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Ioannou K, Bucci M, Tzortzakakis A, Savitcheva I, Nordberg A, Chiotis K. Tau PET positivity predicts clinically relevant cognitive decline driven by Alzheimer's disease compared to comorbid cases; proof of concept in the ADNI study. Mol Psychiatry 2024:10.1038/s41380-024-02672-9. [PMID: 39179903 DOI: 10.1038/s41380-024-02672-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/26/2024] [Accepted: 07/09/2024] [Indexed: 08/26/2024]
Abstract
β-amyloid (Aβ) pathology is not always coupled with Alzheimer's disease (AD) relevant cognitive decline. We assessed the accuracy of tau PET to identify Aβ(+) individuals who show prospective disease progression. 396 cognitively unimpaired and impaired individuals with baseline Aβ and tau PET and a follow-up of ≥ 2 years were selected from the Alzheimer's Disease Neuroimaging Initiative dataset. The participants were dichotomously grouped based on either clinical conversion (i.e., change of diagnosis) or cognitive deterioration (fast (FDs) vs. slow decliners (SDs)) using data-driven clustering of the individual annual rates of cognitive decline. To assess cognitive decline in individuals with isolated Aβ(+) or absence of both Aβ and tau (T) pathologies, we investigated the prevalence of non-AD comorbidities and FDG PET hypometabolism patterns suggestive of AD. Baseline tau PET uptake was higher in Aβ(+)FDs than in Aβ(-)FD/SDs and Aβ(+)SDs, independently of baseline cognitive status. Baseline tau PET uptake identified MCI Aβ(+) Converters and Aβ(+)FDs with an area under the curve of 0.85 and 0.87 (composite temporal region of interest) respectively, and was linearly related to the annual rate of cognitive decline in Aβ(+) individuals. The T(+) individuals constituted largely a subgroup of those being Aβ(+) and those clustered as FDs. The most common biomarker profiles in FDs (n = 70) were Aβ(+)T(+) (n = 34, 49%) and Aβ(+)T(-) (n = 19, 27%). Baseline Aβ load was higher in Aβ(+)T(+)FDs (M = 83.03 ± 31.42CL) than in Aβ(+)T(-)FDs (M = 63.67 ± 26.75CL) (p-value = 0.038). Depression diagnosis was more prevalent in Aβ(+)T(-)FDs compared to Aβ(+)T(+)FDs (47% vs. 15%, p-value = 0.021), as were FDG PET hypometabolism pattern not suggestive of AD (86% vs. 50%, p-value = 0.039). Our findings suggest that high tau PET uptake is coupled with both Aβ pathology and accelerated cognitive decline. In cases of isolated Aβ(+), cognitive decline may be associated with changes within the AD spectrum in a multi-morbidity context, i.e., mixed AD.
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Affiliation(s)
- Konstantinos Ioannou
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Marco Bucci
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Antonios Tzortzakakis
- Division of Radiology, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Medical Radiation Physics and Nuclear Medicine, Section for Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Irina Savitcheva
- Medical Radiation Physics and Nuclear Medicine, Section for Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Agneta Nordberg
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Konstantinos Chiotis
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
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2
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Cheng S, Yin R, Wu K, Wang Q, Zhang H, Ling L, Chen W, Shi L. Trajectories and influencing factors of cognitive function and physical disability in Chinese older people. Front Public Health 2024; 12:1380657. [PMID: 39026589 PMCID: PMC11256785 DOI: 10.3389/fpubh.2024.1380657] [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: 02/01/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Dementia and physical disability are serious problems faced by the aging population, and their occurrence and development interact. Methods Based on data from a national cohort of Chinese people aged 60 years and above from the China Health and Retirement Longitudinal Survey from 2011 to 2018, we applied the group-based trajectory model to identify the heterogeneous trajectories of cognitive function and physical disability in participants with different physical disability levels. Next, multinomial logistic regression models were used to explore the factors affecting these trajectories. Results The cognitive function trajectories of the Chinese older people could be divided into three characteristic groups: those who maintained the highest baseline level of cognitive function, those with a moderate baseline cognitive function and dramatic progression, and those with the worst baseline cognitive function and rapid-slow-rapid progression. The disability trajectories also fell into three characteristic groups: a consistently low baseline disability level, a low initial disability level with rapid development, and a high baseline disability level with rapid development. Compared with those free of physical disability at baseline, a greater proportion of participants who had physical disability at baseline experienced rapid cognitive deterioration. Education, income, type of medical insurance, gender, and marital status were instrumental in the progression of disability and cognitive decline in the participants. Discussion We suggest that the Chinese government, focusing on the central and western regions and rural areas, should develop education for the older people and increase their level of economic security to slow the rate of cognitive decline and disability among this age group. These could become important measures to cope with population aging.
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Affiliation(s)
- Shuyuan Cheng
- International Cooperation and Exchange Department, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Health Policy and Management Department, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Rong Yin
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Kunpeng Wu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Qiong Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hui Zhang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wen Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Leiyu Shi
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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van Loenhoud AC, Groot C, Bocancea DI, Barkhof F, Teunissen C, Scheltens P, van de Flier WM, Ossenkoppele R. Association of Education and Intracranial Volume With Cognitive Trajectories and Mortality Rates Across the Alzheimer Disease Continuum. Neurology 2022; 98:e1679-e1691. [PMID: 35314498 PMCID: PMC9052567 DOI: 10.1212/wnl.0000000000200116] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/11/2022] [Indexed: 12/04/2022] Open
Abstract
Objective To investigate relationships of education and intracranial volume (ICV) (factors related to cognitive and brain reserve, respectively) with cognitive trajectories and mortality in individuals with biomarker-defined Alzheimer disease (AD). Methods We selected 1,298 β-amyloid–positive memory clinic patients with subjective cognitive decline (SCD, n = 142), mild cognitive impairment (MCI, n = 274), or AD dementia (n = 882) from the Amsterdam Dementia Cohort. All participants underwent baseline MRI and neuropsychological assessment, and 68% received cognitive follow-up (median 2.3 years, interquartile range 2.4). Mortality data were collected from the Central Public Administration. In the total sample and stratified by disease stage (i.e., SCD/MCI vs dementia), we examined education and ICV as predictors of baseline and longitudinal cognitive performance on 5 cognitive domains (memory, attention, executive, language, and visuospatial functions; linear mixed models) and time to death (Cox proportional hazard models). Analyses were adjusted for age, sex, whole brain gray matter atrophy, and MRI field strength. Results Education and ICV showed consistent positive associations with baseline cognition across disease stages. Longitudinally, we observed a relationship between higher education and faster cognitive decline among patients with dementia on global cognition, memory, executive function, and language (range β = −0.06 to −0.13; all p < 0.05). Furthermore, in the total sample, both higher education and larger ICV were related to lower mortality risk (hazard ratio 0.84 and 0.82, respectively; p < 0.05). Discussion In this β-amyloid–positive memory clinic sample, both cognitive and brain reserve were positively associated with baseline cognition, whereas only education was related to longitudinal cognition (i.e., accelerated decline among more highly educated patients with dementia). Higher education and ICV both moderately attenuated overall mortality risk in AD.
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Affiliation(s)
- Anna C van Loenhoud
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Colin Groot
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Diana I Bocancea
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Queen Square Institute of Neurology and Center for Medical Image Computing, University College London, United Kingdom
| | - Charlotte Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wiesje M van de Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Rik Ossenkoppele
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Clinical Memory Research Unit, Lund University, Lund, Sweden
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Alantie S, Tyrkkö J, Makkonen T, Renvall K. Is Old Age Just a Number in Language Skills? Language Performance and Its Relation to Age, Education, Gender, Cognitive Screening, and Dentition in Very Old Finnish Speakers. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:274-291. [PMID: 34929110 DOI: 10.1044/2021_jslhr-21-00178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE This study reports on how very old (VO) Finnish people without dementia perform in the Western Aphasia Battery (WAB) and two verbal fluency tasks and which demographic factors predict the performance. METHOD The study included fifty 80- to 100-year-old community-dwelling Finnish speakers with no dementing illnesses or speech-language disabilities, who completed the WAB and two verbal fluency tasks. Multifactorial statistical analyses with recursive partitioning were carried out to determine the significant predictors out of five predictor variables (age, gender, education, dentition, and Mini-Mental State Examination [MMSE]) for four response variables (WAB Aphasia Quotient [AQ], Language Quotient [LQ], semantic, and phonemic word fluencies). RESULTS Overall, individual variation was notable in VO speakers. All predictor variables were statistically significantly associated with one or more of the language skills. Age was the most significant predictor; the critical age of 85-86 years was associated with a decline in WAB-AQ and semantic fluency. Poor dentition and the MMSE score both predicted a decline in WAB-LQ and phonemic fluency. A high level of education was positively associated with the skills of the best-performing individuals in WAB-AQ, WAB-LQ, and semantic fluency. CONCLUSIONS VO age is a significant factor contributing to language performance. However, a younger age, a good cognitive performance, intact teeth, and a higher educational level also seem to have a preservative power as regards language skills. Gender differences should be interpreted with caution. The results of this study provide culture- and language-specific normative data, which aids in differentiating typical aging from the signs of acute or degenerative neuropathology to ensure appropriate medical and therapeutic interventions.
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Affiliation(s)
- Sonja Alantie
- Department of Psychology and Speech-Language Pathology, University of Turku, Finland
- Speech-Language Pathology, Tampere University Hospital, Finland
| | - Jukka Tyrkkö
- Department of Languages, Linnaeus University, Växjö, Sweden
| | - Tanja Makkonen
- Department of Psychology and Speech-Language Pathology, University of Turku, Finland
- Speech-Language Pathology, Tampere University Hospital, Finland
| | - Kati Renvall
- Department of Psychology and Speech-Language Pathology, University of Turku, Finland
- Department of Cognitive Science, Macquarie University, Sydney, New South Wales, Australia
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Manandhar B, Zhang H. Random Change-Point Non-linear Mixed Effects Model for left-censored longitudinal data: An application to HIV surveillance. PROCEEDINGS. AMERICAN STATISTICAL ASSOCIATION. ANNUAL MEETING 2021; 2021:1320-1327. [PMID: 38855090 PMCID: PMC11162255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
A change-point model is essential in longitudinal data to infer an individual specific time to an event that induces a change of trend. However, in general, change points are not known for population-based data. We present an unknown change-point model that fits the linear and non-linear mixed effects for pre- and post-change points. We address the left-censored observations. Through stochastic approximation expectation maximization (SAEM) with the Metropolis Hasting sampler, we fit a random change-point non-linear mixed effects model. We apply our method on the longitudinal viral load (VL) data reported to the HIV surveillance registry from New York City.
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Affiliation(s)
- Binod Manandhar
- City University of New York, Graduate School of Public Health, 55 W 125th St,New York, NY 10027
| | - Hongbin Zhang
- City University of New York, Graduate School of Public Health, 55 W 125th St,New York, NY 10027
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6
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Graham EK, James BD, Jackson KL, Willroth EC, Luo J, Beam CR, Pedersen NL, Reynolds CA, Katz M, Lipton RB, Boyle P, Wilson R, Bennett DA, Mroczek DK. A coordinated analysis of the associations among personality traits, cognitive decline, and dementia in older adulthood. JOURNAL OF RESEARCH IN PERSONALITY 2021; 92:104100. [PMID: 34083845 PMCID: PMC8168939 DOI: 10.1016/j.jrp.2021.104100] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There are individual differences in the rates of cognitive decline across later adulthood. Personality traits are among the factors that may account for these differences. The current project investigated whether personality traits were associated with trajectories of cognitive decline, and whether the associations were different before and after dementia diagnosis. The data was analyzed using linear mixed effects regression. Across study aims is a focus on replicability and generalizability. Each question was addressed in four independent longitudinal studies (EAS, MAP, ROS, SATSA), then meta-analyzed, providing estimates of replicability. Results indicated that low neuroticism and high openness were associated with total cognitive function. We detected evidence for cognitive decline in all four samples, and openness was associated with decline post dementia diagnosis.
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7
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Williams BD, Pendleton N, Chandola T. Does the association between cognition and education differ between older adults with gradual or rapid trajectories of cognitive decline? NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2021; 29:1-21. [PMID: 33683174 DOI: 10.1080/13825585.2021.1889958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
Education is associated with improved baseline cognitive performance in older adults, but the association with maintenance of cognitive function is less clear. Education may be associated with different types of active cognitive reserve in those following different cognitive trajectories. We used data on n = 5642 adults aged >60 from the English Longitudinal Study of Aging (ELSA) over 5 waves (8 years). We used growth mixture models to test if the association between educational attainment and rate of change in verbal fluency or immediate recall varied by latent class trajectory. For recall, 91.5% (n = 5164) of participants were in a gradual decline class and 8.5% (n = 478) in a rapid decline class. For fluency, 90.0% (n = 4907) were in a gradual decline class and 10.0% (n = 561) were in a rapid decline class. Educational attainment was associated with improved baseline performance for both verbal fluency and recall. In the rapidly declining classes, educational attainment was not associated with rate of change for either outcome. In the verbal fluency gradual decline class, education was associated with higher (an additional 0.05-0.38 words per 2 years) or degree level education (an additional 0.04-0.42 words per 2 years) when compared to those with no formal qualifications. We identified no evidence of a protective effect of education against rapid cognitive decline. There was some evidence of active cognitive reserve for verbal fluency but not recall, which may reflect a small degree of domain-specific protection against age-related cognitive decline.
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Affiliation(s)
| | - Neil Pendleton
- Cathie Marsh Institute for Social Research, University of Manchester, Manchester, UK
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Tarani Chandola
- Cathie Marsh Institute for Social Research, University of Manchester, Manchester, UK
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8
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Lange-Maia BS, Karvonen-Gutierrez CA, Kazlauskaite R, Strotmeyer ES, Karavolos K, Appelhans BM, Janssen I, Avery EF, Dugan SA, Kravitz HM. Impact of Chronic Medical Condition Development on Longitudinal Physical Function from Mid- to Early Late-Life: The Study of Women's Health Across the Nation. J Gerontol A Biol Sci Med Sci 2021; 75:1411-1417. [PMID: 31732730 DOI: 10.1093/gerona/glz243] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic medical conditions (CMCs) often emerge and accumulate during the transition from mid- to late-life, and the resulting multimorbidity can greatly impact physical function. We assessed the association of CMC presence and incidence on trajectories of physical function from mid- to early late-life in the Study of Women's Health Across the Nation. METHODS Physical function was assessed at eight clinic visits (average 14 years follow-up) using the physical function subscale of the Short Form-36. CMCs included osteoarthritis, diabetes, stroke, hypertension, heart disease, cancer, osteoporosis, and depressive symptomatology, and were considered cumulatively. Repeated-measures Poisson models estimated longitudinal change (expressed as percent difference) in physical function by chronic CMCs. Change-points assessed physical function change coincident with the development of a new condition. RESULTS Women (N = 2,283) followed from age 50.0 ± 2.7 to 64.0 ± 3.7 years; 7.3% had zero CMCs through follow-up, 22.5% (N = 513) had no baseline CMCs but developed ≥1, 22.7% women had ≥1 baseline CMC but never developed another, and 47.6% had ≥1 baseline CMC and developed ≥1 more. Each additional baseline CMC was associated with 4.0% worse baseline physical function and annual decline of 0.20%/year. Women with more baseline CMCs had greater decline in physical function with a new CMC (-1.90% per condition); and annual decline when developing a new condition accelerated by -0.33%/year per condition. CONCLUSIONS Self-reported physical function changes are evident from mid- to early late-life with the development of CMCs. Preventing or delaying CMCs may delay declines in physical function, and these potential pathways to disability warrant further research.
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Affiliation(s)
- Brittney S Lange-Maia
- Department of Preventive Medicine, Chicago, Illinois.,Center for Community Health Equity, Rush University Medical Center, Chicago, Illinois
| | | | - Rasa Kazlauskaite
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Elsa S Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh
| | | | | | - Imke Janssen
- Department of Preventive Medicine, Chicago, Illinois
| | - Elizabeth F Avery
- Department of Preventive Medicine, Chicago, Illinois.,Center for Community Health Equity, Rush University Medical Center, Chicago, Illinois
| | - Sheila A Dugan
- Department of Physical Medicine and Rehabilitation, Chicago, Illinois
| | - Howard M Kravitz
- Department of Preventive Medicine, Chicago, Illinois.,Department of Psychiatry, Rush University Medical Center, Chicago, Illinois
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Disease progression modeling of Alzheimer's disease according to education level. Sci Rep 2020; 10:16808. [PMID: 33033321 PMCID: PMC7544693 DOI: 10.1038/s41598-020-73911-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 09/16/2020] [Indexed: 01/07/2023] Open
Abstract
To develop a disease progression model of Alzheimer’s disease (AD) that shows cognitive decline from subjective cognitive impairments (SCI) to the end stage of AD dementia (ADD) and to investigate the effect of education level on the whole disease spectrum, we enrolled 565 patients who were followed up more than three times and had a clinical dementia rating sum of boxes (CDR-SB). Three cohorts, SCI (n = 85), amnestic mild cognitive impairment (AMCI, n = 240), and ADD (n = 240), were overlapped in two consecutive cohorts (SCI and AMCI, AMCI and ADD) to construct a model of disease course, and a model with multiple single-cohorts was estimated using a mixed-effect model. To examine the effect of education level on disease progression, the disease progression model was developed with data from lower (≤ 12) and higher (> 12) education groups. Disease progression takes 274.3 months (22.9 years) to advance from 0 to 18 points using the CDR-SB. Based on our predictive equation, it takes 116.5 months to progress from SCI to AMCI and 56.2 months to progress from AMCI to ADD. The rate of CDR-SB progression was different according to education level. The lower-education group showed faster CDR-SB progression from SCI to AMCI compared to the higher-education group, and this trend disappeared from AMCI to ADD. In the present study, we developed a disease progression model of AD spectrum from SCI to the end stage of ADD. Our disease modeling provides us with more understanding of the effect of education on cognitive trajectories.
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Li H, Benitez A, Neelon B. A Bayesian hierarchical change point model with parameter constraints. Stat Methods Med Res 2020; 30:316-330. [PMID: 32921225 DOI: 10.1177/0962280220948097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Alzheimer's disease is the leading cause of dementia among adults aged 65 or above. Alzheimer's disease is characterized by a change point signaling a sudden and prolonged acceleration in cognitive decline. The timing of this change point is of clinical interest because it can be used to establish optimal treatment regimens and schedules. Here, we present a Bayesian hierarchical change point model with a parameter constraint to characterize the rate and timing of cognitive decline among Alzheimer's disease patients. We allow each patient to have a unique random intercept, random slope before the change point, random change point time, and random slope after the change point. The difference in slope before and after a change point is constrained to be nonpositive, and its parameter space is partitioned into a null region (representing normal aging) and a rejection region (representing accelerated decline). Using the change point time, the estimated slope difference, and the threshold of the null region, we are able to (1) distinguish normal aging patients from those with accelerated cognitive decline, (2) characterize the rate and timing for patients experiencing cognitive decline, and (3) predict personalized risk of progression to dementia due to Alzheimer's disease. We apply the approach to data from the Religious Orders Study, a national cohort study of aging Catholic nuns, priests, and lay brothers.
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Affiliation(s)
- Hong Li
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Andreana Benitez
- Departments of Neurology and Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
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11
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Lövdén M, Fratiglioni L, Glymour MM, Lindenberger U, Tucker-Drob EM. Education and Cognitive Functioning Across the Life Span. Psychol Sci Public Interest 2020; 21:6-41. [PMID: 32772803 PMCID: PMC7425377 DOI: 10.1177/1529100620920576] [Citation(s) in RCA: 385] [Impact Index Per Article: 96.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cognitive abilities are important predictors of educational and occupational performance, socioeconomic attainment, health, and longevity. Declines in cognitive abilities are linked to impairments in older adults' everyday functions, but people differ from one another in their rates of cognitive decline over the course of adulthood and old age. Hence, identifying factors that protect against compromised late-life cognition is of great societal interest. The number of years of formal education completed by individuals is positively correlated with their cognitive function throughout adulthood and predicts lower risk of dementia late in life. These observations have led to the propositions that prolonging education might (a) affect cognitive ability and (b) attenuate aging-associated declines in cognition. We evaluate these propositions by reviewing the literature on educational attainment and cognitive aging, including recent analyses of data harmonized across multiple longitudinal cohort studies and related meta-analyses. In line with the first proposition, the evidence indicates that educational attainment has positive effects on cognitive function. We also find evidence that cognitive abilities are associated with selection into longer durations of education and that there are common factors (e.g., parental socioeconomic resources) that affect both educational attainment and cognitive development. There is likely reciprocal interplay among these factors, and among cognitive abilities, during development. Education-cognitive ability associations are apparent across the entire adult life span and across the full range of education levels, including (to some degree) tertiary education. However, contrary to the second proposition, we find that associations between education and aging-associated cognitive declines are negligible and that a threshold model of dementia can account for the association between educational attainment and late-life dementia risk. We conclude that educational attainment exerts its influences on late-life cognitive function primarily by contributing to individual differences in cognitive skills that emerge in early adulthood but persist into older age. We also note that the widespread absence of educational influences on rates of cognitive decline puts constraints on theoretical notions of cognitive aging, such as the concepts of cognitive reserve and brain maintenance. Improving the conditions that shape development during the first decades of life carries great potential for improving cognitive ability in early adulthood and for reducing public-health burdens related to cognitive aging and dementia.
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Affiliation(s)
- Martin Lövdén
- Aging Research Center, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Ulman Lindenberger
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, Berlin, Germany, and London, United Kingdom
| | - Elliot M. Tucker-Drob
- Department of Psychology and Population Research Center, University of Texas at Austin
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12
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Adamo DE, Anderson T, Koochaki M, Fritz NE. Declines in grip strength may indicate early changes in cognition in healthy middle-aged adults. PLoS One 2020; 15:e0232021. [PMID: 32324794 PMCID: PMC7179876 DOI: 10.1371/journal.pone.0232021] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 04/06/2020] [Indexed: 12/22/2022] Open
Abstract
Declining grip strength is an indicator of cognitive loss in older individuals but it has not been explored people younger than 65 years old. The purpose of this study was to investigate the relationship between grip strength and specific cognitive tests known to decline with mild cognitive impairment in young and middle-aged adults. Declines in cognitive performance in middle-aged adults may provide evidence that these changes occur earlier than previously reported. A cross sectional design was used to compare differences between young and middle-aged healthy adults and to investigate associations between cognitive and grip strength measures within groups. Healthy young (20–30 years old) and middle-aged (45–65 years old) adults completed five cognitive tests including the Stroop, California Verbal Learning Test, Symbol Digit Modalities Test, Trail Making Tests and the Controlled Oral Word Association Test. All participants completed right and left maximum grip strength measures. Middle-aged adults performed significantly worse on right and left grip strength and the Stroop test (p<0.05) when compared to the younger group. There were no significant relationships among grip strength and cognitive performance at the whole-group level or within the younger-age group; however, weaker grip strength was significantly associated with poorer Controlled Oral Word Association Test total cluster (r = 0.458; p < .05) and Stroop interference (r = 0.471; p < .05) scores in the middle-aged group. Findings from this study suggest that cognitive changes may occur earlier than previously thought (prior to age 65). Weaker grip strength was significantly associated with poorer function in two of the cognitive measures in the middle-age group, suggesting that some domains of cognition, specifically semantic categorization and executive function, may be particularly sensitive to age-related changes.
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Affiliation(s)
- Diane E. Adamo
- Program in Physical Therapy, Wayne State University, Detroit, Michigan, United States of America
- Institute of Gerontology, Wayne State University, Detroit, Michigan, United States of America
| | - Tara Anderson
- Program in Physical Therapy, Wayne State University, Detroit, Michigan, United States of America
| | - Mahtab Koochaki
- Program in Physical Therapy, Wayne State University, Detroit, Michigan, United States of America
| | - Nora E. Fritz
- Program in Physical Therapy, Wayne State University, Detroit, Michigan, United States of America
- Department of Neurology, Wayne State University, Detroit, Michigan, United States of America
- * E-mail:
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Wilson RS, Yu L, Leurgans SE, Bennett DA, Boyle PA. Proportion of cognitive loss attributable to terminal decline. Neurology 2019; 94:e42-e50. [PMID: 31792096 DOI: 10.1212/wnl.0000000000008671] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/27/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To estimate the proportion of late-life cognitive loss attributable to impending death. METHODS Older persons (n = 1,071) in a longitudinal cohort study without dementia at enrollment underwent annual cognitive assessments (mean 10.6 years, SD 4.6, range 4-24) prior to death. We estimated the onset of terminal acceleration in cognitive decline and rates of decline before and after this point in change point models that allowed calculation of the percent of cognitive loss attributable to terminal decline. Outcomes were composite measures of global and specific cognitive functions. We also estimated dementia and mild cognitive impairment (MCI) incidence before and during the terminal period. RESULTS A mean of 3.7 years before death (95% credible interval [CI] -3.8 to -3.5), the rate of global cognitive decline accelerated to -0.313 unit per year (95% CI -0.337 to -0.290), a more than 7-fold increase indicative of terminal decline. The mean global cognitive score dropped 0.377 unit (SD 0.516) assuming no terminal decline and 1.192 units (SD 1.080) with terminal decline. As a result, 71% (95% bootstrapped CI 0.70, 0.73) of overall global cognitive loss was terminal. In subsequent analyses, terminal decline accounted for 70% of episodic memory loss, 65% of semantic memory loss, 57% of working memory loss, 52% of perceptual speed loss, and 53% of visuospatial loss. MCI incidence in the preterminal and terminal periods was similar, but dementia incidence was more than 6-fold higher in the terminal period than preterminal. CONCLUSION Most late-life cognitive loss is driven by terminal decline.
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Affiliation(s)
- Robert S Wilson
- From the Departments of Neurological Sciences (R.S.W., L.Y., S.E.L., D.A.B.) and Behavioral Sciences (R.S.W., P.A.B.), Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.
| | - Lei Yu
- From the Departments of Neurological Sciences (R.S.W., L.Y., S.E.L., D.A.B.) and Behavioral Sciences (R.S.W., P.A.B.), Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL
| | - Sue E Leurgans
- From the Departments of Neurological Sciences (R.S.W., L.Y., S.E.L., D.A.B.) and Behavioral Sciences (R.S.W., P.A.B.), Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL
| | - David A Bennett
- From the Departments of Neurological Sciences (R.S.W., L.Y., S.E.L., D.A.B.) and Behavioral Sciences (R.S.W., P.A.B.), Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL
| | - Patricia A Boyle
- From the Departments of Neurological Sciences (R.S.W., L.Y., S.E.L., D.A.B.) and Behavioral Sciences (R.S.W., P.A.B.), Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL
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14
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Buchman AS, Yu L, Wilson RS, Leurgans SE, Nag S, Shulman JM, Barnes LL, Schneider JA, Bennett DA. Progressive parkinsonism in older adults is related to the burden of mixed brain pathologies. Neurology 2019; 92:e1821-e1830. [PMID: 30894446 PMCID: PMC6550497 DOI: 10.1212/wnl.0000000000007315] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 12/17/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To examine whether indices of Parkinson disease (PD) pathology and other brain pathologies are associated with the progression of parkinsonism in older adults. METHODS We used data from decedents who had undergone annual clinical testing prior to death and structured brain autopsy. Parkinsonism was based on assessment with a modified Unified Parkinson's Disease Rating Scale and a clinical diagnosis of PD was based on medical history. We used a series of mixed-effects models controlling for age and sex to investigate the association of PD pathology (nigral neuronal loss and Lewy bodies) and indices of 8 other brain pathologies with the progression of parkinsonism prior to death. RESULTS During an average of 8.5 years' follow-up, more than half (771/1,430, 53.9%) developed parkinsonism proximate to death. On average, parkinsonism was progressive (estimate 0.130, SE 0.005, p < 0.001) in all older adults, but more rapid in adults with a clinical diagnosis of PD (n = 52; 3.6%) (estimate 0.066, SE 0.021, p < 0.001). Progression of parkinsonism was more rapid in adults with PD pathology (estimate 0.087, SE 0.013, p < 0.001). Alzheimer disease and several cerebrovascular pathologies were all independently associated with more rapid progression (all p values <0.05). The association between a higher person-specific weighted pathology score and more rapidly progressive parkinsonism did not differ between individuals with and without a clinical diagnosis of PD (estimate 0.003, SE 0.047, p = 0.957). CONCLUSION The rate of progressive parkinsonism in older adults with and without a clinical diagnosis of PD is related to the burden of mixed brain pathologies.
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Affiliation(s)
- Aron S Buchman
- From the Rush Alzheimer's Disease Center (A.S.B., L.Y., R.S.W., S.E.L., S.N., L.L.B., J.A.S., D.A.B.), and Departments of Neurological Sciences (A.S.B., L.Y., R.S.W., S.E.L., J.A.S., D.A.B.), Behavioral Sciences (R.S.W., L.L.B.), and Pathology (Neuropathology) (S.N., J.A.S.), Rush University Medical Center, Chicago, IL; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine, Houston, TX; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston.
| | - Lei Yu
- From the Rush Alzheimer's Disease Center (A.S.B., L.Y., R.S.W., S.E.L., S.N., L.L.B., J.A.S., D.A.B.), and Departments of Neurological Sciences (A.S.B., L.Y., R.S.W., S.E.L., J.A.S., D.A.B.), Behavioral Sciences (R.S.W., L.L.B.), and Pathology (Neuropathology) (S.N., J.A.S.), Rush University Medical Center, Chicago, IL; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine, Houston, TX; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston
| | - Robert S Wilson
- From the Rush Alzheimer's Disease Center (A.S.B., L.Y., R.S.W., S.E.L., S.N., L.L.B., J.A.S., D.A.B.), and Departments of Neurological Sciences (A.S.B., L.Y., R.S.W., S.E.L., J.A.S., D.A.B.), Behavioral Sciences (R.S.W., L.L.B.), and Pathology (Neuropathology) (S.N., J.A.S.), Rush University Medical Center, Chicago, IL; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine, Houston, TX; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston
| | - Sue E Leurgans
- From the Rush Alzheimer's Disease Center (A.S.B., L.Y., R.S.W., S.E.L., S.N., L.L.B., J.A.S., D.A.B.), and Departments of Neurological Sciences (A.S.B., L.Y., R.S.W., S.E.L., J.A.S., D.A.B.), Behavioral Sciences (R.S.W., L.L.B.), and Pathology (Neuropathology) (S.N., J.A.S.), Rush University Medical Center, Chicago, IL; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine, Houston, TX; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston
| | - Sukriti Nag
- From the Rush Alzheimer's Disease Center (A.S.B., L.Y., R.S.W., S.E.L., S.N., L.L.B., J.A.S., D.A.B.), and Departments of Neurological Sciences (A.S.B., L.Y., R.S.W., S.E.L., J.A.S., D.A.B.), Behavioral Sciences (R.S.W., L.L.B.), and Pathology (Neuropathology) (S.N., J.A.S.), Rush University Medical Center, Chicago, IL; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine, Houston, TX; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston
| | - Joshua M Shulman
- From the Rush Alzheimer's Disease Center (A.S.B., L.Y., R.S.W., S.E.L., S.N., L.L.B., J.A.S., D.A.B.), and Departments of Neurological Sciences (A.S.B., L.Y., R.S.W., S.E.L., J.A.S., D.A.B.), Behavioral Sciences (R.S.W., L.L.B.), and Pathology (Neuropathology) (S.N., J.A.S.), Rush University Medical Center, Chicago, IL; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine, Houston, TX; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston
| | - Lisa L Barnes
- From the Rush Alzheimer's Disease Center (A.S.B., L.Y., R.S.W., S.E.L., S.N., L.L.B., J.A.S., D.A.B.), and Departments of Neurological Sciences (A.S.B., L.Y., R.S.W., S.E.L., J.A.S., D.A.B.), Behavioral Sciences (R.S.W., L.L.B.), and Pathology (Neuropathology) (S.N., J.A.S.), Rush University Medical Center, Chicago, IL; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine, Houston, TX; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston
| | - Julie A Schneider
- From the Rush Alzheimer's Disease Center (A.S.B., L.Y., R.S.W., S.E.L., S.N., L.L.B., J.A.S., D.A.B.), and Departments of Neurological Sciences (A.S.B., L.Y., R.S.W., S.E.L., J.A.S., D.A.B.), Behavioral Sciences (R.S.W., L.L.B.), and Pathology (Neuropathology) (S.N., J.A.S.), Rush University Medical Center, Chicago, IL; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine, Houston, TX; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston
| | - David A Bennett
- From the Rush Alzheimer's Disease Center (A.S.B., L.Y., R.S.W., S.E.L., S.N., L.L.B., J.A.S., D.A.B.), and Departments of Neurological Sciences (A.S.B., L.Y., R.S.W., S.E.L., J.A.S., D.A.B.), Behavioral Sciences (R.S.W., L.L.B.), and Pathology (Neuropathology) (S.N., J.A.S.), Rush University Medical Center, Chicago, IL; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine, Houston, TX; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston
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Wilson RS, Yu L, Lamar M, Schneider JA, Boyle PA, Bennett DA. Education and cognitive reserve in old age. Neurology 2019; 92:e1041-e1050. [PMID: 30728309 PMCID: PMC6442015 DOI: 10.1212/wnl.0000000000007036] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/29/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the contribution of education to cognitive reserve. METHODS Analyses are based on older participants in a longitudinal clinical-pathologic cohort study who had annual cognitive testing (n = 2,899) and subgroups that developed incident dementia (n = 696), died, and underwent a neuropathologic examination from which 10 neurodegenerative and cerebrovascular markers were derived (n = 752), or both (n = 405). Cognitive test scores were converted to a standard scale and averaged to yield composite measures of cognition. RESULTS Participants had a mean of 16.3 years of education (SD = 3.7, range 0-30). In all participants, education was associated with initial level of global cognition but not rate of cognitive change. In those who developed dementia, rate of global cognitive decline accelerated a mean of 1.8 years before the diagnosis, but education was not related to the onset or rate of accelerated decline. In the deceased, rate of global cognitive decline accelerated a mean of 3.4 years before death, but higher educational attainment was related to earlier (not later) onset of accelerated decline and unrelated to rate of acceleration. Higher education was associated with lower likelihood of gross and microscopic cerebral infarcts but not with other neuropathologic markers. Education was not related to global cognitive change not attributable to neuropathologic burden and did not decrease the association of higher neuropathologic burden with more rapid cognitive decline. CONCLUSION The results suggest that the contribution of education to cognitive reserve is limited to its association with level of cognitive function before old age.
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Affiliation(s)
- Robert S Wilson
- From the Departments of Neurological Sciences (R.S.W., L.Y., J.A.S., D.A.B.), Behavioral Sciences (R.S.W., M.L., P.A.B.), and Pathology (J.A.S.), Rush University Medical Center, Rush Alzheimer's Disease Center, Chicago, IL.
| | - Lei Yu
- From the Departments of Neurological Sciences (R.S.W., L.Y., J.A.S., D.A.B.), Behavioral Sciences (R.S.W., M.L., P.A.B.), and Pathology (J.A.S.), Rush University Medical Center, Rush Alzheimer's Disease Center, Chicago, IL
| | - Melissa Lamar
- From the Departments of Neurological Sciences (R.S.W., L.Y., J.A.S., D.A.B.), Behavioral Sciences (R.S.W., M.L., P.A.B.), and Pathology (J.A.S.), Rush University Medical Center, Rush Alzheimer's Disease Center, Chicago, IL
| | - Julie A Schneider
- From the Departments of Neurological Sciences (R.S.W., L.Y., J.A.S., D.A.B.), Behavioral Sciences (R.S.W., M.L., P.A.B.), and Pathology (J.A.S.), Rush University Medical Center, Rush Alzheimer's Disease Center, Chicago, IL
| | - Patricia A Boyle
- From the Departments of Neurological Sciences (R.S.W., L.Y., J.A.S., D.A.B.), Behavioral Sciences (R.S.W., M.L., P.A.B.), and Pathology (J.A.S.), Rush University Medical Center, Rush Alzheimer's Disease Center, Chicago, IL
| | - David A Bennett
- From the Departments of Neurological Sciences (R.S.W., L.Y., J.A.S., D.A.B.), Behavioral Sciences (R.S.W., M.L., P.A.B.), and Pathology (J.A.S.), Rush University Medical Center, Rush Alzheimer's Disease Center, Chicago, IL
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Karr JE, Graham RB, Hofer SM, Muniz-Terrera G. When does cognitive decline begin? A systematic review of change point studies on accelerated decline in cognitive and neurological outcomes preceding mild cognitive impairment, dementia, and death. Psychol Aging 2019; 33:195-218. [PMID: 29658744 DOI: 10.1037/pag0000236] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Older adults who ultimately develop dementia experience accelerated cognitive decline long before diagnosis. A similar acceleration in cognitive decline occurs in the years before death as well. To evaluate preclinical and terminal cognitive decline, past researchers have incorporated change points in their analyses of longitudinal data, identifying point estimates of how many years prior to diagnosis or death that decline begins to accelerate. The current systematic review aimed to summarize the published literature on preclinical and terminal change points in relation to mild cognitive impairment (MCI), dementia, and death, identifying the order in which cognitive and neurological outcomes decline and factors that modify the onset and rate of decline. A systematic search protocol yielded 35 studies, describing 16 longitudinal cohorts, modeling change points for cognitive and neurological outcomes preceding MCI, dementia, or death. Change points for cognitive abilities ranged from 3-7 years prior to MCI diagnosis, 1-11 years prior to dementia diagnosis, and 3-15 years before death. No sequence of decline was observed preceding MCI or death, but the following sequence was tentatively accepted for Alzheimer's disease: verbal memory, visuospatial ability, executive functions and fluency, and last, verbal IQ. Some of the modifiers of the onset and rate of decline examined by previous researchers included gender, education, genetics, neuropathology, and personality. Change point analyses evidence accelerated decline preceding MCI, dementia, and death, but moderators of the onset and rate of decline remain ambiguous due to between-study modeling differences, and coordinated analyses may improve comparability across future studies. (PsycINFO Database Record
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17
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Lee S, Zhou X, Gao Y, Vardarajan B, Reyes-Dumeyer D, Rajan KB, Wilson RS, Evans DA, Besser LM, Kukull WA, Bennett DA, Brickman AM, Schupf N, Mayeux R, Barral S. Episodic memory performance in a multi-ethnic longitudinal study of 13,037 elderly. PLoS One 2018; 13:e0206803. [PMID: 30462667 PMCID: PMC6248922 DOI: 10.1371/journal.pone.0206803] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 10/21/2018] [Indexed: 02/02/2023] Open
Abstract
Age-related changes in memory are not uniform, even in the absence of dementia. Characterization of non-disease associated cognitive changes is crucial to gain a more complete understanding of brain aging. Episodic memory was investigated in 13,037 ethnically diverse elderly (ages 72 to 85 years) with two to 15 years of follow-up, and with known dementia status, age, sex, education, and APOE genotypes. Adjusted trajectories of episodic memory performance over time were estimated using Latent Class Mixed Models. Analysis was conducted using two samples at baseline evaluation: i) non-cognitively impaired individuals, and ii) all individuals regardless of dementia status. We calculated the age-specific annual incidence rates of dementia in the non-demented elderly (n = 10,220). Two major episodic memory trajectories were estimated: 1) Stable-consisting of individuals exhibiting a constant or improved memory function, and 2) Decliner-consisting of individuals whose memory function declined. The majority of the study participants maintain their memory performance over time. Compared to those with Stable trajectory, individuals characterized as Decliners were more likely to have non-white ethnic background, fewer years of education, a higher frequency of ε4 allele at APOE gene and five times more likely to develop dementia. The steepest decline in episodic memory was observed in Caribbean-Hispanics compared to non-Hispanic whites (p = 4.3 x 10(-15)). The highest incident rates of dementia were observed in the oldest age group, among those of Caribbean-Hispanics ancestry and among Decliners who exhibited rates five times higher than those with Stable trajectories (11 per 100 person-years versus 3 per 100 person-years. Age, education, ethnic background and APOE genotype influence the maintenance of episodic memory. Declining memory is one of the strongest predictors of incident dementia.
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Affiliation(s)
- Seonjoo Lee
- Research Foundation for Mental Hygiene and the Department of Biostatics, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
| | - Xingtao Zhou
- The Georgetown University Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C., United States of America
| | - Yizhe Gao
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
| | - Badri Vardarajan
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
| | - Dolly Reyes-Dumeyer
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
| | - Kumar B. Rajan
- Department of Public Health Sciences, University of California at Davis, Davis, California, United States of America
| | - Robert S. Wilson
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Denis A. Evans
- Department of Internal Medicine, Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Lilah M. Besser
- School of Urban and Regional Planning, Florida Atlantic University, Boca Raton, Florida, United States of America
| | - Walter A. Kukull
- Department of Epidemiology, National Alzheimer's Coordinating Center, University of Washington, Seattle, Washington, United States of America
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Adam M. Brickman
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
| | - Nicole Schupf
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York, United States of America
| | - Richard Mayeux
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
| | - Sandra Barral
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, United States of America
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
- Gertrude H. Sergievsky Center and Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, New York, United States of America
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Jung NY, Cho H, Kim YJ, Kim HJ, Lee JM, Park S, Kim ST, Kim EJ, Kim JS, Moon SH, Lee JH, Ewers M, Na DL, Seo SW. The impact of education on cortical thickness in amyloid-negative subcortical vascular dementia: cognitive reserve hypothesis. ALZHEIMERS RESEARCH & THERAPY 2018; 10:103. [PMID: 30261914 PMCID: PMC6161352 DOI: 10.1186/s13195-018-0432-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/17/2018] [Indexed: 01/22/2023]
Abstract
Background The protective effect of education has been well established in Alzheimer’s disease, whereas its role in patients with isolated cerebrovascular diseases remains unclear. We examined the correlation of education with cortical thickness and cerebral small vessel disease markers in patients with pure subcortical vascular mild cognitive impairment (svMCI) and patients with pure subcortical vascular dementia (SVaD). Methods We analyzed 45 patients with svMCI and 47 patients with SVaD with negative results on Pittsburgh compound B positron emission tomographic imaging who underwent structural brain magnetic resonance imaging. The main outcome was cortical thickness measured using surface-based morphometric analysis. We also assessed the volumes of white matter hyperintensities (WMH) and numbers of lacunes as other outcomes. To investigate the correlation of education with cortical thickness, WMH volume, and number of lacunes, multiple linear regression analyses were performed after controlling for covariates, including Mini Mental State Examination, in the svMCI and SVaD groups. Results In the SVaD group, higher education was correlated with more severe cortical thinning in the bilateral dorsolateral frontal, left medial frontal, and parahippocampal areas, whereas there was no correlation of education with cortical thickness in the svMCI group. There was no correlation between education and cerebral small vessel disease, including WMH and lacunes, in both patients with svMCI and patients with SVaD. Conclusions Our findings suggest that the compensatory effects of education on cortical thinning apply to patients with SVaD, which might be explained by the cognitive reserve hypothesis.
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Affiliation(s)
- Na-Yeon Jung
- Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Korea.,Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Hanna Cho
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yeo Jin Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Jong Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, Korea
| | - Seongbeom Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Sung Tae Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University Hospital, Busan, Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung Hwan Moon
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Hong Lee
- Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Michael Ewers
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. .,Neuroscience Center, Samsung Medical Center, Seoul, Korea.
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19
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Mungas D, Gavett B, Fletcher E, Farias ST, DeCarli C, Reed B. Education amplifies brain atrophy effect on cognitive decline: implications for cognitive reserve. Neurobiol Aging 2018; 68:142-150. [PMID: 29798764 PMCID: PMC5993638 DOI: 10.1016/j.neurobiolaging.2018.04.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 01/24/2023]
Abstract
Level of education is often regarded as a proxy for cognitive reserve in older adults. This implies that brain degeneration has a smaller effect on cognitive decline in those with more education, but this has not been directly tested in previous research. We examined how education, quantitative magnetic resonance imaging-based measurement of brain degeneration, and their interaction affect cognitive decline in diverse older adults spanning the spectrum from normal cognition to dementia. Gray matter atrophy was strongly related to cognitive decline. While education was not related to cognitive decline, brain atrophy had a stronger effect on cognitive decline in those with more education. Importantly, high education was associated with slower decline in individuals with lesser atrophy but with faster decline in those with greater atrophy. This moderation effect was observed in Hispanics (who had high heterogeneity of education) but not in African-Americans or Caucasians. These results suggest that education is an indicator of cognitive reserve in individuals with low levels of brain degeneration, but the protective effect of higher education is rapidly depleted as brain degeneration progresses.
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Affiliation(s)
- Dan Mungas
- Department of Neurology, University of California, Davis, CA, USA.
| | - Brandon Gavett
- Department of Psychology, University of Colorado, Colorado Springs, CO, USA
| | - Evan Fletcher
- Department of Neurology, University of California, Davis, CA, USA
| | | | - Charles DeCarli
- Department of Neurology, University of California, Davis, CA, USA
| | - Bruce Reed
- Center for Scientific Review, National Institutes of Health, Bethesda, MD, USA
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20
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Robitaille A, van den Hout A, Machado RJM, Bennett DA, Čukić I, Deary IJ, Hofer SM, Hoogendijk EO, Huisman M, Johansson B, Koval AV, van der Noordt M, Piccinin AM, Rijnhart JJM, Singh-Manoux A, Skoog J, Skoog I, Starr J, Vermunt L, Clouston S, Muniz Terrera G. Transitions across cognitive states and death among older adults in relation to education: A multistate survival model using data from six longitudinal studies. Alzheimers Dement 2018; 14:462-472. [PMID: 29396108 PMCID: PMC6377940 DOI: 10.1016/j.jalz.2017.10.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 08/22/2017] [Accepted: 10/02/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION This study examines the role of educational attainment, an indicator of cognitive reserve, on transitions in later life between cognitive states (normal Mini-Mental State Examination (MMSE), mild MMSE impairment, and severe MMSE impairment) and death. METHODS Analysis of six international longitudinal studies was performed using a coordinated approach. Multistate survival models were used to estimate the transition patterns via different cognitive states. Life expectancies were estimated. RESULTS Across most studies, a higher level of education was associated with a lower risk of transitioning from normal MMSE to mild MMSE impairment but was not associated with other transitions. Those with higher levels of education and socioeconomic status had longer nonimpaired life expectancies. DISCUSSION This study highlights the importance of education in later life and that early life experiences can delay later compromised cognitive health. This study also demonstrates the feasibility and benefit in conducting coordinated analysis across multiple studies to validate findings.
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Affiliation(s)
- Annie Robitaille
- Department of Psychology, University of Victoria, Victoria, BC, Canada.
| | - Ardo van den Hout
- Department of Statistical Science, University College London, London, UK
| | - Robson J M Machado
- Department of Statistical Science, University College London, London, UK
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, US
| | - Iva Čukić
- Department of Psychology, University of Edinburgh, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Department of Psychology, University of Edinburgh, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Scott M Hofer
- Department of Psychology, University of Victoria, Victoria, BC, Canada; Department of Neurology, Oregon Health & Science University, Portland, OR, US
| | - Emiel O Hoogendijk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Boo Johansson
- Department of Psychology and Centre for Health and Ageing AGECAP, University of Gothenburg, Gothenburg, Sweden
| | - Andriy V Koval
- Department of Psychology, University of Victoria, Victoria, BC, Canada
| | - Maaike van der Noordt
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Andrea M Piccinin
- Department of Psychology, University of Victoria, Victoria, BC, Canada
| | - Judith J M Rijnhart
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Archana Singh-Manoux
- Department of Epidemiology & Public Health, University College London, London, UK; INSERM, U1018, Epidemiology of Ageing & Age-related diseases, Villejuif, France
| | - Johan Skoog
- Department of Psychology and Centre for Health and Ageing AGECAP, University of Gothenburg, Gothenburg, Sweden
| | - Ingmar Skoog
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Centre for Health and Ageing AGECAP, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - John Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Department of Clinical and Surgical Sciences, Geriatric Medicine Unit, University of Edinburgh, Edinburgh, UK; Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Lisa Vermunt
- Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Sean Clouston
- Program in Public Health and Department of Preventive Medicine, Stony Brook University, Stony Brook, New York, US
| | - Graciela Muniz Terrera
- Department of Psychology, University of Victoria, Victoria, BC, Canada; Centre for Dementia Prevention, The University of Edinburgh, Edinburgh, UK
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21
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Bennett DA, Buchman AS, Boyle PA, Barnes LL, Wilson RS, Schneider JA. Religious Orders Study and Rush Memory and Aging Project. J Alzheimers Dis 2018; 64:S161-S189. [PMID: 29865057 PMCID: PMC6380522 DOI: 10.3233/jad-179939] [Citation(s) in RCA: 662] [Impact Index Per Article: 110.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Religious Orders Study and Rush Memory and Aging Project are both ongoing longitudinal clinical-pathologic cohort studies of aging and Alzheimer's disease (AD). OBJECTIVES To summarize progress over the past five years and its implications for understanding neurodegenerative diseases. METHODS Participants in both studies are older adults who enroll without dementia and agree to detailed longitudinal clinical evaluations and organ donation. The last review summarized findings through the end of 2011. Here we summarize progress and study findings over the past five years and discuss new directions for how these studies can inform on aging and AD in the future. RESULTS We summarize 1) findings on the relation of neurobiology to clinical AD; 2) neurobiologic pathways linking risk factors to clinical AD; 3) non-cognitive AD phenotypes including motor function and decision making; 4) the development of a novel drug discovery platform. CONCLUSION Complexity at multiple levels needs to be understood and overcome to develop effective treatments and preventions for cognitive decline and AD dementia.
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Affiliation(s)
- David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL., USA
| | - Aron S. Buchman
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL., USA
| | - Patricia A. Boyle
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL., USA
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL., USA
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL., USA
| | - Robert S. Wilson
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL., USA
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL., USA
| | - Julie A Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL., USA
- Department of Pathology (Neuropathology), Rush University Medical Center, Chicago, IL., USA
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22
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Ganguli M, Albanese E, Seshadri S, Bennett DA, Lyketsos C, Kukull WA, Skoog I, Hendrie HC. Population Neuroscience: Dementia Epidemiology Serving Precision Medicine and Population Health. Alzheimer Dis Assoc Disord 2018; 32:1-9. [PMID: 29319603 PMCID: PMC5821530 DOI: 10.1097/wad.0000000000000237] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Over recent decades, epidemiology has made significant contributions to our understanding of dementia, translating scientific discoveries into population health. Here, we propose reframing dementia epidemiology as "population neuroscience," blending techniques and models from contemporary neuroscience with those of epidemiology and biostatistics. On the basis of emerging evidence and newer paradigms and methods, population neuroscience will minimize the bias typical of traditional clinical research, identify the relatively homogenous subgroups that comprise the general population, and investigate broader and denser phenotypes of dementia and cognitive impairment. Long-term follow-up of sufficiently large study cohorts will allow the identification of cohort effects and critical windows of exposure. Molecular epidemiology and omics will allow us to unravel the key distinctions within and among subgroups and better understand individuals' risk profiles. Interventional epidemiology will allow us to identify the different subgroups that respond to different treatment/prevention strategies. These strategies will inform precision medicine. In addition, insights into interactions between disease biology, personal and environmental factors, and social determinants of health will allow us to measure and track disease in communities and improve population health. By placing neuroscience within a real-world context, population neuroscience can fulfill its potential to serve both precision medicine and population health.
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Affiliation(s)
- Mary Ganguli
- Departments of Psychiatry and Neurology, School of Medicine and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | | | | | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL
| | - Constantine Lyketsos
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Walter A Kukull
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Ingmar Skoog
- Institute of Neuroscience and Physiology, Gothenburg University, Gothenburg, Sweden
| | - Hugh C Hendrie
- Regenstrief Institute Inc., Indiana University Center for Aging Research, Indianapolis, IN
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23
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Downer B, Chen NW, Raji M, Markides KS. A longitudinal study of cognitive trajectories in Mexican Americans age 75 and older. Int J Geriatr Psychiatry 2017; 32:1122-1130. [PMID: 27595613 PMCID: PMC5503790 DOI: 10.1002/gps.4575] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To identify distinct trajectories for global cognition, memory, and non-memory domains among Mexican American adults 75 years of age and older. METHODS The final sample included 1336 participants of the Hispanic Established Population for the Epidemiologic Study of the Elderly observed during four Waves from 2004-2005 to 2012-2013. Latent class growth curve models were used to identify distinct trajectories for global cognition, memory, and non-memory. RESULTS Three trajectory classes were identified for global cognition, memory, and non-memory domains. Nearly 31% of the final sample maintained high global cognition (persistent high), 52.6% experienced slight decline (decline but high), and 15% experienced severe decline in global cognition (decline to low). Over 95% of participants classified in the decline to low trajectory for global cognition were also classified as decline to low for memory and non-memory. This high level of consistency for memory and non-memory domains was observed for the decline but high (97.0%) and persistent high (93.7%) trajectory classes. CONCLUSIONS These results indicate that the majority of Mexican American older adults will experience varying degrees of cognitive decline. However, a substantial proportion of older Mexican Americans are able to maintain high cognitive functioning into advanced age despite the high prevalence of risk factors for cognitive decline in this population. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Brian Downer
- Division of Rehabilitation Sciences, University of Texas Medical Branch, GalvestonTexas, USA
| | - Nai-Wei Chen
- Preventive Medicine and Community Health, University of Texas Medical Branch, GalvestonTexas, USA
| | - Mukaila Raji
- Division of Geriatric Medicine, University of Texas Medical Branch, GalvestonTexas, USA
| | - Kyriakos S. Markides
- Preventive Medicine and Community Health, University of Texas Medical Branch, GalvestonTexas, USA
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24
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Li G, Larson EB, Shofer JB, Crane PK, Gibbons LE, McCormick W, Bowen JD, Thompson ML. Cognitive Trajectory Changes Over 20 Years Before Dementia Diagnosis: A Large Cohort Study. J Am Geriatr Soc 2017; 65:2627-2633. [PMID: 28940184 DOI: 10.1111/jgs.15077] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Longitudinal studies have shown an increase in cognitive decline many years before clinical diagnosis of dementia. We sought to estimate changes, relative to "normal" aging, in the trajectory of scores on a global cognitive function test-the Cognitive Abilities Screening Instrument (CASI). DESIGN A prospective cohort study. SETTING Community-dwelling members of a U.S. health maintenance organization. PARTICIPANTS Individuals aged 65 and older who had no dementia diagnosis at baseline and had at least two visits with valid CASI test score (N = 4,315). MEASUREMENTS Average longitudinal trajectories, including changes in trajectory before clinical diagnosis in those who would be diagnosed with dementia, were estimated for CASI item response theory (IRT) scores. The impact of sex, education level, and APOE genotype on cognitive trajectories was assessed. RESULTS Increased cognitive decline relative to "normal" aging was evident in CASI IRT at least 10 years before clinical diagnosis. Male gender, lower education, and presence of ≥1 APOE ε4 alleles were associated with lower average IRT scores. In those who would be diagnosed with dementia, a trajectory change point was estimated at an average of 3.1 years (95% confidence interval 3.0-3.2) before clinical diagnosis, after which cognitive decline appeared to accelerate. The change point did not differ by sex, education level, or APOE ε4 genotype. There were subtle differences in trajectory slopes by sex and APOE ε4 genotype, but not by education. CONCLUSION Decline in average global cognitive function was evident at least 10 years before clinical diagnosis of dementia. The decline accelerated about 3 years before clinical diagnosis.
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Affiliation(s)
- Ge Li
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.,Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington
| | - Eric B Larson
- Department of General Internal Medicine, University of Washington, Seattle, Washington.,Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Jane B Shofer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Paul K Crane
- Department of General Internal Medicine, University of Washington, Seattle, Washington
| | - Laura E Gibbons
- Department of General Internal Medicine, University of Washington, Seattle, Washington
| | - Wayne McCormick
- Department of General Internal Medicine, University of Washington, Seattle, Washington
| | - James D Bowen
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington
| | - Mary Lou Thompson
- Department of Biostatistics, University of Washington, Seattle, Washington
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25
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Duke Han S, Boyle PA, Yu L, Arfanakis K, James BD, Fleischman DA, Bennett DA. Grey matter correlates of susceptibility to scams in community-dwelling older adults. Brain Imaging Behav 2017; 10:524-32. [PMID: 26100658 DOI: 10.1007/s11682-015-9422-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Susceptibility to scams is a significant issue among older adults, even among those with intact cognition. Age-related changes in brain macrostructure may be associated with susceptibility to scams; however, this has yet to be explored. Based on previous work implicating frontal and temporal lobe functioning as important in decision making, we tested the hypothesis that susceptibility to scams is associated with smaller grey matter volume in frontal and temporal lobe regions in a large community-dwelling cohort of non-demented older adults. Participants (N = 327, mean age = 81.55, mean education = 15.30, 78.9 % female) completed a self-report measure used to assess susceptibility to scams and an MRI brain scan. Results indicated an inverse association between overall grey matter and susceptibility to scams in models adjusted for age, education, and sex; and in models further adjusted for cognitive function. No significant associations were observed for white matter, cerebrospinal fluid, or total brain volume. Models adjusted for age, education, and sex revealed seven clusters showing smaller grey matter in the right parahippocampal/hippocampal/fusiform, left middle temporal, left orbitofrontal, right ventromedial prefrontal, right middle temporal, right precuneus, and right dorsolateral prefrontal regions. In models further adjusted for cognitive function, results revealed three significant clusters showing smaller grey matter in the right parahippocampal/hippocampal/fusiform, right hippocampal, and right middle temporal regions. Lower grey matter concentration in specific brain regions may be associated with susceptibility to scams, even after adjusting for cognitive ability. Future research is needed to determine whether grey matter reductions in these regions may be a biomarker for susceptibility to scams in old age.
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Affiliation(s)
- S Duke Han
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina St., Suite 1022, Chicago, IL, 60612, USA. .,Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, 60612, USA. .,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, 60612, USA. .,Mental Health Care Group, VA Long Beach Healthcare System, Long Beach, CA, 90822, USA.
| | - Patricia A Boyle
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina St., Suite 1022, Chicago, IL, 60612, USA.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina St., Suite 1022, Chicago, IL, 60612, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Konstantinos Arfanakis
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, 60612, USA.,Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Bryan D James
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina St., Suite 1022, Chicago, IL, 60612, USA.,Department of Internal Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Debra A Fleischman
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina St., Suite 1022, Chicago, IL, 60612, USA.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, 60612, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, 60612, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina St., Suite 1022, Chicago, IL, 60612, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, 60612, USA
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26
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Qian J, Hyman BT, Betensky RA. Neurofibrillary Tangle Stage and the Rate of Progression of Alzheimer Symptoms: Modeling Using an Autopsy Cohort and Application to Clinical Trial Design. JAMA Neurol 2017; 74:540-548. [PMID: 28288263 PMCID: PMC5547572 DOI: 10.1001/jamaneurol.2016.5953] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Importance The heterogeneity of rate of clinical progression among patients with Alzheimer disease leads to difficulty in providing clinical counseling and diminishes the power of clinical trials using disease-modifying agents. Objective To gain a better understanding of the factors that affect the natural history of progression in Alzheimer disease for the purpose of improving both clinical care and clinical trial design. Design, Setting, and Participants A longitudinal cohort study of aging from 2005 to 2014 in the National Alzheimer Coordinating Center. Clinical evaluation of the participants was conducted in 31 National Institute on Aging's Alzheimer Disease Centers. Nine hundred eighty-four participants in the National Alzheimer Coordinating Center cohort study who died and underwent autopsy and met inclusion and exclusion criteria. Main Outcomes and Measures We sought to model the possibility that knowledge of neurofibrillary tangle burden in the presence of moderate or frequent plaques would add to the ability to predict clinical rate of progression during the ensuing 2 to 3 years. We examined the National Alzheimer Coordinating Center autopsy data to evaluate the effect of different neurofibrillary tangle stages on the rates of progression on several standard clinical instruments: the Clinical Dementia Rating Scale sum of boxes, a verbal memory test (logical memory), and a controlled oral word association task (vegetable naming), implementing a reverse-time longitudinal modeling approach in conjunction with latent class estimation to adjust for unmeasured sources of heterogeneity. Results Several correlations between clinical variables and neurocognitive performance suggest a basis for heterogeneity: Higher education level was associated with lower Clinical Dementia Rating Scale sum of boxes (β = -0.19; P < .001), and frequent vs moderate neuritic plaques were associated with higher Clinical Dementia Rating Scale sum of boxes (β = 1.64; P < .001) and lower logical memory score (β = -1.07; P = .005). The rate of change of the clinical and cognitive scores varied depending on Braak stage, when adjusting for plaques, age of death, sex, education, and APOE genotype. For example, comparing high vs low Braak stage with other variables fixed, the logical memory score decreased a substantial 0.38 additional units per year (95% CI, -0.70 to -0.06; P = .02). Using these data, we estimate that a 300-participant clinical trial with end point of a 20% improvement in slope in rate of change of Clinical Dementia Rating Scale sum of boxes has 89% power when all participants in the trial are from the high Braak stage, compared with 29% power if Braak stage had not used for eligibility. Conclusions and Relevance We found that knowledge of neurofibrillary tangle stage, modeled as the sort of information that could be available from tau positron-emission tomography scans and its use to determine eligibility to a trial, could dramatically improve the power of clinical trials and equivalently reduce the required sample sizes of clinical trials.
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Affiliation(s)
- Jing Qian
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst
| | - Bradley T Hyman
- Neurology Service, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Rebecca A Betensky
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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27
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Yu L, Lutz MW, Wilson RS, Burns DK, Roses AD, Saunders AM, Gaiteri C, De Jager PL, Barnes LL, Bennett DA. TOMM40'523 variant and cognitive decline in older persons with APOE ε3/3 genotype. Neurology 2017; 88:661-668. [PMID: 28108637 PMCID: PMC5317377 DOI: 10.1212/wnl.0000000000003614] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 11/14/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To interrogate a poly-T variant (rs10524523, '523) in TOMM40, a gene adjacent to the APOE gene on chromosome 19, in older persons with APOE ε3/3 homozygosity for association with cognitive decline, the clinical hallmark of Alzheimer disease (AD). METHODS Data came from participants in 2 cohort studies of aging and dementia who underwent annual clinical evaluations for up to 21 years. APOE and TOMM40'523 genotypes were determined from DNA from blood or brain samples. Linear mixed models compared the rates of decline in cognition among APOE ε3/3 carriers with different '523 genotypes. RESULTS The 1,170 APOE ε3/3 homozygotes were of European ancestry, were free of dementia at baseline, and had an average age of 78.5 years at baseline. Three major genotypes at the '523 variant were linked to APOE ε3/3; 26.5% had 2 short poly-Ts (S/S), 48.5% had 1 short and 1 very long poly-T (S/VL), and 24.0% had 2 very long poly-Ts (VL/VL). Participants with '523-S/S had faster decline in global cognition than participants with '523-S/VL or VL/VL (p = 0.002). The same association was observed for episodic memory (p < 0.001) and semantic memory (p = 0.003) but not for working memory, perceptual speed, or visuospatial ability. CONCLUSIONS Our data reveal an association of APOE ε3/3-TOMM40'523 haplotypes with cognitive decline in community-based older persons such that the S/S poly-T genotype is related to faster cognitive decline, primarily in the domains of episodic and semantic memory.
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Affiliation(s)
- Lei Yu
- From the Rush Alzheimer's Disease Center (L.Y., R.S.W., C.G., L.L.B., D.A.B.) and Department of Neurological Sciences (L.Y., R.S.W., C.G., L.L.B., D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (M.W.L., A.D.R., A.M.S.), Duke University School of Medicine, Durham; Zinfandel Pharmaceuticals, Inc (D.K.B., A.D.R.), Research Triangle Park, NC; Program in Translational NeuroPsychiatric Genomics (P.L.D.), Institute for the Neurosciences, Departments of Neurology and Psychiatry, Brigham and Women's Hospital; Harvard Medical School (P.L.D.), Boston; and Program in Medical and Population Genetics (P.L.D.), Broad Institute, Cambridge, MA.
| | - Michael W Lutz
- From the Rush Alzheimer's Disease Center (L.Y., R.S.W., C.G., L.L.B., D.A.B.) and Department of Neurological Sciences (L.Y., R.S.W., C.G., L.L.B., D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (M.W.L., A.D.R., A.M.S.), Duke University School of Medicine, Durham; Zinfandel Pharmaceuticals, Inc (D.K.B., A.D.R.), Research Triangle Park, NC; Program in Translational NeuroPsychiatric Genomics (P.L.D.), Institute for the Neurosciences, Departments of Neurology and Psychiatry, Brigham and Women's Hospital; Harvard Medical School (P.L.D.), Boston; and Program in Medical and Population Genetics (P.L.D.), Broad Institute, Cambridge, MA
| | - Robert S Wilson
- From the Rush Alzheimer's Disease Center (L.Y., R.S.W., C.G., L.L.B., D.A.B.) and Department of Neurological Sciences (L.Y., R.S.W., C.G., L.L.B., D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (M.W.L., A.D.R., A.M.S.), Duke University School of Medicine, Durham; Zinfandel Pharmaceuticals, Inc (D.K.B., A.D.R.), Research Triangle Park, NC; Program in Translational NeuroPsychiatric Genomics (P.L.D.), Institute for the Neurosciences, Departments of Neurology and Psychiatry, Brigham and Women's Hospital; Harvard Medical School (P.L.D.), Boston; and Program in Medical and Population Genetics (P.L.D.), Broad Institute, Cambridge, MA
| | - Daniel K Burns
- From the Rush Alzheimer's Disease Center (L.Y., R.S.W., C.G., L.L.B., D.A.B.) and Department of Neurological Sciences (L.Y., R.S.W., C.G., L.L.B., D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (M.W.L., A.D.R., A.M.S.), Duke University School of Medicine, Durham; Zinfandel Pharmaceuticals, Inc (D.K.B., A.D.R.), Research Triangle Park, NC; Program in Translational NeuroPsychiatric Genomics (P.L.D.), Institute for the Neurosciences, Departments of Neurology and Psychiatry, Brigham and Women's Hospital; Harvard Medical School (P.L.D.), Boston; and Program in Medical and Population Genetics (P.L.D.), Broad Institute, Cambridge, MA
| | - Allen D Roses
- From the Rush Alzheimer's Disease Center (L.Y., R.S.W., C.G., L.L.B., D.A.B.) and Department of Neurological Sciences (L.Y., R.S.W., C.G., L.L.B., D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (M.W.L., A.D.R., A.M.S.), Duke University School of Medicine, Durham; Zinfandel Pharmaceuticals, Inc (D.K.B., A.D.R.), Research Triangle Park, NC; Program in Translational NeuroPsychiatric Genomics (P.L.D.), Institute for the Neurosciences, Departments of Neurology and Psychiatry, Brigham and Women's Hospital; Harvard Medical School (P.L.D.), Boston; and Program in Medical and Population Genetics (P.L.D.), Broad Institute, Cambridge, MA
| | - Ann M Saunders
- From the Rush Alzheimer's Disease Center (L.Y., R.S.W., C.G., L.L.B., D.A.B.) and Department of Neurological Sciences (L.Y., R.S.W., C.G., L.L.B., D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (M.W.L., A.D.R., A.M.S.), Duke University School of Medicine, Durham; Zinfandel Pharmaceuticals, Inc (D.K.B., A.D.R.), Research Triangle Park, NC; Program in Translational NeuroPsychiatric Genomics (P.L.D.), Institute for the Neurosciences, Departments of Neurology and Psychiatry, Brigham and Women's Hospital; Harvard Medical School (P.L.D.), Boston; and Program in Medical and Population Genetics (P.L.D.), Broad Institute, Cambridge, MA
| | - Chris Gaiteri
- From the Rush Alzheimer's Disease Center (L.Y., R.S.W., C.G., L.L.B., D.A.B.) and Department of Neurological Sciences (L.Y., R.S.W., C.G., L.L.B., D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (M.W.L., A.D.R., A.M.S.), Duke University School of Medicine, Durham; Zinfandel Pharmaceuticals, Inc (D.K.B., A.D.R.), Research Triangle Park, NC; Program in Translational NeuroPsychiatric Genomics (P.L.D.), Institute for the Neurosciences, Departments of Neurology and Psychiatry, Brigham and Women's Hospital; Harvard Medical School (P.L.D.), Boston; and Program in Medical and Population Genetics (P.L.D.), Broad Institute, Cambridge, MA
| | - Philip L De Jager
- From the Rush Alzheimer's Disease Center (L.Y., R.S.W., C.G., L.L.B., D.A.B.) and Department of Neurological Sciences (L.Y., R.S.W., C.G., L.L.B., D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (M.W.L., A.D.R., A.M.S.), Duke University School of Medicine, Durham; Zinfandel Pharmaceuticals, Inc (D.K.B., A.D.R.), Research Triangle Park, NC; Program in Translational NeuroPsychiatric Genomics (P.L.D.), Institute for the Neurosciences, Departments of Neurology and Psychiatry, Brigham and Women's Hospital; Harvard Medical School (P.L.D.), Boston; and Program in Medical and Population Genetics (P.L.D.), Broad Institute, Cambridge, MA
| | - Lisa L Barnes
- From the Rush Alzheimer's Disease Center (L.Y., R.S.W., C.G., L.L.B., D.A.B.) and Department of Neurological Sciences (L.Y., R.S.W., C.G., L.L.B., D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (M.W.L., A.D.R., A.M.S.), Duke University School of Medicine, Durham; Zinfandel Pharmaceuticals, Inc (D.K.B., A.D.R.), Research Triangle Park, NC; Program in Translational NeuroPsychiatric Genomics (P.L.D.), Institute for the Neurosciences, Departments of Neurology and Psychiatry, Brigham and Women's Hospital; Harvard Medical School (P.L.D.), Boston; and Program in Medical and Population Genetics (P.L.D.), Broad Institute, Cambridge, MA
| | - David A Bennett
- From the Rush Alzheimer's Disease Center (L.Y., R.S.W., C.G., L.L.B., D.A.B.) and Department of Neurological Sciences (L.Y., R.S.W., C.G., L.L.B., D.A.B.), Rush University Medical Center, Chicago, IL; Department of Neurology (M.W.L., A.D.R., A.M.S.), Duke University School of Medicine, Durham; Zinfandel Pharmaceuticals, Inc (D.K.B., A.D.R.), Research Triangle Park, NC; Program in Translational NeuroPsychiatric Genomics (P.L.D.), Institute for the Neurosciences, Departments of Neurology and Psychiatry, Brigham and Women's Hospital; Harvard Medical School (P.L.D.), Boston; and Program in Medical and Population Genetics (P.L.D.), Broad Institute, Cambridge, MA
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Machulda MM, Hagen CE, Wiste HJ, Mielke MM, Knopman DS, Roberts RO, Vemuri P, Lowe VJ, Jack CR, Petersen RC. [Formula: see text]Practice effects and longitudinal cognitive change in clinically normal older adults differ by Alzheimer imaging biomarker status. Clin Neuropsychol 2017; 31:99-117. [PMID: 27724156 PMCID: PMC5408356 DOI: 10.1080/13854046.2016.1241303] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 09/18/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this study was to examine practice effects and longitudinal cognitive change in 190 clinically normal elderly classified according to a two-feature biomarker model for Alzheimer's disease. METHODS All participants completed neuropsychological testing, MRI, FDG-PET, and PiB-PET at their baseline evaluation. We divided participants into four groups based on neuroimaging measures of amyloid (A+ or A-) and neurodegeneration (N+ or N-) and reexamined cognition at 15- and 30-month intervals. RESULTS The A-N- group showed significant improvements in the memory and global scores. The A+N- group also showed significant improvements in the memory and global scores as well as attention. The A-N+ group showed a significant decline in attention at 30 months. The A+N+ group showed significant improvements in memory and the global score at 15 months followed by a significant decline in the global score at 30 months. CONCLUSION Amyloidosis in the absence of neurodegeneration did not have an adverse impact on practice effects or the 30-month cognitive trajectories. In contrast, participants with neurodegeneration (either A-N+ or A+N+) had worse performance at the 30-month follow-up. Our results show that neurodegeneration has a more deleterious effect on cognition than amyloidosis in clinically normal individuals.
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Affiliation(s)
- Mary M. Machulda
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology
| | - Clint E. Hagen
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research
| | - Heather J. Wiste
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research
| | - Michelle M. Mielke
- Division of Epidemiology, Department of Health Sciences Research
- Department of Neurology, College of Medicine, Mayo Clinic, 200 1 Street SW, Rochester, MN 55905
| | - David S. Knopman
- Department of Neurology, College of Medicine, Mayo Clinic, 200 1 Street SW, Rochester, MN 55905
| | - Rosebud O. Roberts
- Division of Epidemiology, Department of Health Sciences Research
- Department of Neurology, College of Medicine, Mayo Clinic, 200 1 Street SW, Rochester, MN 55905
| | - Prashanthi Vemuri
- Department of Radiology, College of Medicine, Mayo Clinic, 200 1 Street SW, Rochester, MN 55905
| | - Val J. Lowe
- Department of Radiology, College of Medicine, Mayo Clinic, 200 1 Street SW, Rochester, MN 55905
| | - Clifford R. Jack
- Department of Radiology, College of Medicine, Mayo Clinic, 200 1 Street SW, Rochester, MN 55905
| | - Ronald C. Petersen
- Department of Neurology, College of Medicine, Mayo Clinic, 200 1 Street SW, Rochester, MN 55905
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Aguirre-Acevedo DC, Lopera F, Henao E, Tirado V, Muñoz C, Giraldo M, Bangdiwala SI, Reiman EM, Tariot PN, Langbaum JB, Quiroz YT, Jaimes F. Cognitive Decline in a Colombian Kindred With Autosomal Dominant Alzheimer Disease: A Retrospective Cohort Study. JAMA Neurol 2016; 73:431-8. [PMID: 26902171 DOI: 10.1001/jamaneurol.2015.4851] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Data from an autosomal dominant Alzheimer disease (ADAD) kindred were used to track the longitudinal trajectory of cognitive decline associated with preclinical ADAD and explore factors that may modify the rate of cognitive decline. OBJECTIVES To evaluate the onset and rate of cognitive decline during preclinical ADAD and the effect of socioeconomic, vascular, and genetic factors on the cognitive decline. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective cohort study from January 1, 1995, through June 31, 2012, of individuals from Antioquia, Colombia, who tested positive for the ADAD-associated PSEN1 E280A mutation. Data analysis was performed from August 20, 2014, through November 30, 2015. A mixed-effects model was used to estimate annual rates of change in cognitive test scores and to mark the onset of cognitive decline. MAIN OUTCOMES AND MEASURES Memory, language, praxis, and total scores from the Consortium to Establish a Registry for Alzheimer Disease test battery. Chronologic age was used as a time scale in the models. We explore the effects of sex; educational level; socioeconomic status; residence area; occupation type; marital status; history of hypertension, diabetes mellitus, and dyslipidemia; tobacco and alcohol use; and APOE ε4 on the rates of cognitive decline. RESULTS A total of 493 carriers met the inclusion criteria and were analyzed. A total of 256 carriers had 2 or more assessments. At the time of the initial assessment, participants had a mean (SD) age of 33.4 (11.7) years and a mean (SD) educational level of 7.2 (4.2) years. They were predominantly female (270 [54.8%]), married (293 [59.4%]), and of low socioeconomic status (322 [65.3%]). Word list recall scores provided the earliest indicator of preclinical cognitive decline at 32 years of age, 12 and 17 years before the kindred's respective median ages at mild cognitive impairment and dementia onset. After the change point, carriers had a statistically significant cognitive decline with a loss of 0.24 (95% CI, -0.26 to -0.22) points per year for the word list recall test and 2.13 (95% CI, -2.29 to -1.96) points per year for total scores. Carriers with high educational levels had an increase of approximately 36% in the rate of cognitive decline after the change point when compared with those with low educational levels (-2.89 vs -2.13 points per year, respectively). Onset of cognitive decline was delayed by 3 years in individuals with higher educational levels compared with those with lower educational levels. Those with higher educational level, middle/high socioeconomic status, history of diabetes and hypertension, and tobacco and alcohol use had a steeper cognitive decline after onset. CONCLUSIONS AND RELEVANCE Preclinical cognitive decline was evident in PSEN1 E280A mutation carriers 12 years before the onset of clinical impairment. Educational level may be a protective factor against the onset of cognitive impairment.
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Affiliation(s)
- Daniel C Aguirre-Acevedo
- Neuroscience Group of Antioquia, University of Antioquia, Medellín, Colombia2Academic Group of Clinical Epidemiology, University of Antioquia, Medellín, Colombia
| | - Francisco Lopera
- Neuroscience Group of Antioquia, University of Antioquia, Medellín, Colombia
| | - Eliana Henao
- Neuroscience Group of Antioquia, University of Antioquia, Medellín, Colombia
| | - Victoria Tirado
- Neuroscience Group of Antioquia, University of Antioquia, Medellín, Colombia
| | - Claudia Muñoz
- Neuroscience Group of Antioquia, University of Antioquia, Medellín, Colombia
| | - Margarita Giraldo
- Neuroscience Group of Antioquia, University of Antioquia, Medellín, Colombia
| | | | | | | | | | - Yakeel T Quiroz
- Neuroscience Group of Antioquia, University of Antioquia, Medellín, Colombia5Departments of Psychiatry and Neurology, Massachusetts General Hospital, Boston
| | - Fabian Jaimes
- Academic Group of Clinical Epidemiology, University of Antioquia, Medellín, Colombia6Research Unit, Hospital Pablo Tobón Uribe, Medellín, Colombia
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Buchman AS, Yu L, Boyle PA, Schneider JA, De Jager PL, Bennett DA. Higher brain BDNF gene expression is associated with slower cognitive decline in older adults. Neurology 2016; 86:735-41. [PMID: 26819457 PMCID: PMC4763800 DOI: 10.1212/wnl.0000000000002387] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 08/04/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES We tested whether brain-derived neurotrophic factor (BDNF) gene expression levels are associated with cognitive decline in older adults. METHODS Five hundred thirty-five older participants underwent annual cognitive assessments and brain autopsy at death. BDNF gene expression was measured in the dorsolateral prefrontal cortex. Linear mixed models were used to examine whether BDNF expression was associated with cognitive decline adjusting for age, sex, and education. An interaction term was added to determine whether this association varied with clinical diagnosis proximate to death (no cognitive impairment, mild cognitive impairment, or dementia). Finally, we examined the extent to which the association of Alzheimer disease (AD) pathology with cognitive decline varied by BDNF expression. RESULTS Higher brain BDNF expression was associated with slower cognitive decline (p < 0.001); cognitive decline was about 50% slower with the 90th percentile BDNF expression vs 10th. This association was strongest in individuals with dementia. The level of BDNF expression was lower in individuals with pathologic AD (p = 0.006), but was not associated with macroscopic infarcts, Lewy body disease, or hippocampal sclerosis. BDNF expression remained associated with cognitive decline in a model adjusting for age, sex, education, and neuropathologies (p < 0.001). Furthermore, the effect of AD pathology on cognitive decline varied by BDNF expression such that the effect was strongest for high levels of AD pathology (p = 0.015); thus, in individuals with high AD pathology (90th percentile), cognitive decline was about 40% slower with the 90th percentile BDNF expression vs 10th. CONCLUSIONS Higher brain BDNF expression is associated with slower cognitive decline and may also reduce the deleterious effects of AD pathology on cognitive decline.
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Affiliation(s)
- Aron S Buchman
- From the Rush Alzheimer's Disease Center (A.S.B., L.Y., P.A.B., J.A.S., D.A.B.), Neurological Science (A.S.B., L.Y., J.A.S., D.A.B.), Behavioral Sciences (P.A.B.), Pathology (Neuropathology) (J.A.S.), Rush University Medical Center, Chicago, IL; Program in Translational NeuroPsychiatric Genomics (P.L.D.), Institute for the Neurosciences, Departments of Neurology and Psychiatry, Brigham and Women's Hospital, Boston; Harvard Medical School (P.L.D.), Boston; and Program in Medical and Population Genetics, Broad Institute (P.L.D.), Cambridge, MA.
| | - Lei Yu
- From the Rush Alzheimer's Disease Center (A.S.B., L.Y., P.A.B., J.A.S., D.A.B.), Neurological Science (A.S.B., L.Y., J.A.S., D.A.B.), Behavioral Sciences (P.A.B.), Pathology (Neuropathology) (J.A.S.), Rush University Medical Center, Chicago, IL; Program in Translational NeuroPsychiatric Genomics (P.L.D.), Institute for the Neurosciences, Departments of Neurology and Psychiatry, Brigham and Women's Hospital, Boston; Harvard Medical School (P.L.D.), Boston; and Program in Medical and Population Genetics, Broad Institute (P.L.D.), Cambridge, MA
| | - Patricia A Boyle
- From the Rush Alzheimer's Disease Center (A.S.B., L.Y., P.A.B., J.A.S., D.A.B.), Neurological Science (A.S.B., L.Y., J.A.S., D.A.B.), Behavioral Sciences (P.A.B.), Pathology (Neuropathology) (J.A.S.), Rush University Medical Center, Chicago, IL; Program in Translational NeuroPsychiatric Genomics (P.L.D.), Institute for the Neurosciences, Departments of Neurology and Psychiatry, Brigham and Women's Hospital, Boston; Harvard Medical School (P.L.D.), Boston; and Program in Medical and Population Genetics, Broad Institute (P.L.D.), Cambridge, MA
| | - Julie A Schneider
- From the Rush Alzheimer's Disease Center (A.S.B., L.Y., P.A.B., J.A.S., D.A.B.), Neurological Science (A.S.B., L.Y., J.A.S., D.A.B.), Behavioral Sciences (P.A.B.), Pathology (Neuropathology) (J.A.S.), Rush University Medical Center, Chicago, IL; Program in Translational NeuroPsychiatric Genomics (P.L.D.), Institute for the Neurosciences, Departments of Neurology and Psychiatry, Brigham and Women's Hospital, Boston; Harvard Medical School (P.L.D.), Boston; and Program in Medical and Population Genetics, Broad Institute (P.L.D.), Cambridge, MA
| | - Philip L De Jager
- From the Rush Alzheimer's Disease Center (A.S.B., L.Y., P.A.B., J.A.S., D.A.B.), Neurological Science (A.S.B., L.Y., J.A.S., D.A.B.), Behavioral Sciences (P.A.B.), Pathology (Neuropathology) (J.A.S.), Rush University Medical Center, Chicago, IL; Program in Translational NeuroPsychiatric Genomics (P.L.D.), Institute for the Neurosciences, Departments of Neurology and Psychiatry, Brigham and Women's Hospital, Boston; Harvard Medical School (P.L.D.), Boston; and Program in Medical and Population Genetics, Broad Institute (P.L.D.), Cambridge, MA
| | - David A Bennett
- From the Rush Alzheimer's Disease Center (A.S.B., L.Y., P.A.B., J.A.S., D.A.B.), Neurological Science (A.S.B., L.Y., J.A.S., D.A.B.), Behavioral Sciences (P.A.B.), Pathology (Neuropathology) (J.A.S.), Rush University Medical Center, Chicago, IL; Program in Translational NeuroPsychiatric Genomics (P.L.D.), Institute for the Neurosciences, Departments of Neurology and Psychiatry, Brigham and Women's Hospital, Boston; Harvard Medical School (P.L.D.), Boston; and Program in Medical and Population Genetics, Broad Institute (P.L.D.), Cambridge, MA
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Li C, Dowling NM, Chappell R. Quantile regression with a change-point model for longitudinal data: An application to the study of cognitive changes in preclinical alzheimer's disease. Biometrics 2015; 71:625-35. [PMID: 25892034 PMCID: PMC4575281 DOI: 10.1111/biom.12313] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 02/01/2015] [Accepted: 03/01/2015] [Indexed: 11/30/2022]
Abstract
Progressive and insidious cognitive decline that interferes with daily life is the defining characteristic of Alzheimer's disease (AD). Epidemiological studies have found that the pathological process of AD begins years before a clinical diagnosis is made and can be highly variable within a given population. Characterizing cognitive decline in the preclinical phase of AD is critical for the development of early intervention strategies when disease-modifying therapies may be most effective. In the last decade, there has been an increased interest in the application of change-point models to longitudinal cognitive outcomes prior to and after diagnosis. Most of the proposed statistical methodology for describing decline relies upon distributional assumptions that may not hold. In this article, we introduce a quantile regression with a change-point model for longitudinal data of cognitive function in persons bound to develop AD. A change-point in our model reflects the transition from the cognitive decline due to normal aging to the accelerated decline due to disease progression. Quantile regression avoids common distributional assumptions on cognitive outcomes and allows the covariate effects and the change-point to vary for different quantiles of the response. We provided an approach for estimating the model parameters, including the change-point, and presented inferential procedures based on the asymptotic properties of the estimators. A simulation study showed that the estimation and inferential procedures perform reasonably well in finite samples. The practical use of our model was illustrated by an application to longitudinal episodic memory outcomes from two cohort studies of aging and AD.
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Affiliation(s)
- Chenxi Li
- Department of Epidemiology and Biostatistics, Michigan State University, East lansing, MI 48824, U.S.A
| | - N. Maritza Dowling
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53792, U.S.A
| | - Rick Chappell
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53792, U.S.A
- Department of Statistics, University of Wisconsin-Madison, Madison, WI 53706, U.S.A
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Han SD, Boyle PA, James BD, Yu L, Bennett DA. Poorer Financial and Health Literacy Among Community-Dwelling Older Adults With Mild Cognitive Impairment. J Aging Health 2015; 27:1105-17. [PMID: 25903976 DOI: 10.1177/0898264315577780] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Literacy is an important determinant of financial and health outcomes in old age, and cognitive decline has been linked with lower literacy. We tested the hypothesis that mild cognitive impairment (MCI) is associated with poorer financial and health literacy. METHOD Participants (n = 730) from the Rush Memory and Aging Project were given a clinical evaluation and an assessment of total, financial, and health literacy. Regression was used to examine whether MCI was associated with lower literacy. In secondary analyses, we investigated the association of particular cognitive systems with literacy. RESULTS MCI was associated with lower total, financial, and health literacy. An interaction was observed such that higher education reduced the effect of MCI on total and financial literacy. Multiple cognitive systems were associated with literacy in participants with MCI, and semantic memory accounted for the most variance. DISCUSSION Persons with MCI exhibit poorer financial and health literacy, and education mitigates this effect.
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Affiliation(s)
- S Duke Han
- Rush University Medical Center, Chicago, IL, USA VA Long Beach Healthcare System, CA, USA
| | | | | | - Lei Yu
- Rush University Medical Center, Chicago, IL, USA
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Yu L, Boyle PA, Leurgans S, Schneider JA, Kryscio RJ, Wilson RS, Bennett DA. Effect of common neuropathologies on progression of late life cognitive impairment. Neurobiol Aging 2015; 36:2225-2231. [PMID: 25976345 DOI: 10.1016/j.neurobiolaging.2015.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 03/24/2015] [Accepted: 04/15/2015] [Indexed: 11/27/2022]
Abstract
Brain pathologies of Alzheimer's (AD), cerebrovascular, and Lewy body diseases are common in old age, but the relationship of these pathologies with progression from normal cognitive function to the various stages of cognitive impairment is unknown. In this study, we fit latent Markov models from longitudinal cognitive data to empirically derive 3 latent stages corresponding to no impairment, mild impairment, and moderate impairment; then, we examined the associations of common neuropathologies with the rates of transition among these stages. Cognitive and neuropathological data were available from 653 autopsied participants in 2 ongoing cohort studies of aging who were cognitively healthy at baseline (mean baseline age 79.1 years) and had longitudinal cognitive data. On average, participants in these analyses developed mild impairment 5 years after enrollment, progressed to moderate impairment after an additional 3.4 years, and stayed impaired for 2.8 years until death. AD and chronic macroscopic infarcts were associated with a higher risk of progression to mild impairment and subsequently to moderate impairment. By contrast, Lewy bodies were associated only with progression from mild to moderate impairment. The 5-year probability of progression to mild or moderate impairment was 20% for persons without any of these 3 pathologies, 38% for AD only, 51% for AD and macroscopic infarcts, and 56% for AD, infarcts, and Lewy bodies. Thus, the presence of AD pathology alone nearly doubles the risk of developing cognitive impairment in late life, and the presence of multiple pathologies further increases this risk over multiple years before death.
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Affiliation(s)
- Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.
| | - Patricia A Boyle
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sue Leurgans
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA; Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA; Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Richard J Kryscio
- Department of Statistics, University of Kentucky, Lexington, KY, USA
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA; Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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Bennett DA, Arnold SE, Valenzuela MJ, Brayne C, Schneider JA. Cognitive and social lifestyle: links with neuropathology and cognition in late life. Acta Neuropathol 2014; 127:137-50. [PMID: 24356982 PMCID: PMC4054865 DOI: 10.1007/s00401-013-1226-2] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 11/17/2013] [Accepted: 11/30/2013] [Indexed: 12/26/2022]
Abstract
Many studies report an association of cognitive and social experiential factors and related traits with dementia risk. Further, many clinical-pathologic studies find a poor correspondence between levels of neuropathology and the presence of dementia and level of cognitive impairment. The poor correspondence suggests that other factors contribute to the maintenance or loss of cognitive function, with factors associated with the maintenance of function referred to as neural or cognitive reserve. This has led investigators to examine the associations of cognitive and social experiential factors with neuropathology as a first step in disentangling the complex associations between these experiential risk factors, neuropathology, and cognitive impairment. Despite the consistent associations of a range of cognitive and social lifestyle factors with cognitive decline and dementia risk, the extant clinical-pathologic data find only a single factor from one cohort, linguistic ability, related to AD pathology. Other factors, including education, harm avoidance, and emotional neglect, are associated with cerebrovascular disease. Overall, the associations are weak. Some factors, such as education, social networks, and purpose in life, modify the relation of neuropathology to cognition. Finally, some factors such as cognitive activity appear to bypass known pathologies altogether suggesting a more direct association with biologic indices that promote person-specific differences in reserve and resilience. Future work will first need to replicate findings across more studies to ensure the veracity of the existing data. Second, effort is needed to identify the molecular substrates of neural reserve as potential mediators of the association of lifestyle factors with cognition.
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Affiliation(s)
- David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA,
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Yu L, Boyle P, Schneider JA, Segawa E, Wilson RS, Leurgans S, Bennett DA. APOE ε4, Alzheimer's disease pathology, cerebrovascular disease, and cognitive change over the years prior to death. Psychol Aging 2013; 28:1015-23. [PMID: 23647000 PMCID: PMC3766432 DOI: 10.1037/a0031642] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The goal of this study was to examine the association of the APOE ε4 allele with the late-life cognitive trajectory and test the hypothesis that the association of ε4 with cognitive decline is explained by Alzheimer's disease (AD) neuropathology. Participants (N = 581) came from 2 longitudinal clinical-pathologic studies of aging and dementia, the Religious Orders Study (ROS) and the Memory and Aging Project (MAP). Longitudinal measures of cognition were derived from detailed annual neuropsychological testing. Uniform neuropathologic evaluations provided quantitative measures of AD pathology, chronic cerebral infarctions, and Lewy bodies. Participants with 1 or more copies of the ε4 allele (ε2/4 excluded) were considered ε4 carriers. Random change point models were applied to examine the association of the ε4 allele with onset of terminal decline as well as preterminal and terminal slopes. On average, the onset of terminal decline occurred around 3 years before death, and the rate of terminal decline was eightfold faster than the preterminal decline. The presence of the ε4 allele was associated with an earlier onset of terminal decline and faster rates of decline before and after its onset. After adjusting for AD pathology, the ε4 allele was no longer associated with onset of terminal decline or preterminal slope, and the association with terminal slope became marginal. The APOE ε4 allele is an important determinant of late-life change in cognition, including terminal decline, and works primarily through AD pathology.
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Affiliation(s)
- Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center
| | - Patricia Boyle
- Rush Alzheimer's Disease Center, Rush University Medical Center
| | | | - Eisuke Segawa
- Rush Alzheimer's Disease Center, Rush University Medical Center
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center
| | - Sue Leurgans
- Rush Alzheimer's Disease Center, Rush University Medical Center
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center
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Fung WLA, Naylor MG, Bennett DA, Lange C, Blacker D. Principal components methods for narrow-sense heritability in the analysis of multidimensional longitudinal cognitive phenotypes. Am J Med Genet B Neuropsychiatr Genet 2013; 162B:770-8. [PMID: 23650207 PMCID: PMC3758806 DOI: 10.1002/ajmg.b.32151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 02/27/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Genetic association studies of longitudinal cognitive phenotypes are an alternate approach to discovering genetic risk factors for Alzheimer's disease (AD). However, the standard linear mixed model approach is limited in the face of multidimensional longitudinal data and multiple genotypes. In this setting, the principal components of heritability (PCH) approach may increase efficiency by deriving a linear combination of phenotypes to maximize the heritability attributable to a particular genetic locus. The current study investigated the performance of two PCH methods, the Principal Components of Heritability Association Test (PCHAT) and C2BAT, in detecting association of the known AD susceptibility allele APOE-ϵ4 with cognitive function at baseline and decline in cognition over time. METHODS PCHAT, C2BAT, and standard linear mixed models were used to test for association between APOE-ϵ4 allele and performance on 19 neuropsychological tests using subjects without dementia at baseline from the Religious Orders Study (ROS) (n = 693) and Memory and Aging Project (MAP) (n = 778). Analyses were conducted across the three methods for three nested phenotype definitions (all 19 measures, executive function and episodic memory measures, and episodic memory only), and for baseline data only versus longitudinal change. RESULTS In all cases, APOE-ϵ4 was significantly associated with baseline level of and change over time in cognitive function, and PCHAT and C2BAT yielded evidence of association comparable to or stronger than conventional methods. CONCLUSION PCHAT, C2BAT, and other PCH methods may have utility for genetic association studies of multidimensional cognitive and other phenotypes by maximizing genetic information while limiting multiple comparisons.
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Affiliation(s)
- Wai Lun Alan Fung
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
,Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Melissa G. Naylor
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Christoph Lange
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
,Channing Laboratory, Brigham and Women’s Hospital, Boston, MA, USA
| | - Deborah Blacker
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
,Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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Machulda MM, Pankratz VS, Christianson TJ, Ivnik RJ, Mielke MM, Roberts RO, Knopman DS, Boeve BF, Petersen RC. Practice effects and longitudinal cognitive change in normal aging vs. incident mild cognitive impairment and dementia in the Mayo Clinic Study of Aging. Clin Neuropsychol 2013; 27:1247-64. [PMID: 24041121 DOI: 10.1080/13854046.2013.836567] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objective of this study was to examine practice effects and longitudinal cognitive change in a population-based cohort classified as clinically normal at their initial evaluation. We examined 1390 individuals with a median age of 78.1 years and re-evaluated them up to four times at approximate 15-month intervals, with an average follow-up time of 5 years. Of the 1390 participants, 947 (69%) individuals remained cognitively normal, 397 (29%) progressed to mild cognitive impairment (MCI), and 46 (3%) to dementia. The stable normal group showed an initial practice effect in all domains which was sustained in memory and visuospatial reasoning. There was only a slight decline in attention and language after visit 3. We combined individuals with incident MCI and dementia to form one group representing those who declined. The incident MCI/dementia group showed an unexpected practice effect in memory from baseline to visit 2, with a significant decline thereafter. This group did not demonstrate practice effects in any other domain and showed a downward trajectory in all domains at each evaluation. Modeling cognitive change in an epidemiologic sample may serve as a useful benchmark for evaluating cognitive change in future intervention studies.
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Affiliation(s)
- Mary M Machulda
- a Department of Psychiatry and Psychology , College of Medicine, Mayo Clinic , Rochester , MN , USA
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