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Zheng Y, Cai X, Wang D, Chen X, Wang T, Xie Y, Li H, Wang T, He Y, Li J, Li J. Exploring the relationship between lipid metabolism and cognition in individuals living with stable-phase Schizophrenia: a small cross-sectional study using Olink proteomics analysis. BMC Psychiatry 2024; 24:593. [PMID: 39227832 PMCID: PMC11370234 DOI: 10.1186/s12888-024-06054-x] [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: 07/02/2024] [Accepted: 08/30/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Cognitive impairment is a core symptom of schizophrenia. Metabolic abnormalities impact cognition, and although the influence of blood lipids on cognition has been documented, it remains unclear. We conducted a small cross-sectional study to investigate the relationship between blood lipids and cognition in patients with stable-phase schizophrenia. Using Olink proteomics, we explored the potential mechanisms through which blood lipids might affect cognition from an inflammatory perspective. METHODS A total of 107 patients with stable-phase schizophrenia and cognitive impairment were strictly included. Comprehensive data collection included basic patient information, blood glucose, blood lipids, and body mass index. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) and the MATRICS Consensus Cognitive Battery (MCCB). After controlling for confounding factors, we identified differential metabolic indicators between patients with mild and severe cognitive impairment and conducted correlation and regression analyses. Furthermore, we matched two small sample groups of patients with lipid metabolism abnormalities and used Olink proteomics to analyze inflammation-related differential proteins, aiming to further explore the association between lipid metabolism abnormalities and cognition. RESULTS The proportion of patients with severe cognitive impairment (SCI) was 34.58%. Compared to patients with mild cognitive impairment (MCI), those with SCI performed worse in the Attention/Alertness (t = 2.668, p = 0.009) and Working Memory (t = 2.496, p = 0.014) cognitive dimensions. Blood lipid metabolism indicators were correlated with cognitive function, specifically showing that higher levels of TG (r = -0.447, p < 0.001), TC (r = -0.307, p = 0.002), and LDL-C (r = -0.607, p < 0.001) were associated with poorer overall cognitive function. Further regression analysis indicated that TG (OR = 5.578, P = 0.003) and LDL-C (OR = 5.425, P = 0.001) may be risk factors for exacerbating cognitive impairment in individuals with stable-phase schizophrenia. Proteomics analysis revealed that, compared to individuals with stable-phase schizophrenia and normal lipid metabolism, those with hyperlipidemia had elevated levels of 10 inflammatory proteins and decreased levels of 2 inflammatory proteins in plasma, with these changes correlating with cognitive function. The differential proteins were primarily involved in pathways such as cytokine-cytokine receptor interaction, chemokine signaling pathway, and IL-17 signaling pathway. CONCLUSION Blood lipids are associated with cognitive function in individuals with stable-phase schizophrenia, with higher levels of TG, TC, and LDL-C correlating with poorer overall cognitive performance. TG and LDL-C may be risk factors for exacerbating cognitive impairment in these patients. From an inflammatory perspective, lipid metabolism abnormalities might influence cognition by activating or downregulating related proteins, or through pathways such as cytokine-cytokine receptor interaction, chemokine signaling pathway, and IL-17 signaling pathway.
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Affiliation(s)
- Yingkang Zheng
- The First Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xiaojun Cai
- The First Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, China.
- Department of Endocrinology, Heilongjiang Academy of Chinese Medicine, Harbin, China.
| | - Dezhong Wang
- Department of Endocrinology, Heilongjiang Academy of Chinese Medicine, Harbin, China
| | - Xinghai Chen
- Department of Endocrinology, Heilongjiang Academy of Chinese Medicine, Harbin, China
| | - Tao Wang
- Department of Endocrinology, Heilongjiang Academy of Chinese Medicine, Harbin, China
| | - Yanpeng Xie
- Department of Endocrinology, Heilongjiang Academy of Chinese Medicine, Harbin, China
| | - Haojing Li
- Department of Endocrinology, Heilongjiang Academy of Chinese Medicine, Harbin, China
| | - Tong Wang
- Department of Endocrinology, Heilongjiang Academy of Chinese Medicine, Harbin, China
| | - Yinxiong He
- The First Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Jiarui Li
- The First Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Juan Li
- The First Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, China
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Le Bars S, Glaab E. Single-Cell Cortical Transcriptomics Reveals Common and Distinct Changes in Cell-Cell Communication in Alzheimer's and Parkinson's Disease. Mol Neurobiol 2024:10.1007/s12035-024-04419-7. [PMID: 39143450 DOI: 10.1007/s12035-024-04419-7] [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: 03/02/2024] [Accepted: 08/02/2024] [Indexed: 08/16/2024]
Abstract
Alzheimer's disease (AD) and Parkinson's disease (PD) cause significant neuronal loss and severely impair daily living. Despite different clinical manifestations, these disorders share common pathological molecular hallmarks, including mitochondrial dysfunction and synaptic degeneration. A detailed comparison of molecular changes at single-cell resolution in the cortex, as one of the main brain regions affected in both disorders, may reveal common susceptibility factors and disease mechanisms. We performed single-cell transcriptomic analyses of post-mortem cortical tissue from AD and PD subjects and controls to identify common and distinct disease-associated changes in individual genes, cellular pathways, molecular networks, and cell-cell communication events, and to investigate common mechanisms. The results revealed significant disease-specific, shared, and opposing gene expression changes, including cell type-specific signatures for both diseases. Hypoxia signaling and lipid metabolism emerged as significantly modulated cellular processes in both AD and PD, with contrasting expression alterations between the two diseases. Furthermore, both pathway and cell-cell communication analyses highlighted shared significant alterations involving the JAK-STAT signaling pathway, which has been implicated in the inflammatory response in several neurodegenerative disorders. Overall, the analyses revealed common and distinct alterations in gene signatures, pathway activities, and gene regulatory subnetworks in AD and PD. The results provide insights into coordinated changes in pathway activity and cell-cell communication that may guide future diagnostics and therapeutics.
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Affiliation(s)
- Sophie Le Bars
- Biomedical Data Science Group, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Enrico Glaab
- Biomedical Data Science Group, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg.
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Sun M, Chen WM, Wu SY, Zhang J. Protective Effects Against Dementia Undergo Different Statin Type, Intensity, and Cumulative Dose in Older Adult Type 2 Diabetes Mellitus Patients. J Am Med Dir Assoc 2024; 25:470-479.e1. [PMID: 38128583 DOI: 10.1016/j.jamda.2023.11.010] [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: 07/12/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES This study investigated the relationship between statin use and dementia risk in older adults with type 2 diabetes (T2DM). It also assessed the impact of various statin types, dosage intensity, and cumulative doses on dementia risk. DESIGN Employing the inverse probability of treatment weighting (IPTW) Cox hazards model, this research explored the influence of statin utilization on dementia incidence. SETTING AND PARTICIPANTS The study included older adult T2DM patients aged 60 years or older who received statins (case group) and those who did not (control group) during the follow-up period. METHODS The IPTW Cox hazards model quantified the association between statin use and dementia incidence. Subgroup analyses investigated different statin types, usage intensity, and cumulative dose-dependent relationships with dementia risk, measured by adjusted hazard ratios (aHRs) with corresponding 95% CIs. RESULTS Statin users experienced a significant reduction in dementia risk (aHR: 0.47, 95% CI: 0.46-0.48). Subgroup analysis using IPTW Cox regression revealed varying dementia incidence reductions among users of different statin types, with aHRs (95% CIs) ranging from 0.09 to 0.69. Multivariate analyses unveiled a dose-dependent relationship, showing reduced dementia incidence based on cumulative defined daily doses (cDDDs) per year. The corresponding aHRs (95% CIs) were 0.20 to 0.72 across quartiles 4 to 1 of cDDD-years, with a significant trend (P < .001). The optimal daily statin use was 0.88 defined daily doses (DDDs), associated with the lowest dementia risk. CONCLUSIONS AND IMPLICATIONS Statins significantly reduced dementia risk in older adult T2DM patients. Higher cumulative defined daily doses (cDDD-years) were linked to more substantial risk reductions. This research underscores the clinical benefits of statin use in preventing dementia in this population and calls for further investigation into the underlying mechanisms. It also raises the possibility of influencing policy decisions to manage dementia risk in this vulnerable group.
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Affiliation(s)
- Mingyang Sun
- Department of Anesthesiology and Perioperative Medicine, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Wan-Ming Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan; Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan; Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan; Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan; Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan, China.
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Amidfar M, Askari G, Kim YK. Association of metabolic dysfunction with cognitive decline and Alzheimer's disease: A review of metabolomic evidence. Prog Neuropsychopharmacol Biol Psychiatry 2024; 128:110848. [PMID: 37634657 DOI: 10.1016/j.pnpbp.2023.110848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/28/2023] [Accepted: 08/24/2023] [Indexed: 08/29/2023]
Abstract
The discovery of new biomarkers that can distinguish Alzheimer's disease (AD) from mild cognitive impairment (MCI) in the early stages will help to provide new diagnostic and therapeutic strategies and slow the transition from MCI to AD. Patients with AD may present with a concomitant metabolic disorder, such as diabetes, obesity, and dyslipidemia, as a risk factor for AD that may be involved in the onset of both AD pathology and cognitive impairment. Therefore, metabolite profiling, or metabolomics, can be very useful in diagnosing AD, developing new therapeutic targets, and evaluating both the course of treatment and the clinical course of the disease. In addition, studying the relationship between nutritional behavior and AD requires investigation of the role of conditions such as obesity, hypertension, dyslipidemia, and elevated glucose level. Based on this literature review, nutritional recommendations, including weight loss by reducing calorie and cholesterol intake and omega-3 fatty acid supplementation can prevent cognitive decline and dementia in the elderly. The underlying metabolic causes of the pathology and cognitive decline caused by AD and MCI are not well understood. In this review article, metabolomics biomarkers for diagnosis of AD and MCI and metabolic risk factors for cognitive decline in AD were evaluated.
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Affiliation(s)
- Meysam Amidfar
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Askari
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yong-Ku Kim
- Department of Psychiatry, College of Medicine, Korea University, Seoul, South Korea.
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Petek B, Häbel H, Xu H, Villa-Lopez M, Kalar I, Hoang MT, Maioli S, Pereira JB, Mostafaei S, Winblad B, Gregoric Kramberger M, Eriksdotter M, Garcia-Ptacek S. Statins and cognitive decline in patients with Alzheimer's and mixed dementia: a longitudinal registry-based cohort study. Alzheimers Res Ther 2023; 15:220. [PMID: 38115091 PMCID: PMC10731754 DOI: 10.1186/s13195-023-01360-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Disturbances in brain cholesterol homeostasis may be involved in the pathogenesis of Alzheimer's disease (AD). Lipid-lowering medications could interfere with neurodegenerative processes in AD through cholesterol metabolism or other mechanisms. OBJECTIVE To explore the association between the use of lipid-lowering medications and cognitive decline over time in a cohort of patients with AD or mixed dementia with indication for lipid-lowering treatment. METHODS A longitudinal cohort study using the Swedish Registry for Cognitive/Dementia Disorders, linked with other Swedish national registries. Cognitive trajectories evaluated with mini-mental state examination (MMSE) were compared between statin users and non-users, individual statin users, groups of statins and non-statin lipid-lowering medications using mixed-effect regression models with inverse probability of drop out weighting. A dose-response analysis included statin users compared to non-users. RESULTS Our cohort consisted of 15,586 patients with mean age of 79.5 years at diagnosis and a majority of women (59.2 %). A dose-response effect was demonstrated: taking one defined daily dose of statins on average was associated with 0.63 more MMSE points after 3 years compared to no use of statins (95% CI: 0.33;0.94). Simvastatin users showed 1.01 more MMSE points (95% CI: 0.06;1.97) after 3 years compared to atorvastatin users. Younger (< 79.5 years at index date) simvastatin users had 0.80 more MMSE points compared to younger atorvastatin users (95% CI: 0.05;1.55) after 3 years. Simvastatin users had 1.03 more MMSE points (95% CI: 0.26;1.80) compared to rosuvastatin users after 3 years. No differences regarding statin lipophilicity were observed. The results of sensitivity analysis restricted to incident users were not consistent. CONCLUSIONS Some patients with AD or mixed dementia with indication for lipid-lowering medication may benefit cognitively from statin treatment; however, further research is needed to clarify the findings of sensitivity analyses.
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Affiliation(s)
- Bojana Petek
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
- Clinical Institute of Genomic Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Henrike Häbel
- Medical Statistics Unit, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Marta Villa-Lopez
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Faculty of Medicine, University Complutense of Madrid, Madrid, Spain
- Department of Neurology, University of Alberta Hospital, Edmonton, Canada
| | - Irena Kalar
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Minh Tuan Hoang
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Silvia Maioli
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Joana B Pereira
- Division of Neuro, Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Shayan Mostafaei
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Aging and Inflammation Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Milica Gregoric Kramberger
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Aging and Inflammation Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
- Aging and Inflammation Theme, Karolinska University Hospital, Stockholm, Sweden.
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Upadhyaya P, Ling Y, Chen L, Kim Y, Jiang X. Inferring Personalized Treatment Effect of Antihypertensives on Alzheimer's Disease Using Deep Learning. IEEE INTERNATIONAL CONFERENCE ON HEALTHCARE INFORMATICS. IEEE INTERNATIONAL CONFERENCE ON HEALTHCARE INFORMATICS 2023; 2023:49-57. [PMID: 38516035 PMCID: PMC10956734 DOI: 10.1109/ichi57859.2023.00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Alzheimer's disease (AD) is one of the leading causes of death in the United States, especially among the elderly. Recent studies have shown how hypertension is related to cognitive decline in elderly patients, which in turn leads to increased mortality as well as morbidity. There have been various studies that have looked at the effect of antihypertensive drugs in reducing cognitive decline, and their results have proved inconclusive. However, most of these studies assume the treatment effect is similar for all patients, thus considering only the average treatment effects of antihypertensive drugs. In this paper, we assume that the effect of antihypertensives on the onset of AD depends on patient characteristics. We develop a deep learning method called LASSO-Dragonnet to estimate the individualized treatment effects of each patient. We considered six antihypertensive drugs, and each of the six models considered one of the drugs as the treatment and the remaining as control. Our studies showed that although many antihypertensives have a positive impact in delaying AD onset on average, the impact varies from individual to individual, depending on their various characteristics. We also analyzed the importance of various covariates in such an estimation. Our results showed that the individualized treatment effects of each patient could be estimated accurately using a deep learning method, and that the importance of various covariates could be determined.
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Affiliation(s)
| | - Yaobin Ling
- School of Biomedical Informatics, UT Health, Houston, USA
| | - Luyao Chen
- School of Biomedical Informatics, UT Health, Houston, USA
| | - Yejin Kim
- School of Biomedical Informatics, UT Health, Houston, USA
| | - Xiaoqian Jiang
- School of Biomedical Informatics, UT Health, Houston, USA
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Nijskens C, Henstra M, Rhodius-Meester H, Yasar S, van Poelgeest E, Peters M, Muller M. Cardiovascular Risk Management in Persons with Dementia. J Alzheimers Dis 2023; 93:879-889. [PMID: 37125555 PMCID: PMC10258883 DOI: 10.3233/jad-230019] [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] [Accepted: 03/28/2023] [Indexed: 05/02/2023]
Abstract
The number of people living with dementia, such as Alzheimer's disease, is increasing worldwide. Persons with dementia often have a high risk of atherosclerotic cardiovascular disease and they are therefore theoretically eligible for treatment of hypertension and hyperlipidemia. However, in this population, beneficial and harmful effects of cardiovascular risk management (CVRM) may be different compared to older persons without cognitive impairment. Current CVRM guidelines are based on trials from which persons with dementia were excluded. In this narrative review, we will discuss how current guidelines can be translated to persons with dementia and which aspects should be taken into account when treating hypertension and hyperlipidemia to prevent major adverse cardiovascular events (MACE). Survival time is significantly shorter in persons with dementia. We therefore suggest that since the main goal of CVRM is prevention of MACE, first of all, the patient's life expectancy and treatment wishes should be evaluated. Risk assessment tools are to be used with care, as they tend to overestimate the 5- and 10-year risk of MACE and benefit from CVRM in the prevention of MACE in persons with dementia. When the clinician and patient have decided that treatment is initiated or intensified, patients should be closely monitored since they are at high risk for adverse drugs events and overtreatment due to the natural course of blood pressure in persons with dementia. In the event of intolerance or side effects, medication should be switched or withdrawn. For persons with dementia and limited life expectancy, deprescribing should be part of usual care.
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Affiliation(s)
- Charlotte Nijskens
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Geriatrics section, Amsterdam, The Netherlands
| | - Marieke Henstra
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Geriatrics section, Amsterdam, The Netherlands
| | - Hanneke Rhodius-Meester
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Geriatrics section, Amsterdam, The Netherlands
- Department of Neurology, Amsterdam UMC location Vrije Universiteit Amsterdam, Alzheimer Center Amsterdam, Amsterdam, The Netherlands
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Sevil Yasar
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Eveline van Poelgeest
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Geriatrics section, Amsterdam, The Netherlands
| | - Mike Peters
- Department of Internal and Geriatric Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Majon Muller
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Geriatrics section, Amsterdam, The Netherlands
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Wu SE, Chen WL. Longitudinal trajectories of metabolic syndrome on different neurocognitive domains: a cohort study from the Taiwan biobank. Aging (Albany NY) 2021; 13:15400-15412. [PMID: 34114969 PMCID: PMC8221342 DOI: 10.18632/aging.203099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/18/2021] [Indexed: 12/28/2022]
Abstract
Metabolic syndrome (MetS) brings considerable effects on cognitive function, but trajectories within remain unclear. We investigated the interactions between distinct MetS components and cognitive domains. A total of 5693 participants from the Taiwan biobank during 2008–2018 were enrolled. Participants were classified as either normal or as having MetS at two time points; i.e., study entry and follow-up. At both the time points, cognitive evaluations using the Mini-Mental State Examination (MMSE) were conducted. The hazard ratios (HRs) of mild cognitive impairment (MCI) and dementia were higher in participants meeting more diagnostic components of MetS. Of the five criteria of MetS, three were significantly associated with MCI and dementia: high blood pressure (MCI: HR = 1.203, p < 0.001; dementia: HR = 1.345, p < 0.001), abdominal obesity (MCI: HR = 1.137, p = 0.006; dementia: HR = 1.442, p < 0.001), and low high-density lipoprotein (HDL) level (MCI: HR = 1.149, p = 0.007; dementia: HR = 1.364, p < 0.001). Of the cognitive domains measured, three were significantly associated with MetS; namely, orientation, language, and visuospatial abilities. Participants who were initially diagnosed with MetS but were normal at follow-up had an HR of 1.374 for dementia (p = 0.019), which was beyond our expectations. The undiminished risk of cognitive decline in subjects returning to normal status illustrated that neural injury caused by MetS takes a long time to get repaired. Consequently, earlier detection and management of adjustable risk factors of MetS should be encouraged to minimize the damage.
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Affiliation(s)
- Shou-En Wu
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Wei-Liang Chen
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Department of Biochemistry, National Defense Medical Center, Taiwan, Republic of China
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9
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Zhou Z, Ryan J, Ernst ME, Zoungas S, Tonkin AM, Woods RL, McNeil JJ, Reid CM, Curtis AJ, Wolfe R, Wrigglesworth J, Shah RC, Storey E, Murray A, Orchard SG, Nelson MR. Effect of Statin Therapy on Cognitive Decline and Incident Dementia in Older Adults. J Am Coll Cardiol 2021; 77:3145-3156. [PMID: 34167639 DOI: 10.1016/j.jacc.2021.04.075] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/08/2021] [Accepted: 04/19/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The neurocognitive effect of statins in older adults remain uncertain. OBJECTIVES The aim of this study was to investigate the associations of statin use with cognitive decline and incident dementia among older adults. METHODS This analysis included 18,846 participants ≥65 years of age in a randomized trial of aspirin, who had no prior cardiovascular events, major physical disability, or dementia initially and were followed for 4.7 years. Outcome measures included incident dementia and its subclassifications (probable Alzheimer's disease, mixed presentations); mild cognitive impairment (MCI) and its subclassifications (MCI consistent with Alzheimer's disease, other MCI); and changes in domain-specific cognition, including global cognition, memory, language and executive function, psychomotor speed, and the composite of these domains. Associations of baseline statin use versus nonuse with dementia and MCI outcomes were examined using Cox proportional hazards models and with cognitive change using linear mixed-effects models, adjusting for potential confounders. The impact of statin lipophilicity on these associations was further examined, and effect modifiers were identified. RESULTS Statin use versus nonuse was not associated with dementia, MCI, or their subclassifications or with changes in cognitive function scores over time (p > 0.05 for all). No differences were found in any outcomes between hydrophilic and lipophilic statin users. Baseline neurocognitive ability was an effect modifier for the associations of statins with dementia (p for interaction < 0.001) and memory change (p for interaction = 0.02). CONCLUSIONS In adults ≥65 years of age, statin therapy was not associated with incident dementia, MCI, or declines in individual cognition domains. These findings await confirmation from ongoing randomized trials.
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Affiliation(s)
- Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA; Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Andrea J Curtis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jo Wrigglesworth
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Elsdon Storey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anne Murray
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA; Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Minneapolis, Minnesota, USA; University of Minnesota, Minneapolis, Minnesota, USA
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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10
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Dong MX, Wei YD, Hu L. Lipid metabolic dysregulation is involved in Parkinson's disease dementia. Metab Brain Dis 2021; 36:463-470. [PMID: 33433787 DOI: 10.1007/s11011-020-00665-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/25/2020] [Indexed: 12/13/2022]
Abstract
Dementia is very common in the late stage of patient with Parkinson's disease (PD). We aim to explore its underlying pathogenesis and identify candidate biomarkers using untargeted metabolomics analysis. Consecutive PD patients and healthy controls were recruited. Clinical data were assessed and patients were categorized into Parkinson's disease without dementia (PDND) and Parkinson's disease dementia (PDD). Fast plasma samples were obtained and untargeted liquid chromatography-mass spectrometry-based metabolomics analysis was performed. Based on the identified differentially-expressed metabolites from the metabolomics analysis, multivariate linear regression analyses and receiver operating characteristic (ROC) curves were further employed. According to the clinical data, the mean ages of PDND and PDD patients were significantly higher than those of healthy controls. The incidence of hypercholesterolemia was decreased in PDD patients. PDD patients also had lower levels of triglyceride, low-density lipoprotein cholesterol, and apolipoprotein B. There were 24 and 57 differentially expressed metabolites in PDD patients when compared with the healthy controls and PDND patients from the metabolomics analysis. Eleven lipid metabolites were simultaneously decreased between these two groups, and can be further subcategorized into fatty acyls, glycerolipids, glycerophospholipids, sphingolipids, and prenol lipids. The plasma levels of the eleven metabolites were positively correlated with MMSE score and can be candidate biomarkers for PDD patients with areas under the curve ranging from 0.724 to 0.806 based on the ROC curves. Plasma lipoproteins are significantly lower in PDD patients. A panel of eleven lipid metabolites were also decreased and can be candidate biomarkers for the diagnosis of PDD patients. Lipid metabolic dysregulation is involved in the pathogenesis of Parkinson's disease dementia.
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Affiliation(s)
- Mei-Xue Dong
- Department of Neurology, Renmin Hospital of Wuhan University, Hubei General Hospital, No. 99 Zhangzhidong Road, Wuchang District, Wuhan, Hubei, China
| | - You-Dong Wei
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ling Hu
- Department of Neurology, Renmin Hospital of Wuhan University, Hubei General Hospital, No. 99 Zhangzhidong Road, Wuchang District, Wuhan, Hubei, China.
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11
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Gan J, Liu S, Wu H, Chen Z, Fei M, Xu J, Dou Y, Wang X, Ji Y. The Impact of the COVID-19 Pandemic on Alzheimer's Disease and Other Dementias. Front Psychiatry 2021; 12:703481. [PMID: 34335338 PMCID: PMC8317553 DOI: 10.3389/fpsyt.2021.703481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Numerous countries went into lockdown to contain the COVID-19 outbreak, which has impeded follow-up of chronic diseases, such as cognitive impairment (CI). Cognitive and neuropsychiatric changes during the COVID-19 pandemic are neglected in China, which is the world's whistleblower. To investigate the cognitive and neuropsychologic changes in CI, as well as the proportions of rapid cognitive decline (RCD) before and during the COVID-19 pandemic to provide clinical evidence for CI intervention during a public health emergency. Methods: We performed a descriptive and retrospective study based on medical records from the memory clinic of Tianjin Dementia Institute collected through face-to-face evaluations. Information of 205 patients with CI, including patients with mild cognitive impairment and dementia, of whom 131 with Alzheimer's disease (AD) were analyzed and compared to a control group before the COVID-19 pandemic. Results: Among the 205 CI patients, the scores on the Chinese Mini Mental State Examination (C-MMSE), the Montreal Cognitive Assessment (MoCA), activities of daily living (ADLs), and the global Neuropsychiatric Inventory (NPI) were significantly different at the baseline and follow-up evaluations (p < 0.05) after 14.07 (±2.87) months. The same findings were recorded among AD patients, and they exhibited more sleep disturbances at the follow-up than at baseline (32.8 vs. 20.6%, p = 0.035). When compared to the control group, slightly worse performance of cognitive, -1.00 (-4.00, 1.00) from the C-MMSE, -1.00 (-2.00, 0.00) on the MoCA, 1.00 (0.00, 9.00) on ADLs and neuropsychological 0.00 (-1.00, 3.50) on the global NPI profile, at the follow-up were presented, particularly for delusion, agitation, irritability, and appetite disturbances (p < 0.05). Twenty-five (19.1%) AD patients and 48 (36.6%) controls suffered RCD during the COVID-19 pandemic. Moreover, AD patients during the COVID-19 pandemic were 0.408 times (95% confidence interval: 0.232-0.716) less likely to suffer RCD than the control. Conclusion: Confinement might ease the cognitive and neuropsychiatric deterioration of AD patients compared to those not in crisis and help prevent RCD in AD patients.
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Affiliation(s)
- Jinghuan Gan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuai Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.,Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China.,Graduate School of Tianjin Medical University, Tianjin, China
| | - Hao Wu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.,Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China.,Graduate School of Tianjin Medical University, Tianjin, China
| | - Zhichao Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Min Fei
- Graduate School of Tianjin Medical University, Tianjin, China.,Department of Neurology, Yuncheng Central Hospital of Shanxi Province, Shanxi, China
| | - Junying Xu
- Department of Neurology, Tianjin Baodi People's Hospital, Tianjin, China
| | - Yuchao Dou
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.,Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
| | - Xiaodan Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.,Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China
| | - Yong Ji
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.,Tianjin Key Laboratory of Cerebrovascular and of Neurodegenerative Diseases, Tianjin Dementia Institute, Tianjin, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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12
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Samaras K, Makkar SR, Crawford JD, Kochan NA, Slavin MJ, Wen W, Trollor JN, Brodaty H, Sachdev PS. Effects of Statins on Memory, Cognition, and Brain Volume in the Elderly. J Am Coll Cardiol 2019; 74:2554-2568. [DOI: 10.1016/j.jacc.2019.09.041] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 11/26/2022]
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13
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Vascular risk factors and the relationships between cognitive impairment and hypoperfusion in late-onset Alzheimer's disease. Acta Neuropsychiatr 2018; 30:350-358. [PMID: 30132427 DOI: 10.1017/neu.2018.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Our recent single-photon emission computed tomography (SPECT) study of patients with late-onset Alzheimer's disease (AD) revealed that regional cerebral blood flow (rCBF) was reduced in the frontal, temporal, and limbic lobes, and to a lesser degree in the parietal and occipital lobes. Moreover, these patients' scores on the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) were significantly correlated with rCBF in some gyri of the frontal, parietal, and limbic lobes. Our present study aimed to understand how vascular factors and metabolic disease influenced the relationship between rCBF and ADAS-cog scores. METHODS We divided late-onset AD patients into two groups according to their Hachinski Ischemic Score (HIS), low vascular risk patients had values of ≤4 (n=25) and high vascular risk patients had scores ≥5 (n=15). We examined rCBF using brain perfusion SPECT data. RESULTS The degrees and patterns of reduced rCBF were largely similar between late-onset AD patients in both groups, regardless of HIS values. Cognitive function was significantly associated with rCBF among late-onset AD patients with low vascular risk (HIS≤4), but not among those with high vascular risk (HIS≥5). Furthermore, metabolic diseases, such as hypertension and diabetes mellitus, disrupted the relationships between hypoperfusion and cognitive impairments in late-onset AD patients. CONCLUSION Factors other than hypoperfusion, such as hypertension and diabetes mellitus, could be involved in the cognitive dysfunction of late-onset AD patients with high vascular risk.
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14
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Tchalla AE, Clément JP, Saulnier I, Beaumatin B, Lachal F, Gayot C, Bosetti A, Desormais I, Perrochon A, Preux PM, Couratier P, Dantoine T. Predictors of Rapid Cognitive Decline in Patients with Mild-to-Moderate Alzheimer Disease: A Prospective Cohort Study with 12-Month Follow-Up Performed in Memory Clinics. Dement Geriatr Cogn Disord 2018; 45:56-65. [PMID: 29684916 DOI: 10.1159/000487938] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 02/22/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Alzheimer disease (AD) is particularly devastating, with no cure, no means of prevention, and no proven way to slow progression. AD is associated with the worsening of cognitive function attributable to a variety of factors of which little is known. Our main objective was to determine factors associated with rapid cognitive decline (RCD) in older AD patients. METHODS We conducted a 12-month, prospective, multi-centre cohort study. Community-living individuals aged ≥65 years with mild-to-moderate AD were included. RCD was defined as the loss of ≥3 points/year in the Mini-Mental State Examination (MMSE) score. Potential individual-level predictors were collected at baseline. RESULTS A total of 521 individuals were included. The mean age was 80.8 ± 9.0 years and 66.0% were females. The average baseline MMSE score was 20.5 ± 4.5. The incidence of RCD was 40.9% (95% confidence interval [CI], 36.7-45.1). RCD was more common in patients with moderate (53.5%) than mild (22.3%) AD. The factors associated with RCD were: a parental history of dementia (odds ratio [OR], 2.32 [95% CI, 1.24-4.21], p = 0.011), psychotic symptoms (OR, 2.06 [95% CI, 1.22-3.48], p = 0.007), malnutrition (OR, 1.61 [95% CI, 1.06-2.63], p = 0.028), and the female gender (OR, 1.48 [95% CI, 1.03-2.15], p = 0.036). An MMSE score < 20 at treatment onset was also associated with RCD (p < 0.001). CONCLUSION The factors associated with RCD were an MMSE score < 20 at treatment onset, female gender, psychotic symptoms, malnutrition, and a family history of dementia. These results may be directly relevant to patients, their families, and their physicians, enabling early anticipation of difficult clinical trajectories and poor functional outcomes.
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Affiliation(s)
- Achille E Tchalla
- CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France.,Université de Limoges, EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, Limoges, France.,Centre de Mémoire de Recherche et de Ressources (CMRR) du Limousin, CHU de Limoges, Limoges, France
| | - Jean-Pierre Clément
- Centre de Mémoire de Recherche et de Ressources (CMRR) du Limousin, CHU de Limoges, Limoges, France.,Université de Limoges, IFR 145 GEIST, Institut d'Epidémiologie Neurologique et de Neurologie Tropicale, INSERM, UMR 1094 NeuroEpidemiologie Tropicale, Limoges, France
| | - Isabelle Saulnier
- CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France.,Université de Limoges, EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, Limoges, France.,Centre de Mémoire de Recherche et de Ressources (CMRR) du Limousin, CHU de Limoges, Limoges, France
| | - Betty Beaumatin
- CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France.,Centre de Mémoire de Recherche et de Ressources (CMRR) du Limousin, CHU de Limoges, Limoges, France
| | - Florent Lachal
- CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France.,Université de Limoges, EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, Limoges, France
| | - Caroline Gayot
- CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France
| | - Anaïs Bosetti
- CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France
| | - Iléana Desormais
- Université de Limoges, IFR 145 GEIST, Institut d'Epidémiologie Neurologique et de Neurologie Tropicale, INSERM, UMR 1094 NeuroEpidemiologie Tropicale, Limoges, France
| | - Anaïck Perrochon
- Université de Limoges, EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, Limoges, France
| | - Pierre-Marie Preux
- Université de Limoges, IFR 145 GEIST, Institut d'Epidémiologie Neurologique et de Neurologie Tropicale, INSERM, UMR 1094 NeuroEpidemiologie Tropicale, Limoges, France
| | - Philippe Couratier
- Centre de Mémoire de Recherche et de Ressources (CMRR) du Limousin, CHU de Limoges, Limoges, France.,Université de Limoges, IFR 145 GEIST, Institut d'Epidémiologie Neurologique et de Neurologie Tropicale, INSERM, UMR 1094 NeuroEpidemiologie Tropicale, Limoges, France
| | - Thierry Dantoine
- CHU de Limoges, Pôle HU Gérontologie Clinique, Limoges, France.,Université de Limoges, EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, Limoges, France.,Centre de Mémoire de Recherche et de Ressources (CMRR) du Limousin, CHU de Limoges, Limoges, France
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15
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Abstract
Previous studies have indicated that statins use is associated with risk of dementia, but presented controversial results. Medline, Embase, Web of Science, and the Cochrane Database were searched update to November 2017 to identify the potential relationship between statins use and dementia. Thirty-one eligible studies involving a total of 3332,706 participants with 184,666 incident cases were included in this meta-analysis. Statins use was associated with dementia risk decrement (relevant risk [RR]: 0.85; 95% confidence interval [CI], 0.80-0.89). Subgroup analysis showed statins use was associated with Alzheimer disease (AD) (RR: 0.81; 95% CI, 0.73-0.89) and non-AD dementia (RR: 0.81; 95% CI, 0.73-0.89) risk decrement. Furthermore, statins use was associated with dementia risk decrement in female (RR: 0.89; 95% CI, 0.80-0.98) and male (RR: 0.88; 95% CI, 0.83-0.93). In addition, a dose-response showed per 1 year of duration of statins use incremental increase was associated with 20% dementia risk decrement (RR: 0.80; 95% CI, 0.73-0.87), and per 5-mg mean daily dose incremental increase in statins use was associated with 11% dementia risk decrement (RR: 0.89; 95% CI, 0.83-0.96). Statins use was associated with dementia risk decrement. The potency and the cumulative duration of statin utilized played critical roles.
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Affiliation(s)
- Xiaoyu Zhang
- Department of General Rehabilitation, Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing
| | - Jianzhong Wen
- Department of Anesthesiology, Second Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi
| | - Zhiqiang Zhang
- Department of Community Chronic Disease Research Center, Institute of Chinese Basic Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
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16
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Hypercholesterolaemia and vascular dementia. Clin Sci (Lond) 2017; 131:1561-1578. [PMID: 28667059 DOI: 10.1042/cs20160382] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 03/08/2017] [Accepted: 03/21/2017] [Indexed: 12/30/2022]
Abstract
Vascular dementia (VaD) is the second commonest cause of dementia. Stroke is the leading cause of disability in adults in developed countries, the second major cause of dementia and the third commonest cause of death. Traditional vascular risk factors-diabetes, hypercholesterolaemia, hypertension and smoking-are implicated as risk factors for VaD. The associations between cholesterol and small vessel disease (SVD), stroke, cognitive impairment and subsequent dementia are complex and as yet not fully understood. Similarly, the effects of lipids and lipid-lowering therapy on preventing or treating dementia remain unclear; the few trials that have assessed lipid-lowering therapy for preventing (two trials) or treating (four trials) dementia found no evidence to support the use of lipid-lowering therapy for these indications. It is appropriate to treat those patients with vascular risk factors that meet criteria for lipid-lowering therapy for the primary and secondary prevention of cardiovascular and cerebrovascular events, and in line with current guidelines. Managing the individual patient in a holistic manner according to his or her own vascular risk profile is recommended. Although the paucity of randomized controlled evidence makes for challenging clinical decision making, it provides multiple opportunities for on-going and future research, as discussed here.
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17
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O'Brien PD, Hinder LM, Callaghan BC, Feldman EL. Neurological consequences of obesity. Lancet Neurol 2017; 16:465-477. [PMID: 28504110 PMCID: PMC5657398 DOI: 10.1016/s1474-4422(17)30084-4] [Citation(s) in RCA: 303] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/09/2017] [Accepted: 03/15/2017] [Indexed: 02/07/2023]
Abstract
The high prevalence of obesity is associated with an enormous medical, social, and economic burden. The metabolic dysfunction, dyslipidaemia, and inflammation caused by obesity contribute to the development of a wide variety of disorders and effects on the nervous system. In the CNS, mild cognitive impairment can be attributed to obesity-induced alterations in hippocampal structure and function in some patients. Likewise, compromised hypothalamic function and subsequent defects in maintaining whole-body energy balance might be early events that contribute to weight gain and obesity development. In the peripheral nervous system, obesity-driven alterations in the autonomic nervous system prompt imbalances in sympathetic-parasympathetic activity, while alterations in the sensory-somatic nervous system underlie peripheral polyneuropathy, a common complication of diabetes. Pharmacotherapy and bariatric surgery are promising interventions for people with obesity that can improve neurological function. However, lifestyle interventions via dietary changes and exercise are the preferred approach to combat obesity and reduce its associated health risks.
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Affiliation(s)
| | - Lucy M Hinder
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | | | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
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18
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Vasantharekha R, Priyanka HP, Swarnalingam T, Srinivasan AV, ThyagaRajan S. Interrelationship between Mini-Mental State Examination scores and biochemical parameters in patients with mild cognitive impairment and Alzheimer's disease. Geriatr Gerontol Int 2016; 17:1737-1745. [PMID: 27921357 DOI: 10.1111/ggi.12957] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 07/30/2016] [Accepted: 09/20/2016] [Indexed: 11/30/2022]
Abstract
AIM The aim of the present study was to provide first-hand information about the prevalence of mild cognitive impairment (MCI) and Alzheimer's disease (AD) in Tamil Nadu, a southern state in India, and examine if there exists a relationship between cognitive functions and biochemical parameters in these patients. METHODS Surveys were collected from adults, older men and women (n = 3126) from different regions of Tamil Nadu, which were followed up after 12 months for 1337 participants. Mini-Mental State Examination (MMSE) scores, lipid profile, and liver function tests were carried out in the elderly, MCI and AD patients. Based on the MMSE scores, the elderly population was classified into old control (28.97 ± 1.49; n = 1868), MCI (19.58 ± 1.17; n = 734) and AD (7.18 ± 1.38; n = 304) groups. Peripheral blood samples were collected after overnight fast from both male and female volunteers (n = 40 per group) who were categorized as young adult control, old control, MCI and AD. RESULTS AD patients showed lower MMSE scores compared with the young adults, old and MCI groups, and MMSE further decreased at follow-up examination a year later. In the serum of AD patients, high-density lipoprotein, alkaline phosphatase activity and bilirubin levels were lower, whereas low-density lipoprotein, total cholesterol and triglycerides levels were higher. MMSE was positively correlated with high-density lipoprotein, and negatively correlated with other lipid parameters in AD. CONCLUSIONS Hypercholesterolemia is a risk factor for AD that might result in neurotoxicity and cognitive impairment. Dysfunction of lipoprotein and heme metabolism might also provide additional targets for AD diagnosis. Geriatr Gerontol Int 2017; 17: 1737-1745.
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Affiliation(s)
- Ramasamy Vasantharekha
- Integrative Medicine Laboratory, Department of Biotechnology, SRM University, Kattankulathur, Tamil Nadu, India
| | - Hannah P Priyanka
- Integrative Medicine Laboratory, Department of Biotechnology, SRM University, Kattankulathur, Tamil Nadu, India
| | - Thangavel Swarnalingam
- Department of Anesthesiology, Tagore Medical College Hospital and Research Center, Tamil Nadu, India
| | | | - Srinivasan ThyagaRajan
- Integrative Medicine Laboratory, Department of Biotechnology, SRM University, Kattankulathur, Tamil Nadu, India
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19
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Barbe C, Morrone I, Novella JL, Dramé M, Wolak-Thierry A, Aquino JP, Ankri J, Jolly D, Mahmoudi R. Predictive Factors of Rapid Cognitive Decline in Patients with Alzheimer Disease. Dement Geriatr Cogn Dis Extra 2016; 6:549-558. [PMID: 28101101 PMCID: PMC5216188 DOI: 10.1159/000450975] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/07/2016] [Indexed: 11/19/2022] Open
Abstract
Aim To determine predictive factors associated with rapid cognitive decline (RCD) in elderly patients suffering from Alzheimer disease (AD). Methods Patients suffering from mild to moderate AD were included. RCD was defined as the loss of at least 3 points on the Mini-Mental State Examination (MMSE) over 12 months. Factors associated with RCD were identified by logistic regression. Results Among 123 patients included, 61 were followed up until 12 months. RCD occurred in 46% of patients (n = 28). Polymedication (p < 0.0001), the fact that the caregiver was the child or spouse of the patient (p < 0.0001) and autonomy for washing (p < 0.0001) were protective factors against RCD, while the presence of caregiver burden (p < 0.0001) was shown to be a risk factor for RCD. Conclusion Early detection of the RCD risk in AD patients could make it possible to anticipate the patient's medical needs and adjust the care plan for caregiver burden.
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Affiliation(s)
- Coralie Barbe
- Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France; Department of Research and Public Health, Reims University Hospital, Reims, France
| | - Isabella Morrone
- Department of Geriatrics and Internal Medicine, Reims University Hospital, Reims, France
| | - J L Novella
- Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France; Department of Geriatrics and Internal Medicine, Reims University Hospital, Reims, France
| | - Moustapha Dramé
- Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France; Department of Research and Public Health, Reims University Hospital, Reims, France
| | - Aurore Wolak-Thierry
- Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France; Department of Research and Public Health, Reims University Hospital, Reims, France
| | | | - Joël Ankri
- Centre of Gerontology, Public Assistance, Hospitals of Paris, Paris Cedex, France
| | - Damien Jolly
- Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France; Department of Research and Public Health, Reims University Hospital, Reims, France
| | - Rachid Mahmoudi
- Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France; Department of Geriatrics and Internal Medicine, Reims University Hospital, Reims, France
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20
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Samaras K, Brodaty H, Sachdev PS. Does statin use cause memory decline in the elderly? Trends Cardiovasc Med 2016; 26:550-65. [DOI: 10.1016/j.tcm.2016.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/21/2016] [Accepted: 03/21/2016] [Indexed: 12/31/2022]
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21
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Dziedzic T, Pera J, Klimkowicz-Mrowiec A, Mroczko B, Slowik A. Biochemical and Radiological Markers of Alzheimer's Disease Progression. J Alzheimers Dis 2016; 50:623-44. [PMID: 26757184 DOI: 10.3233/ifs-150578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Alzheimer's disease (AD) is a neurodegenerative, inevitably progressive disease with a rate of cognitive, functional, and behavioral decline that varies highly from patient to patient. Although several clinical predictors of AD progression have been identified, to our mind in clinical practice there is a lack of a reliable biomarker that enables one to stratify the risk of deterioration. Identification of biomarkers that allow the monitoring of AD progression could change the way physicians and caregivers make treatment decisions. This review summarizes the results of studies on potential biochemical and radiological markers related to AD progression.
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Affiliation(s)
- Tomasz Dziedzic
- Department of Neurology, Jagiellonian University, Krakow, Poland
| | - Joanna Pera
- Department of Neurology, Jagiellonian University, Krakow, Poland
| | | | - Barbara Mroczko
- Department of Neurodegeneration Diagnostics, Medical University of Białystok, Poland.,Department of Biochemical Diagnostics, University Hospital, Białystok, Poland
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University, Krakow, Poland
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22
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Pallebage-Gamarallage M, Takechi R, Lam V, Elahy M, Mamo J. Pharmacological modulation of dietary lipid-induced cerebral capillary dysfunction: Considerations for reducing risk for Alzheimer's disease. Crit Rev Clin Lab Sci 2015; 53:166-83. [PMID: 26678521 DOI: 10.3109/10408363.2015.1115820] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
An increasing body of evidence suggests that cerebrovascular dysfunction and microvessel disease precede the evolution of hallmark pathological features that characterise Alzheimer's disease (AD), consistent with a causal association for onset or progression. Recent studies, principally in genetically unmanipulated animal models, suggest that chronic ingestion of diets enriched in saturated fats and cholesterol may compromise blood-brain barrier (BBB) integrity resulting in inappropriate blood-to-brain extravasation of plasma proteins, including lipid macromolecules that may be enriched in amyloid-β (Aβ). Brain parenchymal retention of blood proteins and lipoprotein bound Aβ is associated with heightened neurovascular inflammation, altered redox homeostasis and nitric oxide (NO) metabolism. Therefore, it is a reasonable proposition that lipid-lowering agents may positively modulate BBB integrity and by extension attenuate risk or progression of AD. In addition to their robust lipid lowering properties, reported beneficial effects of lipid-lowering agents were attributed to their pleiotropic properties via modulation of inflammation, oxidative stress, NO and Aβ metabolism. The review is a contemporary consideration of a complex body of literature intended to synthesise focussed consideration of mechanisms central to regulation of BBB function and integrity. Emphasis is given to dietary fat driven significant epidemiological evidence consistent with heightened risk amongst populations consuming greater amounts of saturated fats and cholesterol. In addition, potential neurovascular benefits associated with the use of hypolipidemic statins, probucol and fenofibrate are also presented in the context of lipid-lowering and pleiotropic properties.
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Affiliation(s)
- Menuka Pallebage-Gamarallage
- a Faculty of Health Sciences , School of Public Health Curtin University , Perth , WA , Australia and.,b Curtin Health Innovation Research Institute of Aging and Chronic Disease, Curtin University , Perth , WA , Australia
| | - Ryusuke Takechi
- a Faculty of Health Sciences , School of Public Health Curtin University , Perth , WA , Australia and.,b Curtin Health Innovation Research Institute of Aging and Chronic Disease, Curtin University , Perth , WA , Australia
| | - Virginie Lam
- a Faculty of Health Sciences , School of Public Health Curtin University , Perth , WA , Australia and.,b Curtin Health Innovation Research Institute of Aging and Chronic Disease, Curtin University , Perth , WA , Australia
| | - Mina Elahy
- a Faculty of Health Sciences , School of Public Health Curtin University , Perth , WA , Australia and.,b Curtin Health Innovation Research Institute of Aging and Chronic Disease, Curtin University , Perth , WA , Australia
| | - John Mamo
- a Faculty of Health Sciences , School of Public Health Curtin University , Perth , WA , Australia and.,b Curtin Health Innovation Research Institute of Aging and Chronic Disease, Curtin University , Perth , WA , Australia
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Xia W, Mo H. Potential of tocotrienols in the prevention and therapy of Alzheimer's disease. J Nutr Biochem 2015; 31:1-9. [PMID: 27133418 DOI: 10.1016/j.jnutbio.2015.10.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/19/2015] [Accepted: 10/23/2015] [Indexed: 02/07/2023]
Abstract
Currently there is no cure for Alzheimer's disease (AD); clinical trials are underway to reduce amyloid generation and deposition, a neuropathological hallmark in brains of AD patients. While genetic factors and neuroinflammation contribute significantly to AD pathogenesis, whether increased cholesterol level is a causative factor or a result of AD is equivocal. Prenylation of proteins regulating neuronal functions requires mevalonate-derived farnesyl pyrophosphate (FPP) and geranylgeranyl pyrophosphate (GGPP). The observation that the levels of FPP and GGPP, but not that of cholesterol, are elevated in AD patients is consistent with the finding that statins, competitive inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, reduce FPP and GGPP levels and amyloid β protein production in preclinical studies. Retrospective studies show inverse correlations between incidence of AD and the intake and serum levels of the HMG CoA reductase-suppressive tocotrienols; tocopherols show mixed results. Tocotrienols, but not tocopherols, block the processing and nuclear localization of sterol regulatory element binding protein-2, the transcriptional factor for HMG CoA reductase and FPP synthase, and enhance the degradation of HMG CoA reductase. Consequently, tocotrienols deplete the pool of FPP and GGPP and potentially blunt prenylation-dependent AD pathogenesis. The antiinflammatory activity of tocotrienols further contributes to their protection against AD. The mevalonate- and inflammation-suppressive activities of tocotrienols may represent those of an estimated 23,000 mevalonate-derived plant secondary metabolites called isoprenoids, many of which are neuroprotective. Tocotrienol-containing plant foods and tocotrienol derivatives and formulations with enhanced bioavailability may offer a novel approach in AD prevention and treatment.
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Affiliation(s)
- Weiming Xia
- Geriatric Research Education and Clinical Center, ENR Memorial Veterans Hospital, Bedford, MA.
| | - Huanbiao Mo
- Department of Nutrition, Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta, GA; Center for Obesity Reversal, Georgia State University, Atlanta, GA.
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Abstract
Dementia is a major public health concern, affecting an estimated 7% of the population over 65 and 30% over 80 years of age. There is mounting evidence in the literature from meta-analyses of high-quality prospective cohort studies that statins may have a positive impact in reducing the incidence of dementia. Little is known, however, on whether certain types of statins are more impactful than others. This narrative review specifically explores the various properties of different statin types and whether these differences lead to a clinically significant differential impact on cognitive function. We critically evaluate the literature, emphasizing interesting and important new findings, and overall aim to bring the reader up-to-date on evidence-based recommendations.
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Hendrie HC, Hake A, Lane K, Purnell C, Unverzagt F, Smith-Gamble V, Murrell J, Ogunniyi A, Baiyewu O, Callahan C, Saykin A, Taylor S, Hall K, Gao S. Statin Use, Incident Dementia and Alzheimer Disease in Elderly African Americans. Ethn Dis 2015; 25:345-54. [PMID: 26673814 DOI: 10.18865/ed.25.3.345] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To investigate the association between statin use, incident dementia, and Alzheimer disease (AD) in a prospective elderly African American cohort. DESIGN Two stage design with a screening interview followed by a comprehensive in-home assessment conducted over an eight-year period. Diagnoses of incident AD and dementia were made by consensus. Statin use was collected at each evaluation. Measurements of low-density lipoprotein cholesterol (LDL), C-reactive protein (CRP) and APOE genotype were obtained from baseline blood samples. Logistic regression models were used to test the association of statin use on incident dementia and AD and its possible association with lipid and CRP levels. SETTING Indianapolis, Indiana. PARTICIPANTS From an original cohort of 2629 participants, a subsample of 974 African Americans aged >70 years with normal cognition, at least one follow up evaluation, complete statin information, and biomarker availability were included. MAIN OUTCOME MEASURES Incident dementia and incident AD. RESULTS After controlling for age at diagnosis, sex, education level, presence of the APOE ε4 allele and history of stroke for the incident dementia model, baseline use of statins was associated with a significantly decreased risk of incident dementia (OR=.44, P=.029) and incident AD (OR=.40, P=.029). The significant effect of statin use on reduced AD risk and trend for dementia risk was found only for those participants who reported consistent use over the observational period (incident AD: P=.034; incident dementia: P=.061). Additional models found no significant interaction between baseline statin use, baseline LDL, or CRP level and incident dementia/AD. CONCLUSIONS Consistent use of statin medications during eight years of follow-up resulted in significantly reduced risk for incident AD and a trend toward reduced risk for incident dementia.
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Affiliation(s)
- Hugh C Hendrie
- 1. Center for Aging Research, Indiana University School of Medicine ; 4. Department of Psychiatry, Indiana University School of Medicine
| | - Ann Hake
- 2. Department of Neurology, Indiana University School of Medicine
| | - Kathleen Lane
- 3. Department of Biostatistics, Indiana University School of Medicine
| | | | | | | | - Jill Murrell
- 5. Department of Pathology and Laboratory Medicine, Indiana University School of Medicine
| | | | | | - Chris Callahan
- 1. Center for Aging Research, Indiana University School of Medicine
| | - Andrew Saykin
- 7. Center for Neuroimaging, Indiana University School of Medicine
| | - Stanley Taylor
- 3. Department of Biostatistics, Indiana University School of Medicine
| | - Kathleen Hall
- 4. Department of Psychiatry, Indiana University School of Medicine
| | - Su Gao
- 3. Department of Biostatistics, Indiana University School of Medicine
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Tedone E, Arosio B, Colombo F, Ferri E, Asselineau D, Piette F, Gussago C, Belmin J, Pariel S, Benlhassan K, Casati M, Bornand A, Rossi PD, Mazzola P, Annoni G, Doulazmi M, Mariani J, Porretti L, Bray DH, Mari D. Leukocyte Telomere Length in Alzheimer’s Disease Patients with a Different Rate of Progression. J Alzheimers Dis 2015; 46:761-9. [DOI: 10.3233/jad-142808] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Enzo Tedone
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - Beatrice Arosio
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
- Geriatric Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Federico Colombo
- Flow Cytometry Service, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Evelyn Ferri
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - Delphine Asselineau
- ImmunoClin Ltd, London, UK
- UPMC University Paris 06, UMR 8526 Biological Adaptation and Ageing (B2A) Team Brain Development, Repair and Aging (BDRA), Paris, France
- CNRS, UMR 8526 Biological Adaptation and Ageing (B2A) Team Brain Development, Repair and Aging (BDRA), Paris, France
| | - Francois Piette
- AP-HP, DHU FAST GH Pitie-Salpêtrière-Charles Foix, Paris, France
| | - Cristina Gussago
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - Joel Belmin
- AP-HP, DHU FAST GH Pitie-Salpêtrière-Charles Foix, Paris, France
| | - Sylvie Pariel
- AP-HP, DHU FAST GH Pitie-Salpêtrière-Charles Foix, Paris, France
| | | | - Martina Casati
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - Anne Bornand
- AP-HP, DHU FAST GH Pitie-Salpêtrière-Charles Foix, Paris, France
| | - Paolo Dionigi Rossi
- Geriatric Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Mazzola
- Geriatric Clinic, Department of Health Science, Milan Center for Neuroscience, University Study of Milano-Bicocca, Milan, Italy
| | - Giorgio Annoni
- Geriatric Clinic, Department of Health Science, Milan Center for Neuroscience, University Study of Milano-Bicocca, Milan, Italy
| | - Mohamed Doulazmi
- UPMC University Paris 06, UMR 8526 Biological Adaptation and Ageing (B2A) Team Brain Development, Repair and Aging (BDRA), Paris, France
- CNRS, UMR 8526 Biological Adaptation and Ageing (B2A) Team Brain Development, Repair and Aging (BDRA), Paris, France
- AP-HP, DHU FAST GH Pitie-Salpêtrière-Charles Foix, Paris, France
| | - Jean Mariani
- UPMC University Paris 06, UMR 8526 Biological Adaptation and Ageing (B2A) Team Brain Development, Repair and Aging (BDRA), Paris, France
- CNRS, UMR 8526 Biological Adaptation and Ageing (B2A) Team Brain Development, Repair and Aging (BDRA), Paris, France
- AP-HP, DHU FAST GH Pitie-Salpêtrière-Charles Foix, Paris, France
| | - Laura Porretti
- Flow Cytometry Service, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Daniela Mari
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
- Geriatric Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Churchward MA, Todd KG. Statin treatment affects cytokine release and phagocytic activity in primary cultured microglia through two separable mechanisms. Mol Brain 2014; 7:85. [PMID: 25424483 PMCID: PMC4247600 DOI: 10.1186/s13041-014-0085-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 11/08/2014] [Indexed: 12/14/2022] Open
Abstract
Background As the primary immune cells of the central nervous system, microglia contribute to development, homeostasis, and plasticity of the central nervous system, in addition to their well characterized roles in the foreign body and inflammatory responses. Increasingly, inappropriate activation of microglia is being reported as a component of inflammation in neurodegenerative and neuropsychiatric disorders. The statin class of cholesterol-lowering drugs have been observed to have anti-inflammatory and protective effects in both neurodegenerative diseases and ischemic stroke, and are suggested to act by attenuating microglial activity. Results We sought to investigate the effects of simvastatin treatment on the secretory profile and phagocytic activity of primary cultured rat microglia, and to dissect the mechanism of action of simvastatin on microglial activity. Simvastatin treatment altered the release of cytokines and trophic factors from microglia, including interleukin-1-β, tumour necrosis factor-α, and brain derived neurotrophic factor in a cholesterol-dependent manner. Conversely, simvastatin inhibited phagocytosis in microglia in a cholesterol-independent manner. Conclusions The disparity in cholesterol dependence of cytokine release and phagocytosis suggests the two effects occur through distinct molecular mechanisms. These two pathways may provide an opportunity for further refinement of pharmacotherapies for neuroinflammatory, neurodegenerative, and neuropsychiatric disorders.
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Affiliation(s)
- Matthew A Churchward
- Neurochemical Research Unit, University of Alberta Faculty of Medicine, Edmonton, AB, Canada, T6G 2R3. .,Department of Psychiatry, University of Alberta Faculty of Medicine, Edmonton, AB, Canada, T6G 2R3.
| | - Kathryn G Todd
- Neurochemical Research Unit, University of Alberta Faculty of Medicine, Edmonton, AB, Canada, T6G 2R3. .,Department of Psychiatry, University of Alberta Faculty of Medicine, Edmonton, AB, Canada, T6G 2R3. .,Neuroscience and Mental Health Institute, University of Alberta Faculty of Medicine, Edmonton, AB, Canada, T6G 2R3.
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Valenti R, Pantoni L, Markus HS. Treatment of vascular risk factors in patients with a diagnosis of Alzheimer's disease: a systematic review. BMC Med 2014; 12:160. [PMID: 25385407 PMCID: PMC4226862 DOI: 10.1186/s12916-014-0160-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 08/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing evidence suggests vascular risk factors (VRF) play a role in the pathogenesis of Alzheimer's disease (AD). Epidemiological studies have found associations between VRF and risk of AD. Treating VRF in patients with AD offers a potential treatment option but ineffective treatments should be avoided in this group who are frequently on multiple medications and in whom compliance may be challenging. METHODS Studies containing information on the treatment of VRF in patients with a diagnosis of AD were identified using a defined search strategy. Randomised controlled trials and observational studies were included. RESULTS The pre-specified search strategy retrieved 11,992 abstract articles, and 25 papers including those identified on review of reference lists and reviews met the inclusion criteria. Of these, 11 were randomised controlled trials (RCTs) and 14 observational studies. Observational studies suggested that a VRF package and treatment of hypertension and statin therapy may be associated with improved outcome but these studies suffered from potential bias. The few RCTs performed were mostly small with short duration follow-up, and do not provide clear evidence either way. CONCLUSIONS Observational data raises the possibility that treating VRF could alter the rate of decline in AD. However RCT data are not yet available to support this hypothesis and to alter clinical practice. RCTs in larger numbers of individuals with longer follow-up, ideally in the early stages of AD, are required to address this potentially important treatment question.
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Affiliation(s)
| | | | - Hugh S Markus
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
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Swaminathan A, Jicha GA. Nutrition and prevention of Alzheimer's dementia. Front Aging Neurosci 2014; 6:282. [PMID: 25368575 PMCID: PMC4202787 DOI: 10.3389/fnagi.2014.00282] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 09/25/2014] [Indexed: 11/13/2022] Open
Abstract
A nutritional approach to prevent, slow, or halt the progression of disease is a promising strategy that has been widely investigated. Much epidemiologic data suggests that nutritional intake may influence the development and progression of Alzheimer’s dementia (AD). Modifiable, environmental causes of AD include potential metabolic derangements caused by dietary insufficiency and or excess that may be corrected by nutritional supplementation and or dietary modification. Many nutritional supplements contain a myriad of health promoting constituents (anti-oxidants, vitamins, trace minerals, flavonoids, lipids, …etc.) that may have novel mechanisms of action affecting cellular health and regeneration, the aging process itself, or may specifically disrupt pathogenic pathways in the development of AD. Nutritional modifications have the advantage of being cost effective, easy to implement, socially acceptable and generally safe and devoid of significant adverse events in most cases. Many nutritional interventions have been studied and continue to be evaluated in hopes of finding a successful agent, combination of agents, or dietary modifications that can be used for the prevention and or treatment of AD. The current review focuses on several key nutritional compounds and dietary modifications that have been studied in humans, and further discusses the rationale underlying their potential utility for the prevention and treatment of AD.
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Affiliation(s)
- Arun Swaminathan
- Department of Neurology and Sanders-Brown Center on Aging, College of Medicine, University of Kentucky Lexington, KY, USA
| | - Gregory A Jicha
- Department of Neurology and Sanders-Brown Center on Aging, College of Medicine, University of Kentucky Lexington, KY, USA
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Abstract
BACKGROUND The use of statin therapy in established Alzheimer's disease (AD) or vascular dementia (VaD) is a relatively unexplored area. In AD, β-amyloid protein (Aβ) is deposited in the form of extracellular plaques and previous studies have determined Aβ generation is cholesterol dependent. Hypercholesterolaemia has also been implicated in the pathogenesis of VaD. Due to the role of statins in cholesterol reduction, it is biologically plausible they may be efficacious in the treatment of AD and VaD. OBJECTIVES To assess the clinical efficacy and safety of statins in the treatment of AD and VaD. To evaluate if the efficacy of statins in the treatment of AD and VaD depends on cholesterol level, ApoE genotype or cognitive level. SEARCH METHODS We searched ALOIS, the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group, The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS, as well as many trials registries and grey literature sources (20 January 2014). SELECTION CRITERIA Double-blind, randomised controlled trials of statins given for at least six months in people with a diagnosis of dementia. DATA COLLECTION AND ANALYSIS Two independent authors extracted and assessed data against the inclusion criteria. We pooled data where appropriate and entered them into a meta-analysis. We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We identified four studies (1154 participants, age range 50 to 90 years). All participants had a diagnosis of probable or possible AD according to standard criteria and most participants were established on a cholinesterase inhibitor. The primary outcome in all studies was change in Alzheimer's Disease Assessment Scale - cognitive subscale (ADAS-Cog) from baseline. When we pooled data, there was no significant benefit from statin (mean difference -0.26, 95% confidence interval (CI) -1.05 to 0.52, P value = 0.51). All studies provided change in Mini Mental State Examination (MMSE) from baseline. There was no significant benefit from statins in MMSE when we pooled the data (mean difference -0.32, 95% CI -0.71 to 0.06, P value = 0.10). Three studies reported treatment-related adverse effects. When we pooled data, there was no significant difference between statins and placebo (odds ratio 1.09, 95% CI 0.58 to 2.06, P value = 0.78). There was no significant difference in behaviour, global function or activities of daily living in the statin and placebo groups. We assessed risk of bias as low for all studies. We found no studies assessing role of statins in treatment of VaD. AUTHORS' CONCLUSIONS Analyses from the studies available, including two large randomised controlled trials, indicate that statins have no benefit on the primary outcome measures of ADAS-Cog or MMSE.
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Affiliation(s)
- Bernadette McGuinness
- Belfast Health and Social Care TrustDepartment of Geriatric MedicineLisburn RoadBelfastCo AntrimUK
| | - David Craig
- Craigavon Area HospitalGeriatric MedicineCraigavonNorthern IrelandUK
| | - Roger Bullock
- Kingshill Research Centre, Victoria HospitalOkus RoadSwindonUKSN4 4HZ
| | - Reem Malouf
- University of OxfordNational Perinatal Epidemiology Unit (NPEU)Old Road CampusOxfordUKOX3 7LF
| | - Peter Passmore
- Queen's University BelfastCentre for Public HealthBlock B, ICSB, Grosvenor RoadBelfastNorthern IrelandUKBT12
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Murao K, Bombois S, Cordonnier C, Hénon H, Bordet R, Pasquier F, Leys D. Influence of cognitive impairment on the management of ischaemic stroke. Rev Neurol (Paris) 2014; 170:177-86. [PMID: 24613474 DOI: 10.1016/j.neurol.2014.01.665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 01/03/2014] [Accepted: 01/30/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Because of ageing of the population, it is more and more frequent to treat ischaemic stroke patients with pre-stroke cognitive impairment (PSCI). Currently, there is no specific recommendation on ischaemic stroke management in these patients, both at the acute stage and in secondary prevention. However, these patients are less likely to receive treatments proven effective in randomised controlled trials, even in the absence of contra-indication. OBJECTIVE To review the literature to assess efficacy and safety of validated therapies for acute ischaemic stroke and secondary prevention in PSCI patients. RESULTS Most randomised trials did not take into account the pre-stroke cognitive status. The few observational studies conducted at the acute stage or in secondary prevention, did not provide any information that the benefit could be either lost or replaced by harm in the presence of PSCI. CONCLUSIONS There is no reason not to treat ischaemic stroke patients with PSCI according to the currently available recommendations for acute management and secondary prevention. Further observational studies are needed and pre-stroke cognition should be taken into account in future stroke trials.
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Affiliation(s)
- K Murao
- EA 1046, Departments of Neurology, University Lille North of France, UDSL, Lille University Hospital, 1, place de Verdun, 59045 Lille cedex, France
| | - S Bombois
- EA 1046, Departments of Neurology, University Lille North of France, UDSL, Lille University Hospital, 1, place de Verdun, 59045 Lille cedex, France; Departments of Neurology, Memory Centre, Lille University Hospital, 1, place de Verdun, 59045 Lille cedex, France.
| | - C Cordonnier
- EA 1046, Departments of Neurology, University Lille North of France, UDSL, Lille University Hospital, 1, place de Verdun, 59045 Lille cedex, France; Departments of Neurology, Stroke centre, Lille University Hospital, 1, place de Verdun, 59045 Lille cedex, France
| | - H Hénon
- EA 1046, Departments of Neurology, University Lille North of France, UDSL, Lille University Hospital, 1, place de Verdun, 59045 Lille cedex, France; Departments of Neurology, Stroke centre, Lille University Hospital, 1, place de Verdun, 59045 Lille cedex, France
| | - R Bordet
- EA 1046, Departments of Neurology, University Lille North of France, UDSL, Lille University Hospital, 1, place de Verdun, 59045 Lille cedex, France; Department, of Pharmacology. Lille University Hospital, 1, place de Verdun, 59045 Lille cedex, France
| | - F Pasquier
- EA 1046, Departments of Neurology, University Lille North of France, UDSL, Lille University Hospital, 1, place de Verdun, 59045 Lille cedex, France; Departments of Neurology, Memory Centre, Lille University Hospital, 1, place de Verdun, 59045 Lille cedex, France
| | - D Leys
- EA 1046, Departments of Neurology, University Lille North of France, UDSL, Lille University Hospital, 1, place de Verdun, 59045 Lille cedex, France; Departments of Neurology, Stroke centre, Lille University Hospital, 1, place de Verdun, 59045 Lille cedex, France
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Solomon A, Kivipelto M. Cholesterol-modifying strategies for Alzheimer’s disease. Expert Rev Neurother 2014; 9:695-709. [DOI: 10.1586/ern.09.25] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
BACKGROUND The rate of cognitive decline in Alzheimer's disease (AD) varies considerably between individuals. Predicting rapid cognitive decline might help clinicians provide prognostic information, select subjects for trial intervention and/or reduce costs. METHODS PubMed and PsycINFO were searched for all the English written studies published until the end of 2010 on rapid cognitive decline in AD and factors associated with it. RESULTS More than 300 individual articles were retrieved. We selected 82 relevant studies. The main findings of these papers are that younger, more educated and more impaired patients are more likely to show rapid cognitive decline. ApoE alleles seem not to modify the velocity of clinical progression of dementia, or at most could have a very small effect. No inference can be made for all the other variables analysed. CONCLUSIONS There are many studies on rapid cognitive decline. Results are heterogeneous and often contradictory. No reliable conclusions about factors that may be associated with rapid cognitive decline can yet be drawn.
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Affiliation(s)
- Alessandro Sona
- AOU San Giovanni Battista - Molinette, Geriatria e Malattie Metaboliche dell'Osso, Università degli Studi di Torino , Torino , Italia
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Steenland K, Zhao L, Goldstein FC, Levey AI. Statins and cognitive decline in older adults with normal cognition or mild cognitive impairment. J Am Geriatr Soc 2013; 61:1449-55. [PMID: 24000778 DOI: 10.1111/jgs.12414] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To determine the effect of statins on cognitive decline in healthy elderly adults. DESIGN Longitudinal. SETTING National Institute of Aging network of Alzheimer's Disease Centers. PARTICIPANTS Research volunteers with normal cognition at baseline evaluated an average 4.1 times over 3.4 years (1,244 statin users, 2,363 nonusers) and with mild cognitive impairment (MCI) at baseline evaluated an average 3.9 times over 2.8 years (763 users, 917 nonusers). MEASUREMENTS Cognitive performance was assessed according to 10 neuropsychological indices and the Clinical Dementia Rating Sum of Boxes (CDR-SOB). Repeated-measures analyses adjusted for age, sex, education, comorbidities, and family history of dementia were conducted. RESULTS Of participants with normal cognition at baseline, statin users performed significantly better across all visits in attention (Trails A) and had significantly slower annual worsening in CDR-SOB scores (P = .006) and slower worsening in Mini-Mental State Examination scores than nonusers (which was not significant after adjusting for multiple comparisons, P = .05). For participants with MCI, statin users performed significantly better across all visits on attention measures (Trail-Making Test Part A), verbal skills (Category Fluency), and executive functioning (Trail-Making Test Part B, Digit Symbol, and Digits Backward), but there were no differences in cognitive decline between users and nonusers. CONCLUSION Elderly adults with normal cognition at baseline who used statins had a slower rate of annual worsening in CDR-SOB than nonusers.
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Affiliation(s)
- Kyle Steenland
- Department of Environmental and Occupational Health, School of Public Health, Atlanta, Georgia
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Abstract
Whether cholesterol is implicated in the pathogenesis of Alzheimer's disease (AD) is still controversial. Several studies that explored the association between lipids and/or lipid-lowering treatment and AD indicate a harmful effect of dyslipidemia on AD risk. The findings are supported by genetic linkage and association studies that have clearly identified several genes involved in cholesterol metabolism or transport as AD susceptibility genes, including apolipoprotein E (APOE), apolipoprotein J (APOJ, CLU), ATP-binding cassette subfamily A member 7(ABCA7), and sortilin-related receptor (SORL1). Functional cell biology studies further support a critical involvement of lipid raft cholesterol in the modulation of Aβ precursor protein processing by β-secretase and γ-secretase resulting in altered Aβ production. However, conflicting evidence comes from epidemiological studies showing no or controversial association between dyslipidemia and AD risk, randomized clinical trials observing no beneficial effect of statin therapy, and cell biology studies suggesting that there is little exchange between circulating and brain cholesterol, that increased membrane cholesterol level is protective by inhibiting loss of membrane integrity through amyloid cytotoxicity, and that cellular cholesterol inhibits colocalization of β-secretase 1 and Aβ precursor protein in nonraft membrane domains, thereby increasing generation of plasmin, an Aβ-degrading enzyme. The aim of this article is to provide a comprehensive review of the findings of epidemiological, genetic, and cell biology studies aiming to elucidate the role of cholesterol in the pathogenesis of AD.
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McGuinness B, O'Hare J, Craig D, Bullock R, Malouf R, Passmore P. Cochrane review on 'Statins for the treatment of dementia'. Int J Geriatr Psychiatry 2013; 28:119-26. [PMID: 22473869 DOI: 10.1002/gps.3797] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 02/16/2012] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This review aimed to assess the clinical efficacy and tolerability of statins in the treatment of dementia. METHODS We searched the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group, The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS, as well as many trials registries and grey literature sources (27 October 2008). Double-blind, randomized controlled trials of statins given for at least 6 months in people with a diagnosis of dementia were included. Two independent authors extracted and assessed data independently against the inclusion criteria. Data were pooled where appropriate and entered into a meta-analysis. RESULTS Three studies were identified (748 participants, age range 50-90 years). All patients had a diagnosis of probable or possible Alzheimer's disease according to standard criteria, and most patients were established on a cholinesterase inhibitor. Change in Alzheimer's Disease Assessment Scale cognitive subscale from baseline was a primary outcome in three studies; when data were pooled, statins did not provide any beneficial effect in this cognitive measure (mean difference -1.12; 95% confidence interval -3.99, 1.75; p = 0.44). All studies provided a change in Mini-Mental State Examination from baseline; there was no significant benefit from statins in this cognitive measure when the data were pooled (mean difference -1.53; 95% confidence interval -3.28; 0.21, p = 0.08). There were no studies identified assessing the role of statins in treatment of vascular dementia. There was no evidence that statins were detrimental to cognition. CONCLUSIONS There is insufficient evidence to recommend statins for the treatment of dementia.
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Wolozin B. Statins and therapy of Alzheimer's disease: questions of efficacy versus trial design. ALZHEIMERS RESEARCH & THERAPY 2012; 4:3. [PMID: 22264400 PMCID: PMC3471428 DOI: 10.1186/alzrt101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Recent trials of statins produced no benefit for subjects with Alzheimer's disease. These negative studies add to a growing list of negative clinical trials. These data point to a need for reevaluating the pathophysiology of late-onset Alzheimer's disease. Late-onset Alzheimer's disease might result from the cumulative effects of at least four different factors: β-amyloid accumulation, cardiovascular disease, aging and the associated loss of synaptic plasticity, and inflammation. Successful therapy of subjects with overt dementia might require approaches targeting all four pathophysiological domains.
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Affiliation(s)
- Benjamin Wolozin
- Departments of Pharmacology and Neurology, Boston University School of Medicine, 715 Albany Street, Room R614, Boston, MA 02118-2526, USA.
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Shepardson NE, Shankar GM, Selkoe DJ. Cholesterol level and statin use in Alzheimer disease: II. Review of human trials and recommendations. ARCHIVES OF NEUROLOGY 2011; 68:1385-92. [PMID: 22084122 PMCID: PMC3248784 DOI: 10.1001/archneurol.2011.242] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Substantial evidence has accumulated in support of the hypothesis that elevated cholesterol levels increase the risk of developing Alzheimer disease (AD). As a result, much work has investigated the potential use of lipid-lowering agents, particularly statins, as preventive or therapeutic agents for AD. Although epidemiology and preclinical statin research (described in part I of this review) have generally supported an adverse role of high cholesterol levels regarding AD, human studies of statins (reviewed herein) show highly variable outcomes, making it difficult to draw firm conclusions. We identify several confounding factors among the human studies, including differing blood-brain barrier permeabilities among statins, the stage in AD at which statins were administered, and the drugs' pleiotropic metabolic effects, all of which contribute to the substantial variability observed to date. We recommend that future human studies of this important therapeutic topic (1) take the blood-brain barrier permeabilities of statins into account when analyzing results, (2) include specific analyses of the effects on low- and high-density lipoprotein cholesterol, and, most important, (3) conduct statin treatment trials solely in patients with mild AD, who have the best chance for disease modification.
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Affiliation(s)
- Nina E. Shepardson
- Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Ganesh M. Shankar
- Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Department of Neurological Surgery, Massachusetts General Hospital, Boston, MA
| | - Dennis J. Selkoe
- Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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Lesser G, Beeri M, Schmeidler J, Purohit D, Haroutunian V. Cholesterol and LDL relate to neuritic plaques and to APOE4 presence but not to neurofibrillary tangles. Curr Alzheimer Res 2011; 8:303-12. [PMID: 21244352 PMCID: PMC3267087 DOI: 10.2174/156720511795563755] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 11/10/2010] [Indexed: 11/22/2022]
Abstract
UNLABELLED Elevated serum total cholesterol (TC) has been considered a risk factor for Alzheimer's disease (AD), but conflicting results have confused understanding of the relationships of serum lipids to the presence of AD in the elderly. METHODS To clarify these issues, we evaluated correlations of admission TC, low-density (LDL) and high-density (HDL)cholesterol directly with the densities of Alzheimer hallmarks--neuritic plaques (NP) and neurofibrillary tangles (NFT)--in nursing home residents (n=281). RESULTS Significant positive associations of TC and LDL with NP densities were found in both the neocortex (TC: r=0.151, p=0.013 and LDL: r=0.190, p=0.005) and the hippocampal/entorhinal (allocortical)region (TC: r=0.182, p=0.002 and LDL: r=0.203, p=0.003). Associations of HDL with NP were less strong but also significant.In contrast, after adjustment for confounders, no correlations of NFT with any lipid were significant.When subjects with any non-AD neuropathology (largely vascular) were excluded, the TC-plaque and LDL-plaque associations for the remaining "Pure AD" subgroup were consistently stronger than for the full sample. The TC- and LDL-plaque correlations were also stronger for the subgroup of 87 subjects with an APOE ε4 allele. CONCLUSIONS The findings indicate that serum TC and LDL levels clearly relate to densities of NP, but not to densities of NFT. The stronger associations found in the subgroup that excluded all subjects with non-AD neuropathology suggest that cerebrovascular involvement does not explain these lipid-plaque relationships. Since the associations of TC/LDL with NP were particularly stronger in ε4 carriers, varying prevalence of this allele may explain some discrepancies among prior studies.
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Affiliation(s)
- G.T. Lesser
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY, USA
- Department of Medicine, Jewish Home Lifecare, New York, NY, USA
| | - M.S. Beeri
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - J. Schmeidler
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - D.P. Purohit
- Department of Pathology, Mount Sinai School of Medicine, New York, USA
| | - V. Haroutunian
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
- Bronx VA Medical Center, Bronx, NY, USA
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Abstract
BACKGROUND The use of statin therapy in established Alzheimer's disease (AD) or vascular dementia (VaD) is a relatively unexplored area. In AD ss-amyloid protein (Ass) is deposited in the form of extracellular plaques and previous studies have determined Ass generation is cholesterol dependent. Hypercholesterolaemia has also been implicated in the pathogenesis of VaD. Due to the role of statins in cholesterol reduction it is biologically plausible they may be efficacious in the treatment of AD and dementia. OBJECTIVES To assess the clinical efficacy and tolerability of statins in the treatment of dementia. SEARCH STRATEGY We searched the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group, The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS, as well as many trials registries and grey literature sources (27 October 2008). SELECTION CRITERIA Double-blind, randomized controlled trials of statins given for at least six months in people with a diagnosis of dementia. DATA COLLECTION AND ANALYSIS Two independent authors extracted and assessed data independently against the inclusion criteria. Data were pooled where appropriate and entered into a meta-analysis. MAIN RESULTS Three studies were identified (748 participants, age range 50-90 years). All patients had a diagnosis of probable or possible AD according to standard criteria and most patients were established on a cholinesterase inhibitor. Treatment in ADCLT 2005 consisted of 80mg atorvastatin compared to placebo for 52 weeks, serum low density lipoprotein (LDL) cholesterol was reduced by 54% in the atorvastatin group. Treatment in Simons 2002 consisted of 40mg simvastatin compared to placebo for 26 weeks, serum LDL cholesterol was reduced by 52% in the simvastatin group. Treatment in LEADe 2010 consisted of 80mg atorvastatin compared to placebo for 72 weeks, LDL cholesterol was reduced by 50.2% by month 3 and remained constant through month 18. Change in Alzheimer's Disease Assessment Scale- cognitive subscale (ADAS-Cog) from baseline was a primary outcome in 3 studies; when data were pooled there was considerable heterogeneity so the random effects model was used, statins did not provide any beneficial effect in this cognitive measure [mean difference -1.12, 95% CI -3.99, 1.75, p = 0.44]. All studies provided change in Mini Mental State Examination (MMSE) from baseline; again random effects model was used due to considerable heterogeneity: there was no significant benefit from statins in this cognitive measure when the data were pooled [mean difference -1.53, 95% CI -3.28, 0.21, p = 0.08]. There was some evidence that patients on statins in ADCLT 2005 maintained better cognitive function if serum cholesterol was high at baseline, MMSE was higher at baseline or if they had an apolipoprotein E4 allele present. This would need to be confirmed in larger studies however. Treatment related adverse effects were available from two studies, LEADe 2010 and Simons 2002; when data were pooled there was no significant difference between statins and placebo [odds ratio 2.45, 95% CI 0.69, 8.62, p = 0.16]. There was no significant difference in global function, behaviour or activities of daily living in the statin and placebo groups. One large randomised controlled trial (RCT) ( CLASP 2008) has not yet published its results. There were no studies identified assessing role of statins in treatment of VaD. There was no evidence that statins were detrimental to cognition. AUTHORS' CONCLUSIONS There is insufficient evidence to recommend statins for the treatment of dementia. Analysis from the studies available, including one large RCT, indicate statins have no benefit on the outcome measures ADAS-Cog or MMSE. We need to await full results from CLASP 2008 before we can be certain. This Cochrane review will be updated as these results become available.
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Affiliation(s)
- Bernadette McGuinness
- Department of Geriatric Medicine, Queen's University Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast, UK, BT9 7BL
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Schreurs BG. The effects of cholesterol on learning and memory. Neurosci Biobehav Rev 2010; 34:1366-79. [PMID: 20470821 PMCID: PMC2900496 DOI: 10.1016/j.neubiorev.2010.04.010] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 04/26/2010] [Accepted: 04/28/2010] [Indexed: 02/07/2023]
Abstract
Cholesterol is vital to normal brain function including learning and memory but that involvement is as complex as the synthesis, metabolism and excretion of cholesterol itself. Dietary cholesterol influences learning tasks from water maze to fear conditioning even though cholesterol does not cross the blood brain barrier. Excess cholesterol has many consequences including peripheral pathology that can signal brain via cholesterol metabolites, pro-inflammatory mediators and antioxidant processes. Manipulations of cholesterol within the central nervous system through genetic, pharmacological, or metabolic means circumvent the blood brain barrier and affect learning and memory but often in animals already otherwise compromised. The human literature is no less complex. Cholesterol reduction using statins improves memory in some cases but not others. There is also controversy over statin use to alleviate memory problems in Alzheimer's disease. Correlations of cholesterol and cognitive function are mixed and association studies find some genetic polymorphisms are related to cognitive function but others are not. In sum, the field is in flux with a number of seemingly contradictory results and many complexities. Nevertheless, understanding cholesterol effects on learning and memory is too important to ignore.
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Affiliation(s)
- Bernard G Schreurs
- Blanchette Rockefeller Neurosciences Institute and Department of Physiology and Pharmacology, West Virginia University School of Medicine, BRNI Building, Morgantown, WV 26505-3409-08, USA.
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Serrano-Pozo A, Vega GL, Lütjohann D, Locascio JJ, Tennis MK, Deng A, Atri A, Hyman BT, Irizarry MC, Growdon JH. Effects of simvastatin on cholesterol metabolism and Alzheimer disease biomarkers. Alzheimer Dis Assoc Disord 2010; 24:220-6. [PMID: 20473136 PMCID: PMC3694274 DOI: 10.1097/wad.0b013e3181d61fea] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Preclinical and epidemiologic studies suggest a protective effect of statins on Alzheimer disease (AD). Experimental evidence indicates that some statins can cross the blood-brain barrier, alter brain cholesterol metabolism, and may ultimately decrease the production of amyloid-beta (Abeta) peptide. Despite these promising leads, clinical trials have yielded inconsistent results regarding the benefits of statin treatment in AD. Seeking to detect a biological signal of statins effect on AD, we conducted a 12-week open-label trial with simvastatin 40 mg/d and then 80 mg/d in 12 patients with AD or amnestic mild cognitive impairment and hypercholesterolemia. We quantified cholesterol precursors and metabolites and AD biomarkers of Abeta and tau in both plasma and cerebrospinal fluid at baseline and after the 12-week treatment period. We found a modest but significant inhibition of brain cholesterol biosynthesis after simvastatin treatment, as indexed by a decrease of cerebrospinal fluid lathosterol and plasma 24S-hydroxycholesterol. Despite this effect, there were no changes in AD biomarkers. Our findings indicate that simvastatin treatment can affect brain cholesterol metabolism within 12 weeks, but did not alter molecular indices of AD pathology during this short-term treatment.
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Affiliation(s)
- Alberto Serrano-Pozo
- Memory Disorders Unit, Department of Neurology and Massachusetts Alzheimer's Disease Research Center. Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
- Servicio de Neurología, Instituto de Biomedicina de Sevilla (IBiS), Hospitales Universitarios Virgen del Rocío, Av. Manuel Siurot s/n, 41013 Seville, Spain
| | - Gloria L. Vega
- Department of Clinical Nutrition, Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dieter Lütjohann
- Institute of Clinical Chemistry and Pharmacology. University of Bonn, Bonn, Germany
| | - Joseph J. Locascio
- Memory Disorders Unit, Department of Neurology and Massachusetts Alzheimer's Disease Research Center. Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Marsha K. Tennis
- Memory Disorders Unit, Department of Neurology and Massachusetts Alzheimer's Disease Research Center. Massachusetts General Hospital, Boston
| | - Amy Deng
- Memory Disorders Unit, Department of Neurology and Massachusetts Alzheimer's Disease Research Center. Massachusetts General Hospital, Boston
| | - Alireza Atri
- Memory Disorders Unit, Department of Neurology and Massachusetts Alzheimer's Disease Research Center. Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
- Center for Translational Cognitive Neuroscience, and Geriatric Research, Education and Clinical Center, Veterans Administration Bedford Medical Center, Bedford, MA
| | - Bradley T. Hyman
- Memory Disorders Unit, Department of Neurology and Massachusetts Alzheimer's Disease Research Center. Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Michael C. Irizarry
- Memory Disorders Unit, Department of Neurology and Massachusetts Alzheimer's Disease Research Center. Massachusetts General Hospital, Boston
| | - John H. Growdon
- Memory Disorders Unit, Department of Neurology and Massachusetts Alzheimer's Disease Research Center. Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
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Hughes M, Snetkov V, Rose RS, Trousil S, Mermoud JE, Dingwall C. Neurite-like structures induced by mevalonate pathway blockade are due to the stability of cell adhesion foci and are enhanced by the presence of APP. J Neurochem 2010; 114:832-42. [PMID: 20477946 DOI: 10.1111/j.1471-4159.2010.06811.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Epidemiological studies have shown an association between statin use and a decreased risk of dementia. However, the mechanism by which this beneficial effect is brought about is unclear. In the context of Alzheimer's disease, at least three possibilities have been studied; reduction in amyloid beta peptide (Abeta) production, the promotion of alpha-secretase cleavage and positive effects on neurite outgrowth. By investigating the effects of mevalonate pathway blockade on neurite outgrowth using real-time imaging, we found that rather than promote the production of neurite extensions, inhibition rapidly induced cell rounding. Crucially, neurite-like structures were generated through the persistence of cell-cell and cell-substrate adhesions and not through a mechanism of positive outgrowth. This effect can be strikingly enhanced by the over-expression of human amyloid precursor protein and is isoprenoid rather than cholesterol dependent.
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Affiliation(s)
- Mary Hughes
- Pharmaceutical Sciences Division, King's College London, London, UK
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Lepara O, Valjevac A, Alajbegović A, Zaćiragić A, Nakas-Ićindić E. Decreased serum lipids in patients with probable Alzheimer's disease. Bosn J Basic Med Sci 2009; 9:215-20. [PMID: 19754476 DOI: 10.17305/bjbms.2009.2809] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Alzheimer;s disease (AD) is a multifactorial disease but its aetiology and pathophisiology are still not fully understood. Epidemiologic studies examining the association between lipids and dementia have reported conflicting results. High total cholesterol has been associated with both an increased, and decreased, risk of AD and/or vascular dementia (VAD), whereas other studies found no association. The aim of this study was to investigate the serum lipids concentration in patients with probable AD, as well as possible correlation between serum lipids concentrations and cognitive impairment. Our cross-sectional study included 30 patients with probable AD and 30 age and sex matched control subjects. The probable AD was clinically diagnosed by NINCDS-ADRDA criteria. Serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) levels were determined at the initial assessment using standard enzymatic colorimetric techniques. Low-density lipoprotein cholesterol (LDL-C) and very low density lipoprotein cholesterol (VLDL-C) levels were calculated. Subjects with probable AD had significantly lower serum TG (p<0,01), TC (p<0,05), LDL-C (p<0,05) and VLDL-C (p<0,01) compared to the control group. We did not observe significant difference in HDL-C level between patients with probable AD and control subjects. Negative, although not significant correlation between TG, TC and VLDL-C and MMSE in patients with AD was observed. In the control group of subjects there was a negative correlation between TC and MMSE but it was not statistically significant (r = -0,28). Further studies are required to explore the possibility for serum lipids to serve as diagnostic and therapeutic markers of AD.
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Affiliation(s)
- Orhan Lepara
- Institute of Physiology and Biochemistry, University of Sarajevo, Bosnia and Herzegovina
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Fong TG, Fearing MA, Jones RN, Shi P, Marcantonio ER, Rudolph JL, Yang FM, Kiely DK, Inouye SK. Telephone interview for cognitive status: Creating a crosswalk with the Mini-Mental State Examination. Alzheimers Dement 2009; 5:492-7. [PMID: 19647495 DOI: 10.1016/j.jalz.2009.02.007] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 02/09/2009] [Accepted: 02/24/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Brief cognitive screening measures are valuable tools for both research and clinical applications. The most widely used instrument, the Mini-Mental State Examination (MMSE), is limited in that it must be administered face-to-face, cannot be used in participants with visual or motor impairments, and is protected by copyright. Screening instruments such as the Telephone Interview for Cognitive Status (TICS) were developed to provide a valid alternative, with comparable cut-point scores to rate global cognitive function. METHODS The MMSE, TICS-30, and TICS-40 scores from 746 community-dwelling elders who participated in the Aging, Demographics, and Memory Study (ADAMS) were analyzed with equipercentile equating, a statistical process of determining comparable scores based on percentile equivalents for different forms of an examination. RESULTS Scores from the MMSE and TICS-30 and TICS-40 corresponded well, and clinically relevant cut-point scores were determined. For example, an MMSE score of 23 is equivalent to 17 and 20 on the TICS-30 and TICS-40, respectively. CONCLUSIONS These findings indicate that TICS and MMSE scores can be linked directly. Clinically relevant and important MMSE cut points and the respective ADAMS TICS-30 and TICS-40 cut-point scores are included, to identify the degree of cognitive impairment among respondents with any type of cognitive disorder. These results will help in the widespread application of TICS in both research and clinical practice.
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Affiliation(s)
- Tamara G Fong
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
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Interaction between HMGCR and ABCA1 cholesterol-related genes modulates Alzheimer's disease risk. Brain Res 2009; 1280:166-71. [DOI: 10.1016/j.brainres.2009.05.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 05/05/2009] [Accepted: 05/08/2009] [Indexed: 11/18/2022]
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Weinstein AM, Barton C, Ross L, Kramer JH, Yaffe K. Treatment practices of mild cognitive impairment in California Alzheimer's Disease Centers. J Am Geriatr Soc 2009; 57:686-90. [PMID: 19392962 DOI: 10.1111/j.1532-5415.2009.02200.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To examine "real world" treatments for patients with mild cognitive impairment (MCI). DESIGN Cross-sectional. SETTING California Department of Public Health Alzheimer's Disease (AD) Research Centers of California. PARTICIPANTS Five hundred seventy-eight patients diagnosed with MCI. MEASUREMENTS All patients underwent comprehensive neurological and neuropsychological evaluations. Logistic regression models were used to determine patient characteristics associated with use of anti-AD medications, statins, antioxidants, and folic acid. RESULTS One hundred sixty-six patients (28.7%) were taking anti-AD medications; use was associated with greater functional impairment, higher education, MCI subtype, and older age (P<.05 for all). Two hundred fifty-two patients (43.6%) were taking statins; use was associated with diabetes mellitus, hypertension, myocardial infarct, male sex, and MCI subtype (P<.05 for all). One hundred fifteen patients (19.9%) were taking antioxidants; use was associated with higher education and diabetes mellitus and varied according to site (P<.05 for all). Thirty-seven patients (6.4%) were taking folic acid; use was associated with nonwhite race, male sex, and greater functional impairment (P<.05 for all). CONCLUSION This study suggests that patients with MCI are frequently being treated with "off label" cholinesterase inhibitors and memantine, as well as other possible cognition-enhancing drugs. Further investigation of the effect of treatment patterns on the clinical course of MCI is needed.
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Affiliation(s)
- Andrea M Weinstein
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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Use of statins and risk of hospitalization with dementia: a Danish population-based case-control study. Alzheimer Dis Assoc Disord 2009; 23:18-22. [PMID: 18695588 DOI: 10.1097/wad.0b013e318180f55b] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Several epidemiologic studies have indicated reduced risk of dementia among users of statins. We assessed the risk of hospitalization with dementia associated with use of statins in a population-based case-control study in 4 Northern Danish counties in the period 1991 to 2005. We identified 11,039 cases with dementia and 110,340 age- matched and sex-matched population controls using data from the National Patient Registry, the Danish Psychiatric Central Register, and the Civil Registration System. Prescriptions for statins filled before the admission for dementia were identified using population-based prescription databases. We used conditional logistic regression analysis to compute relative risk of hospitalization with dementia associated with use of statins using nonusers as reference group. We found an overall reduced risk of hospitalization with dementia among statin users (adjusted odds ratio: 0.67, 95% confidence intervals: 0.60-0.75). The reduced risk associated with statin use remained robust in various subanalyses, however, we found no clear dose-response pattern between the number of filled prescriptions for statin and the risk of hospitalization with dementia. In conclusion, we found a reduced risk of hospitalization with dementia among users of statins, however, whether this association is causal remains to be clarified.
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Saxena U. Lipid metabolism and Alzheimer's disease: pathways and possibilities. Expert Opin Ther Targets 2009; 13:331-8. [DOI: 10.1517/14728220902738720] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Helzner EP, Luchsinger JA, Scarmeas N, Cosentino S, Brickman AM, Glymour MM, Stern Y. Contribution of vascular risk factors to the progression in Alzheimer disease. ARCHIVES OF NEUROLOGY 2009; 66:343-8. [PMID: 19273753 PMCID: PMC3105324 DOI: 10.1001/archneur.66.3.343] [Citation(s) in RCA: 213] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Vascular factors including medical history (heart disease, stroke, diabetes, and hypertension), smoking, and prediagnosis blood lipid measurements (cholesterol: total, high-density lipoprotein, low-density lipoprotein [LDL-C], and triglyceride concentrations) may be predictors for progression of Alzheimer disease (AD). OBJECTIVE To determine whether prediagnosis vascular risk factors are associated with progression of AD. DESIGN Inception cohort followed up longitudinally for a mean of 3.5 (up to 10.2) years. SETTING Washington Heights/Inwood Columbia Aging Project, New York, New York. Patients One hundred fifty-six patients with incident AD (mean age at diagnosis, 83 years). Main Outcome Measure Change in a composite score of cognitive ability from diagnosis onward. RESULTS In generalized estimating equation models (adjusted for age, race/ethnicity, and years of education), higher cholesterol (total cholesterol and LDL-C) concentrations and history of diabetes were associated with faster cognitive decline. Each 10-U increase in cholesterol and LDL-C was associated with a 0.10-SD decrease in cognitive score per year of follow-up (P < .001 for total cholesterol; P = .001 for LDL-C). High-density lipoprotein cholesterol and triglyceride concentrations were not associated with rate of decline. A history of diabetes was associated with an additional 0.05-SD decrease in cognitive score per year (P = .05). History of heart disease and stroke were associated with cognitive decline only in carriers of the apolipoprotein E epsilon4 (APOE-epsilon4) gene. In a final generalized estimating equation model that included high-density lipoprotein cholesterol and LDL-C concentrations and history of diabetes, only higher LDL-C was independently associated with faster cognitive decline. CONCLUSION Higher prediagnosis total cholesterol and LDL-C concentrations and history of diabetes were associated with faster cognitive decline in patients with incident AD, which provides further evidence for the role of vascular risk factors in the course of AD.
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Affiliation(s)
- Elizabeth P. Helzner
- Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, N.Y
| | - José A. Luchsinger
- Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, N.Y
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, N.Y
- Department of Neurology, Columbia University Medical Center, New York, N.Y
| | - Nikolaos Scarmeas
- Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, N.Y
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, N.Y
- Department of Neurology, Columbia University Medical Center, New York, N.Y
| | - Stephanie Cosentino
- Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, N.Y
| | - Adam M. Brickman
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, N.Y
| | - M. Maria Glymour
- Department of Epidemiology, Mailman School of Public Health at Columbia University
| | - Yaakov Stern
- Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, N.Y
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, N.Y
- Department of Neurology, Columbia University Medical Center, New York, N.Y
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