Research, Wenzhou Medical University, 325027, Wenzhou, Zhejiang, China.,Queensland Brain Institute, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Peter M Visscher
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia. .,Queensland Brain Institute, The University of Queensland, Brisbane, QLD, 4072, Australia.
| | - Naomi R Wray
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia. .,Queensland Brain Institute, The University of Queensland, Brisbane, QLD, 4072, Australia.
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Cornelis MC, Wang Y, Holland T, Agarwal P, Weintraub S, Morris MC. Age and cognitive decline in the UK Biobank. PLoS One 2019; 14:e0213948. [PMID: 30883587 PMCID: PMC6422276 DOI: 10.1371/journal.pone.0213948] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/04/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Age-related cognitive decline is a well-known phenomenon after age 65 but little is known about earlier changes and prior studies are based on relatively small samples. We investigated the impact of age on cognitive decline in the largest population sample to date including young to old adults. METHOD Between 100,352 and 468,534 participants aged 38-73 years from UK Biobank completed at least one of seven self-administered cognitive functioning tests: prospective memory (PM), pairs matching (Pairs), fluid intelligence (FI), reaction time (RT), symbol digit substitution, trail making A and B. Up to 26,005 participants completed at least one of two follow-up assessments of PM, Pairs, FI and RT. Multivariable regression models examined the association between age (<45[reference], 45-49, 50-54, 55-59, 60-64, 65+) and cognition scores at baseline. Mixed models estimated the impact of age on cognitive decline over follow-up (~5.1 years). RESULTS FI was higher between ages 50 and 64 and lower at 65+ compared to <45 at baseline. Performance on all other baseline tests was lower with older age: with increasing age category, difference in test scores ranged from 2.5 to 7.8%(P<0.0001). Compared to <45 at baseline, RT and Pairs performance declined faster across all older age cohorts (3.0 and 1.2% change, respectively, with increasing age category, P<0.0001). Cross-sectional results yielded 8 to 12-fold higher differences in RT and Pairs with age compared to longitudinal results. CONCLUSIONS Our findings suggest that declines in cognitive abilities <65 are small. The cross-sectional differences in cognition scores for middle to older adult years may be due in part to age cohort effects.
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Affiliation(s)
- Marilyn C. Cornelis
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- * E-mail:
| | - Yamin Wang
- Rush Institute for Healthy Aging, Rush University, Chicago, Illinois, United States of America
| | - Thomas Holland
- Rush Institute for Healthy Aging, Rush University, Chicago, Illinois, United States of America
| | - Puja Agarwal
- Rush Institute for Healthy Aging, Rush University, Chicago, Illinois, United States of America
| | - Sandra Weintraub
- Mesulam Cognitive Neurology and Alzheimer’s Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Martha Clare Morris
- Rush Institute for Healthy Aging, Rush University, Chicago, Illinois, United States of America
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Ostroumova OD, Borisova EV, Kochetkov AI, Ostroumova TM, Bondarec OV. Improving the cognitive functions in the middle-aged patients with essential arterial hypertension after the treatment with amlodipine/valsartan single-pill combination. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2019. [DOI: 10.20996/1819-6446-2019-15-1-54-62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Different antihypertensive drugs differently affect cognitive function, and data on the effect of single-pill combination (SPC) of antihypertensive drugs on cognitive function are presented only in single studies.Aim. To investigate the impact of amlodipine/valsartan SPC (A/V SPC) on blood pressure (BP) level and cognitive functions in the middle-aged antihypertensive treatment-naive patients with stage II grade 1-2 essential arterial hypertension.Methods. A group of patients with stage II grade 1-2 essential arterial hypertension who had not previously received regular antihypertensive treatment (n=38, age 49.7±7.0 years) was retrospectively formed. All the patients were treated with A/V SPC and all of them achieved target office BP (less than 140/90 mm Hg). And after 12-week follow-up (since the time of reaching the target BP) the antihypertensive treatment efficacy assessment using ambulatory BP monitoring (ABPM) were performed in all included hypertensive patients. Age-matched healthy people with normal BP (n=20, mean age 45.4±5.1years) represented a control group. In all participants cognitive functions were evaluated by 5 different tests at baseline and at the end of follow-up: Montreal Cognitive Assessment (MoCA); Trail Making test (part A and part B), Stroop Color and Word Test; verbal fluency test; 10-item word list learning task. Baseline Hamilton depression and anxiety rating scale data were also available in all individuals.Results. According to the ABPM data 24-hour, day-time and night-time systolic, diastolic and pulse BP significantly decreased after the treatment with A/V SPC (p<0.001 for systolic and diastolic BP and p<0.01 for pulse BP). After the treatment with A/V SPC significantly improved results of cognitive tests in hypertensive patients: decreased time in Trail Making Test part B (from 114.7±37.0 to 96.3±26.5 s; р=0.001); time difference between part B and part A of Trail Making Test (from 75.2±32.8 to 57.7±20.1 s; р=0.002); time in Stroop test part 3 (from 117.0±28.1 to 108.0±28.4 s; р=0.013); and interference score (from 50.9±19.2 to 43.1±22.0 s; р=0.011); increased MoCA score (from 28.4±1.3 to 29.4±1.2; р=0.001); as well as increased the 10-item word list learning task – immediate recall (from 5.7±1.3 to 6.5±1.2 words; р=0.001); 10-item word list learning task – delayed recall (from 6.3±2.1 to 6.9±1.7 words; р=0.006); literal fluency (from 11.7±3.4 to 13.2±3.2 words; р=0.020) and categorical fluency (from 7.3±2.5 to 9.5±2.9 words; p<0.001). In control group at the end of follow-up compared to baseline significantly increased the 10-item word list learning task – immediate recall (from 5.8±0.9 to 6.6±1.1 words; р<0.05) and delayed recall (from 5.9±1.8 to 8.2±1.4 words; р<0.001).Conclusion. In retrospective analysis improvement of cognitive function was found in middle-aged patients with hypertension, taking A/V SPC for 12 weeks after reaching the target BP.
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Affiliation(s)
- O. D. Ostroumova
- Pirogov Russian National Research Medical University; I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - E. V. Borisova
- A.I. Evdokimov Moscow State University of Medicine and Dentistry; E.O. Mukhin Municipal Clinical Hospital
| | | | - T. M. Ostroumova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - O. V. Bondarec
- A.I. Evdokimov Moscow State University of Medicine and Dentistry
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Salahuddin Z, Wong K. Comment on “The Feasibility and Potential Impact of Brain Training Games on Cognitive and Emotional Functioning in Middle-Aged Adults” by McLaughlin et al. doi: 10.1089/g4h.2017.0032. Games Health J 2018. [DOI: 10.1089/g4h.2018.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
| | - Kendra Wong
- King's College London, London, United Kingdom
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Le TT, Kuplicki R, Yeh HW, Aupperle RL, Khalsa SS, Simmons WK, Paulus MP. Effect of Ibuprofen on BrainAGE: A Randomized, Placebo-Controlled, Dose-Response Exploratory Study. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 3:836-843. [PMID: 29941380 PMCID: PMC6510235 DOI: 10.1016/j.bpsc.2018.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/02/2018] [Accepted: 05/02/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The age of a person's brain can be estimated from structural brain images using an aggregate measure of variation in morphology across the whole brain. The brain age gap estimation (BrainAGE) score is computed as the difference between kernel-estimated brain age and chronological age. In this exploratory study, we investigated the application of the BrainAGE measure to identify potential novel effects of pharmacological agents on brain morphology. METHODS Twenty healthy participants (23-47 years of age) completed three structural magnetic resonance imaging scans 45 minutes after administration of placebo or 200 or 600 mg of ibuprofen in a double-blind, crossover study. An externally derived BrainAGE model from a sample of 480 healthy participants was used to examine the acute effect of ibuprofen on temporary neuroanatomical changes in healthy individuals. RESULTS The BrainAGE model produced age prediction for each participant with a mean absolute error of 6.7 years between the estimated and chronological age. The intraclass correlation coefficient for BrainAGE was 0.96. Relative to placebo, 200 and 600 mg of ibuprofen significantly decreased BrainAGE by 1.18 and 1.15 years, respectively (p < .05). The trained BrainAGE model identified the medial prefrontal cortex to be the strongest age predictor. CONCLUSIONS BrainAGE is a potentially useful construct to examine neurological effects of therapeutic drugs. Ibuprofen temporarily reduces BrainAGE by approximately 1 year, which is likely due to its acute anti-inflammatory effects.
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Affiliation(s)
- Trang T Le
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma; Department of Mathematics, University of Tulsa, Tulsa, Oklahoma
| | - Rayus Kuplicki
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma
| | - Hung-Wen Yeh
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma
| | - Robin L Aupperle
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma; Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma
| | - Sahib S Khalsa
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma; Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma
| | - W Kyle Simmons
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma; Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma
| | - Martin P Paulus
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma.
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Ostroumova OD, Chikh EV, Rebrova EV, Ryazanova AY. Statin Therapy and Cognitive Impairment: Benefit or Harm? RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2018. [DOI: 10.20996/1819-6446-2018-14-4-529-536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Statins are now widely used drugs for the treatment of dyslipidemia, effective drugs for lowering the level of low-density lipoprotein cholesterol, and also for reducing the risk of cardiovascular and cerebrovascular events. It is believed that statins are well tolerated. However, the potential relationship between statins and cognitive impairment in some people is assumed. This review paper was written in the light of the search for information on a specific problem of the potential adverse effects of statins on the cognitive function. The purpose of the article is to seek advice for health professionals on monitoring and reducing the risk of potential cognitive impairment during statin therapy. Rosuvastatin may be safer amongst statins in terms of influencing cognitive function. Evaluation of cognitive dysfunction in patients before starting therapy with statins is not necessary. Therapy with statins is not accompanied by a risk of developing cognitive dysfunction according to cohort and randomized studies. The presence of cognitive dysfunction and the exclusion of other possible causes of it, as well as the evaluation of the benefit/risk ratio for the abolition of statin therapy, are necessary in detecting cognitive dysfunction during statin therapy. A decrease in the dose of statin or the cessation of its use to assess the reversibility of symptoms is possible on the basis of the individual characteristics of the patient. Alternative replacement for another inhibitor of HMG-CoA reductase should occur if the statin is discontinued. A drug that less penetrates the blood-brain barrier, for example rosuvastatin, is more preferable.
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Mason A, Holmes C, Edwards CJ. Inflammation and dementia: Using rheumatoid arthritis as a model to develop treatments? Autoimmun Rev 2018; 17:919-925. [PMID: 30005856 DOI: 10.1016/j.autrev.2018.04.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/03/2018] [Indexed: 12/28/2022]
Abstract
Dementia is a major international public health problem which looks set to grow as the ageing population increases. Despite large amounts of investment there has been relatively little progress in developing new therapies to combat this. There is a growing body of evidence that both local and systemic inflammation are important in dementia; with cerebral inflammation occurring secondarily to beta-amyloid plaques, raised levels of serum inflammatory molecules and cytokines being present in Alzheimer's disease patients and systemic inflammation being associated with cerebral microvasculature disease in vascular dementia. Observational studies had suggested that non-steroidal anti-inflammatory drugs may reduce the risk of dementia, but subsequent interventional studies have been disappointing. More recently some observational studies have suggested a protective effect from conventional synthetic disease modifying anti-rheumatic drugs (csDMARDS) and tumour necrosis factor inhibiting (TNFi) biological therapies. Treatments for inflammatory rheumatic diseases have previously been repurposed and used successfully in other diseases, such as TNFi for inflammatory bowel disease. There are also studies looking at the use of csDMARDs such as methotrexate to improve outcomes after cardiovascular events. Ongoing interventional trials are currently looking at whether therapies designed to treat inflammatory and autoimmune diseases have the potential to be used to treat dementia.
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Affiliation(s)
- Alice Mason
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Christopher J Edwards
- University Hospital Southampton NHS Foundation Trust, Southampton, UK; MSK Research Unit, NIHR Clinical Research Facility, University of Southampton & University Hospital Southampton NHS Foundation Trust, UK.
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Winchester LM, Powell J, Lovestone S, Nevado-Holgado AJ. Red blood cell indices and anaemia as causative factors for cognitive function deficits and for Alzheimer's disease. Genome Med 2018; 10:51. [PMID: 29954452 PMCID: PMC6022699 DOI: 10.1186/s13073-018-0556-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 06/07/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Studies have shown that low haemoglobin and anaemia are associated with poor cognition, and anaemia is known to be associated with Alzheimer's disease (AD), but the mechanism of this risk is unknown. Here, we first seek to confirm the association between cognition and anaemia and secondly, in order to further understand the mechanism of this association, to estimate the direction of causation using Mendelian randomisation. METHODS Two independent cohorts were used in this analysis: AddNeuroMed, a longitudinal study of 738 subjects including AD and age-matched controls with blood cell measures, cognitive assessments and gene expression data from blood; and UK Biobank, a study of 502,649 healthy participants, aged 40-69 years with cognitive test measures and blood cell indices at baseline. General linear models were calculated using cognitive function as the outcome with correction for age, sex and education. In UK Biobank, SNPs with known blood cell measure associations were analysed with Mendelian randomisation to estimate direction of causality. In AddNeuroMed, gene expression data was used in pathway enrichment analysis to identify associations reflecting biological function. RESULTS Both sample sets evidence a reproducible association between cognitive performance and mean corpuscular haemoglobin (MCH), a measure of average mass of haemoglobin per red blood cell. Furthermore, in the AddNeuroMed cohort, where longitudinal samples were available, we showed a greater decline in red blood cell indices for AD patients when compared to controls (p values between 0.05 and 10-6). In the UK Biobank cohort, we found lower haemoglobin in participants with reduced cognitive function. There was a significant association for MCH and red blood cell distribution width (RDW, a measure of cell volume variability) compared to four cognitive function tests including reaction time and reasoning (p < 0.0001). Using Mendelian randomisation, we then showed a significant effect of MCH on the verbal-numeric and numeric traits, implying that anaemia has causative effect on cognitive performance. CONCLUSIONS Lower haemoglobin levels in blood are associated to poor cognitive function and AD. We have used UK Biobank SNP data to determine the relationship between cognitive testing and haemoglobin measures and suggest that haemoglobin level and therefore anaemia does have a primary causal impact on cognitive performance.
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Affiliation(s)
| | - John Powell
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
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Chronic use of proton pump inhibitors, adverse events and potential biological mechanisms: A translational analysis. Therapie 2018; 73:273-281. [DOI: 10.1016/j.therap.2017.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 08/31/2017] [Indexed: 01/12/2023]
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Judge A, Garriga C, Arden NK, Lovestone S, Prieto-Alhambra D, Cooper C, Edwards CJ. Protective effect of antirheumatic drugs on dementia in rheumatoid arthritis patients. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2017; 3:612-621. [PMID: 29201995 PMCID: PMC5700830 DOI: 10.1016/j.trci.2017.10.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction Rheumatoid arthritis is a systemic inflammatory disease, and classical disease-modifying antirheumatic drugs (cDMARDs) have proven efficacy. It is unknown what impact cDMARDs might have on dementia as an outcome. Methods Incident diagnoses of rheumatoid arthritis in persons over 18 years from 1995 to 2011 were identified from the UK Clinical Practice Research Datalink. There were 3876 cDMARD users and were propensity score matched to 1938 nonusers, on a wide range of confounders. Impact on dementia was assessed using survival models. Results cDMARD users were at reduced risk of dementia (hazard ratio: 0.60; 95% confidence interval: 0.42–0.85). The effect was strongest in methotrexate users (hazard ratio: 0.52; 95% confidence interval; 0.34–0.82). Discussion The strong effect of cDMARD use on halving of dementia risk requires replication in a trial and may provide an important therapeutic pharmacological treatment.
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Affiliation(s)
- Andy Judge
- Oxford NIHR Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Cesar Garriga
- Oxford NIHR Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nigel K Arden
- Oxford NIHR Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Simon Lovestone
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford UK
| | - Dani Prieto-Alhambra
- Oxford NIHR Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Cyrus Cooper
- Oxford NIHR Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Christopher J Edwards
- Oxford NIHR Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Department of Rheumatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,NIHR Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK
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