1
|
Beydoun MA, Beydoun HA, Georgescu MF, Maino Vieytes CA, Fanelli-Kuczmarski MT, Noren Hooten N, Evans MK, Zonderman AB. Plasma homocysteine and longitudinal change in cognitive function among urban adults. J Affect Disord 2024; 364:65-79. [PMID: 39134149 PMCID: PMC11423561 DOI: 10.1016/j.jad.2024.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 07/05/2024] [Accepted: 08/09/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Cross-sectional and longitudinal studies have inconsistently linked cognitive performance and change over time to an elevated level of homocysteine (Hcy), with few conducted among urban adults. METHODS Longitudinal data [Visit 1 (2004-2009) and Visit 2 (2009-2013)] were analyzed from up to 1430 selected Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) participants. Baseline and follow-up blood Hcy was measured, while 11 cognitive function test scores were assessed at either of these two visits. Overall, sex- and race-stratified associations were evaluated using mixed-effects linear regression models, adjusting for key potential confounders. Interaction effects between Hcy and serum levels of folate and vitamin B-12 were also tested. RESULTS We found that greater LnHcyv1 was significantly associated with poorer baseline attention based on higher Loge (TRAILS A, in seconds) [β (SE): 0.101 (0.031), P = 0.001]. Heterogeneity was also found by sex and by race. Most notably, among men only, LnHcyv1 was associated with faster decline on the BVRT (# of errors), a measure of visuo-spatial memory (β (SE): 0.297(0.115), P = 0.010, reduced model); while among African American adults only, an elevated and increasing LnHcy over time was associated with faster rate of decline on Loge (TRAILS B, in seconds) [β (SE): +0.012 (0.005), p = 0.008], a measure of executive function. Interactions between Hcy, folate and vitamin B-12 blood exposures were also detected. CONCLUSIONS In summary, sex- and race-specific adverse association between elevated Hcy and cognitive performance over time were detected among middle-aged urban adults, in domains of attention, visuo-spatial memory and executive functioning.
Collapse
Affiliation(s)
- May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD 21224, USA
| | - Hind A Beydoun
- VA National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Washington, DC 20420, USA; Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Michael F Georgescu
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD 21224, USA
| | - Christian A Maino Vieytes
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD 21224, USA
| | - Marie T Fanelli-Kuczmarski
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD 21224, USA
| | - Nicole Noren Hooten
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD 21224, USA
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD 21224, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD 21224, USA
| |
Collapse
|
2
|
Ramires Júnior OV, Silveira JS, Gusso D, Krupp Prauchner GR, Ferrary Deniz B, Almeida WD, Pereira LO, Wyse AT. Homocysteine decreases VEGF, EGF, and TrkB levels and increases CCL5/RANTES in the hippocampus: Neuroprotective effects of rivastigmine and ibuprofen. Chem Biol Interact 2024; 403:111260. [PMID: 39357784 DOI: 10.1016/j.cbi.2024.111260] [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: 04/30/2024] [Revised: 09/21/2024] [Accepted: 09/30/2024] [Indexed: 10/04/2024]
Abstract
Homocysteine (Hcy) is produced through methionine transmethylation. Elevated Hcy levels are termed Hyperhomocysteinemia (HHcy) and represent a risk factor for neurodegenerative conditions such as Alzheimer's disease. This study aimed to explore the impact of mild HHcy and the neuroprotective effects of ibuprofen and rivastigmine via immunohistochemical analysis of glial markers (Iba-1 and GFAP). Additionally, we assessed levels of vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), chemokine ligand 5 (CCL5/RANTES), CX3C chemokine ligand 1 (CX3CL1), and the NGF/p75NTR/tropomyosin kinase B (TrkB) pathway in the hippocampus of adult rats. Mild chronic HHcy was induced chemically in Wistar rats by subcutaneous administration of Hcy (4 mg/kg body weight) twice daily for 30 days. Rivastigmine (0.5 mg/kg) and ibuprofen (40 mg/kg) were administered intraperitoneally once daily. Results revealed elevated levels of CCL5/RANTES and reduced levels of VEGF, EGF, and TrkB in the hippocampus of HHcy-exposed rats. Rivastigmine mitigated the neurotoxic effects of HHcy by increasing TrkB and VEGF levels. Conversely, ibuprofen attenuated CCL5/RANTES levels against the neurotoxicity of HHcy, significantly reducing this chemokine's levels. HHcy-induced neurochemical impairment in the hippocampus may jeopardize neurogenesis, synapse formation, axonal transport, and inflammatory balance, leading to neurodegeneration. Treatments with rivastigmine and ibuprofen alleviated some of these detrimental effects. Reversing HHcy-induced damage through these compounds could serve as a potential neuroprotective strategy against brain damage.
Collapse
Affiliation(s)
- Osmar Vieira Ramires Júnior
- Program in Biological Sciences: Biochemistry, Institute of Basic Health Sciences (ICBS), Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Laboratory of Neuroprotection and Neurometabolic Diseases, Department of Biochemistry, ICBS, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Anexo, Zip code 90035003, Porto Alegre, RS, Brazil
| | - Josiane Silva Silveira
- Laboratory of Neuroprotection and Neurometabolic Diseases, Department of Biochemistry, ICBS, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Anexo, Zip code 90035003, Porto Alegre, RS, Brazil
| | - Darlan Gusso
- Program in Biological Sciences: Biochemistry, Institute of Basic Health Sciences (ICBS), Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Laboratory of Neuroprotection and Neurometabolic Diseases, Department of Biochemistry, ICBS, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Anexo, Zip code 90035003, Porto Alegre, RS, Brazil
| | - Gustavo Ricardo Krupp Prauchner
- Program in Biological Sciences: Biochemistry, Institute of Basic Health Sciences (ICBS), Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Laboratory of Neuroprotection and Neurometabolic Diseases, Department of Biochemistry, ICBS, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Anexo, Zip code 90035003, Porto Alegre, RS, Brazil
| | - Bruna Ferrary Deniz
- Departamento de Ciências Morfológicas, ICBS, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Departamento de Fisiologia e Farmacologia, Instiruto de Biologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Wellington de Almeida
- Program in Neurosciences, ICBS, Federal Universityof Rio Grande do Sul, Porto Alegre, RS, Brazil; Departamento de Ciências Morfológicas, ICBS, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Lenir Orlandi Pereira
- Program in Neurosciences, ICBS, Federal Universityof Rio Grande do Sul, Porto Alegre, RS, Brazil; Departamento de Ciências Morfológicas, ICBS, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Angela Ts Wyse
- Program in Biological Sciences: Biochemistry, Institute of Basic Health Sciences (ICBS), Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Laboratory of Neuroprotection and Neurometabolic Diseases, Department of Biochemistry, ICBS, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Anexo, Zip code 90035003, Porto Alegre, RS, Brazil.
| |
Collapse
|
3
|
MELEK İM, KUŞ B, KAPTAN Z, PETEKKAYA E. Correlation of metal ions with specific brain region volumes in neurodegenerative diseases. Turk J Med Sci 2023; 53:1465-1475. [PMID: 38812995 PMCID: PMC10763799 DOI: 10.55730/1300-0144.5714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 10/26/2023] [Accepted: 08/26/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim There are reports stating that deteriorations in metal homeostasis in neurodegenerative diseases promote abnormal protein accumulation. In this study, the serum metal levels in Alzheimer's disease (AD) and Parkinson's disease (PD) and its relationship with the cortical regions of the brain were investigated. Materials and methods The patients were divided into 3 groups consisting of the AD group, PD group, and healthy control group (n = 15 for each). The volumes of specific brain regions were measured over the participants' 3-dimensional magnetic resonance images, and they were compared across the groups. Copper, zinc, iron, and ferritin levels in the serums were determined, and their correlations with the brain region volumes were examined. Results The volumes of left hippocampus and right substantia nigra were lower in the AD and PD groups, while the volume of the left nucleus caudatus (CdN) and bilateral insula were lower in the AD group compared to the control group. Serum zinc levels were lower in the AD and PD groups, while the iron level was lower in the PD group in comparison to the control group. In addition, the serum ferritin level was higher in the AD group than in the control group. Serum zinc and copper levels in the AD group were positively correlated with the volumes of the right entorhinal cortex, thalamus, CdN, and insula. Serum zinc and copper levels in the PD group showed a negative correlation with the left nucleus accumbens (NAc), right putamen, and right insula volumes. While the serum ferritin level in the PD group displayed a positive correlation with the bilateral CdN, putamen, and NAc, as well as the right hippocampus and insula volumes, no area was detected that showed a correlation with the serum ferritin level in the AD group. Conclusion A relationship was determined between the serum metal levels in the AD and PD groups and certain brain cortical regions that showed volumetric changes, which can be important for the early diagnosis of neurodegenerative diseases.
Collapse
Affiliation(s)
- İsmet Murat MELEK
- Department of Neurology, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay,
Turkiye
| | - Berna KUŞ
- Department of Biochemistry, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay,
Turkiye
| | - Zülal KAPTAN
- Department of Physiology, Faculty of Medicine, Beykent University, İstanbul,
Turkiye
| | - Emine PETEKKAYA
- Department of Anatomy, Faculty of Medicine, Kastamonu University, Kastamonu,
Turkiye
| |
Collapse
|
4
|
Nguyen VP, Collins AE, Hickey JP, Pfeifer JA, Kalisch BE. Sex Differences in the Level of Homocysteine in Alzheimer's Disease and Parkinson's Disease Patients: A Meta-Analysis. Brain Sci 2023; 13:brainsci13010153. [PMID: 36672134 PMCID: PMC9856546 DOI: 10.3390/brainsci13010153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/08/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Although recent studies suggest homocysteine (Hcy) is an independent risk factor for neurodegenerative disorders, little is known about sex differences in the levels of Hcy. In this study, we conducted a comparative meta-analysis to investigate sex differences in the levels of Hcy in both Alzheimer’s disease (AD) and Parkinson’s disease (PD) patients. Reports of Hcy stratified by sex in both AD and PD patients were obtained from electronic databases. From the initial 1595 records, 921 were assessed for eligibility, of which 16 sufficiently reported sex differences. Standardized mean difference (SMDs) using random effects together with tests of heterogeneity and quality assessment were applied in this meta-analysis. Data from 3082 diagnosed patients (1162 males and 1920 females) were included. There were statistically significant differences in the levels of Hcy between sexes in AD and PD patients, with an SMD of 0.291 [0.17, 0.41], p < 0.05, 95% CI, with higher Hcy levels detected in males. Subgroup comparisons did not find a statistically significant difference in the levels of Hcy between AD and PD patients. The overall risk of bias for the analyzed studies was low, with some moderate risk of bias across select domains. This meta-analysis determined that compared to females, males with either AD or PD have higher levels of Hcy. These findings suggest that Hcy could be a useful biomarker for predicting neurodegenerative diseases in males; however, further studies are needed to confirm the clinical utility of this suggestion.
Collapse
|
5
|
Luzzi S, Cherubini V, Falsetti L, Viticchi G, Silvestrini M, Toraldo A. Homocysteine, Cognitive Functions, and Degenerative Dementias: State of the Art. Biomedicines 2022; 10:2741. [PMID: 36359260 PMCID: PMC9687733 DOI: 10.3390/biomedicines10112741] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 07/30/2023] Open
Abstract
There is strong evidence that homocysteine is a risk factor not only for cerebrovascular diseases but also for degenerative dementias. A recent consensus statement renewed the importance and the role of high levels of homocysteine in cognitive decline in several forms of degenerative dementia, such as Alzheimer's disease. Although the molecular mechanisms by which homocysteine causes cell dysfunction are known, both the impact of homocysteine on specific cognitive functions and the relationship between homocysteine level and non-Alzheimer dementias have been poorly investigated. Most of the studies addressing the impact of hyperhomocysteinemia on dementias have not examined the profile of performance across different cognitive domains, and have only relied on screening tests, which provide a very general and coarse-grained picture of the cognitive status of the patients. Yet, trying to understand whether hyperhomocysteinemia is associated with the impairment of specific cognitive functions would be crucial, as it would be, in parallel, learning whether some brain circuits are particularly susceptible to the damage caused by hyperhomocysteinemia. These steps would allow one to (i) understand the actual role of homocysteine in the pathogenesis of cognitive decline and (ii) improve the diagnostic accuracy, differential diagnosis and prognostic implications. This review is aimed at exploring and revising the state of the art of these two strictly related domains. Suggestions for future research are provided.
Collapse
Affiliation(s)
- Simona Luzzi
- Neurology Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Veronica Cherubini
- Neurology Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Lorenzo Falsetti
- Internal and Subintensive Medicine Department, Azienda Ospedaliero-Universitaria “Ospedali Riuniti” di Ancona, 60126 Ancona, Italy
| | - Giovanna Viticchi
- Neurology Unit, Azienda Ospedaliero-Universitaria “Ospedali Riuniti” di Ancona, 60126 Ancona, Italy
| | - Mauro Silvestrini
- Neurology Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Alessio Toraldo
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Milan Center for Neuroscience (NeuroMI), 20126 Milan, Italy
| |
Collapse
|
6
|
Xiang Y, Song F, Jiang L, Liu Z, Tu Y. A novel fluorescent nano carbon quantum dots derived from Lactarius hatsudake for high selective vitamin B12 detection. J AOAC Int 2022; 105:1350-1359. [PMID: 35244160 DOI: 10.1093/jaoacint/qsac033] [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: 12/19/2021] [Revised: 01/27/2022] [Accepted: 02/24/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND (OBJECTIVE) A large edible fungus Lactarius hatsudake (Lh) was used as carbon source to produce fluorescent carbon dots (CDs) with high quantum yield and high photostability by one-step hydrothermal method. METHODS The structure and optical properties of Lh-CDs were characterized by XRD, XPS, FTIR, and UV-Vis, and the stability of Lh-CDs was studied. The maximum excitation wavelength and emission wavelength of Lh-CDs were 324 and 408 nm, respectively, and the average fluorescence lifetime was 2.29 ns. RESULTS The linear range is 0∼20 μM (R2=0.9972) with detection limit of 36.9 nM. HIGHLIGHTS At the same time, the mechanism of fluorescence quenching was internal filtration effect. CONCLUSION It showed that Lh-CDS had good selectivity, high sensitivity, and good anti-interference ability to VB12, which provided a new detection method for VB12.
Collapse
Affiliation(s)
- Yingying Xiang
- Department of Stomatology, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, 650031 China
| | - Fei Song
- Department of Minimally Invasive Intervention, the Third Affiliated Hospital of Kunming Medical University, Kunming, 650118 China
| | - Lei Jiang
- School of Chemistry and Chemical Engineering, Kunming University, 650214 China
| | - Ze Liu
- School of Chemistry and Chemical Engineering, Kunming University, 650214 China
| | - Yujiao Tu
- School of Chemistry and Chemical Engineering, Kunming University, 650214 China
| |
Collapse
|
7
|
Wang Z, Zhu W, Xing Y, Jia J, Tang Y. B vitamins and prevention of cognitive decline and incident dementia: a systematic review and meta-analysis. Nutr Rev 2021; 80:931-949. [PMID: 34432056 DOI: 10.1093/nutrit/nuab057] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
CONTEXT Elevation of homocysteine (Hcy) levels is well-established as a risk factor for dementia, yet controversy exists regarding whether B-vitamin-mediated reduction of homocysteine levels can benefit cognitive function. OBJECTIVE To investigate whether B vitamin supplementation can reduce the risk of cognitive decline and incident dementia. DATA SOURCES The PubMed, EMBASE, Cochrane Library, and Web of Science were systematically searched for articles published from the inception dates to March 1, 2020. Randomized controlled trials (RCT) were included if B vitamins were supplied to investigate their effect on the rate of cognitive decline. Cohort studies investigating dietary intake of B vitamins and the risk of incident dementia were eligible. Cross-sectional studies comparing differences in levels of B vitamins and Hcy were included. DATA EXTRACTION Two reviewers independently performed data extraction and assessed the study quality. DATA ANALYSIS Random-effect or fixed-effect models, depending on the degree of heterogeneity, were performed to calculate mean differences (MDs), hazard ratios (HRs), and odds ratios (ORs). RESULTS A total of 95 studies with 46175 participants (25 RCTs, 20 cohort studies, and 50 cross-sectional studies) were included in this meta-analysis. This meta-analysis supports that B vitamins can benefit cognitive function as measured by Mini-Mental State Examination score changes (6155 participants; MD, 0.14, 95%CI 0.04 to 0.23), and this result was also significant in studies where placebo groups developed cognitive decline (4211 participants; MD, 0.16, 95%CI 0.05 to 0.26), suggesting that B vitamins slow cognitive decline. For the > 12 months interventional period stratum, B vitamin supplementation decreased cognitive decline (3814 participants; MD, 0.15, 95%CI 0.05 to 0.26) compared to placebo; no such outcome was detected for the shorter interventional stratum (806 participants; MD, 0.18, 95%CI -0.25 to 0.61). In the non-dementia population, B vitamin supplementation slowed cognitive decline (3431 participants; MD, 0.15, 95%CI 0.04 to 0.25) compared to placebo; this outcome was not found for the dementia population (642 participants; MD, 0.20, 95%CI -0.35 to 0.75). Lower folate levels (but not B12 or B6 deficiency) and higher Hcy levels were significantly associated with higher risks of dementia (folate: 6654 participants; OR, 1.76, 95%CI 1.24 to 2.50; Hcy: 12665 participants; OR, 2.09, 95%CI 1.60 to 2.74) and cognitive decline (folate: 4336 participants; OR, 1.26, 95%CI 1.02 to 1.55; Hcy: 6149 participants; OR, 1.19, 95%CI 1.05 to 1.34). Among the population without dementia aged 50 years and above, the risk of incident dementia was significantly decreased among individuals with higher intake of folate (13529 participants; HR, 0.61, 95%CI 0.47 to 0.78), whereas higher intake of B12 or B6 was not associated with lower dementia risk. CONCLUSIONS This meta-analysis suggests that B vitamin supplementation is associated with slowing of cognitive decline, especially in populations who received early intervention and intervention of long duration; the study also indicates that higher intake of dietary folate, but not B12 or B6, is associated with a reduced risk of incident dementia in non-dementia aged population. Given the prevalence of dementia cases in many countries with aging populations, public health policies should be introduced to ensure that subgroups of the population at risk have an adequate B vitamin status.
Collapse
Affiliation(s)
- Zhibin Wang
- Zhibin Wang, Wei Zhu, Yi Xing, Jianping Jia, and Yi Tang are with the Innovation Center for Neurological Disorders, Department of Neurology, Xuanwu Hospital, Capital Medical University, National Center for Neurological Disorders, Beijing, China. Jianping Jia is with the Beijing Key Laboratory of Geriatric Cognitive Disorders, Beijing, China. Jianping Jia is with the Clinical Center for Neurodegenerative Disease and Memory Impairment, Capital Medical University, Beijing, China. Jianping Jia is with the Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China. Yi Tang is with the Neurodegenerative Laboratory of Ministry of Education of the Peoples Republic of China, Beijing, China
| | - Wei Zhu
- Zhibin Wang, Wei Zhu, Yi Xing, Jianping Jia, and Yi Tang are with the Innovation Center for Neurological Disorders, Department of Neurology, Xuanwu Hospital, Capital Medical University, National Center for Neurological Disorders, Beijing, China. Jianping Jia is with the Beijing Key Laboratory of Geriatric Cognitive Disorders, Beijing, China. Jianping Jia is with the Clinical Center for Neurodegenerative Disease and Memory Impairment, Capital Medical University, Beijing, China. Jianping Jia is with the Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China. Yi Tang is with the Neurodegenerative Laboratory of Ministry of Education of the Peoples Republic of China, Beijing, China
| | - Yi Xing
- Zhibin Wang, Wei Zhu, Yi Xing, Jianping Jia, and Yi Tang are with the Innovation Center for Neurological Disorders, Department of Neurology, Xuanwu Hospital, Capital Medical University, National Center for Neurological Disorders, Beijing, China. Jianping Jia is with the Beijing Key Laboratory of Geriatric Cognitive Disorders, Beijing, China. Jianping Jia is with the Clinical Center for Neurodegenerative Disease and Memory Impairment, Capital Medical University, Beijing, China. Jianping Jia is with the Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China. Yi Tang is with the Neurodegenerative Laboratory of Ministry of Education of the Peoples Republic of China, Beijing, China
| | - Jianping Jia
- Zhibin Wang, Wei Zhu, Yi Xing, Jianping Jia, and Yi Tang are with the Innovation Center for Neurological Disorders, Department of Neurology, Xuanwu Hospital, Capital Medical University, National Center for Neurological Disorders, Beijing, China. Jianping Jia is with the Beijing Key Laboratory of Geriatric Cognitive Disorders, Beijing, China. Jianping Jia is with the Clinical Center for Neurodegenerative Disease and Memory Impairment, Capital Medical University, Beijing, China. Jianping Jia is with the Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China. Yi Tang is with the Neurodegenerative Laboratory of Ministry of Education of the Peoples Republic of China, Beijing, China
| | - Yi Tang
- Zhibin Wang, Wei Zhu, Yi Xing, Jianping Jia, and Yi Tang are with the Innovation Center for Neurological Disorders, Department of Neurology, Xuanwu Hospital, Capital Medical University, National Center for Neurological Disorders, Beijing, China. Jianping Jia is with the Beijing Key Laboratory of Geriatric Cognitive Disorders, Beijing, China. Jianping Jia is with the Clinical Center for Neurodegenerative Disease and Memory Impairment, Capital Medical University, Beijing, China. Jianping Jia is with the Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China. Yi Tang is with the Neurodegenerative Laboratory of Ministry of Education of the Peoples Republic of China, Beijing, China
| |
Collapse
|
8
|
Blasko I, Defrancesco M, Oberacher H, Loacker L, Kemmler G, Marksteiner J, Humpel C. Plasma phosphatidylcholines and vitamin B12/folate levels are possible prognostic biomarkers for progression of Alzheimer's disease. Exp Gerontol 2021; 147:111264. [PMID: 33516907 DOI: 10.1016/j.exger.2021.111264] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 12/11/2020] [Accepted: 01/24/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In clinical practice it is important to identify patients suffering from mild cognitive impairment (MCI) who will progress to Alzheimer's disease (AD). The purpose of this study is to investigate whether lipid metabolites and vitamin B12 and folate levels are effective biomarker for an accurate prediction of MCI-to-AD conversion. METHODS During the standard diagnostic assessment at our memory clinic 48 cognitively healthy subjects and MCI patients were recruited. These participants were followed up after 7-9 years. Blood was collected, various biochemical markers (including vitamin B12 and folate) analysed and plasma lipids were measured using the AbsoluteIDQ p150 Kit. RESULTS There was no significant change in lipid levels in controls converting to MCI. However, we found significant changes in five lipids in converters from controls to AD. Interestingly, also two lipids were altered when MCI re-converted to controls. Vitamin B12 levels were not affected by conversion but folate levels significantly decreased in MCI-AD conversion. CONCLUSIONS Taken together, our study provides evidence that some plasma lipids are significantly altered in subjects converting to AD. Future studies will investigate whether the peripheral lipid changes correspond with changes in the brain during the course of the disease. Although this is a small study, there are indications that lipids may be suitable as prognostic markers.
Collapse
Affiliation(s)
- Imrich Blasko
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria.
| | - Michaela Defrancesco
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Oberacher
- Institute of Legal Medicine and Core Facility Metabolomics, Medical University of Innsbruck, Innsbruck, Austria
| | - Lorin Loacker
- Central Institute of Medicinal and Chemical Laboratory Diagnostics, University Hospital, Innsbruck, Austria
| | - Georg Kemmler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Christian Humpel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
9
|
Low S, Ng TP, Lim CL, Wang J, Moh A, Ang SF, Goh KS, Ang K, Tang WE, Kwan PY, Lim Z, Subramaniam T, Sum CF, Lim SC. Association between vascular measures and cognitive function in type 2 diabetes. J Diabetes Complications 2020; 34:107724. [PMID: 32900592 DOI: 10.1016/j.jdiacomp.2020.107724] [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: 04/25/2020] [Revised: 08/02/2020] [Accepted: 08/23/2020] [Indexed: 11/15/2022]
Abstract
AIM To examine correlation between vascular measures and cognitive performance in type 2 diabetes (T2D). METHODS This was a cross-sectional study on patients (N = 1167) aged ≥45 years attending Diabetes Centre in a tertiary hospital and primary care polyclinic. The following vascular measures were measured: systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), pulse wave velocity (PWV) and augmentation index (AI). Cognition was assessed by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Multiple linear regression was used to examine relationships between vascular measures and cognition, adjusting for demographics, education, depression, clinical covariates and presence of APOE Ɛ4 allele. RESULTS In unadjusted analyses, all the vascular measures, except for MAP, were associated with RBANS total score. In fully adjusted analyses, the association with RBANS total score persisted for peripheral PP, aortic PP and aortic DBP with βs -0.05 (95%CI -0.07 to -0.02; p = 0.001), -0.04 (95%CI -0.06 to -0.01; p = 0.002) and 0.05 (95%CI 0.00 to 0.09; p = 0.033). Association between peripheral and aortic PP and RBANS total score was unaffected by age-stratification (age <60 and ≥60 years). In contrast, significant association between aortic DBP and RBANS total score was only observed for those ≥60 years. Peripheral and aortic PP (which estimate pulsatility) are negatively associated with attention, visuospatial/constructional and language ability. CONCLUSIONS Peripheral and aortic PP, and aortic DBP were independently correlated with cognitive performance globally and in multiple domains. Further research should be conducted to establish the clinical relevance and importance.
Collapse
Affiliation(s)
- Serena Low
- Diabetes Centre, Admiralty Medical Centre, Singapore, Block 676, Level 4, Kampung Admiralty, Woodlands Drive 71, 730676, Singapore; Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, 90 Yishun Central, 768828, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Tower Block, Level 9, 1E Kent Ridge Road, 119228, Singapore
| | - Chin Leong Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore
| | - Jiexun Wang
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, 90 Yishun Central, 768828, Singapore
| | - Angela Moh
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, 90 Yishun Central, 768828, Singapore
| | - Su Fen Ang
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, 90 Yishun Central, 768828, Singapore
| | - Kiat Sern Goh
- Department of Geriatrics, Changi General Hospital, Singapore, 2 Simei Street 3, 529889, Singapore
| | - Keven Ang
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, 90 Yishun Central, 768828, Singapore
| | - Wern Ee Tang
- National Healthcare Group Polyclinics, Singapore, 3 Fusionopolis Link, Nexus@one-north, South Tower, 138543, Singapore
| | - Pek Yee Kwan
- National Healthcare Group Polyclinics, Singapore, 3 Fusionopolis Link, Nexus@one-north, South Tower, 138543, Singapore
| | - Ziliang Lim
- National Healthcare Group Polyclinics, Singapore, 3 Fusionopolis Link, Nexus@one-north, South Tower, 138543, Singapore
| | - Tavintharan Subramaniam
- Diabetes Centre, Admiralty Medical Centre, Singapore, Block 676, Level 4, Kampung Admiralty, Woodlands Drive 71, 730676, Singapore
| | - Chee Fang Sum
- Diabetes Centre, Admiralty Medical Centre, Singapore, Block 676, Level 4, Kampung Admiralty, Woodlands Drive 71, 730676, Singapore
| | - Su Chi Lim
- Diabetes Centre, Admiralty Medical Centre, Singapore, Block 676, Level 4, Kampung Admiralty, Woodlands Drive 71, 730676, Singapore; Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, 90 Yishun Central, 768828, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore.
| |
Collapse
|
10
|
Xuan K, Zhao T, Qu G, Liu H, Chen X, Sun Y. The efficacy of statins in the treatment of Alzheimer's disease: a meta-analysis of randomized controlled trial. Neurol Sci 2020; 41:1391-1404. [PMID: 31930449 DOI: 10.1007/s10072-020-04243-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Alzheimer's disease (AD) is a common type of dementia, which has caused heavy global economic and health burden, and the using of statins to treat AD has caused widely debated. The purpose of this meta-analysis is to explore the effect of statins in the treatment of Alzheimer's disease. METHODS Studies were retrieved by searching PubMed, Embase, Cochrane library, OvisdSP, Web of Science, Chinese Nation Knowledge Infrastructure (CNKI) and Chinese Biomedical Database (CBM) databases before March 31, 2019. We extracted the Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale-cognitive (ADAS-Cog), Neuropsychiatric Inventory (NPI), Activities of Daily Living (ADL) scale score, and other information. The pooled Weighted Mean Difference (WMD) and their 95% confidence intervals (95% CI) were calculated with random effect model or fixed random effect model. RESULTS A total of nine randomized controlled trials were included that contained 1489 patients; of them, 742 patients in the statins group, 747 patients in the control group. There were nine studies used the MMSE scale, five studies used the ADAS-Cog scale, four studies used the NPI scale, and six studies used the ADL scale. Meta-analysis of the nine studies that reported the MMSE scale scores indicated that there is no significant effect of statins as compared with control group (the pooled WMD = 1.09, 95% CI, - 0.00, 2.18, p = 0.05, I2 = 87.9%). Meta-analysis of the five studies that reported the ADAS-Cog scale scores also indicated that there is no significant effect of statins as compared with control group (the pooled WMD = - 0.16, 95% CI, - 2.67, 2.36, p = 0.90, I2 = 80.1%). Meta-analysis of the four studies that reported the NPI scale scores indicated that treatment with statins could slow the rise in the NPI scale scores (the pooled WMD = - 1.16, 95% CI, - 1.88, - 0.44, p = 0.002, I2 = 45.4%). Meta-analysis of the six studies that reported the ADL scale scores indicated that treatment with statins could improve patients' daily living ability (the pooled WMD = - 4.06, 95% CI, - 6.88, - 1.24, p = 0.005, I2 = 86.7%). Results of subgroup analysis indicated that the use of statins in the short term (≤ 12 months) associated with the change of the MMSE scale scores (the pooled WMD = 1.78, 95% CI, 0.53, 3.04, p = 0.005, I2 = 79.6%). Sensitivity analysis and publication bias test were both negative, and the results were relatively reliable and stable. CONCLUSION Statins used in AD patients had beneficial effects on the scores of MMSE scale in the short term (≤ 12 months), and statins could slow the deterioration of neuropsychiatric status and significantly improve activities of daily living ability in AD patients, but statins did not show an advantage in the change of the ADAS-Cog scale scores.
Collapse
Affiliation(s)
- Kun Xuan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Tianming Zhao
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Guangbo Qu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Haixia Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Xin Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yehuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China. .,Center for Evidence-Based Practice, Anhui Medical University, Hefei, Anhui, China.
| |
Collapse
|
11
|
Beydoun MA, Tajuddin SM, Shaked D, Beydoun HA, Evans MK, Zonderman AB. One-carbon metabolism gene polymorphisms are associated with cognitive trajectory among African-American adults. Neurobiol Aging 2019; 84:238.e5-238.e18. [PMID: 31208817 DOI: 10.1016/j.neurobiolaging.2019.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 02/04/2019] [Accepted: 05/16/2019] [Indexed: 11/30/2022]
Abstract
The sex-specific link between longitudinal annual rate of cognitive change (LARCC) and polymorphisms in one-carbon metabolism enzymatic genes remains unclear, particularly among African-American adults. We tested associations of 14 single nucleotide polymorphisms (SNPs) from MTHFR, MTRR, MTR, and SHMT genes and select MTHFR haplotypes and latent classes (SNPHAP/SNPLC) with LARCC. Up to 797 African-American participants in the Healthy Aging in Neighborhoods of Diversity across the Life Span study (age: 30-64 y, 52% women) had 1.6-1.7 (i.e., 1 or 2) repeated measures (follow-up time, mean = 4.69 y) on 9 cognitive test scores, reflecting verbal and visual memory, verbal fluency, psychomotor speed, attention, and executive function: California Verbal Learning Test-immediate recall (CVLT-List A), CVLT-DFR (delayed free recall), Benton Visual Retention Test (BVRT), Animal Fluency (AF), Digits Span Forward and Backward tests, and Trail Making Test parts A and B (Trails A and B). Multiple linear mixed-effects and multiple linear regression models were conducted. Overall, MTHFR SNPs rs4846051(A1317G, G>A) and rs1801131(A1298C, G>T) were associated with slower and faster declines on AF, respectively, whereas rs2066462(C1056T, A>G) was related to slower decline on Trails B (executive function). Among men, rs4846051(A1317G, G>A) was linked to faster decline on BVRT (visual memory), whereas rs2066462(C1056T, A>G) and rs9651118(C>T) were associated with slower decline on CVLT-List A and rs9651118(C>T) with faster decline on CVLT-DFR. Among women, a slower decline on the domain "verbal memory/fluency" was observed with rs1801133(C677T, A>G). MTHFR2SNPHAP [rs1801133(C677T, A>G)/rs1801131(A1298C, G>T): GG] was associated with slower decline on AF among women, whereas MTHFR3SNPHAP(AT) was linked with slower decline on CVLT-List A among men but faster decline on "verbal memory/fluency" among women. Similar patterns were observed for MTHFR SNPLCs. In sum, MTHFR gene variations can differentially impact longitudinal changes in multiple cognitive domains among African-American adults.
Collapse
Affiliation(s)
- May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA.
| | - Salman M Tajuddin
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Danielle Shaked
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA; Department of Psychology, University of Maryland Baltimore County, Catonsville, MD, USA
| | - Hind A Beydoun
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| |
Collapse
|
12
|
The gender- and age- dependent relationships between serum lipids and cognitive impairment: a cross-sectional study in a rural area of Xi'an, China. Lipids Health Dis 2019; 18:4. [PMID: 30611281 PMCID: PMC6320576 DOI: 10.1186/s12944-018-0956-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 12/27/2018] [Indexed: 01/23/2023] Open
Abstract
Background Serum lipids [total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and triglyceride (TG)] are risk factors for stroke, but the relationships between serum lipids and cognitive impairment have not been verified completely. In this study, we studied the relationships between serum lipids and cognitive impairment and explored whether gender and age had effects on the relationships. Methods In this cross-sectional study, we collected serum lipids and cognitive function information from 1762 participants (aged 40–85). Univariate analysis, multivariate analysis, and both gender- and age-based stratified multivariate analysis were used. Results In the entire sample set, there was no significant correlation between serum lipid parameters (TC, LDL-C, HDL-C and TG) and cognitive impairment. In both gender- and age-based stratified multivariate analysis, high serum TC was positively associated with cognitive impairment in the elderly (> 55) male participants (OR = 4.404, 95% CI = 1.264–15.344, p = 0.02), and high serum LDL-C was positively correlated with cognitive impairment in the elderly female subjects (OR = 2.496, 95% CI = 1.057–5.896, p = 0.037), while high serum TG was negatively associated with cognitive impairment in the middle-aged (≤ 55) male participants (OR = 0.157, 95% CI = 0.051–0.484, p = 0.001). Conclusions The relationships between serum lipids and cognitive impairment are gender- and age- dependent, with high serum TC and LDL-C may be risk factors of cognitive impairment in the elderly male and female subjects respectively, while high serum TG may be protector of cognitive impairment in the middle-aged male participants.
Collapse
|
13
|
Inflammation as a Possible Link Between Dyslipidemia and Alzheimer’s Disease. Neuroscience 2018; 376:127-141. [DOI: 10.1016/j.neuroscience.2018.02.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 02/05/2018] [Accepted: 02/07/2018] [Indexed: 01/08/2023]
|
14
|
Barocco F, Spallazzi M, Concari L, Gardini S, Pelosi A, Caffarra P. The Progression of Alzheimer's Disease: Are Fast Decliners Really Fast? A Four-Year Follow-Up. J Alzheimers Dis 2017; 57:775-786. [PMID: 28304306 PMCID: PMC5389047 DOI: 10.3233/jad-161264] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: The rate of cognitive and functional decline in Alzheimer’s disease (AD) changes across individuals. Objectives: Our purpose was to assess whether the concept of “fast decline” really fits its definition and whether cognitive and functional variables at onset can predict the progression of AD. Methods: 324 AD patients were included. We retrospectively examined their Mini-Mental State Examination (MMSE) total score and sub-items, Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL) at baseline and every six months for a 4-year follow-up. Patients were divided into “fast decliners” (n = 62), defined by a loss ≥5 points on the MMSE score within the first year from the baseline; “intermediate decliners” (n = 37), by a loss ≥5 points after the first year and before the 18th month; or “slow decliners” (n = 225), composed of the remaining patients. Results: At baseline, the groups did not differ on demographic, clinical, and cognitive variables. The decline at the end of the 4-year follow-up period seems to be similar among the different decline clusters. Predictors of disease progression have not been identified; only the MMSE total score at 12 months <14/30 was indicative of a poor prognosis. Conclusions: Even with the limitation due to the small sample size, the lack of differences in the disease progression in time in the different clusters suggest the inconsistency of the so-called “fast decliners”. This study was unable to show any significant difference among clusters of AD progression within a 4-year time interval. Further studies should better clarify whether a more consistent distinction exists between slow and fast decliners.
Collapse
Affiliation(s)
- Federica Barocco
- Section of Neurology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Spallazzi
- Section of Neurology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | - Annalisa Pelosi
- Section of Psychology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paolo Caffarra
- Section of Neurology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| |
Collapse
|
15
|
Mehl-Madrona L, Mainguy B. Collaborative Management of Neurocognitive Disorders in Primary Care: Explorations of an Attempt at Culture Change. Perm J 2017; 21:16-027. [PMID: 28333613 DOI: 10.7812/tpp/16-027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Minor neurocognitive disorder (MiND; previously mild cognitive impairment) is a transitional zone between normal cognitive function and early stages of major neurocognitive disorder (previously called dementia). Of people with MiND, 5% to 10% progress to major neurocognitive disorder. Simple interventions such as memory activities, balance exercises, and anti-inflammatory diets have been shown to improve cognitive ability. Also, education and support in group settings have proved beneficial for patients with MiND. DESIGN Survey evaluation of outcomes of geriatric consultation and prospective educational study. MAIN OUTCOME MEASURES We collaborated with an academic training program to introduce into primary care the ideas of educational activities and participation in group medical care for people with MiND. Educational programs were developed and presented to family medicine residents and practicing physicians, and their knowledge was assessed before and after education. RESULTS Two group programs were implemented: one at our hospital and one at a local skilled nursing facility. These were initially envisioned as time-limited, but participants insisted on their continuance. Thirty-two different patients attended the groups for at least six sessions. Participants enthusiastically reported positive change on qualitative interviews and showed improvement in cognition, balance, and self-esteem. Family medicine residents and practicing physicians both shifted toward lifestyle medicine and significantly changed their views on the efficacy of treatments. Despite these activities, community physicians making referrals for geriatric consultations did not change their discussions with patients and families about exercise, diet, cognitive enhancement, and socialization for MiND. CONCLUSION Group visits that emphasized support for increased exercise, improved diet, more movement and balance, and cognitive enhancement appear to please and benefit patients with MiND. Physicians are more open to these approaches with training after initial skepticism. A struggle exists to convince the profession that lifestyle change may be beneficial in MiND.
Collapse
Affiliation(s)
- Lewis Mehl-Madrona
- Faculty Physician at the Eastern Maine Medical Center Family Medicine Residency in Bangor and Associate Professor of Family Medicine at the Univerity of New England in Augusta, ME. He is also affiliated with the Coyote Institute in Orono, ME.
| | - Barbara Mainguy
- Psychotherapist and Reiki practitioner. She is the Education Director at the Coyote Institute in Orono, ME.
| |
Collapse
|
16
|
Li H, Song J, Zhang J, Wang T, Yan Y, Tao Z, Li S, Zhang H, Kang T, Yang J. Ginseng Protein Reverses Amyloid Beta Peptide and H2O2Cytotoxicity in Neurons, and Ameliorates Cognitive Impairment in AD Rats Induced by a Combination of D-Galactose and AlCl3. Phytother Res 2016; 31:284-295. [DOI: 10.1002/ptr.5747] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/26/2016] [Accepted: 10/30/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Hongyan Li
- Pharmaceutical College; Liaoning University of Traditional Chinese Medicine; Dalian 116600 China
| | - Jie Song
- Pharmaceutical College; Liaoning University of Traditional Chinese Medicine; Dalian 116600 China
| | - Jianghua Zhang
- Faculty of Light Industry and Chemical Engineering; Dalian Polytechnic University; Dalian 116034 China
- State Key Laboratory of Fine Chemicals; Dalian University of Technology; Dalian 116024 China
| | - Tianmin Wang
- Pharmaceutical College; Liaoning University of Traditional Chinese Medicine; Dalian 116600 China
| | - Yuhui Yan
- Pharmaceutical College; Liaoning University of Traditional Chinese Medicine; Dalian 116600 China
| | - Zhenyu Tao
- Pharmaceutical College; Liaoning University of Traditional Chinese Medicine; Dalian 116600 China
| | - Shaoheng Li
- Pharmaceutical College; Liaoning University of Traditional Chinese Medicine; Dalian 116600 China
| | - Hui Zhang
- Pharmaceutical College; Changchun University of Traditional Chinese Medicine; Changchun 130117 China
| | - Tingguo Kang
- Pharmaceutical College; Liaoning University of Traditional Chinese Medicine; Dalian 116600 China
| | - Jingxian Yang
- Pharmaceutical College; Liaoning University of Traditional Chinese Medicine; Dalian 116600 China
| |
Collapse
|
17
|
Setién-Suero E, Suárez-Pinilla M, Suárez-Pinilla P, Crespo-Facorro B, Ayesa-Arriola R. Homocysteine and cognition: A systematic review of 111 studies. Neurosci Biobehav Rev 2016; 69:280-98. [PMID: 27531233 DOI: 10.1016/j.neubiorev.2016.08.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 06/14/2016] [Accepted: 08/10/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Elevated plasma homocysteine (Hcy) levels have been associated with cognitive dysfunction in a wide range of conditions. The aim of this review is to establish which cognitive domains and populations are the most affected. METHODS We systematically review the literature and consider all articles that showed any relationship between plasma Hcy levels and scores achieved on cognitive performance tests in both, the general population and patients suffering from central nervous system disorders and other diseases. When effect sizes were available and combinable, several meta-analyses were performed. RESULTS We found 111 pertinent articles. There were 24 cohort studies, 18 randomized trials, 21 case-control studies, and 48 cross-sectional studies. This review reveals a positive trend between cognitive decline and increased plasma Hcy concentrations in general population and in patients with cognitive impairments. Results from the meta-analyses also confirm this trend. Treatment with vitamin supplementation fails to show a reduction in cognitive decline. DISCUSSION Further investigations are warranted to clarify this relationship. Earlier detection of the elevated Hcy levels may be an effective intervention to prevent cognitive impairment and dementia.
Collapse
Affiliation(s)
- Esther Setién-Suero
- University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.
| | - Marta Suárez-Pinilla
- Sackler Centre for Consciousness Science, Department of Informatics, University of Sussex, United Kingdom
| | - Paula Suárez-Pinilla
- University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain
| | - Benedicto Crespo-Facorro
- University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain
| | - Rosa Ayesa-Arriola
- University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain
| |
Collapse
|
18
|
Li H, Kang T, Qi B, Kong L, Jiao Y, Cao Y, Zhang J, Yang J. Neuroprotective effects of ginseng protein on PI3K/Akt signaling pathway in the hippocampus of D-galactose/AlCl3 inducing rats model of Alzheimer's disease. JOURNAL OF ETHNOPHARMACOLOGY 2016; 179:162-169. [PMID: 26721223 DOI: 10.1016/j.jep.2015.12.020] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/08/2015] [Accepted: 12/17/2015] [Indexed: 06/05/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Alzheimer disease (AD) is a progressive neurodegenerative disease, with progressive memory loss, cognitive deterioration, and behavioral disorders. Ginseng (Panax ginseng C.A. Meyer) is widely used in China to treat various kinds of nervous system disorders. The study aimed to explore the therapeutic effect of ginseng protein (GP) on Alzheimer's disease and its correlation with the PI3K/Akt signaling pathway to understand the mechanism underlying the neuroprotective effect of ginseng. MATERIAL AND METHODS The AD rat model was established by intraperitoneally injecting D-galactose [60mg/(kgd)] followed by intragastrically administering AlCl3 [40mg/(kgd)] for 90 days. From day 60, the GP groups were intragastrically administered with GP 0.05 or 0.1g/kg twice daily for 30 days. The ethology of rats was tested by Morris water maze test. The content of Aβ1-42 and p-tau in the hippocampus of rats was detected by enzyme-linked immunosorbent assay. The expression of mRNAs and proteins of PI3K, Akt, phosphorylated Akt (p-Akt), Bcl-2, and Bax in the hippocampus was detected by real-time quantitative reverse transcription polymerase chain reaction and Western blot assay. RESULTS GP was found to significantly improve the memory ability of AD rats and prolong the times of crossing the platform and the percentage of residence time in the original platform quadrant of spatial probe test. GP also reduced the content of Aβ1-42 and p-tau and improved the mRNA and protein expression of PI3K, p-Akt/Akt, and Bcl-2/Bax in the hippocampus. CONCLUSIONS GP could improve the memory ability and reduce the content of Aβ1-42 and p-tau in AD rats. The anti-AD effects of GP were in part mediated by PI3K/Akt signaling pathway activation.
Collapse
Affiliation(s)
- Hongyan Li
- Pharmaceutical College, Liaoning University of Traditional Chinese Medicine, Dalian 116600, China
| | - Tingguo Kang
- Pharmaceutical College, Liaoning University of Traditional Chinese Medicine, Dalian 116600, China
| | - Bin Qi
- College of pharmacy of Changchun University of Traditional Chinese Medicine, Changchun 130117, China
| | - Liang Kong
- Pharmaceutical College, Liaoning University of Traditional Chinese Medicine, Dalian 116600, China
| | - Yanan Jiao
- Pharmaceutical College, Liaoning University of Traditional Chinese Medicine, Dalian 116600, China
| | - Yang Cao
- Dalian Huaxin Physicochemical Testing Centre Ltd., Dalian 116600, China
| | - Jianghua Zhang
- College of Light Industry and Chemical Engineering, Dalian Polytechnic University, Dalian 116034, China.
| | - Jingxian Yang
- Pharmaceutical College, Liaoning University of Traditional Chinese Medicine, Dalian 116600, China.
| |
Collapse
|
19
|
Raszewski G, Loroch M, Owoc A, Łukawski K, Filip R, Bojar I. Homocysteine and cognitive disorders of postmenopausal women measured by a battery of computer tests--central nervous system vital signs. Arch Womens Ment Health 2015; 18:623-30. [PMID: 25822709 DOI: 10.1007/s00737-015-0518-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 03/17/2015] [Indexed: 11/28/2022]
Abstract
The purpose of the study was the analysis of cognitive functions in postmenopausal women having different status of homocysteine levels by a battery of computer tests-central nervous system vital signs (CNS-VS). We examined whether homocysteine increases the risk of cognitive decline and which cognitive domains are more affected. We showed that the considerably better neurocognitive index was obtained by women with low homocysteine levels in comparison with those with hyperhomocysteinemia (p = 0.0017). Similarly, results were obtained in the field of executive functioning (p = 0.0011), complex attention (p = 0.0106), cognitive flexibility (p = 0.0016), and memory (p = 0.0145). Verbal memory and visual memory did not differ considerably among the studied groups. Also, we demonstrated that ε4/ε4 genotype was the most common (15.5 %) in women with hyperhomocysteinemia than in groups of patients with low (0 %) or normal (1.9 %) homocysteine levels. In summary, hyperhomocysteinemia was related with increased risk of decline in executive functioning, complex attention, cognitive flexibility, and memory in postmenopausal women.
Collapse
Affiliation(s)
- Grzegorz Raszewski
- Department of Physiopathology, Institute of Rural Health, Jaczewskiego 2, 20-950, Lublin, Poland,
| | | | | | | | | | | |
Collapse
|
20
|
Wu MK, Lu YT, Huang CW, Lin PH, Chen NC, Lui CC, Chang WN, Lee CC, Chang YT, Chen SF, Chang CC. Clinical Significance of Cerebrovascular Biomarkers and White Matter Tract Integrity in Alzheimer Disease: Clinical correlations With Neurobehavioral Data in Cross-Sectional and After 18 Months Follow-ups. Medicine (Baltimore) 2015; 94:e1192. [PMID: 26181568 PMCID: PMC4617061 DOI: 10.1097/md.0000000000001192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cerebrovascular risk factors and white matter (WM) damage lead to worse cognitive performance in Alzheimer dementia (AD). This study investigated WM microstructure using diffusion tensor imaging in patients with mild to moderate AD and investigated specific fiber tract involvement with respect to predefined cerebrovascular risk factors and neurobehavioral data prediction cross-sectionally and after 18 months. To identify the primary pathoanatomic relationships of risk biomarkers to fiber tract integrity, we predefined 11 major association tracts and calculated tract specific fractional anisotropy (FA) values. Eighty-five patients with AD underwent neurobehavioral assessments including the minimental state examination (MMSE) and 12-item neuropsychiatric inventory twice with a 1.5-year interval to represent major outcome factors. In the cross-sectional data, total cholesterol, low-density lipoprotein, vitamin B12, and homocysteine levels correlated variably with WM FA values. After entering the biomarkers and WM FA into a regression model to predict neurobehavioral outcomes, only fiber tract FA or homocysteine level predicted the MMSE score, and fiber tract FA or age predicted the neuropsychiatric inventory total scores and subdomains of apathy, disinhibition, and aberrant motor behavior. In the follow-up neurobehavioral data, the mean global FA value predicted the MMSE and aberrant motor behavior subdomain, while age predicted the anxiety and elation subdomains. Cerebrovascular risk biomarkers may modify WM microstructural organization, while the association with fiber integrity showed greater clinical significance to the prediction of neurobehavioral outcomes both cross-sectionally and longitudinally.
Collapse
Affiliation(s)
- Ming-Kung Wu
- From the Department of Psychiatry (M-KW, S-FC); Department of Neurology, Cognition and Aging Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine (Y-TL, C-WH, N-CC, W-NC, Y-TC, S-FC, C-CC); Department of Health and Beauty, Shu-Zen College of Medicine and Management (P-HL, Chen-Chang Lee); and Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (Chun-Chung Lui)
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Beydoun MA, Beydoun HA, Gamaldo AA, Teel A, Zonderman AB, Wang Y. Epidemiologic studies of modifiable factors associated with cognition and dementia: systematic review and meta-analysis. BMC Public Health 2014; 14:643. [PMID: 24962204 PMCID: PMC4099157 DOI: 10.1186/1471-2458-14-643] [Citation(s) in RCA: 481] [Impact Index Per Article: 48.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 05/13/2014] [Indexed: 12/15/2022] Open
Abstract
Background Cognitive impairment, including dementia, is a major health concern with the increasing aging population. Preventive measures to delay cognitive decline are of utmost importance. Alzheimer’s disease (AD) is the most frequent cause of dementia, increasing in prevalence from <1% below the age of 60 years to >40% above 85 years of age. Methods We systematically reviewed selected modifiable factors such as education, smoking, alcohol, physical activity, caffeine, antioxidants, homocysteine (Hcy), n-3 fatty acids that were studied in relation to various cognitive health outcomes, including incident AD. We searched MEDLINE for published literature (January 1990 through October 2012), including cross-sectional and cohort studies (sample sizes > 300). Analyses compared study finding consistency across factors, study designs and study-level characteristics. Selecting studies of incident AD, our meta-analysis estimated pooled risk ratios (RR), population attributable risk percent (PAR%) and assessed publication bias. Results In total, 247 studies were retrieved for systematic review. Consistency analysis for each risk factor suggested positive findings ranging from ~38.9% for caffeine to ~89% for physical activity. Education also had a significantly higher propensity for “a positive finding” compared to caffeine, smoking and antioxidant-related studies. Meta-analysis of 31 studies with incident AD yielded pooled RR for low education (RR = 1.99; 95% CI: 1.30-3.04), high Hcy (RR = 1.93; 95% CI: 1.50-2.49), and current/ever smoking status (RR = 1.37; 95% CI: 1.23-1.52) while indicating protective effects of higher physical activity and n-3 fatty acids. Estimated PAR% were particularly high for physical activity (PAR% = 31.9; 95% CI: 22.7-41.2) and smoking (PAR%=31.09%; 95% CI: 17.9-44.3). Overall, no significant publication bias was found. Conclusions Higher Hcy levels, lower educational attainment, and decreased physical activity were particularly strong predictors of incident AD. Further studies are needed to support other potential modifiable protective factors, such as caffeine.
Collapse
Affiliation(s)
- May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, 251 Bayview Blvd,, Suite 100, Room #: 04B118, Baltimore, MD 21224, USA.
| | | | | | | | | | | |
Collapse
|
22
|
Rogne S, Vangberg T, Eldevik P, Wikran G, Mathiesen EB, Schirmer H. Mild cognitive impairment, risk factors and magnetic resonance volumetry: role of probable Alzheimer's disease in the family. Dement Geriatr Cogn Disord 2014; 36:87-98. [PMID: 23797189 DOI: 10.1159/000350408] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2013] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND/AIMS Late-onset Alzheimer's disease (LOAD) comprises sporadic LOAD and familial LOAD. We wanted to determine whether total plasma homocysteine (Hcy), cardiovascular risk factors and volumetric analyses of cerebral magnetic resonance imaging (MRI) were differently associated with mild cognitive impairment (MCI) in subjects from families with aggregation of LOAD (probable familial LOAD) and MCI in subjects from families without LOAD (probable sporadic LOAD). METHODS A total of 103 subjects with MCI without known stroke or other apparent causative diseases were included as cases together with 58 controls. The cases were stratified into 3 groups according to the number of biological relatives with probable LOAD on one side of the family. Cerebral MRI was obtained from all. The case groups were compared to the control group in sex-specific analyses of covariance. RESULTS Hcy was significantly elevated in all cases compared to controls, except for women with probable familial LOAD. These women also had significantly smaller hippocampal volume and significantly larger lateral ventricles, unlike the women in the other case groups. CONCLUSIONS Our findings suggest that research on Hcy, cardiovascular risk factors and other potential risk factors for LOAD might benefit from distinguishing between sporadic and familial LOAD.
Collapse
Affiliation(s)
- Sigbjørn Rogne
- Department of Clinical Medicine, University of Tromsø, Tromsø, Norway. Sigbjorn.Rogne @ unn.no
| | | | | | | | | | | |
Collapse
|
23
|
The influence of vascular risk factors on cognitive decline in patients with dementia: A systematic review. Maturitas 2013; 76:113-7. [DOI: 10.1016/j.maturitas.2013.06.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 06/07/2013] [Accepted: 06/14/2013] [Indexed: 11/22/2022]
|
24
|
Allam M, Fahmy E, Elatti SA, Amer H, Abo-krysha N, El-Sawy E. Association between total plasma homocysteine level and cognitive functions in elderly Egyptian subjects. J Neurol Sci 2013; 332:86-91. [DOI: 10.1016/j.jns.2013.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 05/21/2013] [Accepted: 06/19/2013] [Indexed: 12/13/2022]
|
25
|
Modulatory effects of vitamin E, acetyl-l-carnitine and α-lipoic acid on new potential biomarkers for Alzheimer's disease in rat model. ACTA ACUST UNITED AC 2012; 64:549-56. [DOI: 10.1016/j.etp.2010.11.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 11/12/2010] [Indexed: 02/01/2023]
|
26
|
Agarwal R, Chhillar N, Kushwaha S, Singh NK, Tripathi CB. Role of vitamin B(12), folate, and thyroid stimulating hormone in dementia: A hospital-based study in north Indian population. Ann Indian Acad Neurol 2011; 13:257-62. [PMID: 21264133 PMCID: PMC3021928 DOI: 10.4103/0972-2327.74193] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Revised: 05/31/2010] [Indexed: 11/28/2022] Open
Abstract
Background: Vitamin B12 and folate represent modifiable risk factors for dementia. They may increase the risk of Alzheimer′s dementia (AD) and vascular dementia (VaD) as their deficiency can increase the homocysteine level due to slowed methylation reaction. Homocysteine has a neurotoxic effect that could lead to neurologic disturbances. Hence, it is important to explore the status of serum B12 and folate in AD and VaD to evolve the treatment strategies for the same. Objectives: A retrospective study was conducted to assess the levels of vitamin B12, folate, and thyroid stimulating hormone (TSH) in serum and the relationship of these factors, including age and sex to cognitive decline in VaD, AD, and dementia due to other causes (DOC). Materials and Methods: Serum vitamin B12, folate, TSH, and total cholesterol were studied in 32 AD patients (mean age: 65 years), 12 VaD patients (mean age: 61 years), 83 DOC (mean age: 65 years), and 127 control subjects (mean age: 49 years). Results: In AD, VaD, and DOC, the levels of vitamin B12 and folate were significantly lower (P < 0.002; 0.026; 0.002 for vitamin B12 and P < 0.000 in all the 3 groups for folate) as compared with the controls. Similarly, TSH levels were significantly lower in AD and DOC (P < 0.008; 0.038) as compared with the controls. Conclusion: Vitamin B12 and folate were significantly low in both AD and VaD patients. Hence, B vitamin supplementation should be considered as possible targets for the therapeutic intervention in dementia.
Collapse
Affiliation(s)
- Rachna Agarwal
- Department of Neurochemistry, Institute of Human Behaviour & Allied Sciences, Delhi, India
| | | | | | | | | |
Collapse
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
Reitz C, Tang MX, Schupf N, Manly JJ, Mayeux R, Luchsinger JA. Association of higher levels of high-density lipoprotein cholesterol in elderly individuals and lower risk of late-onset Alzheimer disease. ACTA ACUST UNITED AC 2011; 67:1491-7. [PMID: 21149810 DOI: 10.1001/archneurol.2010.297] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To reexamine the association of lipid levels with Alzheimer disease (AD) using Cox proportional hazards models. DESIGN Prospective cohort study. SETTING Northern Manhattan, New York. PARTICIPANTS One thousand one hundred thirty elderly individuals free of cognitive impairment at baseline. MAIN OUTCOME MEASURE High-density lipoprotein cholesterol (HDL-C) levels. RESULTS Higher levels of HDL-C (>55 mg/dL) were associated with a decreased risk of both probable and possible AD and probable AD compared with lower HDL-C levels (hazard ratio, 0.4; 95% confidence interval, 0.2-0.9; P = .03 and hazard ratio, 0.4; 95% confidence interval, 0.2-0.9; P = .03). In addition, higher levels of total and non-HDL-C were associated with a decreased risk of AD in analyses adjusting for age, sex, education, ethnic group, and APOE e4 genotype. CONCLUSION High HDL-C levels in elderly individuals may be associated with a decreased risk of AD.
Collapse
Affiliation(s)
- Christiane Reitz
- Gertrude H. Sergievsky Center, Columbia University, New York, NY 10032, USA.
| | | | | | | | | | | |
Collapse
|
29
|
Abstract
INTRODUCTION Although consensus guidelines recommend checking serum B12 in patients with dementia, clinicians are often faced with various questions: (1) Which patients should be tested? (2) What test should be ordered? (3) How are inferences made from such testing? (4) In addition to serum B12, should other tests be ordered? (5) Is B12 deficiency compatible with dementia of the Alzheimer's type? (6) What is to be expected from treatment? (7) How is B12 deficiency treated? METHODS On January 31st, 2009, a Medline search was performed revealing 1,627 citations related to cobalamin deficiency, hyperhomocysteinemia, and dementia. After limiting the search terms, all abstracts and/or articles and other references were categorized into six major groups (general, biochemistry, manifestations, associations and risks, evaluation, and treatment) and then reviewed in answering the above questions. RESULTS The six major groups above are described in detail. Seventy-five key studies, series, and clinical trials were identified. Evidence-based suggestions for patient management were developed. DISCUSSION Evidence is convincing that hyperhomocysteinemia, with or without hypovitaminosis B12, is a risk factor for dementia. In the absence of hyperhomocysteinemia, evidence is less convincing that hypovitaminosis B12 is a risk factor for dementia. B12 deficiency manifestations are variable and include abnormal psychiatric, neurological, gastrointestinal, and hematological findings. Radiological images of individuals with hyperhomocysteinemia frequently demonstrate leukoaraiosis. Assessing serum B12 and treatment of B12 deficiency is crucial for those cases in which pernicious anemia is suspected and may be useful for mild cognitive impairment and mild to moderate dementia. The serum B12 level is the standard initial test: 200 picograms per milliliter or less is low, and 201 to 350 picograms per milliliter is borderline low. Other tests may be indicated, including plasma homocysteine, serum methylmalonic acid, antiparietal cell and anti-intrinsic factor antibodies, and serum gastrin level. In B12 deficiency dementia with versus without pernicious anemia, there appear to be different manifestations, need for further workup, and responses to treatment. Dementia of the Alzheimer's type is a compatible diagnosis when B12 deficiency is found, unless it is caused by pernicious anemia. Patients with pernicious anemia generally respond favorably to supplemental B12 treatment, especially if pernicious anemia is diagnosed early in the course of the disease. Some patients without pernicious anemia, but with B12 deficiency and either mild cognitive impairment or mild to moderate dementia, might show some degree of cognitive improvement with supplemental B12 treatment. Evidence that supplemental B12 treatment is beneficial for patients without pernicious anemia, but with B12 deficiency and moderately-severe to severe dementia is scarce. Oral cyanocobalamin is generally favored over intramuscular cyanocobalamin.
Collapse
Affiliation(s)
- Steven F Werder
- Kansas University School of Medicine - Wichita, Wichita, KS, USA.
| |
Collapse
|
30
|
Brown LA, Riby LM, Reay JL. Supplementing Cognitive Aging: A Selective Review of the Effects of Ginkgo Biloba and a Number of Everyday Nutritional Substances. Exp Aging Res 2010; 36:105-22. [DOI: 10.1080/03610730903417960] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
31
|
Reiman EM, Chen K, Langbaum JBS, Lee W, Reschke C, Bandy D, Alexander GE, Caselli RJ. Higher serum total cholesterol levels in late middle age are associated with glucose hypometabolism in brain regions affected by Alzheimer's disease and normal aging. Neuroimage 2010; 49:169-76. [PMID: 19631758 PMCID: PMC2888804 DOI: 10.1016/j.neuroimage.2009.07.025] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 06/10/2009] [Accepted: 07/15/2009] [Indexed: 11/21/2022] Open
Abstract
Epidemiological studies suggest that higher midlife serum total cholesterol levels are associated with an increased risk of Alzheimer's disease (AD). Using fluorodeoxyglucose positron emission tomography (PET) in the study of cognitively normal late middle-aged people, we demonstrated an association between apolipoprotein E (APOE) epsilon4 gene dose, the major genetic risk factor for late-onset AD, and lower measurements of the cerebral metabolic rate for glucose (CMRgl) in AD-affected brain regions, we proposed using PET as a pre-symptomatic endophenotype to evaluate other putative AD risk modifiers, and we then used it to support an aggregate cholesterol-related genetic risk score in the risk of AD. In the present study, we used PET to investigate the association between serum total cholesterol levels and cerebral metabolic rate for glucose metabolism (CMRgl) in 117 cognitively normal late middle-aged APOE epsilon4 homozygotes, heterozygotes and non-carriers. Higher serum total cholesterol levels were associated with lower CMRgl bilaterally in precuneus, parietotemporal and prefrontal regions previously found to be preferentially affected by AD, and in additional frontal regions previously found to be preferentially affected by normal aging. The associations were greater in APOE epsilon4 carriers than non-carriers in some of the AD-affected brain regions. We postulate that higher midlife serum total cholesterol levels accelerate brain processes associated with normal aging and conspire with other risk factors in the predisposition to AD. We propose using PET in proof-of-concept randomized controlled trials to rapidly evaluate the effects of midlife cholesterol-lowering treatments on the brain changes associated with normal aging and AD.
Collapse
Affiliation(s)
- Eric M Reiman
- Banner Alzheimer's Institute and Banner Good Samaritan PET Center, 901 East Willetta Street, Phoenix, AZ 85006, USA.
| | | | | | | | | | | | | | | |
Collapse
|