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Cavallari M, Touroutoglou A, Katsumi Y, Fong TG, Schmitt E, Travison TG, Shafi MM, Libermann TA, Marcantonio ER, Alsop DC, Jones RN, Inouye SK, Dickerson BC. Relationship between cortical brain atrophy, delirium, and long-term cognitive decline in older surgical patients. Neurobiol Aging 2024; 140:130-139. [PMID: 38788524 DOI: 10.1016/j.neurobiolaging.2024.05.008] [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: 12/12/2022] [Revised: 05/08/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024]
Abstract
In older patients, delirium after surgery is associated with long-term cognitive decline (LTCD). The neural substrates of this association are unclear. Neurodegenerative changes associated with dementia are possible contributors. We investigated the relationship between brain atrophy rates in Alzheimer's disease (AD) and cognitive aging signature regions from magnetic resonance imaging before and one year after surgery, LTCD assessed by the general cognitive performance (GCP) score over 6 years post-operatively, and delirium in 117 elective surgery patients without dementia (mean age = 76). The annual change in cortical thickness was 0.2(1.7) % (AD-signature p = 0.09) and 0.4(1.7) % (aging-signature p = 0.01). Greater atrophy was associated with LTCD (AD-signature: beta(CI) = 0.24(0.06-0.42) points of GCP/mm of cortical thickness; p < 0.01, aging-signature: beta(CI) = 0.55(0.07-1.03); p = 0.03). Atrophy rates were not significantly different between participants with and without delirium. We found an interaction with delirium severity in the association between atrophy and LTCD (AD-signature: beta(CI) = 0.04(0.00-0.08), p = 0.04; aging-signature: beta(CI) = 0.08(0.03-0.12), p < 0.01). The rate of cortical atrophy and severity of delirium are independent, synergistic factors determining postoperative cognitive decline in the elderly.
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Affiliation(s)
- Michele Cavallari
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexandra Touroutoglou
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yuta Katsumi
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tamara G Fong
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Eva Schmitt
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA
| | - Thomas G Travison
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA
| | - Mouhsin M Shafi
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Towia A Libermann
- Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Beth Israel Deaconess Medical Center Genomics, Proteomics, Bioinformatics and Systems Biology Center, Harvard Medical School, Boston, MA, USA
| | - Edward R Marcantonio
- Divisions of General Medicine and Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - David C Alsop
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Richard N Jones
- Departments of Psychiatry and Human Behavior and Neurology, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Sharon K Inouye
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA; Departments of Psychiatry and Human Behavior and Neurology, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Bradford C Dickerson
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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2
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Marcotte TD, Umlauf A, Grelotti DJ, Sones EG, Mastropietro KF, Suhandynata RT, Huestis MA, Grant I, Fitzgerald RL. Evaluation of Field Sobriety Tests for Identifying Drivers Under the Influence of Cannabis: A Randomized Clinical Trial. JAMA Psychiatry 2023; 80:914-923. [PMID: 37531115 PMCID: PMC10398547 DOI: 10.1001/jamapsychiatry.2023.2345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/04/2023] [Indexed: 08/03/2023]
Abstract
Importance With increasing medicinal and recreational cannabis legalization, there is a public health need for effective and unbiased evaluations for determining whether a driver is impaired due to Δ9-tetrahydrocannabinol (THC) exposure. Field sobriety tests (FSTs) are a key component of the gold standard law enforcement officer-based evaluations, yet controlled studies are inconclusive regarding their efficacy in detecting whether a person is under the influence of THC. Objective To examine the classification accuracy of FSTs with respect to cannabis exposure and driving impairment (as determined via a driving simulation). Design, Setting, and Participants This double-blind, placebo-controlled parallel randomized clinical trial was conducted from February 2017 to June 2019 at the Center for Medicinal Cannabis Research, University of California, San Diego. Participants were aged 21 to 55 years and had used cannabis in the past month. Data were analyzed from August 2021 to April 2023. Intervention Participants were randomized 1:1:1 to placebo (0.02% THC), 5.9% THC cannabis, or 13.4% THC cannabis smoked ad libitum. Main Outcome and Measures The primary end point was law enforcement officer determination of FST impairment at 4 time points after smoking. Additional measures included officer estimation as to whether participants were in the THC or placebo group as well as driving simulator data. Officers did not observe driving performance. Results The study included 184 participants (117 [63.6%] male; mean [SD] age, 30 [8.3] years) who had used cannabis a mean (SD) of 16.7 (9.8) days in the past 30 days; 121 received THC and 63, placebo. Officers classified 98 participants (81.0%) in the THC group and 31 (49.2%) in the placebo group as FST impaired (difference, 31.8 percentage points; 95% CI, 16.4-47.2 percentage points; P < .001) at 70 minutes after smoking. The THC group performed significantly worse than the placebo group on 8 of 27 individual FST components (29.6%) and all FST summary scores. However, the placebo group did not complete a median of 8 (IQR, 5-11) FST components as instructed. Of 128 participants classified as FST impaired, officers suspected 127 (99.2%) as having received THC. Driving simulator performance was significantly associated with results of select FSTs (eg, ≥2 clues on One Leg Stand was associated with impairment on the simulator: odds ratio, 3.09; 95% CI, 1.63-5.88; P < .001). Conclusions and Relevance This randomized clinical trial found that when administered by highly trained officers, FSTs differentiated between individuals receiving THC vs placebo and driving abilities were associated with results of some FSTs. However, the high rate at which the participants receiving placebo failed to adequately perform FSTs and the high frequency that poor FST performance was suspected to be due to THC-related impairment suggest that FSTs, absent other indicators, may be insufficient to denote THC-specific impairment in drivers. Trial Registration ClinicalTrials.gov Identifier: NCT02849587.
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Affiliation(s)
- Thomas D. Marcotte
- Center for Medicinal Cannabis Research, Department of Psychiatry, University of California, San Diego
| | - Anya Umlauf
- Center for Medicinal Cannabis Research, Department of Psychiatry, University of California, San Diego
| | - David J. Grelotti
- Center for Medicinal Cannabis Research, Department of Psychiatry, University of California, San Diego
| | - Emily G. Sones
- Center for Medicinal Cannabis Research, Department of Psychiatry, University of California, San Diego
| | - Kyle F. Mastropietro
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego
| | - Raymond T. Suhandynata
- Center for Medicinal Cannabis Research, Department of Pathology, University of California, San Diego
- Center for Medicinal Cannabis Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego
| | - Marilyn A. Huestis
- Institute for Emerging Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Igor Grant
- Center for Medicinal Cannabis Research, Department of Psychiatry, University of California, San Diego
| | - Robert L. Fitzgerald
- Center for Medicinal Cannabis Research, Department of Pathology, University of California, San Diego
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Klein SD, Collins PF, Luciana M. Developmental trajectories of delay discounting from childhood to young adulthood: longitudinal associations and test-retest reliability. Cogn Psychol 2022; 139:101518. [PMID: 36183669 PMCID: PMC10888509 DOI: 10.1016/j.cogpsych.2022.101518] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 01/27/2023]
Abstract
Delay discounting (DD) indexes an individual's preference for smaller immediate rewards over larger delayed rewards, and is considered a form of cognitive impulsivity. Cross-sectional studies have demonstrated that DD peaks in adolescence; longitudinal studies are needed to validate this putative developmental trend, and to determine whether DD assesses a temporary state, or reflects a more stable behavioral trait. In this study, 140 individuals aged 9-23 completed a delay discounting (DD) task and cognitive battery at baseline and every-two years thereafter, yielding five assessments over approximately 10 years. Models fit with the inverse effect of age best approximated the longitudinal trajectory of two DD measures, hyperbolic discounting (log[k]) and area under the indifference-point curve (AUC). Discounting of future rewards increased rapidly from childhood to adolescence and appeared to plateau in late adolescence for both models of DD. Participants with greater verbal intelligence and working memory displayed reduced DD across the duration of the study, suggesting a functional interrelationship between these domains and DD from early adolescence to adulthood. Furthermore, AUC demonstrated good to excellent reliability across assessment points that was superior to log(k), with both measures demonstrating acceptable stability once participants reached late adolescence. The developmental trajectories of DD we observed from childhood through young adulthood suggest that DD may index cognitive control more than reward sensitivity, and that despite modest developmental changes with maturation, AUC may be conceptualized as a trait variable related to cognitive control vs impulsivity.
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Affiliation(s)
- Samuel D Klein
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA.
| | - Paul F Collins
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Monica Luciana
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
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Chu NM, Bae S, Chen X, Ruck J, Gross AL, Albert M, Neufeld KJ, Segev DL, McAdams-DeMarco MA. Delirium, changes in cognitive function, and risk of diagnosed dementia after kidney transplantation. Am J Transplant 2022; 22:2892-2902. [PMID: 35980673 PMCID: PMC10138281 DOI: 10.1111/ajt.17176] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/25/2022] [Accepted: 08/15/2022] [Indexed: 01/25/2023]
Abstract
Kidney transplant (KT) recipients with delirium, a preventable surgical complication, are likely to reap cognitive benefits from restored kidney function, but may be more vulnerable to longer-term neurotoxic stressors post-KT (i.e., aging, immunosuppression). In this prospective cohort study, we measured delirium (chart-based), global cognitive function (3MS), and executive function (Trail Making Test Part B minus Part A) in 894 recipients (2009-2021) at KT, 1/3/6-months, 1-year, and annually post-KT. Dementia was ascertained using linked Medicare claims. We described repeated measures of cognitive performance (mixed effects model) and quantified dementia risk (Fine & Gray competing risk) by post-KT delirium. Of 894 recipients, 43(4.8%) had post-KT delirium. Delirium was not associated with global cognitive function at KT (difference = -3.2 points, 95%CI: -6.7, 0.4) or trajectories post-KT (0.03 points/month, 95%CI: -0.27, 0.33). Delirium was associated with worse executive function at KT (55.1 s, 95%CI: 25.6, 84.5), greater improvements in executive function <2 years post-KT (-2.73 s/month, 95%CI: -4.46,-0.99), and greater decline in executive function >2 years post-KT (1.72 s/month, 95%CI: 0.22, 3.21). Post-KT delirium was associated with over 7-fold greater risk of dementia post-KT (adjusted subdistribution hazard ratio = 7.84, 95%CI: 1.22, 50.40). Transplant centers should be aware of cognitive risks associated with post-KT delirium and implement available preventative interventions to reduce delirium risk.
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Affiliation(s)
- Nadia M. Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Sunjae Bae
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Xiaomeng Chen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jessica Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alden L. Gross
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Karin J. Neufeld
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dorry L. Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Mara A. McAdams-DeMarco
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
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Langheinrich T, Chen C, Thomas O. Update on the Cognitive Presentations of iNPH for Clinicians. Front Neurol 2022; 13:894617. [PMID: 35937049 PMCID: PMC9350547 DOI: 10.3389/fneur.2022.894617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/19/2022] [Indexed: 11/16/2022] Open
Abstract
This mini-review focuses on cognitive impairment in iNPH. This symptom is one of the characteristic triad of symptoms in a condition long considered to be the only treatable dementia. We present an update on recent developments in clinical, neuropsychological, neuroimaging and biomarker aspects. Significant advances in our understanding have been made, notably regarding biomarkers, but iNPH remains a difficult diagnosis. Stronger evidence for permanent surgical treatment is emerging but selection for treatment remains challenging, particularly with regards to cognitive presentations. Encouragingly, there has been increasing interest in iNPH, but more research is required to better define the underlying pathology and delineate it from overlapping conditions, in order to inform best practise for the clinician managing the cognitively impaired patient. In the meantime, we strongly encourage a multidisciplinary approach and a structured service pathway to maximise patient benefit.
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Affiliation(s)
- Tobias Langheinrich
- Department of Neurology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, United Kingdom
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
- *Correspondence: Tobias Langheinrich
| | - Cliff Chen
- Department of Neuropsychology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Owen Thomas
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
- Department of Neuroradiology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, United Kingdom
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6
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Bertola L, Benseñor IJM, Brunoni AR, Caramelli P, Barreto SM, Moreno AB, Griep RH, Viana MC, Lotufo PA, Suemoto CK. Retest effects in a diverse sample: sociodemographic predictors and possible correction approaches. Dement Neuropsychol 2022; 16:171-180. [PMID: 35720646 PMCID: PMC9173799 DOI: 10.1590/1980-5764-dn-2021-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 10/13/2021] [Indexed: 11/21/2022] Open
Abstract
Repeated cognitive assessment in longitudinal studies favors the occurrence of retest effects, usually increasing the scores obtained at the follow-up assessments when compared to baseline. Therefore, retest effects can compromise the evaluation of cognitive decline in older adults.
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Affiliation(s)
- Laiss Bertola
- Universidade de São Paulo, Faculdade de Medicina, São Paulo SP, Brazil
| | - Isabela Judith Martins Benseñor
- Universidade de São Paulo, Hospital Universitário, Centro de Pesquisa Epidemiológica e Clínica, São Paulo SP, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Medicina Interna, São Paulo SP, Brazil
| | - Andre Russowsky Brunoni
- Universidade de São Paulo, Hospital Universitário, Centro de Pesquisa Epidemiológica e Clínica, São Paulo SP, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Medicina Interna, São Paulo SP, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Departamento e Instituto de Psiquiatria, Laboratório de Neurociências, São Paulo SP, Brazil
| | - Paulo Caramelli
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte MG, Brazil
| | - Sandhi Maria Barreto
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Hospital das Clínicas, Belo Horizonte MG, Brazil
| | - Arlinda Barbosa Moreno
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sérgio Arouca, Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Rio de Janeiro RJ, Brazil
| | - Rosane Harter Griep
- Fundação Oswaldo Cruz, Istituto Oswaldo Cruz, Laboratório de Educação em Saúde e Meio Ambiente, Rio de Janeiro RJ, Brazil
| | - Maria Carmen Viana
- Universidade Federal do Espírito Santo, Departamento de Medicina Social, Vitória ES, Brazil
| | - Paulo Andrade Lotufo
- Universidade de São Paulo, Hospital Universitário, Centro de Pesquisa Epidemiológica e Clínica, São Paulo SP, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Medicina Interna, São Paulo SP, Brazil
| | - Claudia Kimie Suemoto
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Geriatria, São Paulo SP, Brazil
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Perioperative neurocognitive and functional neuroimaging trajectories in older APOE4 carriers compared with non-carriers: secondary analysis of a prospective cohort study. Br J Anaesth 2021; 127:917-928. [PMID: 34535274 PMCID: PMC8693648 DOI: 10.1016/j.bja.2021.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/20/2021] [Accepted: 08/01/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Cognitive dysfunction after surgery is a major issue in older adults. Here, we determined the effect of APOE4 on perioperative neurocognitive function in older patients. METHODS We enrolled 140 English-speaking patients ≥60 yr old scheduled for noncardiac surgery under general anaesthesia in an observational cohort study, of whom 52 underwent neuroimaging. We measured cognition; Aβ, tau, p-tau levels in CSF; and resting-state intrinsic functional connectivity in six Alzheimer's disease-risk regions before and 6 weeks after surgery. RESULTS There were no significant APOE4-related differences in cognition or CSF biomarkers, except APOE4 carriers had lower CSF Aβ levels than non-carriers (preoperative median CSF Aβ [median absolute deviation], APOE4 305 pg ml-1 [65] vs 378 pg ml-1 [38], respectively; P=0.001). Controlling for age, APOE4 carriers had significantly greater preoperative functional connectivity than non-carriers between several brain regions implicated in Alzheimer's disease, including between the left posterior cingulate cortex and left angular gyrus (β [95% confidence interval, CI], 0.218 [0.137-0.230]; PFWE=0.016). APOE4 carriers, but not non-carriers, experienced significant connectivity decreases from before to 6 weeks after surgery between several brain regions including between the left posterior cingulate cortex and left angular gyrus (β [95% CI], -0.196 [-0.256 to -0.136]; PFWE=0.001). Most preoperative and postoperative functional connectivity differences did not change after controlling for preoperative CSF Aβ levels. CONCLUSIONS Postoperative change trajectories for cognition and CSF Aβ, tau or p-tau levels did not differ between community dwelling older APOE4 carriers and non-carriers. APOE4 carriers showed greater preoperative functional connectivity and greater postoperative decreases in functional connectivity in key Alzheimer's disease-risk regions, which occur via Aβ-independent mechanisms.
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8
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Grant A, Aubin MJ, Buhrmann R, Kergoat MJ, Li G, Freeman EE. Visual Impairment, Eye Disease, and 3-Year Cognitive Decline: The Canadian Longitudinal Study on Aging. Ophthalmic Epidemiol 2021; 29:545-553. [PMID: 34486480 DOI: 10.1080/09286586.2021.1974494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To examine the longitudinal association between vision-related variables and the 3-year change in cognitive test scores in a community-dwelling sample of adults and to explore whether sex, education, or hearing loss act as effect modifiers. METHODS Data came from two waves of a 3-year population-based prospective cohort study (Canadian Longitudinal Study on Aging), which consisted of 30,097 randomly selected people aged 45-85 years from 7 Canadian provinces. Visual impairment (VI) was defined as binocular presenting visual acuity worse than 20/40. Participants were asked if they had ever had a diagnosis of age-related macular degeneration (AMD), glaucoma, or cataract. Cognitive change over 3 years was examined by calculating the difference between baseline and follow-up scores for the Rey Auditory Verbal Learning Test (RAVLT) and the RAVLT delayed test (memory tests), the Controlled Oral Word Association Test (COWAT) and the Animal Naming Test (ANT) (verbal fluency tests), and the Mental Alternation Test (MAT) (processing speed test). Multiple linear regression was used. RESULTS VI, AMD, and cataract were not associated with 3-year changes on any of the 5 cognitive tests after adjusting for age, sex, ethnicity, education, income, smoking, diabetes, stroke, heart disease, and province. A report of glaucoma was associated with greater declines in MAT scores (β = -0.60, 95% CI -1.03, -0.18). No effect modification was detected. CONCLUSIONS Glaucoma was associated with worsening processing speed. Further research to confirm this finding and to understand the possible reason is necessary.
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Affiliation(s)
- Alyssa Grant
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Marie-Josée Aubin
- Department of Ophthalmology, Université de Montréal, Montreal, Canada.,Centre Universitaire d'ophtalmologie de l'Hôpital Maisonneuve-Rosemont, Montreal, Canada.,Department of Social and Preventive Medicine, Espum, Université de Montréal, Montréal, Canada
| | - Ralf Buhrmann
- Department of Ophthalmology, University of Ottawa, Ottawa, Canada
| | - Marie-Jeanne Kergoat
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Canada.,Department of Medicine, Université de Montréal, Canada
| | - Gisele Li
- Department of Ophthalmology, Université de Montréal, Montreal, Canada.,Centre Universitaire d'ophtalmologie de l'Hôpital Maisonneuve-Rosemont, Montreal, Canada
| | - Ellen E Freeman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada
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9
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Racine AM, Touroutoglou A, Abrantes T, Wong B, Fong TG, Cavallari M, Travison TG, Gou Y, Marcantonio ER, Alsop DC, Jones RN, Inouye SK, Dickerson BC. Older Patients with Alzheimer's Disease-Related Cortical Atrophy Who Develop Post-Operative Delirium May Be at Increased Risk of Long-Term Cognitive Decline After Surgery. J Alzheimers Dis 2021; 75:187-199. [PMID: 32250290 DOI: 10.3233/jad-190380] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Older surgical patients with Alzheimer's disease (AD) dementia and delirium are at increased risk for accelerated long-term cognitive decline. OBJECTIVE Investigate associations between a probabilistic marker of preclinical AD, delirium, and long-term cognitive decline. METHODS The Successful Aging after Elective Surgery cohort includes older adults (≥70 years) without dementia who underwent elective surgery. 140 patients underwent preoperative magnetic resonance imaging and had≥6 months cognitive follow-up. Cortical thickness was measured in 'AD-Signature' regions. Delirium was evaluated each postoperative day by the Confusion Assessment Method. Cognitive performance was assessed using a detailed neuropsychological battery at baseline; months 1, 2, and 6; and every 6 months thereafter until 36 months. Using either a General Cognitive Performance composite (GCP) or individual test scores as outcomes, we performed linear mixed effects models to examine main effects of AD-signature atrophy and the interaction of AD-signature atrophy and delirium on slopes of cognitive change from post-operative months 2-36. RESULTS Reduced baseline AD-signature cortical thickness was associated with greater 36-month cognitive decline in GCP (standardized beta coefficient, β = -0.030, 95% confidence interval [-0.060, -0.001]). Patients who developed delirium who also had thinner AD signature cortex showed greater decline on a verbal learning test (β = -0.100 [-0.192, -0.007]). CONCLUSION Patients with the greatest baseline AD-related cortical atrophy who develop delirium after elective surgery appear to experience the greatest long-term cognitive decline. Thus, atrophy suggestive of preclinical AD and the development of delirium may be high-risk indicators for long-term cognitive decline following surgery.
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Affiliation(s)
- Annie M Racine
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Frontotemporal Disorders Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Alexandra Touroutoglou
- Harvard Medical School, Boston, MA, USA.,Frontotemporal Disorders Unit, Massachusetts General Hospital, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Tatiana Abrantes
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Bonnie Wong
- Harvard Medical School, Boston, MA, USA.,Frontotemporal Disorders Unit, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Tamara G Fong
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michele Cavallari
- Harvard Medical School, Boston, MA, USA.,Department of Radiology, Center for Neurological Imaging, Brigham and Women's Hospital, Boston, MA, USA
| | - Thomas G Travison
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Yun Gou
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Edward R Marcantonio
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - David C Alsop
- Harvard Medical School, Boston, MA, USA.,Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Richard N Jones
- Departments of Psychiatry and Human Behavior and Neurology, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Sharon K Inouye
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Bradford C Dickerson
- Harvard Medical School, Boston, MA, USA.,Frontotemporal Disorders Unit, Massachusetts General Hospital, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Massachusetts Alzheimer's Disease Research Center, Massachusetts General Hospital, Boston, MA, USA
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Jutten RJ, Grandoit E, Foldi NS, Sikkes SAM, Jones RN, Choi S, Lamar ML, Louden DKN, Rich J, Tommet D, Crane PK, Rabin LA. Lower practice effects as a marker of cognitive performance and dementia risk: A literature review. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12055. [PMID: 32671181 PMCID: PMC7346865 DOI: 10.1002/dad2.12055] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Practice effects (PEs) are improvements in performance after repeated exposure to test materials, and typically viewed as a source of bias in repeated cognitive assessments. We aimed to determine whether characterizing PEs could also provide a useful marker of early cognitive decline. METHODS We conducted a systematic review of the literature, searching PsycInfo (Ebsco) and PubMed databases for articles studying PEs in aging and dementia populations. Articles published between 1920 and 2019 were included. RESULT We identified 259 articles, of which 27 studied PEs as markers of cognitive performance. These studies consistently showed that smaller, less-robust PEs were associated with current diagnostic status and/or future cognitive decline. In addition, lower PEs were associated with Alzheimer's disease risk factors and neurodegeneration biomarkers. CONCLUSION PEs provide a potentially useful marker of cognitive decline, and could prove valuable as part of a cost-effective strategy to select individuals who are at-risk for dementia for future interventions.
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Affiliation(s)
- Roos J. Jutten
- Alzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam UMCVrije UniversiteitAmsterdamthe Netherlands
| | | | - Nancy S. Foldi
- Queens College and The Graduate Center of The City University of New YorkQueensNew YorkUSA
| | - Sietske A. M. Sikkes
- Alzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam UMCVrije UniversiteitAmsterdamthe Netherlands
| | - Richard N. Jones
- Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Seo‐Eun Choi
- School of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Melissa L. Lamar
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | | | - Joanne Rich
- University Libraries, University of WashingtonSeattleWashingtonUSA
| | - Douglas Tommet
- Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Paul K. Crane
- School of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Laura A. Rabin
- Brooklyn College and The Graduate Center of The City University of New YorkBrooklynNew YorkUSA
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Daiello LA, Racine AM, Gou RY, Marcantonio ER, Xie Z, Kunze LJ, Vlassakov KV, Inouye SK, Jones RN. Postoperative Delirium and Postoperative Cognitive Dysfunction: Overlap and Divergence. Anesthesiology 2019; 131:477-491. [PMID: 31166241 PMCID: PMC6692220 DOI: 10.1097/aln.0000000000002729] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Postoperative delirium and postoperative cognitive dysfunction share risk factors and may co-occur, but their relationship is not well established. The primary goals of this study were to describe the prevalence of postoperative cognitive dysfunction and to investigate its association with in-hospital delirium. The authors hypothesized that delirium would be a significant risk factor for postoperative cognitive dysfunction during follow-up. METHODS This study used data from an observational study of cognitive outcomes after major noncardiac surgery, the Successful Aging after Elective Surgery study. Postoperative delirium was evaluated each hospital day with confusion assessment method-based interviews supplemented by chart reviews. Postoperative cognitive dysfunction was determined using methods adapted from the International Study of Postoperative Cognitive Dysfunction. Associations between delirium and postoperative cognitive dysfunction were examined at 1, 2, and 6 months. RESULTS One hundred thirty-four of 560 participants (24%) developed delirium during hospitalization. Slightly fewer than half (47%, 256 of 548) met the International Study of Postoperative Cognitive Dysfunction-defined threshold for postoperative cognitive dysfunction at 1 month, but this proportion decreased at 2 months (23%, 123 of 536) and 6 months (16%, 85 of 528). At each follow-up, the level of agreement between delirium and postoperative cognitive dysfunction was poor (kappa less than .08) and correlations were small (r less than .16). The relative risk of postoperative cognitive dysfunction was significantly elevated for patients with a history of postoperative delirium at 1 month (relative risk = 1.34; 95% CI, 1.07-1.67), but not 2 months (relative risk = 1.08; 95% CI, 0.72-1.64), or 6 months (relative risk = 1.21; 95% CI, 0.71-2.09). CONCLUSIONS Delirium significantly increased the risk of postoperative cognitive dysfunction in the first postoperative month; this relationship did not hold in longer-term follow-up. At each evaluation, postoperative cognitive dysfunction was more common among patients without delirium. Postoperative delirium and postoperative cognitive dysfunction may be distinct manifestations of perioperative neurocognitive deficits.
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Affiliation(s)
- Lori A. Daiello
- Alzheimer’s Disease and Memory Disorders Center, Rhode Island Hospital, Providence, RI
- Department of Neurology, Brown University Warren Alpert Medical School, Providence RI
| | - Annie M. Racine
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Harvard Medical School, Boston, MA
| | - Ray Yun Gou
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Edward R. Marcantonio
- Harvard Medical School, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Zhongcong Xie
- Harvard Medical School, Boston, MA
- Department of Anesthesia, Massachusetts General Hospital, Boston, MA
| | - Lisa J Kunze
- Harvard Medical School, Boston, MA
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA
| | - Kamen V. Vlassakov
- Harvard Medical School, Boston, MA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Sharon K. Inouye
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence RI
- Department of Neurology, Brown University Warren Alpert Medical School, Providence RI
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