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Ishikawa J, Toba A, Futami S, Saito Y, Tamura Y, Araki A, Harada K. Association of pulse pressure and mean blood pressure to frailty, sarcopenia, and cognitive dysfunction in elderly outpatients with history of hypertension. Hypertens Res 2024; 47:2029-2040. [PMID: 38671218 DOI: 10.1038/s41440-024-01684-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024]
Abstract
This study aimed to evaluate the relationship between pulse pressure (PP) and sarcopenia, frailty, and cognitive function in elderly patients with hypertension. We evaluated 435 elderly patients with a history of hypertension who visited the frail outpatient clinic between July 2015 and October 2021. Data at the 1-, 2-, and 3-year follow-ups were available for 222, 177, and 164 patients, respectively. Sarcopenia, frailty, and cognitive function, including Mini-Mental State Examination (MMSE) scores, were evaluated. The patients' mean age was 79.2 ± 6.3 years (male, 34.9%). PP and mean blood pressure (BP) were 60.1 ± 13.6 mmHg and 94.1 ± 13.0 mmHg, respectively. At baseline, lower PP was associated with probable dementia (MMSE score ≤23 points) (OR = 0.960 per 1 mmHg increase; 95% CI, 0.933-0.989; P = 0.006) in the model adjusted for conventional confounding factors and comorbidities, whereas higher PP was associated with low handgrip strength (OR = 1.018 per 1 mmHg increase; 95% CI, 1.001-1.036; P = 0.041). In multivariate-adjusted logistic regression analysis of patients with preserved handgrip strength at baseline, reductions in PP (OR = 0.844; 95% CI, 0.731-0.974; P = 0.020) and mean BP (OR = 0.861; 95% CI, 0.758-0.979; P = 0.022) were significantly associated with the incidence of low handgrip strength at 3 years. In conclusion, a higher PP induced by increased arterial stiffness was associated with lower handgrip strength, whereas a lower PP was associated with probable dementia. Reduced PP was associated with decreased handgrip strength after three years.
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Affiliation(s)
- Joji Ishikawa
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
| | - Ayumi Toba
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Shutaro Futami
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yoshihiro Saito
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yoshiaki Tamura
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Kazumasa Harada
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
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Won J, Maillard P, Shan K, Ashley J, Cardim D, Zhu DC, Zhang R. Association of Blood Pressure With Brain White Matter Microstructural Integrity Assessed With MRI Diffusion Tensor Imaging in Healthy Young Adults. Hypertension 2024; 81:1145-1155. [PMID: 38487873 PMCID: PMC11023804 DOI: 10.1161/hypertensionaha.123.22337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/28/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND High blood pressure (BP) in middle-aged and older adults is associated with a brain white matter (WM) microstructural abnormality. However, little evidence is available in healthy young adults. We investigated the associations between high BP and WM microstructural integrity in young adults. METHODS This study included 1015 healthy young adults (542 women, 22-37 years) from the Human Connectome Project. Brachial systolic and diastolic BP were measured using a semiautomatic or manual sphygmomanometer. Diffusion-weighted magnetic resonance imaging was acquired to obtain diffusion tensor imaging metrics of free water (FW) content, FW-corrected WM fractional anisotropy, axial diffusivity, radial diffusivity, and mean diffusivity. Using whole-brain voxel-wise linear regression models and ANCOVA, we examined associations of BP and hypertension stage with diffusion tensor imaging metrics after adjusting for age, sex, education, body mass index, smoking status, alcohol consumption history, and differences in the b value used for diffusion magnetic resonance imaging. RESULTS Systolic and diastolic BP of the sample (mean±SD) were 122.8±13.0 and 76.0±9.9 mm Hg, respectively. Associations of BP with diffusion tensor imaging metrics revealed regional heterogeneity for FW-corrected fractional anisotropy. High BP and high hypertension stage were associated with higher FW and lower FW-corrected axial diffusivity, FW-corrected radial diffusivity, and FW-corrected mean diffusivity. Moreover, associations of high diastolic BP and hypertension stage with high FW were found only in men not in women. CONCLUSIONS High BP in young adults is associated with altered brain WM microstructural integrity, suggesting that high BP may have damaging effects on brain WM microstructural integrity in early adulthood, particularly in men.
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Affiliation(s)
- Junyeon Won
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Pauline Maillard
- Department of Neurology, University of California, Davis, CA, USA
| | - Kevin Shan
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - John Ashley
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Danilo Cardim
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - David C. Zhu
- Department of Radiology and Cognitive Imaging Research Center, Michigan State University, East Lansing, Michigan, USA
| | - Rong Zhang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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Bareiro FAQ, Carnicero JA, Acha AA, Artalejo CR, Jimenez MCG, Mañas LR, García García FJ. How cognitive performance changes according to the ankle-brachial index score in an elderly cohort? Results from the Toledo Study of Healthy Ageing. GeroScience 2024; 46:609-620. [PMID: 37870701 PMCID: PMC10828423 DOI: 10.1007/s11357-023-00966-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/26/2023] [Indexed: 10/24/2023] Open
Abstract
In the ageing process, the vascular system undergoes morphological and functional changes that may condition brain functioning; for this reason, the aims of this study were to assess the effect of vascular function indirectly measured by ankle-brachial index (ABI) on both cognitive performance at baseline and change in cognitive performance at end of follow-up. We developed a prospective, population-based, cohort study with 1147 participants aged > 65 years obtained from the Toledo Study for Healthy Ageing who had cognitive assessment and measured ABI in the first wave (2006-2009) were selected for the cross-sectional analysis. Those participants who also performed the cognitive assessment in the second wave (2011-2013) were selected for the prospective analysis. Cognitive impairment diagnosis and symptoms and/or history of cardio/neurovascular disease were used as exclusion criteria. Multivariate segmented regression model was used to assess the associations between ABI and cognitive performance in both the cross-sectional and prospective analyses. As ABI score decreased from 1.4, the cross-sectional analysis showed a higher decrease in cognitive performance and the prospective analysis showed a higher degree of worsening in cognitive performance. Our findings suggest that the ABI, a widespread measure of vascular health in primary care, may be a useful tool for predicting cognitive performance and its evolution.
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Affiliation(s)
- Fabio A Quiñónez Bareiro
- Department of Geriatrics, Hospital Virgen del Valle, Hospital Universitario de Toledo, Toledo, Spain
| | - José A Carnicero
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain.
- Geriatric Research Group, Biomedical Research Foundation at Getafe University Hospital, Ctra. Toledo Km. 12.5, 28905, Getafe, Spain.
| | - Ana Alfaro Acha
- Department of Geriatrics, Hospital Virgen del Valle, Hospital Universitario de Toledo, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Cristina Rosado Artalejo
- Department of Geriatrics, Hospital Virgen del Valle, Hospital Universitario de Toledo, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - María C Grau Jimenez
- Department of Geriatrics, Hospital Virgen del Valle, Hospital Universitario de Toledo, Toledo, Spain
| | - Leocadio Rodriguez Mañas
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
- Geriatric Department, Hospital Universitario de Getafe, Getafe, Spain
| | - Francisco J García García
- Department of Geriatrics, Hospital Virgen del Valle, Hospital Universitario de Toledo, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
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Ransom KV, Traylor MK, Batman GB, Mulekar MS, Hill BD, Nelson AR, Keller JL. Arterial stiffness mediates the association between age and processing speed at low levels of microvascular function in humans across the adult lifespan. Am J Physiol Heart Circ Physiol 2024; 326:H346-H356. [PMID: 38038715 PMCID: PMC11219056 DOI: 10.1152/ajpheart.00662.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/14/2023] [Accepted: 11/29/2023] [Indexed: 12/02/2023]
Abstract
The function of micro- and macrovessels within the peripheral vasculature has been identified as a target for the investigation of potential cardiovascular-based promoters of cognitive decline. However, little remains known regarding the interaction of the micro- and macrovasculature as it relates to cognitive function, especially in cognitively healthy individuals. Therefore, our purpose was to unravel peripheral factors that contribute to the association between age and processing speed. Ninety-nine individuals (51 men, 48 women) across the adult life span (19-81 yr) were used for analysis. Arterial stiffness was quantified as carotid-femoral pulse-wave velocity (cfPWV) and near-infrared spectroscopy assessed maximal tissue oxygenation (Sto2max) following a period of ischemia. Processing speed was evaluated with Trail Making Test (TMT) Parts A and B. Measures of central (cPP) and peripheral pulse pressure (pPP) were also collected. Moderated mediation analyses were conducted to determine contributions to the age and processing speed relation, and first-order partial correlations were used to assess associations while controlling for the linear effects of age. A P ≤ 0.05 was considered statistically significant. At low levels of Sto2max, there was a significant positive (b = 1.92; P = 0.005) effect of cfPWV on time to completion on TMT part A. In addition, cPP (P = 0.028) and pPP (P = 0.027) remained significantly related to part A when controlling for age. These results suggested that the peripheral microvasculature may be a valuable target for delaying cognitive decline, especially in currently cognitively healthy individuals. Furthermore, we reinforced current evidence that pulse pressure is a key endpoint for trials aimed at preventing or delaying the onset of cognitive decline.NEW & NOTEWORTHY Arterial stiffness partially mediates the association between age and processing speed in the presence of low microvascular function, as demarcated by maximum tissue oxygenation following ischemia. Central and peripheral pulse pressure remained associated with processing speed even after controlling for age. Our findings were derived from a sample that was determined to be cognitively healthy, which highlights the potential for these outcomes to be considered during trials aimed at the prevention of cognitive decline.
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Affiliation(s)
- Kyndall V Ransom
- Integrative Laboratory of Exercise and Applied Physiology, Department of Health, Kinesiology, and Sport, College of Education and Professional Studies, University of South Alabama, Mobile, Alabama, United States
- Chemistry Department, College of Arts and Sciences, University of South Alabama, Mobile, Alabama, United States
| | - Miranda K Traylor
- Integrative Laboratory of Exercise and Applied Physiology, Department of Health, Kinesiology, and Sport, College of Education and Professional Studies, University of South Alabama, Mobile, Alabama, United States
| | - Genevieve B Batman
- Integrative Laboratory of Exercise and Applied Physiology, Department of Health, Kinesiology, and Sport, College of Education and Professional Studies, University of South Alabama, Mobile, Alabama, United States
| | - Madhuri S Mulekar
- Department of Mathematics and Statistics, College of Arts and Sciences, University of South Alabama, Mobile, Alabama, United States
| | - Benjamin D Hill
- Psychology Department, College of Arts and Sciences, University of South Alabama, Mobile, Alabama, United States
| | - Amy R Nelson
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, Alabama, United States
- Gulf Coast Alzheimer's Disease Research Center, College of Medicine, University of South Alabama, Alabama, United States
| | - Joshua L Keller
- Integrative Laboratory of Exercise and Applied Physiology, Department of Health, Kinesiology, and Sport, College of Education and Professional Studies, University of South Alabama, Mobile, Alabama, United States
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, Alabama, United States
- Gulf Coast Alzheimer's Disease Research Center, College of Medicine, University of South Alabama, Alabama, United States
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Yang A, Yang YT, Zhao XM. An augmented Mendelian randomization approach provides causality of brain imaging features on complex traits in a single biobank-scale dataset. PLoS Genet 2023; 19:e1011112. [PMID: 38150468 PMCID: PMC10775988 DOI: 10.1371/journal.pgen.1011112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 01/09/2024] [Accepted: 12/12/2023] [Indexed: 12/29/2023] Open
Abstract
Mendelian randomization (MR) is an effective approach for revealing causal risk factors that underpin complex traits and diseases. While MR has been more widely applied under two-sample settings, it is more promising to be used in one single large cohort given the rise of biobank-scale datasets that simultaneously contain genotype data, brain imaging data, and matched complex traits from the same individual. However, most existing multivariable MR methods have been developed for two-sample setting or a small number of exposures. In this study, we introduce a one-sample multivariable MR method based on partial least squares and Lasso regression (MR-PL). MR-PL is capable of considering the correlation among exposures (e.g., brain imaging features) when the number of exposures is extremely upscaled, while also correcting for winner's curse bias. We performed extensive and systematic simulations, and demonstrated the robustness and reliability of our method. Comprehensive simulations confirmed that MR-PL can generate more precise causal estimates with lower false positive rates than alternative approaches. Finally, we applied MR-PL to the datasets from UK Biobank to reveal the causal effects of 36 white matter tracts on 180 complex traits, and showed putative white matter tracts that are implicated in smoking, blood vascular function-related traits, and eating behaviors.
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Affiliation(s)
- Anyi Yang
- Department of Neurology, Zhongshan Hospital and Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, People’s Republic of China
- MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, People’s Republic of China
| | - Yucheng T. Yang
- Department of Neurology, Zhongshan Hospital and Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, People’s Republic of China
- MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, People’s Republic of China
| | - Xing-Ming Zhao
- Department of Neurology, Zhongshan Hospital and Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, People’s Republic of China
- MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, People’s Republic of China
- State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Fudan University, Shanghai, People’s Republic of China
- International Human Phenome Institutes (Shanghai), Shanghai, People’s Republic of China
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Lefferts WK, Reed KS, Rosonke RE, Augustine JA, Moreau KL. Age-associated increases in middle cerebral artery pulsatility differ between men and women. Am J Physiol Heart Circ Physiol 2023; 325:H1118-H1125. [PMID: 37682233 PMCID: PMC10908402 DOI: 10.1152/ajpheart.00453.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/21/2023] [Accepted: 09/05/2023] [Indexed: 09/09/2023]
Abstract
Mechanisms underlying sex differences in brain aging remain unclear but may relate to changes in cerebral pulsatile blood flow. Sex differences in the stiffening of the large arteries and expansion of pulse pressure with age may accelerate changes in pulsatile (i.e., discontinuous) blood flow in the brain that contribute to brain health. The purpose of this cross-sectional, secondary analysis was to examine sex differences in age-associated changes in large artery (aorta and carotid) stiffness, carotid pulse pressure, and cerebral pulsatility in 206 men and 217 women between 18 and 72 yr of age. Outcomes included aortic stiffness [carotid-femoral pulse wave velocity (cfPWV)] and carotid pulse pressure via tonometry, carotid β-stiffness via ultrasound, and middle cerebral artery (MCA) pulsatility index via transcranial Doppler. Regression analyses revealed a significant age-by-sex interaction, with women exhibiting a slower rate of change compared with men for cfPWV (β = -0.21, P = 0.04), and greater rate of change for carotid stiffness (β = 0.27, P = 0.02), carotid pulse pressure (β = 0.98, P < 0.001), and MCA pulsatility index (β = 0.49, P = 0.002) after adjustment for covariates. The significant age-by-sex interaction for MCA pulsatility was abolished after further adjustment for carotid pulse pressure. Women exhibit accelerated increases in cerebral pulsatility during midlife, likely driven by exaggerated increases in carotid stiffness and pulse pressure compared with men. These data suggest that there are disproportionate increases in cerebral pulsatility in women during midlife that could contribute to accelerated brain aging compared with men.NEW & NOTEWORTHY We identify sex-specific associations between increasing age and cerebral pulsatility and its vascular mechanisms. When compared with men, women in our cross-sectional analysis exhibited greater age-associated increases in carotid stiffness, carotid pulse pressure, and cerebral pulsatility particularly during midlife. These data suggest that the rapid expansion of pulse pressure during midlife contributes to an exaggerated increase in cerebral pulsatility among women and suggest a potential mechanism contributing to sex differences in brain aging.
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Affiliation(s)
- Wesley K Lefferts
- Department of Kinesiology, Iowa State University, Ames, Iowa, United States
| | - Krista S Reed
- Department of Kinesiology, Iowa State University, Ames, Iowa, United States
| | - Rachel E Rosonke
- Department of Kinesiology, Iowa State University, Ames, Iowa, United States
| | | | - Kerrie L Moreau
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
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Hong N, Kim KJ, Yu MH, Jeong SH, Lee S, Lim JS, Rhee Y. Risk of dementia in primary aldosteronism compared with essential hypertension: a nationwide cohort study. Alzheimers Res Ther 2023; 15:136. [PMID: 37568223 PMCID: PMC10416485 DOI: 10.1186/s13195-023-01274-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/12/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Although hypertension is a critical risk factor for dementia, the association between primary aldosteronism (PA) and dementia has been scarcely reported. We aimed to investigate whether the risk of dementia in patients with PA was elevated compared with patients with essential hypertension (EH). METHODS From the National Health Insurance Claim database in Korea (2003-2017), 3,687 patients with PA (adrenalectomy [ADX], n = 1,339, mineralocorticoid receptor antagonist [MRA] n = 2,348) with no prior dementia were age- and sex-matched at a 1:4 ratio to patients with EH (n = 14,741). The primary outcomes were all-cause dementia events, including Alzheimer's disease, vascular dementia, or other dementia combined with a prescription of one or more medications for dementia (donepezil, galantamine, memantine, or rivastigmine). Multivariable Cox regression models were used to evaluate the hazard ratios (HRs) and 95% confidence intervals for the outcome incidence rates between patients with PA and their EH matches. RESULTS During a median follow-up of 5.2 years, there were 156 cases of all-cause dementia (4.2%), 140 cases of Alzheimer's disease (3.8%), and 65 cases of vascular dementia (1.8%). Compared with EH, the risk of all-cause dementia was increased in treated PA (unadjusted hazard ratio [HR] 1.26; p < 0.011). Among PA, MRA group had higher risks of all-cause dementia, especially vascular dementia, adjusted for age, sex, income, comorbidities, and concurrent medication (adjusted HR 1.31; p = 0.027 and adjusted HR 1.62; p = 0.020, respectively) compared to EH. ADX group seemed to have a lower dementia risk than the EH group, but there was no statistical significance after full adjustment. This trend became more prominent when the dementia risks were evaluated from the time of hypertension diagnosis rather than treatment initiation for PA. CONCLUSION The findings of this cohort study suggest that PA, especially the MRA group, is associated with an increased risk of dementia. Monitoring cognitive function in PA patients even after treatment initiation might be warranted to prevent dementia.
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Affiliation(s)
- Namki Hong
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Kyoung Jin Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min Heui Yu
- SENTINEL Team, Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong Ho Jeong
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Seunghyun Lee
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20, Ilsan-Ro, Wonju-Si, Gangwon-Do, 26426, Republic of Korea
| | - Jung Soo Lim
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20, Ilsan-Ro, Wonju-Si, Gangwon-Do, 26426, Republic of Korea.
| | - Yumie Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
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Tsiknia AA, Parada H, Banks SJ, Reas ET. Sleep quality and sleep duration predict brain microstructure among community-dwelling older adults. Neurobiol Aging 2023; 125:90-97. [PMID: 36871334 PMCID: PMC10115563 DOI: 10.1016/j.neurobiolaging.2023.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/11/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023]
Abstract
Although poor sleep quality and extreme sleep durations have been associated with brain atrophy and dementia, it is unclear whether sleep disturbances contribute to neural injury in the absence of neurodegeneration and cognitive impairment. In 146 dementia-free older adults of the Rancho Bernardo Study of Healthy Aging (76.7 ± 7.8 years at MRI), we examined associations of restriction spectrum imaging metrics of brain microstructure with self-reported sleep quality 6.3 ± 0.7 years prior, and with sleep duration reported 25, 15 and 9 years prior. Worse sleep quality predicted lower white matter restricted isotropic diffusion and neurite density and higher amygdala free water, with stronger associations between poor sleep quality and abnormal microstructure for men. Among women only, short or long sleep duration 25 and 15 years before MRI predicted lower white matter restricted isotropic diffusion and increased free water. Associations persisted after accounting for associated health and lifestyle factors. Sleep patterns were not related to brain volume or cortical thickness. Optimizing sleep behaviors throughout the life-course may help to preserve healthy brain aging.
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Affiliation(s)
- Amaryllis A Tsiknia
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Humberto Parada
- Division of Epidemiology and Biostatistics, San Diego State University, San Diego, CA, USA
| | - Sarah J Banks
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Emilie T Reas
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.
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Parada H, Bergstrom J, Bangen KJ, Reas ET. Pulse pressure trajectories predict brain microstructure in community-dwelling older adults: Associations with executive function and modification by APOE. Alzheimers Dement 2023; 19:1963-1973. [PMID: 36377803 PMCID: PMC10182213 DOI: 10.1002/alz.12844] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/16/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Effects of chronic arterial stiffness on brain aging remain unclear. We, therefore, examined whether long-term trajectories of pulse pressure (PP) predicted brain microstructure, microstructure mediated PP-executive function associations, and APOE genotype modified PP-microstructure associations. METHODS We examined associations of PP trajectories with brain microstructure measured using restriction spectrum imaging in 146 community-dwelling older adults, whether microstructure mediated PP trajectory-executive function associations, and whether PP-restriction spectrum imaging correlations were modified by APOE-ε4 status. RESULTS Participants with trajectories of high PP had lower restricted isotropic diffusion (RI) compared to those with low PP trajectories and PP-executive function associations were mediated by subcortical and white matter RI. High PP more strongly correlated with lower RI and higher hindered diffusion among APOE-ε4 carriers than non-carriers. DISCUSSION Prolonged elevated PP predicts microstructural abnormalities which may contribute to impaired executive function. APOE-ε4 carriers may be most vulnerable to the adverse effects of PP on brain microstructure.
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Affiliation(s)
- Humberto Parada
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
- University of California, San Diego Moores Cancer Center, La Jolla, CA, USA
- Department of Radiation Medicine & Applied Science, University of California, San Diego, La Jolla, CA, USA
| | - Jaclyn Bergstrom
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Katherine J. Bangen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Emilie T. Reas
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
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Chow FC, Zhao F, He Y, Song X, Zhang J, Ao D, Wu Y, Hou B, Sorond FA, Ances BM, Letendre S, Heaton RK, Shi C, Feng F, Zhu Y, Wang H, Li T. Brief Report: Sex Differences in the Association Between Cerebrovascular Function and Cognitive Health in People Living With HIV in Urban China. J Acquir Immune Defic Syndr 2023; 92:217-222. [PMID: 36318881 DOI: 10.1097/qai.0000000000003127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/08/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cardiometabolic and cerebrovascular disease are strong independent contributors to cognitive impairment in people living with HIV. Data suggest that cardiovascular risk may play a greater role in cognitive health in women than in men with HIV. METHODS We performed a cross-sectional study of 104 participants with virologically suppressed HIV from 2 clinics in urban China. Participants underwent neuropsychological testing from which we calculated T scores globally and in 5 cognitive domains. We assessed cerebral vasoreactivity of the middle cerebral arteries in response to breath holding. We constructed linear regression models to determine associations between cerebrovascular and cognitive function overall and stratified by sex. RESULTS Women were younger than men (48 versus 51 years, P = 0.053), had fewer years of education (9 years versus 12 years, P = 0.004), and fewer cardiometabolic risk factors (0 versus 1 factor, P = 0.008). In a model with all participants, cerebrovascular function was significantly associated with global cognition (2.74 higher T score per 1-point higher cerebral vasoreactivity [SE 1.30], P = 0.037). Cerebrovascular function remained significantly associated with global cognition among women (4.15 higher T score [SE 1.78], P = 0.028) but not men (1.70 higher T score [SE 1.74], P = 0.33). The relationships between cerebrovascular function and specific cognitive domains followed a similar pattern, with significant associations present among women but not men. CONCLUSIONS Women with well-controlled HIV may be more vulnerable to the effect of cerebrovascular injury on cognitive health than men. Studies evaluating strategies to protect against cognitive impairment in people living with HIV should include adequate representation of women and stratification of analyses by sex.
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Affiliation(s)
- Felicia C Chow
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA
| | - Fang Zhao
- Department of Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, Guangdong, China
| | - Yun He
- Department of Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, Guangdong, China
| | - Xiaojing Song
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiangxia Zhang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Donghui Ao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuchen Wu
- Department of Hematology, Tiantan Hospital, Beijing, China
| | - Bo Hou
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Beau M Ances
- Department of Neurology and Hope Center for Neurological Disorders, Washington University, St. Louis, MO
| | - Scott Letendre
- HIV Neurobehavioral Research Program, Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
| | - Robert K Heaton
- HIV Neurobehavioral Research Program, Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
| | - Chuan Shi
- Institute of Mental Health, National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China; and
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yicheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huanling Wang
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Taisheng Li
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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11
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Tsiknia AA, Bergstrom J, Reas ET. Midlife omega-3 fatty acid intake predicts later life white matter microstructure in an age- and APOE-dependent manner. Cereb Cortex 2023; 33:2143-2151. [PMID: 35584792 PMCID: PMC9977375 DOI: 10.1093/cercor/bhac196] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
Omega-3 intake has been positively associated with healthy brain aging, yet it remains unclear whether high omega-3 intake beginning early in life may optimize its protective effects against brain aging. We examined whether omega-3 intake is associated with brain microstructure over 2 decades later among dementia-free older adults. The 128 participants (62% women; age at magnetic resonance imaging: 76.6 ± 7.9) from the Rancho Bernardo Study of Healthy Aging completed at least 1 dietary assessment between 1984 and 1996 and underwent restriction spectrum imaging (RSI) 22.8 ± 3.1 years later. We evaluated associations between prior omega-3 intake and RSI metrics of gray and white matter (WM) microstructure. Higher prior omega-3 intake was associated with greater restricted diffusion in the superior cortico-striatal fasciculus. A correlation between higher prior omega-3 intake and greater cingulum restricted diffusion was stronger among participants >80 years old. Higher omega-3 intake correlated with greater restricted diffusion in the inferior longitudinal and inferior fronto-occipital fasciculus more strongly for apolipoprotein E (APOE) ε4 carriers than noncarriers. Associations were not modified by adjustment for dietary pattern, health, or lifestyle. High omega-3 intake in midlife may help to maintain WM integrity into older age, particularly in the latest decades of life and among APOE ε4 carriers.
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Affiliation(s)
- Amaryllis A Tsiknia
- Department of Neurosciences, University of California, San Diego, CA 92093-0841, United States
| | - Jaclyn Bergstrom
- School of Public Health and Human Longevity Science, University of California, San Diego, CA 92093, United States
| | - Emilie T Reas
- Department of Neurosciences, University of California, San Diego, CA 92093-0841, United States
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12
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King DLO, Henson RN, Kievit R, Wolpe N, Brayne C, Tyler LK, Rowe JB, Tsvetanov KA. Distinct components of cardiovascular health are linked with age-related differences in cognitive abilities. Sci Rep 2023; 13:978. [PMID: 36653428 PMCID: PMC9849401 DOI: 10.1038/s41598-022-27252-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 12/28/2022] [Indexed: 01/19/2023] Open
Abstract
Cardiovascular ageing contributes to cognitive impairment. However, the unique and synergistic contributions of multiple cardiovascular factors to cognitive function remain unclear because they are often condensed into a single composite score or examined in isolation. We hypothesized that vascular risk factors, electrocardiographic features and blood pressure indices reveal multiple latent vascular factors, with independent contributions to cognition. In a population-based deep-phenotyping study (n = 708, age 18-88), path analysis revealed three latent vascular factors dissociating the autonomic nervous system response from two components of blood pressure. These three factors made unique and additive contributions to the variability in crystallized and fluid intelligence. The discrepancy in fluid relative to crystallized intelligence, indicative of cognitive decline, was associated with a latent vascular factor predominantly expressing pulse pressure. This suggests that higher pulse pressure is associated with cognitive decline from expected performance. The effect was stronger in older adults. Controlling pulse pressure may help to preserve cognition, particularly in older adults. Our findings highlight the need to better understand the multifactorial nature of vascular aging.
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Affiliation(s)
- Deborah L O King
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SP, UK.
- Department of Psychology, Centre for Speech, Language and the Brain, University of Cambridge, Cambridge, CB23 6HT, UK.
| | - Richard N Henson
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 2QQ, UK
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, CB2 7EF, UK
- Cambridge Centre for Ageing and Neuroscience (Cam-CAN), University of Cambridge and MRC Cognition and Brain Sciences Unit, Cambridge, CB2 7EF, UK
| | - Rogier Kievit
- Donders Research Institute for Brain, Cognition and Behaviour, Radboud University, 6525 AJ, Nijmegen, The Netherlands
| | - Noham Wolpe
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 2QQ, UK
- Department of Physical Therapy, The Stanley Steer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carol Brayne
- Cambridge Public Health, Cambridge Public Health, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Lorraine K Tyler
- Department of Psychology, Centre for Speech, Language and the Brain, University of Cambridge, Cambridge, CB23 6HT, UK
- Cambridge Centre for Ageing and Neuroscience (Cam-CAN), University of Cambridge and MRC Cognition and Brain Sciences Unit, Cambridge, CB2 7EF, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SP, UK
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, CB2 7EF, UK
- Cambridge Centre for Ageing and Neuroscience (Cam-CAN), University of Cambridge and MRC Cognition and Brain Sciences Unit, Cambridge, CB2 7EF, UK
| | - Kamen A Tsvetanov
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SP, UK
- Department of Psychology, Centre for Speech, Language and the Brain, University of Cambridge, Cambridge, CB23 6HT, UK
- Cambridge Centre for Ageing and Neuroscience (Cam-CAN), University of Cambridge and MRC Cognition and Brain Sciences Unit, Cambridge, CB2 7EF, UK
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13
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Casaletto KB, Nichols E, Aslanyan V, Simone SM, Rabin JS, La Joie R, Brickman AM, Dams-O’Connor K, Palta P, Kumar RG, George KM, Satizabal CL, Schneider J, Pa J. Sex-specific effects of microglial activation on Alzheimer's disease proteinopathy in older adults. Brain 2022; 145:3536-3545. [PMID: 35869598 PMCID: PMC10233295 DOI: 10.1093/brain/awac257] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/20/2022] [Accepted: 06/22/2022] [Indexed: 02/03/2023] Open
Abstract
Females show a disproportionate burden of Alzheimer's disease pathology and higher Alzheimer's disease dementia prevalences compared to males, yet the mechanisms driving these vulnerabilities are unknown. There is sexual dimorphism in immunological functioning, and neuroimmune processes are implicated in Alzheimer's disease genesis. Using neuropathology indicators from human brain tissue, we examined the mediational role of microglial activation on the relationship between amyloid and tau and how it differs by sex. 187 decedents (64% female; 89 mean age at death; 62% non-demented) from the Rush Memory and Aging Project completed neuropathological evaluations with brain tissue quantified for microglial activation, amyloid-β and tau. Proportion of morphologically activated microglia was determined via immunohistochemistry (HLA-DP-DQ-DR) and morphological staging (stage I, II or III). Amyloid-β and tau burden were quantified via immunohistochemistry (M00872 or AT8, respectively). Using causal counterfactual modelling, we estimated the mediational effect of microglial activation on the amyloid-β to tau relationship in the whole sample and stratified by sex (amyloid-β → microglial activation → tau). Alternative models tested the role of microglia activation as the precipitating event (microglial activation → amyloid-β → tau). Microglial activation significantly mediated 33% [95% confidence interval (CI) 10-67] of the relationship between amyloid-β and tau in the whole sample; stratified analyses suggested this effect was stronger and only statistically significant in females. 57% (95% CI 22-100) of the effect of amyloid-β on tau was mediated through microglial activation in females, compared to 19% (95% CI 0-64) in males. Regional analyses suggested that mediational effects were driven by greater cortical versus subcortical microglial activation. Relationships were independent of cerebrovascular disease indices. Alternative models suggested that in females, microglial activation was a significant exposure both preceding the amyloid-β to tau relationship (mediational effect: 50%, 95% CI 23-90) and directly related to tau burden (microglia direct effect: 50%, 95% CI 10-77). By contrast, in males, only the direct effect of microglial activation to tau reached significance (74%, 95% CI 32-100) (mediational effect: 26%, 95% CI 0-68). Our models suggest a reciprocal, bidirectional relationship between amyloid-β and microglial activation that significantly accounts for tau burden in females. By contrast, in males, direct independent (non-mediational) relationships between microglial activation or amyloid-β with tau were observed. Microglial activation may be disproportionately important for Alzheimer's disease pathogenesis in females. Determining sex-specific vulnerabilities to Alzheimer's disease development both inform fundamental pathophysiology and support precision health approaches for this heterogeneous disease.
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Affiliation(s)
- Kaitlin B Casaletto
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Emma Nichols
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vahan Aslanyan
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Department of Neurology, University of Southern California, Los Angeles, CA, USA
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Jennifer S Rabin
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Kristen Dams-O’Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Priya Palta
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Raj G Kumar
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kristen M George
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
| | - Claudia L Satizabal
- Department of Population Health Science and Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Julie Schneider
- Rush Alzheimer’s Disease Center, Rush University, Chicago, IL, USA
| | - Judy Pa
- Department of Neurosciences, Alzheimer’s Disease Cooperative Study (ADCS), University of California, San Diego, CA, USA
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14
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Heal M, McFall GP, Vergote D, Jhamandas JH, Westaway D, Dixon RA. Bridging Integrator 1 (BIN1, rs6733839) and Sex Are Moderators of Vascular Health Predictions of Memory Aging Trajectories. J Alzheimers Dis 2022; 89:265-281. [DOI: 10.3233/jad-220334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: A promising risk loci for sporadic Alzheimer’s disease (AD), Bridging Integrator 1 (BIN1), is thought to operate through the tau pathology pathway. Objective: We examine BIN1 risk for a moderating role with vascular health (pulse pressure; PP) and sex in predictions of episodic memory trajectories in asymptomatic aging adults. Methods: The sample included 623 participants (Baseline Mean age = 70.1; 66.8% female) covering a 44-year longitudinal band (53–97 years). With an established memory latent variable arrayed as individualized trajectories, we applied Mplus 8.5 to determine the best fitting longitudinal growth model. Main analyses were conducted in three sequential phases to investigate: 1) memory trajectory prediction by PP, 2) moderation by BIN1 genetic risk, and 3) stratification by sex. Results: We first confirmed that good vascular health (lower PP) was associated with higher memory level and shallower decline and males were more severely affected by worsening PP in both memory performance and longitudinal decline. Second, the PP prediction of memory trajectories was significant for BIN1 C/C and C/T carriers but not for persons with the highest AD risk (T/T homozygotes). Third, when further stratified by sex, the BIN1 moderation of memory prediction by PP was selective for females. Conclusion: We observed a novel interaction whereby BIN1 (linked with tauopathy in AD) and sex sequentially moderated a benchmark PP prediction of differential memory decline in asymptomatic aging. This multi-modal biomarker interaction approach, disaggregated by sex, can be an effective method for enhancing precision of AD genetic risk assessment.
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Affiliation(s)
- Mackenzie Heal
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - G. Peggy McFall
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - David Vergote
- Faculté Saint-Jean, University of Alberta, Edmonton, Alberta, Canada
| | - Jack H. Jhamandas
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - David Westaway
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
- Center for Prions and Protein Folding Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Roger A. Dixon
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
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15
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Tsiknia AA, Reas E, Bangen KJ, Sundermann EE, McEvoy L, Brewer JB, Edland SD, Banks SJ. Sex and APOE ε4 modify the effect of cardiovascular risk on tau in cognitively normal older adults. Brain Commun 2022; 4:fcac035. [PMID: 35233525 PMCID: PMC8882003 DOI: 10.1093/braincomms/fcac035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/12/2021] [Accepted: 02/15/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
The interaction between APOE ε4 and vascular risk factors on cognitive function is stronger in women than in men. These effects may be mediated by the amount of tau pathology in the brain. Therefore, we examined whether APOE ε4 and sex modify cross-sectional associations between cardiovascular risk and tau deposition in cognitively normal older adults from the Alzheimer’s Disease Neuroimaging Initiative. We calculated the Framingham Heart Study cardiovascular disease risk score for 141 participants (74 women, 47 APOE ε4 carriers) with complete medical history data, processed tau PET data and a Clinical Dementia Rating global score of 0.0 at the time of the tau PET scan, implying no significant cognitive or functional impairment. We used linear regression models to examine the effects of sex, APOE ε4, cardiovascular risk and their interactions on tau deposition in the entorhinal cortex, inferior temporal cortex and a composite meta-region of interest of temporal lobe areas. We found a significant three-way interaction among sex, APOE ε4 status, and cardiovascular disease risk on tau deposition in the entorhinal cortex (β = 0.04; 95% CI, 0.01 to 0.07; P =0.008), inferior temporal cortex (β = 0.02; 95% CI, 0.0 to 0.05; P =0.029) and meta-region (β = 0.02; 95% CI, 0.0–0.04; P = 0.042). After stratifying by APOE ε4 status to examine interactions between sex and cardiovascular disease risk on tau in APOE ε4 carriers and non-carriers, we found a significant two-way interaction between sex and cardiovascular disease risk on tau in the entorhinal cortex (β = 0.05; 95% CI, 0.02 to 0.08; P =0.001), inferior temporal cortex (β = 0.03; 95% CI, 0.01 to 0.05; P =0.009) and meta-region (β = 0.02; 95% CI, 0.01 to 0.04; P =0.008) only among APOE ε4 carriers. In analyses stratified by sex, higher cardiovascular risk scores were associated with higher levels of tau in the entorhinal cortex (β = 0.05; 95% CI, 0.02 to 0.08; P =0.002), inferior temporal cortex (β = 0.02; 95% CI, 0.0 to 0.05; P =0.023) and meta-region (β = 0.02; 95% CI, 0.01 to 0.04; P =0.013) in female APOE ε4 carriers but not in male carriers. Our findings suggest that cognitively normal older women carrying at least one APOE ε4 allele, may be particularly vulnerable to the effects of cardiovascular disease risk on early tau deposition.
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Affiliation(s)
- Amaryllis A. Tsiknia
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Emilie Reas
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Katherine J. Bangen
- Research Service, VA San Diego Healthcare System, San Diego, La Jolla, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Erin E. Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Linda McEvoy
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - James B. Brewer
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Steven D. Edland
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Sarah J. Banks
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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16
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Purroy F, Sánchez E, Lecube A, Arqué G, Vicente-Pascual M, Mauri-Capdevila G, Torreguitart N, Hernández M, Barbé F, Fernández E, Pamplona R, Farràs C, Mauricio D, Bermúdez-López M. Prevalence and Predictors of Cerebral Microangiopathy Determined by Pulsatility Index in an Asymptomatic Population From the ILERVAS Project. Front Neurol 2022; 12:785640. [PMID: 34970215 PMCID: PMC8712482 DOI: 10.3389/fneur.2021.785640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Little is known about the prevalence of cerebral microangiopathy (CM), which is related to cognitive impairment, in an asymptomatic population. Pulsatility index (PI) is an easily measurable parameter of cerebral vascular resistance in transcranial duplex of the middle cerebral artery (MCA) study. We aimed to determine the prevalence of CM measured by PI of MCA in low to moderate vascular risk subjects. Methods: We included 3,721 subjects between 45 and 70 years without previous history of vascular disease or diabetes mellitus and with at least one other vascular risk factor from the cross-sectional study ILERVAS (Lleida, Spain). Patients underwent transcranial duplex to determine MCA-PI. Possible CM was defined by MCA-PI >1.1. Carotid and femoral arteries ultrasound registration was done to determine the presence, the number, and the area of atheromatous plaques. Body mass index (BMI), pulse pressure (PP) and laboratory data were also recorded. Results: 439 (11.8%) subjects were excluded due to the low quality of transcranial duplex images. Median age was 57 [IQR 52, 62] years. Possible CM was found in 424 (12.9%) subjects. CM patients had higher prevalence of plaques than non-CM (77.4 vs. 66.4%, p < 0.001). PI showed a positive linear correlation with the number of territories with plaques (r = 0.130, p < 0.001), and the total plaque area (r = 0.082, p < 0.001). The predictors of possible CM were the age, male gender, and PP. Conclusions: In low-to-moderate vascular risk asymptomatic population, the proportion of abnormal brain microvascular bed determined by MCA-PI is not negligible. The planned 10-year follow-up will describe the clinical relevance of these findings.
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Affiliation(s)
- Francisco Purroy
- Stroke Unit, University Hospital Arnau de Vilanova, Lleida, Spain.,Clinical Neurosciences Group, IRBLleida, University of Lleida, Lleida, Spain
| | - Enric Sánchez
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Lleida, Spain.,Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, Lleida, Spain.,University of Lleida, Lleida, Spain
| | - Albert Lecube
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Lleida, Spain.,Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, Lleida, Spain.,University of Lleida, Lleida, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas, CIBERDEM, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Gloria Arqué
- Clinical Neurosciences Group, IRBLleida, University of Lleida, Lleida, Spain
| | | | - Gerard Mauri-Capdevila
- Stroke Unit, University Hospital Arnau de Vilanova, Lleida, Spain.,Clinical Neurosciences Group, IRBLleida, University of Lleida, Lleida, Spain
| | - Núria Torreguitart
- Clinical Neurosciences Group, IRBLleida, University of Lleida, Lleida, Spain.,Vascular Surgery Service, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Marta Hernández
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Lleida, Spain.,Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, Lleida, Spain.,University of Lleida, Lleida, Spain
| | - Ferrán Barbé
- Pneumology Service, Translational Research in Respiratory Medicine Research Group, IRBLleida, University Hospital Arnau de Vilanova, University of Lleida, Lleida, Spain.,CIBER de Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III (ISCIII), Lleida, Spain
| | - Elvira Fernández
- Vascular and Renal Translational Research Group, IRBLleida, ReinRen-ISCIII, University of Lleida, Lleida, Spain
| | - Reinald Pamplona
- Department of Experimental Medicine, Metabolic Pathophysiology Research Group, IRBLleida, University of Lleida, Lleida, Spain
| | - Cristina Farràs
- DAP Lleida, Unitat de Suport a la Recerca - IDIAP Jordi Gol, Lleida, Spain
| | - Dídac Mauricio
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Hospital de la Sant Creu i Sant Pau, Barcelona, Spain
| | - Marcelino Bermúdez-López
- Vascular and Renal Translational Research Group, IRBLleida, ReinRen-ISCIII, University of Lleida, Lleida, Spain
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17
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Kehmeier MN, Walker AE. Sex Differences in Large Artery Stiffness: Implications for Cerebrovascular Dysfunction and Alzheimer’s Disease. FRONTIERS IN AGING 2021; 2. [PMID: 35072153 PMCID: PMC8782423 DOI: 10.3389/fragi.2021.791208] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Two in every three Alzheimer’s disease diagnoses are females, calling attention to the need to understand sexual dimorphisms with aging and neurodegenerative disease progression. Dysfunction and damage to the vasculature with aging are strongly linked to Alzheimer’s disease. With aging there is an increase in stiffness of the large elastic arteries, and this stiffening is associated with cerebrovascular dysfunction and cognitive impairment. However, it is unclear how the deleterious effects of arterial stiffness may differ between females and males. While environmental, chromosomal, and sex hormone factors influence aging, there is evidence that the deficiency of estrogen post-menopause in females is a contributor to vascular aging and Alzheimer’s disease progression. The purpose of this mini review is to describe the recent developments in our understanding of sex differences in large artery stiffness, cerebrovascular dysfunction, and cognitive impairment, and their intricate relations. Furthermore, we will focus on the impact of the loss of estrogen post-menopause as a potential driving factor for these outcomes. Overall, a better understanding of how sex differences influence aging physiology is crucial to the prevention and treatment of neurodegenerative diseases.
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