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Choe YM, Baek H, Choi HJ, Byun MS, Yi D, Sohn BK, Sohn CH, Lee DY. Association Between Enlarged Perivascular Spaces and Cognition in a Memory Clinic Population. Neurology 2022; 99:e1414-e1421. [PMID: 35764403 PMCID: PMC9576287 DOI: 10.1212/wnl.0000000000200910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/16/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although enlarged perivascular spaces (EPVS) have been suggested as an emerging measure of small vessel disease (SVD) in the brain, their association with cognitive impairment is not yet clearly understood. We aimed to examine the relationship between each EPVS in the basal ganglia (BG-EPVS) and centrum semiovale (CSO-EPVS) with cognition in a memory clinic population. METHODS Participants with a diverse cognitive spectrum were recruited from a university hospital memory clinic. They underwent comprehensive clinical and neuropsychological assessments and brain MRI. BG-EPVS and CSO-EPVS were measured on T2-weighted MRI and then dichotomized into low and high degrees for further analyses. Other SVD markers were assessed using validated rating scales. RESULTS A total of 910 participants were included in this study. A high degree of BG-EPVS was significantly associated with poorer scores on the executive function domain, but not with other cognitive domains, when age, sex, education, MRI scanner type, and cognitive diagnosis were controlled as covariates. However, the association between BG-EPVS and executive function was no longer significant after controlling for other markers of SVD, such as lacunar infarcts and periventricular white matter hyperintensities, as additional covariates. CSO-EPVS did not have a significant relationship with any cognitive scores, regardless of the covariates. DISCUSSION Our findings from a large memory clinic population suggest that EPVS, regardless of the topographical location, may not be used as a specific SVD marker for cognitive impairment, although an apparent association was observed between a high degree of BG-EPVS and executive dysfunction before controlling other SVD markers that share a common pathophysiologic process with BG-EPVS.
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Affiliation(s)
- Young Min Choe
- From the Department of Neuropsychiatry (Y.M.C.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neuropsychiatry (H.B.), Gyeonggi Provincial Hospital for the Elderly, Yongin; Department of Neuropsychiatry (H.J.C., M.S.B., D.Y.L.), Seoul National University Hospital; Department of Psychiatry (M.S.B., D.Y.L.), Seoul National University College of Medicine; Institute of Human Behavioral Medicine (D.Y., D.Y.L.), Seoul National University Medical Research Center; Department of Psychiatry (B.K.S.), Inje University Sanggye Paik Hospital, Seoul; and Department of Radiology (C.H.S.), Seoul National University Hospital, South Korea
| | - Hyewon Baek
- From the Department of Neuropsychiatry (Y.M.C.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neuropsychiatry (H.B.), Gyeonggi Provincial Hospital for the Elderly, Yongin; Department of Neuropsychiatry (H.J.C., M.S.B., D.Y.L.), Seoul National University Hospital; Department of Psychiatry (M.S.B., D.Y.L.), Seoul National University College of Medicine; Institute of Human Behavioral Medicine (D.Y., D.Y.L.), Seoul National University Medical Research Center; Department of Psychiatry (B.K.S.), Inje University Sanggye Paik Hospital, Seoul; and Department of Radiology (C.H.S.), Seoul National University Hospital, South Korea
| | - Hyo Jung Choi
- From the Department of Neuropsychiatry (Y.M.C.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neuropsychiatry (H.B.), Gyeonggi Provincial Hospital for the Elderly, Yongin; Department of Neuropsychiatry (H.J.C., M.S.B., D.Y.L.), Seoul National University Hospital; Department of Psychiatry (M.S.B., D.Y.L.), Seoul National University College of Medicine; Institute of Human Behavioral Medicine (D.Y., D.Y.L.), Seoul National University Medical Research Center; Department of Psychiatry (B.K.S.), Inje University Sanggye Paik Hospital, Seoul; and Department of Radiology (C.H.S.), Seoul National University Hospital, South Korea
| | - Min Soo Byun
- From the Department of Neuropsychiatry (Y.M.C.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neuropsychiatry (H.B.), Gyeonggi Provincial Hospital for the Elderly, Yongin; Department of Neuropsychiatry (H.J.C., M.S.B., D.Y.L.), Seoul National University Hospital; Department of Psychiatry (M.S.B., D.Y.L.), Seoul National University College of Medicine; Institute of Human Behavioral Medicine (D.Y., D.Y.L.), Seoul National University Medical Research Center; Department of Psychiatry (B.K.S.), Inje University Sanggye Paik Hospital, Seoul; and Department of Radiology (C.H.S.), Seoul National University Hospital, South Korea
| | - Dahyun Yi
- From the Department of Neuropsychiatry (Y.M.C.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neuropsychiatry (H.B.), Gyeonggi Provincial Hospital for the Elderly, Yongin; Department of Neuropsychiatry (H.J.C., M.S.B., D.Y.L.), Seoul National University Hospital; Department of Psychiatry (M.S.B., D.Y.L.), Seoul National University College of Medicine; Institute of Human Behavioral Medicine (D.Y., D.Y.L.), Seoul National University Medical Research Center; Department of Psychiatry (B.K.S.), Inje University Sanggye Paik Hospital, Seoul; and Department of Radiology (C.H.S.), Seoul National University Hospital, South Korea
| | - Bo Kyung Sohn
- From the Department of Neuropsychiatry (Y.M.C.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neuropsychiatry (H.B.), Gyeonggi Provincial Hospital for the Elderly, Yongin; Department of Neuropsychiatry (H.J.C., M.S.B., D.Y.L.), Seoul National University Hospital; Department of Psychiatry (M.S.B., D.Y.L.), Seoul National University College of Medicine; Institute of Human Behavioral Medicine (D.Y., D.Y.L.), Seoul National University Medical Research Center; Department of Psychiatry (B.K.S.), Inje University Sanggye Paik Hospital, Seoul; and Department of Radiology (C.H.S.), Seoul National University Hospital, South Korea
| | - Chul-Ho Sohn
- From the Department of Neuropsychiatry (Y.M.C.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neuropsychiatry (H.B.), Gyeonggi Provincial Hospital for the Elderly, Yongin; Department of Neuropsychiatry (H.J.C., M.S.B., D.Y.L.), Seoul National University Hospital; Department of Psychiatry (M.S.B., D.Y.L.), Seoul National University College of Medicine; Institute of Human Behavioral Medicine (D.Y., D.Y.L.), Seoul National University Medical Research Center; Department of Psychiatry (B.K.S.), Inje University Sanggye Paik Hospital, Seoul; and Department of Radiology (C.H.S.), Seoul National University Hospital, South Korea
| | - Dong Young Lee
- From the Department of Neuropsychiatry (Y.M.C.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neuropsychiatry (H.B.), Gyeonggi Provincial Hospital for the Elderly, Yongin; Department of Neuropsychiatry (H.J.C., M.S.B., D.Y.L.), Seoul National University Hospital; Department of Psychiatry (M.S.B., D.Y.L.), Seoul National University College of Medicine; Institute of Human Behavioral Medicine (D.Y., D.Y.L.), Seoul National University Medical Research Center; Department of Psychiatry (B.K.S.), Inje University Sanggye Paik Hospital, Seoul; and Department of Radiology (C.H.S.), Seoul National University Hospital, South Korea.
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Hwang JY, Byun MS, Choe YM, Lee JH, Yi D, Choi JW, Hwang SH, Lee YJ, Lee DY. Moderating effect of APOE ε4 on the relationship between sleep-wake cycle and brain β-amyloid. Neurology 2018; 90:e1167-e1173. [PMID: 29490913 DOI: 10.1212/wnl.0000000000005193] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 12/22/2017] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To clarify the relationships between sleep-wake cycle and cerebral β-amyloid (Aβ) deposition in cognitively normal (CN) older adults, focusing primarily on the moderating effects of the APOE ε4 allele. METHODS The present study included 133 CN older adults who participated in the Korean Brain Aging Study for Early Diagnosis & Prediction of Alzheimer's Disease cohort. All participants underwent [11C] Pittsburgh compound B-PET imaging to quantify Aβ deposition in the brain and blood sampling for APOE genotyping. Sleep and circadian parameters were measured using actigraphy for 8 consecutive days. RESULTS The APOE ε4 allele had moderating effects on the associations of sleep latency (SL), mesor, and acrophase with cerebral Aβ deposition, and the interactions between APOE ε4 status and SL and between APOE ε4 status and acrophase remained significant after adjusting for multiple comparisons. In APOE ε4 noncarriers, shorter SL, higher mesor, and advanced acrophase were associated with Aβ positivity. In contrast, APOE ε4 carriers showed a relationship between delayed acrophase and Aβ accumulation that approached but did not reach significance. After the Bonferroni correction, the associations of shorter SL and higher mesor with Aβ positivity remained significant for APOE ε4 noncarriers. CONCLUSIONS Our findings suggest that the APOE ε4 allele may act as a moderator in the relationship between the sleep-wake cycle and Aβ accumulation in CN older adults. Thus, APOE ε4 status needs to be considered as a key factor when designing related research or interventions.
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Affiliation(s)
- Jeong Yeon Hwang
- From the Department of Psychiatry (Y.J.L., D.Y.L.), Seoul National University College of Medicine (J.Y.H.); Medical Research Center, Institute of Human Behavioral Medicine (M.S.B., D.Y.L.), Seoul National University; Department of Neuropsychiatry (Y.M.C.), University of Ulsan College of Medicine, Ulsan University Hospital; Department of Psychiatry (J.-W.C.), Eulji General Hospital; Department of Neuropsychiatry (J.H.L., Y.J.L., D.Y.L.), Center for Sleep and Chronobiology (Y.J.L.), Seoul National University Hospital; and Health Service Group (S.H.H.), Samsung Electronics, Co., Ltd., Suwon, Republic of Korea
| | - Min Soo Byun
- From the Department of Psychiatry (Y.J.L., D.Y.L.), Seoul National University College of Medicine (J.Y.H.); Medical Research Center, Institute of Human Behavioral Medicine (M.S.B., D.Y.L.), Seoul National University; Department of Neuropsychiatry (Y.M.C.), University of Ulsan College of Medicine, Ulsan University Hospital; Department of Psychiatry (J.-W.C.), Eulji General Hospital; Department of Neuropsychiatry (J.H.L., Y.J.L., D.Y.L.), Center for Sleep and Chronobiology (Y.J.L.), Seoul National University Hospital; and Health Service Group (S.H.H.), Samsung Electronics, Co., Ltd., Suwon, Republic of Korea
| | - Young Min Choe
- From the Department of Psychiatry (Y.J.L., D.Y.L.), Seoul National University College of Medicine (J.Y.H.); Medical Research Center, Institute of Human Behavioral Medicine (M.S.B., D.Y.L.), Seoul National University; Department of Neuropsychiatry (Y.M.C.), University of Ulsan College of Medicine, Ulsan University Hospital; Department of Psychiatry (J.-W.C.), Eulji General Hospital; Department of Neuropsychiatry (J.H.L., Y.J.L., D.Y.L.), Center for Sleep and Chronobiology (Y.J.L.), Seoul National University Hospital; and Health Service Group (S.H.H.), Samsung Electronics, Co., Ltd., Suwon, Republic of Korea
| | - Jun Ho Lee
- From the Department of Psychiatry (Y.J.L., D.Y.L.), Seoul National University College of Medicine (J.Y.H.); Medical Research Center, Institute of Human Behavioral Medicine (M.S.B., D.Y.L.), Seoul National University; Department of Neuropsychiatry (Y.M.C.), University of Ulsan College of Medicine, Ulsan University Hospital; Department of Psychiatry (J.-W.C.), Eulji General Hospital; Department of Neuropsychiatry (J.H.L., Y.J.L., D.Y.L.), Center for Sleep and Chronobiology (Y.J.L.), Seoul National University Hospital; and Health Service Group (S.H.H.), Samsung Electronics, Co., Ltd., Suwon, Republic of Korea
| | - Dahyun Yi
- From the Department of Psychiatry (Y.J.L., D.Y.L.), Seoul National University College of Medicine (J.Y.H.); Medical Research Center, Institute of Human Behavioral Medicine (M.S.B., D.Y.L.), Seoul National University; Department of Neuropsychiatry (Y.M.C.), University of Ulsan College of Medicine, Ulsan University Hospital; Department of Psychiatry (J.-W.C.), Eulji General Hospital; Department of Neuropsychiatry (J.H.L., Y.J.L., D.Y.L.), Center for Sleep and Chronobiology (Y.J.L.), Seoul National University Hospital; and Health Service Group (S.H.H.), Samsung Electronics, Co., Ltd., Suwon, Republic of Korea
| | - Jae-Won Choi
- From the Department of Psychiatry (Y.J.L., D.Y.L.), Seoul National University College of Medicine (J.Y.H.); Medical Research Center, Institute of Human Behavioral Medicine (M.S.B., D.Y.L.), Seoul National University; Department of Neuropsychiatry (Y.M.C.), University of Ulsan College of Medicine, Ulsan University Hospital; Department of Psychiatry (J.-W.C.), Eulji General Hospital; Department of Neuropsychiatry (J.H.L., Y.J.L., D.Y.L.), Center for Sleep and Chronobiology (Y.J.L.), Seoul National University Hospital; and Health Service Group (S.H.H.), Samsung Electronics, Co., Ltd., Suwon, Republic of Korea
| | - Su Hwan Hwang
- From the Department of Psychiatry (Y.J.L., D.Y.L.), Seoul National University College of Medicine (J.Y.H.); Medical Research Center, Institute of Human Behavioral Medicine (M.S.B., D.Y.L.), Seoul National University; Department of Neuropsychiatry (Y.M.C.), University of Ulsan College of Medicine, Ulsan University Hospital; Department of Psychiatry (J.-W.C.), Eulji General Hospital; Department of Neuropsychiatry (J.H.L., Y.J.L., D.Y.L.), Center for Sleep and Chronobiology (Y.J.L.), Seoul National University Hospital; and Health Service Group (S.H.H.), Samsung Electronics, Co., Ltd., Suwon, Republic of Korea
| | - Yu Jin Lee
- From the Department of Psychiatry (Y.J.L., D.Y.L.), Seoul National University College of Medicine (J.Y.H.); Medical Research Center, Institute of Human Behavioral Medicine (M.S.B., D.Y.L.), Seoul National University; Department of Neuropsychiatry (Y.M.C.), University of Ulsan College of Medicine, Ulsan University Hospital; Department of Psychiatry (J.-W.C.), Eulji General Hospital; Department of Neuropsychiatry (J.H.L., Y.J.L., D.Y.L.), Center for Sleep and Chronobiology (Y.J.L.), Seoul National University Hospital; and Health Service Group (S.H.H.), Samsung Electronics, Co., Ltd., Suwon, Republic of Korea.
| | - Dong Young Lee
- From the Department of Psychiatry (Y.J.L., D.Y.L.), Seoul National University College of Medicine (J.Y.H.); Medical Research Center, Institute of Human Behavioral Medicine (M.S.B., D.Y.L.), Seoul National University; Department of Neuropsychiatry (Y.M.C.), University of Ulsan College of Medicine, Ulsan University Hospital; Department of Psychiatry (J.-W.C.), Eulji General Hospital; Department of Neuropsychiatry (J.H.L., Y.J.L., D.Y.L.), Center for Sleep and Chronobiology (Y.J.L.), Seoul National University Hospital; and Health Service Group (S.H.H.), Samsung Electronics, Co., Ltd., Suwon, Republic of Korea
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Verdelho A, Madureira S, Moleiro C, Ferro JM, Santos CO, Erkinjuntti T, Pantoni L, Fazekas F, Visser M, Waldemar G, Wallin A, Hennerici M, Inzitari D. White matter changes and diabetes predict cognitive decline in the elderly: the LADIS study. Neurology 2010; 75:160-7. [PMID: 20625169 DOI: 10.1212/wnl.0b013e3181e7ca05] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE We aimed to study if age-related white matter changes (WMC) and vascular risk factors were predictors of cognitive decline in elderly subjects with WMC living independently. METHODS The Leukoaraiosis and Disability prospective multinational European study (LADIS) evaluates the impact of WMC on the transition of independent elderly subjects into disability. Independent elderly were enrolled due to the presence of WMC. Subjects were evaluated yearly during 3 years with a comprehensive clinical protocol and a neuropsychological battery. Additionally, dementia, subtypes of dementia, and cognitive decline without dementia were classified according to usual clinical criteria. MRI was performed at entry and at the end of the study. RESULTS A total of 639 subjects were included (74.1 +/- 5 years, 55% women, 9.6 +/- 3.8 years of schooling). At end of follow-up, 90 patients had dementia and 147 had cognitive impairment no dementia. Using Cox regression analysis, WMC severity independently predicted cognitive decline (dementia and not dementia), independently of age, education, and medial temporal atrophy (MTA). Diabetes at baseline was the only vascular risk factor that independently predicted cognitive decline during follow-up, controlling for age, education, WMC severity, and temporal atrophy. Considering subtypes of dementia, Alzheimer disease (AD) was predicted only by MTA, while vascular dementia was predicted by previous stroke, WMC severity, and MTA. CONCLUSION WMC severity and diabetes are independent predictors of cognitive decline in an initially nondisabled elderly population. Vascular dementia is predicted by previous stroke and WMC, while AD is predicted only by MTA.
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Affiliation(s)
- A Verdelho
- Neurosciences Department, Lisbon University, Santa Maria Hospital, Lisbon, Portugal.
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Reed BR, Mungas D, Farias ST, Harvey D, Beckett L, Widaman K, Hinton L, DeCarli C. Measuring cognitive reserve based on the decomposition of episodic memory variance. Brain 2010; 133:2196-209. [PMID: 20591858 DOI: 10.1093/brain/awq154] [Citation(s) in RCA: 178] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
In later adulthood brain pathology becomes common and trajectories of cognitive change are heterogeneous. Among the multiple determinants of late-life cognitive course, cognitive reserve has been proposed as an important factor that modifies or buffers the impact of brain pathology on cognitive function. This article presents and investigates a novel method for measuring and investigating such factors. The core concept is that in a population where pathology is common and variably present, 'reserve' may be defined as the difference between the cognitive performance predicted by an individual's level of pathology and that individual's actual performance. By this definition, people whose measured cognitive performance is better than predicted by pathology have high reserve, whereas those who perform worse than predicted have low reserve. To test this hypothesis, we applied a latent variable model to data from a diverse ageing cohort and decomposed the variance in a measure of episodic memory into three components, one predicted by demographics, one predicted by pathology as measured by structural MRI and a 'residual' or 'reserve' term that included all remaining variance. To investigate the plausibility of this approach, we then tested the residual component as an operational measure of reserve. Specific predictions about the effects of this putative reserve measure were generated from a general conceptual model of reserve. Each was borne from the results. The results show that the current level of reserve, as measured by this decomposition approach, modifies rates of conversion from mild cognitive impairment to dementia, modifies rates of longitudinal decline in executive function and, most importantly, attenuates the effect of brain atrophy on cognitive decline such that atrophy is more strongly associated with cognitive decline in subjects with low reserve than in those with high reserve. Decomposing the variance in cognitive function scores offers a promising new approach to the measure and study of cognitive reserve.
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Affiliation(s)
- Bruce R Reed
- Department of Neurology, School of Medicine, University of California, Davis, CA, USA.
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Mungas D, Harvey D, Reed BR, Jagust WJ, DeCarli C, Beckett L, Mack WJ, Kramer JH, Weiner MW, Schuff N, Chui HC. Longitudinal volumetric MRI change and rate of cognitive decline. Neurology 2006; 65:565-71. [PMID: 16116117 PMCID: PMC1820871 DOI: 10.1212/01.wnl.0000172913.88973.0d] [Citation(s) in RCA: 212] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine how baseline and change of volumetric MRI relate to cognitive decline in older individuals. BACKGROUND Memory is associated with hippocampal integrity, whereas executive function has been linked to impaired frontal lobe function. Previous studies have shown that hippocampal and cortical atrophy are more strongly related to cognition than are measures of subcortical cerebrovascular disease (CVD). The authors hypothesized that memory (MEM) decline would be related to change in hippocampal volume (HC), whereas decline in executive function (EXEC) would be related to change of cortical gray matter volume (CGM) and measures of subcortical CVD. METHODS Subjects from a multicenter study (n = 103) included cognitively normal, mildly impaired, and demented cases with and without subcortical lacunes. All had longitudinal cognitive evaluation (mean = 4.8 years) and two or more MRI scans at least one year apart (mean = 3.4 years). MRI measures included HC, CGM, total lacune volume (LAC), and white matter hyperintensity volume (WMH). Random effects modeling of longitudinal data assessed effects of MRI baseline and MRI change on baseline and change of psychometrically matched measures of MEM and EXEC. RESULTS Change in MEM was related to HC baseline and HC change. Change in EXEC was related to baseline CGM and to change in CGM, HC, and LAC. Results were unchanged when demented cases were excluded. WMH was not associated with change in MEM or EXEC independent of HC, CGM, and LAC. CONCLUSION Hippocampal volume was the primary determinant of memory decline, whereas executive function (EXEC) decline was related to multiple brain components. Results support a hypothesis that MEM decline is strongly influenced by Alzheimer disease (AD), whereas EXEC decline may be complexly determined by cerebrovascular disease and AD.
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Affiliation(s)
- D Mungas
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, CA 95817, USA.
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