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Zhuang X, Cordes D, Caldwell JZK, Bender AR, Miller JB. Disparities in structural brain imaging in older adults from rural communities in Southern Nevada. Front Aging Neurosci 2024; 16:1465744. [PMID: 39430976 PMCID: PMC11486705 DOI: 10.3389/fnagi.2024.1465744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 09/17/2024] [Indexed: 10/22/2024] Open
Abstract
Introduction Identifying the associations between rural-living or neighborhood disadvantage and neurobiology may clarify rural-urban disparities in older adults with cognitive impairment related to Alzheimer's disease. Methods We examined rural-urban differences and neighborhood disadvantages in brain cortical thickness (CT) measures among 71 rural and 87 urban-dwelling older adults. Analysis of covariance was used to test each FreeSurfer-derived CT measures' associations with rural-urban living, clinical impairment status, and their interactions. Post-hoc linear regressions were used to test the association between CT measures and neighborhood disadvantage index. Results Rural-dwelling older adults had thinner cortices in temporal and inferior frontal regions compared to urban participants, especially among clinically normal participants, where the thinner temporal cortex further correlated with higher neighborhood disadvantage. Conversely, rural participants had thicker cortices in superior frontal, parietal and occipital regions. Discussion Our results suggest a complex interplay between community contexts and neurobiology. For memory-related regions, rural-living and neighborhood disadvantage might be negatively associated with subjects' brain structures.
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Affiliation(s)
- Xiaowei Zhuang
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
- Interdisciplinary Neuroscience PhD Program, University of Nevada, Las Vegas, Las Vegas, NV, United States
| | - Dietmar Cordes
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, United States
| | | | - Andrew R. Bender
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | - Justin B. Miller
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
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2
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Burmistrov DE, Gudkov SV, Franceschi C, Vedunova MV. Sex as a Determinant of Age-Related Changes in the Brain. Int J Mol Sci 2024; 25:7122. [PMID: 39000227 PMCID: PMC11241365 DOI: 10.3390/ijms25137122] [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: 05/20/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
The notion of notable anatomical, biochemical, and behavioral distinctions within male and female brains has been a contentious topic of interest within the scientific community over several decades. Advancements in neuroimaging and molecular biological techniques have increasingly elucidated common mechanisms characterizing brain aging while also revealing disparities between sexes in these processes. Variations in cognitive functions; susceptibility to and progression of neurodegenerative conditions, notably Alzheimer's and Parkinson's diseases; and notable disparities in life expectancy between sexes, underscore the significance of evaluating aging within the framework of gender differences. This comprehensive review surveys contemporary literature on the restructuring of brain structures and fundamental processes unfolding in the aging brain at cellular and molecular levels, with a focus on gender distinctions. Additionally, the review delves into age-related cognitive alterations, exploring factors influencing the acceleration or deceleration of aging, with particular attention to estrogen's hormonal support of the central nervous system.
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Affiliation(s)
- Dmitriy E. Burmistrov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 38 Vavilova St., 119991 Moscow, Russia;
| | - Sergey V. Gudkov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 38 Vavilova St., 119991 Moscow, Russia;
- Institute of Biology and Biomedicine, Lobachevsky State University of Nizhny Novgorod, 23 Gagarin Ave., 603022 Nizhny Novgorod, Russia
| | - Claudio Franceschi
- Institute of Biology and Biomedicine, Lobachevsky State University of Nizhny Novgorod, 23 Gagarin Ave., 603022 Nizhny Novgorod, Russia
| | - Maria V. Vedunova
- Institute of Biology and Biomedicine, Lobachevsky State University of Nizhny Novgorod, 23 Gagarin Ave., 603022 Nizhny Novgorod, Russia
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3
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Dratva MA, Banks SJ, Panizzon MS, Galasko D, Sundermann EE. Low testosterone levels relate to poorer cognitive function in women in an APOE-ε4-dependant manner. Biol Sex Differ 2024; 15:45. [PMID: 38835072 PMCID: PMC11151480 DOI: 10.1186/s13293-024-00620-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/15/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Past research suggests that low testosterone levels relate to poorer cognitive function and higher Alzheimer's disease (AD) risk; however, these findings are inconsistent and are mostly derived from male samples, despite similar age-related testosterone decline in females. Both animal and human studies demonstrate that testosterone's effects on brain health may be moderated by apolipoprotein E ε4 allele (APOE-ε4) carrier status, which may explain some previous inconsistencies. We examined how testosterone relates to cognitive function in older women versus men across healthy aging and the AD continuum and the moderating role of APOE-ε4 genotype. METHODS Five hundred and sixty one participants aged 55-90 (155 cognitively normal (CN), 294 mild cognitive impairment (MCI), 112 AD dementia) from the Alzheimer's Disease Neuroimaging Initiative (ADNI), who had baseline cognitive and plasma testosterone data, as measured by the Rules Based Medicine Human DiscoveryMAP Panel were included. There were 213 females and 348 males (self-reported sex assigned at birth), and 52% of the overall sample were APOE-ε4 carriers. We tested the relationship of plasma testosterone levels and its interaction with APOE-ε4 status on clinical diagnostic group (CN vs. MCI vs. AD), global, and domain-specific cognitive performance using ANOVAs and linear regression models in sex-stratified samples. Cognitive domains included verbal memory, executive function, processing speed, and language. RESULTS We did not observe a significant difference in testosterone levels between clinical diagnostic groups in either sex, regrardless of APOE-ε4 status. Across clinical diagnostic group, we found a significant testosterone by APOE-ε4 interaction in females, such that lower testosterone levels related to worse global cognition, processing speed, and verbal memory in APOE-ε4 carriers only. We did not find that testosterone, nor its interaction with APOE-ε4, related to cognitive outcomes in males. CONCLUSIONS Findings suggest that low testosterone levels in older female APOE-ε4 carriers across the aging-MCI-AD continuum may have deleterious, domain-specific effects on cognitive performance. Although future studies including additional sex hormones and longitudinal cognitive trajectories are needed, our results highlight the importance of including both sexes and considering APOE-ε4 carrier status when examining testosterone's role in cognitive health.
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Affiliation(s)
- Melanie A Dratva
- Department of Neurosciences, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
- UCSD ACTRI Building, 2W502-B8, 9452 Medical Center Drive (MC-0841), La Jolla, CA, 92037, USA.
| | - Sarah J Banks
- Department of Neurosciences, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
| | - Matthew S Panizzon
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
- Center for Behavior Genetics of Aging, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92092, USA
| | - Douglas Galasko
- Department of Neurosciences, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
| | - Erin E Sundermann
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
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4
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Harker SA, Al-Hassan L, Huentelman MJ, Braden BB, Lewis CR. APOE ε4-Allele in Middle-Aged and Older Autistic Adults: Associations with Verbal Learning and Memory. Int J Mol Sci 2023; 24:15988. [PMID: 37958971 PMCID: PMC10650864 DOI: 10.3390/ijms242115988] [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: 10/03/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disability and recent evidence suggests that autistic adults are more likely to develop Alzheimer's disease (Alz) and other dementias compared to neurotypical (NT) adults. The ε4-allele of the Apolipoprotein E (APOE) gene is the strongest genetic risk factor for Alz and negatively impacts cognition in middle-aged and older (MA+) adults. This study aimed to determine the impact of the APOE ε4-allele on verbal learning and memory in MA+ autistic adults (ages 40-71 years) compared to matched NT adults. Using the Auditory Verbal Learning Test (AVLT), we found that ε4 carriers performed worse on short-term memory and verbal learning across diagnosis groups, but there was no interaction with diagnosis. In exploratory analyses within sex and diagnosis groups, only autistic men carrying APOE ε4 showed worse verbal learning (p = 0.02), compared to autistic men who were not carriers. Finally, the APOE ε4-allele did not significantly affect long-term memory in this sample. These findings replicate previous work indicating that the APOE ε4-allele negatively impacts short-term memory and verbal learning in MA+ adults and presents new preliminary findings that MA+ autistic men may be vulnerable to the effects of APOE ε4 on verbal learning. Future work with a larger sample is needed to determine if autistic women may also be vulnerable.
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Affiliation(s)
- Samantha A. Harker
- School of Life Sciences and Psychology, Arizona State University, Tempe, AZ 85287, USA;
- College of Health Solutions, Arizona State University, Tempe, AZ 85287, USA; (L.A.-H.); (B.B.B.)
| | - Lamees Al-Hassan
- College of Health Solutions, Arizona State University, Tempe, AZ 85287, USA; (L.A.-H.); (B.B.B.)
| | - Matthew J. Huentelman
- Neurogenomics Division, Translational Genomics Research Institute, Phoenix, AZ 85004, USA;
| | - B. Blair Braden
- College of Health Solutions, Arizona State University, Tempe, AZ 85287, USA; (L.A.-H.); (B.B.B.)
| | - Candace R. Lewis
- School of Life Sciences and Psychology, Arizona State University, Tempe, AZ 85287, USA;
- Neurogenomics Division, Translational Genomics Research Institute, Phoenix, AZ 85004, USA;
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5
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Calvo N, Einstein G. Steroid hormones: risk and resilience in women's Alzheimer disease. Front Aging Neurosci 2023; 15:1159435. [PMID: 37396653 PMCID: PMC10313425 DOI: 10.3389/fnagi.2023.1159435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/23/2023] [Indexed: 07/04/2023] Open
Abstract
More women have Alzheimer disease (AD) than men, but the reasons for this phenomenon are still unknown. Including women in clinical research and studying their biology is key to understand not just their increased risk but also their resilience against the disease. In this sense, women are more affected by AD than men, but their reserve or resilience mechanisms might delay symptom onset. The aim of this review was to explore what is known about mechanisms underlying women's risk and resilience in AD and identify emerging themes in this area that merit further research. We conducted a review of studies analyzing molecular mechanisms that may induce neuroplasticity in women, as well as cognitive and brain reserve. We also analyzed how the loss of steroid hormones in aging may be linked to AD. We included empirical studies with human and animal models, literature reviews as well as meta-analyses. Our search identified the importance of 17-b-estradiol (E2) as a mechanism driving cognitive and brain reserve in women. More broadly, our analysis revealed the following emerging perspectives: (1) the importance of steroid hormones and their effects on both neurons and glia for the study of risk and resilience in AD, (2) E2's crucial role in women's brain reserve, (3) women's verbal memory advantage as a cognitive reserve factor, and (4) E2's potential role in linguistic experiences such as multilingualism and hearing loss. Future directions for research include analyzing the reserve mechanisms of steroid hormones on neuronal and glial plasticity, as well as identifying the links between steroid hormone loss in aging and risk for AD.
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Affiliation(s)
- Noelia Calvo
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Gillian Einstein
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
- Tema Genus, Linköping University, Linköping, Sweden
- Women’s College Research Institute, Toronto, ON, Canada
- Centre for Life Course and Aging, University of Toronto, Toronto, ON, Canada
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6
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Sundermann EE, Campbell LM, Villers O, Bondi MW, Gouaux B, Salmon DP, Galasko D, Soontornniyomkij V, Ellis RJ, Moore DJ. Alzheimer's Disease Pathology in Middle Aged and Older People with HIV: Comparisons with Non-HIV Controls on a Healthy Aging and Alzheimer's Disease Trajectory and Relationships with Cognitive Function. Viruses 2023; 15:1319. [PMID: 37376619 PMCID: PMC10305373 DOI: 10.3390/v15061319] [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: 05/02/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
We determined the prevalence of Alzheimer's disease (AD) pathological hallmarks, amyloid-β and phosphorylated-Tau, in autopsied brains of 49 people with HIV (PWH) (ages: 50-68; mean age = 57.0) from the National NeuroAIDS Tissue Consortium and in a comparative cohort of 55 people without HIV (PWoH) from the UC San Diego Alzheimer's Disease Research Center (17 controls, 14 mild cognitive impairment, 24 AD; ages: 70-102, mean age = 88.7). We examined how AD pathology relates to domain-specific cognitive functions in PWH overall and in sex-stratified samples. Amyloid-β and phosphorylated-Tau positivity (presence of pathology of any type/density) was determined via immunohistochemistry in AD-sensitive brain regions. Among PWH, amyloid-β positivity ranged from 19% (hippocampus) to 41% (frontal neocortex), and phosphorylated-Tau positivity ranged from 47% (entorhinal cortex) to 73% (transentorhinal cortex). Generally, AD pathology was significantly less prevalent, and less severe when present, in PWH versus PWoH regardless of cognitive status. Among PWH, positivity for AD pathology related most consistently to memory-related domains. Positivity for p-Tau pathology related to memory-related domains in women with HIV only, although the sample size of women with HIV was small (n = 10). Results indicate that AD pathology is present in a sizable portion of middle aged and older PWH, although not to the extent in older PWoH. Studies with better age-matched PWoH are needed to examine the effect of HIV status on AD pathology.
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Affiliation(s)
- Erin E. Sundermann
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
| | - Laura M. Campbell
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA
| | - Olivia Villers
- School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Mark W. Bondi
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
- VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA
| | - Ben Gouaux
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
| | - David P. Salmon
- Department of Neurosciences, University of California San Diego, 9375 Gilman Dr., La Jolla, CA 92161, USA
| | - Douglas Galasko
- Department of Neurosciences, University of California San Diego, 9375 Gilman Dr., La Jolla, CA 92161, USA
| | - Virawudh Soontornniyomkij
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
| | - Ronald J. Ellis
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
- Department of Neurosciences, University of California San Diego, 9375 Gilman Dr., La Jolla, CA 92161, USA
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA (D.J.M.)
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7
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Ren QW, Katherine Teng TH, Tse YK, Tay WT, Li HL, Tromp J, Yu SY, Hung D, Wu MZ, Chen C, Yuk Yuen JK, Huang JY, Ouwerkerk W, Li XL, Teramoto K, Chandramouli C, Tse HF, Lam CSP, Yiu KH. Incidence, Clinical Correlates, and Prognostic Impact of Dementia in Heart Failure: A Population-Based Cohort Study. JACC. ASIA 2023; 3:108-119. [PMID: 36873768 PMCID: PMC9982209 DOI: 10.1016/j.jacasi.2022.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 01/05/2023]
Abstract
Background Heart failure (HF) may increase the risk of dementia via shared risk factors. Objectives The authors investigated the incidence, types, clinical correlates, and prognostic impact of dementia in a population-based cohort of patients with index HF. Methods The previously territory-wide database was interrogated to identify eligible patients with HF (N = 202,121) from 1995 to 2018. Clinical correlates of incident dementia and their associations with all-cause mortality were assessed using multivariable Cox/competing risk regression models where appropriate. Results Among a total cohort aged ≥18 years with HF (mean age 75.3 ± 13.0 years, 51.3% women, median follow-up 4.1 [IQR: 1.2-10.2] years), new-onset dementia occurred in 22,145 (11.0%), with age-standardized incidence rate of 1,297 (95% CI: 1,276-1,318) per 10,000 in women and 744 (723-765) per 10,000 in men. Types of dementia were Alzheimer's disease (26.8%), vascular dementia (18.1%), and unspecified dementia (55.1%). Independent predictors of dementia included: older age (≥75 years, subdistribution hazard ratio [SHR]: 2.22), female sex (SHR: 1.31), Parkinson's disease (SHR: 1.28), peripheral vascular disease (SHR: 1.46), stroke (SHR: 1.24), anemia (SHR: 1.11), and hypertension (SHR: 1.21). The population attributable risk was highest for age ≥75 years (17.4%) and female sex (10.2%). New-onset dementia was independently associated with increased risk of all-cause mortality (adjusted SHR: 4.51; P < 0.001). Conclusions New-onset dementia affected more than 1 in 10 patients with index HF over the follow-up, and portended a worse prognosis in these patients. Older women were at highest risk and should be targeted for screening and preventive strategies.
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Affiliation(s)
- Qing-Wen Ren
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore.,School of Allied Health, University of Western Australia, Perth, Australia
| | - Yi-Kei Tse
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | | | - Hang-Long Li
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Jasper Tromp
- National Heart Centre Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Si-Yeung Yu
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Denise Hung
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Mei-Zhen Wu
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Christopher Chen
- Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Jia-Yi Huang
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore.,Department of Dermatology, University of Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - Xin-Li Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | | | | | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore.,University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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8
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Linear Mixed Model Analysis of Polygenic Hazard Score on Verbal Memory Decline in Alzheimer's Disease. Nurs Res 2023; 72:66-73. [PMID: 36097266 DOI: 10.1097/nnr.0000000000000623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) is a chronic, progressive, degenerative disease characterized by cognitive dysfunction, including verbal memory loss. Studies were lacking in examining the longitudinal effect of polygenic hazard score on the Rey Auditory Verbal Learning Test-Delayed Total (AVDELTOT) score (a common measure of verbal memory). A key step in analyzing longitudinal changes in cognitive measures using a linear mixed model (LMM) is choosing a suitable covariance structure. OBJECTIVES The study aims to determine the association between the polygenic hazard score and the AVDELTOT score accounting for repeated measures (the covariance structure). METHODS The AVDELTOT scores were collected at baseline, 12 months, 24 months, 36 months, and 48 months from 283 participants with AD, 347 with cognitive normal, and 846 with mild cognitive impairment in the Alzheimer's Disease Neuroimaging Initiative. The Bayesian information criterion statistic was used to select the best covariance structure from 10 covariance structures in longitudinal analysis of AVDELTOT scores. The multivariable LMM was used to investigate the effect of polygenic hazard score status (low vs. medium vs. high) on changes in AVDELTOT scores while adjusted for age, gender, education, APOE-ε4 genotype, and baseline Mini-Mental State Examination score. RESULTS One-way analysis of variance revealed significant differences in AVDELTOT scores, Mini-Mental State Examination scores, and polygenic hazard scores among AD diagnoses at baseline. Bayesian information criterion favored the compound symmetry covariance structure in the LMM analysis. Using the multivariate LMM, the APOE-ε4 allele and high polygenic hazard score value was significantly associated with AVDELTOT declines. Significant polygenic hazard score status by follow-up visit interactions was discovered. CONCLUSION Our findings provide the first evidence of the effect of polygenic hazard score status and APOE-ε4 allele on declines in verbal memory in people with AD.
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9
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Mielke MM, Aggarwal NT, Vila‐Castelar C, Agarwal P, Arenaza‐Urquijo EM, Brett B, Brugulat‐Serrat A, DuBose LE, Eikelboom WS, Flatt J, Foldi NS, Franzen S, Gilsanz P, Li W, McManus AJ, van Lent DM, Milani SA, Shaaban CE, Stites SD, Sundermann E, Suryadevara V, Trani J, Turner AD, Vonk JMJ, Quiroz YT, Babulal GM. Consideration of sex and gender in Alzheimer's disease and related disorders from a global perspective. Alzheimers Dement 2022; 18:2707-2724. [PMID: 35394117 PMCID: PMC9547039 DOI: 10.1002/alz.12662] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 01/31/2023]
Abstract
Sex or gender differences in the risk of Alzheimer's disease and related dementias (ADRD) differ by world region, suggesting that there are potentially modifiable risk factors for intervention. However, few epidemiological or clinical ADRD studies examine sex differences; even fewer evaluate gender in the context of ADRD risk. The goals of this perspective are to: (1) provide definitions of gender, biologic sex, and sexual orientation. and the limitations of examining these as binary variables; (2) provide an overview of what is known with regard to sex and gender differences in the risk, prevention, and diagnosis of ADRD; and (3) discuss these sex and gender differences from a global, worldwide perspective. Identifying drivers of sex and gender differences in ADRD throughout the world is a first step in developing interventions unique to each geographical and sociocultural area to reduce these inequities and to ultimately reduce global ADRD risk. HIGHLIGHTS: The burden of dementia is unevenly distributed geographically and by sex and gender. Scientific advances in genetics and biomarkers challenge beliefs that sex is binary. Discrimination against women and sex and gender minority (SGM) populations contributes to cognitive decline. Sociocultural factors lead to gender inequities in Alzheimer's disease and related dementias (ADRD) worldwide.
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Affiliation(s)
- Michelle M. Mielke
- Division of Epidemiology, Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Neelum T. Aggarwal
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Clara Vila‐Castelar
- Department of Psychiatry, Harvard Medical SchoolMassachusetts General HospitalMassachusettsBostonUSA
| | - Puja Agarwal
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Internal MedicineRush University Medical CenterChicagoIllinoisUSA
| | - Eider M. Arenaza‐Urquijo
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
- IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- CIBER Fragilidad y Envejecimiento Saludable (CIBERFES)MadridSpain
| | - Benjamin Brett
- Department of NeurosurgeryMedical College of WisconsinWisconsinMilwaukeeUSA
| | - Anna Brugulat‐Serrat
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
- IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- CIBER Fragilidad y Envejecimiento Saludable (CIBERFES)MadridSpain
- Atlantic Fellow for Equity in Brain HealthThe University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lyndsey E. DuBose
- Department of Medicine, Division of GeriatricsUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Willem S. Eikelboom
- Department of NeurologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Jason Flatt
- Social and Behavioral Health Program, School of Public HealthUniversity of Nevada, Las VegasLas VegasNevadaUSA
| | - Nancy S. Foldi
- Department of Psychology, Queens College and The Graduate CenterCity University of New YorkNew YorkUSA
- Department of PsychiatryNew York University Long Island School of MedicineNew YorkUSA
| | - Sanne Franzen
- Department of NeurologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Paola Gilsanz
- Kaiser Permanente Division of ResearchOaklandCaliforniaUSA
| | - Wei Li
- Department of Clinical and Diagnostic SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Alison J. McManus
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Debora Melo van Lent
- UT Health San AntonioGlenn Biggs Institute for Alzheimer's and Neurodegenerative diseasesSan AntonioTexasUSA
- Framingham Heart StudyFraminghamMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
| | - Sadaf Arefi Milani
- Division of Geriatrics & Palliative Medicine, Department of Internal MedicineUniversity of Texas Medical BranchGalvestonTexasUSA
| | - C. Elizabeth Shaaban
- Department of EpidemiologyGraduate School of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Shana D. Stites
- Department of PsychiatryPerlman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Erin Sundermann
- Department of PsychiatryUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Vidyani Suryadevara
- Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Jean‐Francoise Trani
- Department of Public HealthWashington University in St. LouisSt. LouisMissouriUSA
| | - Arlener D. Turner
- Department of Psychiatry & Behavioral SciencesUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Jet M. J. Vonk
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
- Julius Center for Health Sciences and Primary CareDepartment of EpidemiologyUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
| | - Yakeel T. Quiroz
- Department of Psychiatry, Harvard Medical SchoolMassachusetts General HospitalMassachusettsBostonUSA
- Grupo de Neurociencias de Antioquia of Universidad de AntioquiaMedellinColumbiaUSA
| | - Ganesh M. Babulal
- Department of NeurologyWashington University in St. LouisSt. LouisMississippiUSA
- Department of Clinical Research and LeadershipThe George Washington University School of Medicine and Health SciencesWashingtonDCUSA
- Department of Psychology, Faculty of HumanitiesUniversity of JohannesburgJohannesburgSouth Africa
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10
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Chang YL, Moscovitch M. Sex differences in item and associative memory among older adults with amnestic mild cognitive impairment. Neuropsychologia 2022; 176:108375. [PMID: 36179862 DOI: 10.1016/j.neuropsychologia.2022.108375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/01/2022] [Accepted: 09/22/2022] [Indexed: 10/31/2022]
Abstract
In older adults without cognitive impairment, women have an advantage over men in verbal memory tests; however, whether women with amnestic mild cognitive impairment (aMCI) exhibit this advantage remains controversial. We evaluated sex-specific differences in older adults with and without aMCI in item and associative verbal memory by using an associative memory task with immediate and delayed recognition conditions. The associations between memory task performances and medial temporal morphometric measures were examined. The study included 49 individuals with aMCI and 55 healthy older adults (HOs). The results revealed that a female advantage in immediate item and delayed associative memory was evident in HOs, and the female advantage in associative memory persisted even after item memory performance was controlled. By contrast, the female advantage was absent in individuals with aMCI; such women had more associative false alarms than men with aMCI. Furthermore, decreases in item memory, associative memory, and cortical thickness in the perirhinal and entorhinal regions in individuals with aMCI versus their sex-matched controls were more prominent in women than in men. The relation between brain structure and associative memory function was evident only for women, indicating that women and men may have different cognitive and neural mechanisms for processing associative memory. These findings support the concept of cognitive reserve in women during normal aging. Accounting for sex differences in verbal memory performance is crucial to improve aMCI identification, particularly for women.
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Affiliation(s)
- Yu-Ling Chang
- Department of Psychology, College of Science, National Taiwan University, Taipei, 10617, Taiwan; Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, 10617, Taiwan; Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, 10048, Taiwan; Center for Artificial Intelligence and Advanced Robotics, National Taiwan University, Taipei, 10617, Taiwan.
| | - Morris Moscovitch
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON M6A 2E1, Canada; Department of Psychology, University of Toronto, Toronto, ON M5S 3G3, Canada
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11
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Xue J, Yao R, Cui X, Wang B, Wei J, Wu X, Sun J, Yang Y, Xiang J, Liu Y. Abnormal information interaction in multilayer directed network based on cross-frequency integration of mild cognitive impairment and Alzheimer’s disease. Cereb Cortex 2022; 33:4230-4247. [PMID: 36104855 DOI: 10.1093/cercor/bhac339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/14/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Mild cognitive impairment (MCI) and Alzheimer’s disease (AD) have been reported to result in abnormal cross-frequency integration. However, previous studies have failed to consider specific abnormalities in receiving and outputting information among frequency bands during integration. Here, we investigated heterogeneity in receiving and outputting information during cross-frequency integration in patients. The results showed that during cross-frequency integration, information interaction first increased and then decreased, manifesting in the heterogeneous distribution of inter-frequency nodes for receiving information. A possible explanation was that due to damage to some inter-frequency hub nodes, intra-frequency nodes gradually became new inter-frequency nodes, whereas original inter-frequency nodes gradually became new inter-frequency hub nodes. Notably, damage to the brain regions that receive information between layers was often accompanied by a strengthened ability to output information and the emergence of hub nodes for outputting information. Moreover, an important compensatory mechanism assisted in the reception of information in the cingulo-opercular and auditory networks and in the outputting of information in the visual network. This study revealed specific abnormalities in information interaction and compensatory mechanism during cross-frequency integration, providing important evidence for understanding cross-frequency integration in patients with MCI and AD.
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Affiliation(s)
- Jiayue Xue
- College of Information and Computer, Taiyuan University of Technology , No. 209, University Street, Jinzhong, Shanxi, 030600 , China
| | - Rong Yao
- College of Information and Computer, Taiyuan University of Technology , No. 209, University Street, Jinzhong, Shanxi, 030600 , China
| | - Xiaohong Cui
- College of Information and Computer, Taiyuan University of Technology , No. 209, University Street, Jinzhong, Shanxi, 030600 , China
| | - Bin Wang
- College of Information and Computer, Taiyuan University of Technology , No. 209, University Street, Jinzhong, Shanxi, 030600 , China
| | - Jing Wei
- College of Information and Computer, Taiyuan University of Technology , No. 209, University Street, Jinzhong, Shanxi, 030600 , China
| | - Xubin Wu
- College of Information and Computer, Taiyuan University of Technology , No. 209, University Street, Jinzhong, Shanxi, 030600 , China
| | - Jie Sun
- College of Information and Computer, Taiyuan University of Technology , No. 209, University Street, Jinzhong, Shanxi, 030600 , China
| | - Yanli Yang
- College of Information and Computer, Taiyuan University of Technology , No. 209, University Street, Jinzhong, Shanxi, 030600 , China
| | - Jie Xiang
- College of Information and Computer, Taiyuan University of Technology , No. 209, University Street, Jinzhong, Shanxi, 030600 , China
| | - Yi Liu
- Department of Anesthesiology, Shanxi Province Cancer Hospital , No. 3, Workers New Street, Taiyuan, Shanxi, 030013 , China
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12
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Moore RC, Ackerman RA, Russell MT, Campbell LM, Depp CA, Harvey PD, Pinkham AE. Feasibility and validity of ecological momentary cognitive testing among older adults with mild cognitive impairment. Front Digit Health 2022; 4:946685. [PMID: 35990012 PMCID: PMC9390883 DOI: 10.3389/fdgth.2022.946685] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022] Open
Abstract
It is critical to intervene early in the mild cognitive impairment (MCI) stage of the Alzheimer's disease trajectory, but traditional cognitive testing methods are costly, burdensome, and difficult to access. We examined adherence and validity data to a 30-day self-administered ecological momentary cognitive testing protocol among a sample of older adults with MCI and cognitively normal controls to evaluate feasibility, tolerability, and initial validity in comparison to standard neuropsychological tests. Participants included 48 participants with MCI (Mean age = 72 years, SD = 7 years) and 46 demographically-matched cognitively normal (NC) control participants (Mean age = 70 years, SD = 7 years). Participants completed traditional neuropsychological testing to determine MCI status, followed by 30 days of remote ecological momentary cognitive testing. Ecological momentary assessment (EMA) surveys were administered 3 times per day for 30 days (possible total = 90), and mobile cognitive tests were administered every other day (for a total of 15 administrations). Mobile cognitive tests included the Variable Difficulty List Memory Test (VLMT; measure of learning and memory), Memory Matrix (measure of visual working memory), and the Color Trick Test (measure of executive function). EMA and mobile cognitive test adherence, fatigue effects, mobile cognitive test performance and group differences, and psychometrics (reliability, convergent validity, ceiling effects, and practice effects) were examined. Overall mean-level adherence to the mobile cognitive tests was 85% and did not differ by MCI status. The reliability of stable between-person individual differences for the VLMT and Memory Matrix were very high. Moreover, although the reliability of within-person change for Memory Matrix was adequate, the corresponding reliability for VLMT was somewhat low. Averaged performance on the mobile cognitive tests was correlated with lab-based tests measuring the same construct. Participants with MCI performed worse than NCs on the VLMT and Color Trick Test, and there was no evidence of fatigue effects for these two tests. These findings support the feasibility and potential for ecological momentary cognitive testing to support clinical trials and for measuring cognitive changes over time in persons with increased risk for Alzheimer's disease such as those with MCI.
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Affiliation(s)
- Raeanne C. Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
- Correspondence: Raeanne C. Moore
| | - Robert A. Ackerman
- Department of Psychology, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | - Madisen T. Russell
- Department of Psychology, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | - Laura M. Campbell
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Colin A. Depp
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Philip D. Harvey
- Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
- Research Service, Bruce W. Carter VA Medical Center, Miami, FL, United States
| | - Amy E. Pinkham
- Department of Psychology, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
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13
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Zhang C, Ye Y, Zhao H. Comparison of Methods Utilizing Sex-Specific PRSs Derived From GWAS Summary Statistics. Front Genet 2022; 13:892950. [PMID: 35873490 PMCID: PMC9304553 DOI: 10.3389/fgene.2022.892950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
The polygenic risk score (PRS) is calculated as the weighted sum of an individual's genotypes and their estimated effect sizes, which is often used to estimate an individual's genetic susceptibility to complex traits and disorders. It is well known that some complex human traits or disorders have sex differences in trait distributions, disease onset, progression, and treatment response, although the underlying mechanisms causing these sex differences remain largely unknown. PRSs for these traits are often based on Genome-Wide Association Studies (GWAS) data with both male and female samples included, ignoring sex differences. In this study, we present a benchmark study using both simulations with various combinations of genetic correlation and sample size ratios between sexes and real data to investigate whether combining sex-specific PRSs can outperform sex-agnostic PRSs on traits showing sex differences. We consider two types of PRS models in our study: single-population PRS models (PRScs, LDpred2) and multiple-population PRS models (PRScsx). For each trait or disorder, the candidate PRSs were calculated based on sex-specific GWAS data and sex-agnostic GWAS data. The simulation results show that applying LDpred2 or PRScsx to sex-specific GWAS data and then combining sex-specific PRSs leads to the highest prediction accuracy when the genetic correlation between sexes is low and the sample sizes for both sexes are balanced and large. Otherwise, the PRS generated by applying LDpred2 or PRScs to sex-agnostic GWAS data is more appropriate. If the sample sizes between sexes are not too small and very unbalanced, combining LDpred2-based sex-specific PRSs to predict on the sex with a larger sample size and combining PRScsx-based sex-specific PRSs to predict on the sex with a smaller size are the preferred strategies. For real data, we considered 19 traits from Genetic Investigation of ANthropometric Traits (GIANT) consortium studies and UK Biobank with both sex-specific GWAS data and sex-agnostic GWAS data. We found that for waist-to-hip ratio (WHR) related traits, accounting for sex differences and incorporating information from the opposite sex could help improve PRS prediction accuracy. Taken together, our findings in this study provide guidance on how to calculate the best PRS for sex-differentiated traits or disorders, especially as the sample size of GWASs grows in the future.
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Affiliation(s)
- Chi Zhang
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States
| | - Yixuan Ye
- Program of Computational Biology and Bioinformatics, Yale University, New Haven, CT, United States
| | - Hongyu Zhao
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States
- Program of Computational Biology and Bioinformatics, Yale University, New Haven, CT, United States
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14
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Bernier RA, Banks SJ, Panizzon MS, Andrews MJ, Jacobs EG, Galasko DR, Shepherd AL, Akassoglou K, Sundermann EE. The neuroinflammatory marker sTNFR2 relates to worse cognition and tau in women across the Alzheimer's disease spectrum. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12284. [PMID: 35386474 PMCID: PMC8973901 DOI: 10.1002/dad2.12284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/19/2021] [Accepted: 12/06/2021] [Indexed: 11/27/2022]
Abstract
Introduction Despite women showing greater Alzheimer's disease (AD) prevalence, tau burden, and immune/neuroinflammatory response, whether neuroinflammation impacts cognition differently in women versus men and the biological basis of this impact remain unknown. We examined sex differences in how cerebrospinal fluid (CSF) neuroinflammation relates to cognition across the aging-mild cognitive impairment (MCI)-AD continuum and the mediating role of phosphorylated tau (p-tau) versus other AD biomarkers. Methods Participants included 284 individuals from the Alzheimer's Disease Neuroimaging Initiative study. CSF neuroinflammatory markers included interleukin-6, tumor necrosis factor α, soluble tumor necrosis factor receptor 2 (sTNFR2), and chitinase-3-like protein 1. AD biomarkers were CSF p-tau181 and amyloid beta1-42 levels and magnetic resonance imaging measures of hippocampal and white matter hyperintensity volumes. Results We found a sex-by-sTNFR2 interaction on Mini-Mental State Examination and Clinical Dementia Rating-Sum of Boxes. Higher levels of sTNFR2 related to poorer cognition in women only. Among biomarkers, only p-tau181 eliminated the female-specific relationships between neuroinflammation and cognition. Discussion Women may be more susceptible than men to the adverse effects of sTNFR2 on cognition with a potential etiological link with tau to these effects.
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Affiliation(s)
- Rachel A. Bernier
- Department of NeuroscienceUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - Sarah J. Banks
- Department of NeuroscienceUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - Matthew S. Panizzon
- Department of PsychiatryUniversity of California, San DiegoSan DiegoCaliforniaUSA
- Center for Behavior Genetics of AgingUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - Murray J. Andrews
- Department of NeuroscienceUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - Emily G. Jacobs
- Department of Psychological and Brain SciencesUniversity of California, Santa BarbaraSanta BarbaraCaliforniaUSA
| | - Douglas R. Galasko
- Department of NeuroscienceUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - Alyx L. Shepherd
- Department of NeuroscienceUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - Katerina Akassoglou
- Gladstone UCSF Center for Neurovascular Brain ImmunologySan FranciscoCaliforniaUSA
- Gladstone Institute of Neurological DiseaseSan FranciscoCaliforniaUSA
- Department of NeurologyWeill Institute for NeurosciencesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Erin E. Sundermann
- Department of PsychiatryUniversity of California, San DiegoSan DiegoCaliforniaUSA
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15
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Cieri F, Zhuang X, Cordes D, Kaplan N, Cummings J, Caldwell J. Relationship of sex differences in cortical thickness and memory among cognitively healthy subjects and individuals with mild cognitive impairment and Alzheimer disease. Alzheimers Res Ther 2022; 14:36. [PMID: 35193682 PMCID: PMC8864917 DOI: 10.1186/s13195-022-00973-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/27/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND An aging society has increased rates of late onset Alzheimer disease dementia (ADD), the most common form of age-related dementia. This neurodegenerative disease disproportionately affects women. METHODS We use data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) to examine sex differences in cortical thickness (CT) and memory performance. Analyses of covariance (ANCOVA) models were used to examine effects of sex and diagnosis (DX) on CT and verbal memory. For regions demonstrating significant interaction effects of sex and DX, we tested whether sex moderated cognition-thickness relationships. We used machine learning as a complementary method to explore multivariate CT differences between women and men. RESULTS Women demonstrated greater CT in many brain regions. More specifically, men showed relatively consistent CT declines in all stages, from normal control (NC) to ADD in the bilateral cingulate cortex, bilateral temporal regions, and left precuneus; women had more stable CT in these regions between NC and mild cognitive impairment (MCI) stages, but sharper declines from MCI to ADD. Similarly, for the Rey Auditory Verbal Learning Test (RAVLT), ANCOVA analyses showed that women had significantly better immediate and delayed recall scores than men, at NC and MCI stages, but greater differences, cross-sectionally, from MCI to ADD than men. We found significant sex moderation effects between RAVLT-immediate scores and CT of right isthmus-cingulate for all subjects across DX. Partial correlation analyses revealed that increased CT of right isthmus-cingulate was associated with better verbal learning in women, driven by positron emission tomography defined amyloid positive (Aβ+) subjects. Significant sex-moderation effects in cognition-thickness relationships were further found in the right middle-temporal, left precuneus, and left superior temporal regions in Aβ+ subjects. Using a machine learning approach, we investigated multivariate CT differences between women and men, showing an accuracy in classification of 75% for Aβ+ cognitively NC participants. CONCLUSIONS Sex differences in memory and CT can play a key role in the different vulnerability and progression of ADD in women compared to men. Machine learning indicates sex differences in CT are most relevant early in the ADD neurodegeneration.
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Affiliation(s)
- Filippo Cieri
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Xiaowei Zhuang
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA.,Interdisciplinary Neuroscience Program, University of Nevada Las Vegas (UNLV), Las Vegas, NV, USA
| | - Dietmar Cordes
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA.,University of Colorado Boulder, Boulder, CO, USA
| | - Nikki Kaplan
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Jeffery Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas (UNLV), Las Vegas, NV, USA
| | - Jessica Caldwell
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA.
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16
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Vorobyeva O, Pilipovich A, Nikulina K. The influence of age and gender on the characteristics of cognitive impairment in patients with cardiovascular risks. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:85-92. [DOI: 10.17116/jnevro202212206185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Sundermann EE, Barnes LL, Bondi MW, Bennett DA, Salmon DP, Maki PM. Improving Detection of Amnestic Mild Cognitive Impairment with Sex-Specific Cognitive Norms. J Alzheimers Dis 2021; 84:1763-1770. [PMID: 34719502 DOI: 10.3233/jad-215260] [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] [Indexed: 11/15/2022]
Abstract
BackgroundDespite a female advantage in verbal memory, normative data for verbal memory tests used to diagnose Alzheimer's disease (AD) dementia and amnestic mild cognitive impairment (aMCI) often are not sex-adjusted.ObjectiveTo determine whether sex-adjusted norms improve aMCI diagnostic accuracy when accuracy was evaluated by progression to AD dementia over time.MethodsNon-sex-specific and sex-specific verbal memory test norms were incorporated into Jak/Bondi aMCI criteria and applied to older (age 65-90) non-demented women (N = 1,036) and men (N = 355) from the Rush Memory and Aging Project. Using sex-specific aMCI diagnosis as the "true" condition versus non-sex-specific aMCI diagnosis as the "predicted" condition, we identified True Positives, False Positives, True Negatives, and False Negatives and compared AD dementia risk over 10 years among groups.ResultsRates of aMCI were higher in men versus women (χ2 = 15.39, p < 0.001) when determined based on typical diagnostic criteria, but this difference reversed when using sex-specific diagnostic criteria (χ2 = 8.38, p = 0.004). We identified 8%of women as False Negatives and 12%of men as False Positives. Risk of incident AD dementia in False Positive men was significantly lower than in True Positive men (HR = 0.26, 95%CI = 0.12-0.58, p = 0.001). Risk of incident AD dementia in False Negative women was substantially higher than in True Negative women (HR = 3.11, 95%CI = 2.09-4.63, p < 0.001).ConclusionResults suggest that previous reports of higher aMCI rates in men versus women may be an artifact of non-sex-adjusted norms/cut-scores. Incorporation of sex-specific norms/cut-scores for verbal memory impairment into aMCI diagnostic criteria may improve diagnostic accuracy and avoid diagnostic errors in approximately 20%.
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Affiliation(s)
- Erin E Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.,Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - David P Salmon
- Department of Neuroscience, University of California, San Diego, La Jolla, CA, USA
| | - Pauline M Maki
- Department of Psychiatry, Psychology and OBGYN, University of Illinois at Chicago, Chicago, IL, USA
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18
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Banks SJ, Andrews MJ, Digma L, Madsen J, Reas ET, Caldwell JZ, McEvoy LK, Fan CC, Dale AM, Brewer JB. Sex differences in Alzheimer's disease: do differences in tau explain the verbal memory gap? Neurobiol Aging 2021; 107:70-77. [PMID: 34399127 PMCID: PMC8963683 DOI: 10.1016/j.neurobiolaging.2021.05.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/28/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022]
Abstract
To determine if sex differences in verbal memory in AD are related to differences in extent or distribution of pathological tau, we studied 275 participants who were amyloid PET positive and carried clinical classifications of normal cognition, mild cognitive impairment (MCI) or dementia, and had tau (AV1451) PET. We compared tau distribution between men and women, and as a function of genetic risk. In MCI we further explored the relationship between quantity and distribution of tau in relation to verbal memory scores. Women had more tau burden overall, but this was driven by sex differences at the MCI stage. There was no significant difference in tau load by APOE e4 status. Within the MCI group the association between tau and performance in verbal memory tasks was stronger in women than men. The topography of the associations between tau and verbal memory also differed in MCI; women demonstrated stronger relationships between tau distribution and verbal memory performance, especially in the left hemisphere. These findings have implications for understanding tau distribution and spread, and in interpretation of verbal memory performance.
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Affiliation(s)
- Sarah J. Banks
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA,Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA,Corresponding author at: Departments of Neurology and Psychiatry, University of California, San Diego, Office Address: ACTRI 4W-501, Mailing Address: 9500 Gilman Dr, La Jolla CA 92093 M/C 0841, USA. Phone: (858) 246-1264. (S.J. Banks)
| | - Murray J. Andrews
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Leonardino Digma
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - John Madsen
- 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
| | | | - Linda K. McEvoy
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Chun Chieh Fan
- Center for Human Development, University of California, San Diego, La Jolla, CA, USA
| | - Anders M. Dale
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA,Department of Radiology, University of California, San Diego, La Jolla, CA, USA,Center for Molecular Imaging and Genetics, University of California, San Diego, La Jolla, CA, USA,Department of Psychiatry, 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
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19
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Suhrie KR, Hammers DB, Porter SM, Dixon AM, King JB, Anderson JS, Duff K, Hoffman JM. Predicting biomarkers in intact older adults and those with amnestic Mild Cognitive Impairment, and mild Alzheimer's Disease using the Repeatable Battery for the Assessment of Neuropsychological Status. J Clin Exp Neuropsychol 2021; 43:861-878. [PMID: 35019815 DOI: 10.1080/13803395.2021.2023476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has been associated, to varying degrees, with commonly used biomarkers of Alzheimer's disease (AD). Given the ease of RBANS administration as a screening tool for clinical trials and other applications, a better understanding of how RBANS performance is associated with presence of APOE ε4 allele[s], cerebral amyloid burden, and hippocampal volume is warranted. METHOD One hundred twenty-one older adults who were classified as intact, amnestic Mild Cognitive Impairment, or mild AD underwent cognitive assessment with the RBANS, genetic analysis, and quantitative brain imaging. APOE ε4 carrier status, 18F-Flutemetamol composite standardized uptake value ratio (SUVR), and hippocampal volume were each regressed on demographic variables and RBANS Total Scale score, Index scores, and subtest scores. RESULTS Lower RBANS Total Scale score or Delayed Memory Index (DMI) predicted the presence of APOE ε4 allele[s], higher cerebral amyloid burden, and lower hippocampal volumes. DMI was a slightly better predictor than Total Scale score for most AD biomarkers. No demographic variables consistently contributed to these models. CONCLUSIONS The RBANS - DMI in particular - is sensitive to AD pathology. As such, it could be used as a predictive tool, particularly in clinical drug trials to enrich samples prior to less accessible AD biomarker investigation.
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Affiliation(s)
- Kayla R Suhrie
- Center for Alzheimer's Care, Imaging and Research, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Dustin B Hammers
- Center for Alzheimer's Care, Imaging and Research, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Sariah M Porter
- Center for Alzheimer's Care, Imaging and Research, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Ava M Dixon
- Center for Alzheimer's Care, Imaging and Research, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Jace B King
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Jeffrey S Anderson
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Kevin Duff
- Center for Alzheimer's Care, Imaging and Research, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - John M Hoffman
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
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Caldwell JZK, Kinney JW, Ritter A, Salazar A, Wong CG, Cordes D, Slavich GM. Inflammatory cytokine levels implicated in Alzheimer's disease moderate the effects of sex on verbal memory performance. Brain Behav Immun 2021; 95:27-35. [PMID: 33301871 PMCID: PMC8793982 DOI: 10.1016/j.bbi.2020.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/24/2020] [Accepted: 12/04/2020] [Indexed: 12/01/2022] Open
Abstract
Despite having an initial verbal memory advantage over men, women have greater rates of Alzheimer's disease and more rapid cognitive decline once diagnosed. Moreover, although Alzheimer's disease is influenced by inflammation, which itself has known sex differences, no study has investigated whether sex differences in memory are moderated by peripheral inflammatory activity. To address this issue, we analyzed data from 109 individuals (50 women, Mage = 71.62, range = 55-87) diagnosed as cognitively normal, or having mild cognitive impairment or Alzheimer's disease dementia. We then followed the sample for 12 months, as part of a longitudinal study of aging and Alzheimer's disease. At baseline, we assessed levels of the inflammatory cytokines interleukin (IL)-1β (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α) in plasma. At baseline and 12 months, we assessed verbal memory using the Rey Auditory Verbal Learning Test and nonverbal memory using the Brief Visuospatial Memory Test-Revised. As hypothesized, for the full sample, women exhibited stronger verbal (but not nonverbal) memory than men. In women, but not men, higher IL-1β at baseline related to poorer verbal learning across both time points and delayed recall at 12 months. The effect of sex on memory also differed by IL-1β level, with women exhibiting a memory advantage both at baseline and 12 months, but only for those with low-to-moderate IL-1β levels. Therefore, high peripheral inflammation levels may lead to a sex-specific memory vulnerability relevant for Alzheimer's disease.
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Affiliation(s)
| | | | - Aaron Ritter
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Arnold Salazar
- Department of Brain Health, University of Nevada, Las Vegas, NV, USA
| | - Christina G Wong
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Dietmar Cordes
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - George M Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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21
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Rabipour S, Rajagopal S, Pasvanis S, Rajah MN. Generalization of memory-related brain function in asymptomatic older women with a family history of late onset Alzheimer's Disease: Results from the PREVENT-AD Cohort. Neurobiol Aging 2021; 104:42-56. [PMID: 33964608 DOI: 10.1016/j.neurobiolaging.2021.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/04/2021] [Accepted: 03/18/2021] [Indexed: 11/18/2022]
Abstract
Late-onset Alzheimer's disease (AD) disproportionately affects women compared to men. Episodic memory decline is one of the earliest and most pronounced deficits observed in AD. However, it remains unclear whether sex influences episodic memory-related brain function in cognitively intact older adults at risk of developing AD. Here we used task-based multivariate partial least squares analysis to examine sex differences in episodic memory-related brain activity and brain activity-behavior correlations in a matched sample of cognitively intact older women and men with a family history of AD from the PREVENT-AD cohort study in Montreal, Canada (Mage=63.03±3.78; Meducation=15.41±3.40). We observed sex differences in task-related brain activity and brain activity-behavior correlations during the encoding of object-location associative memories and object-only item memory, and the retrieval of object only item memories. Our findings suggest a generalization of episodic memory-related brain activation and performance in women compared to men. Follow up analyses should test for sex differences in the relationship between brain activity patterns and performance longitudinally, in association with risk factors for AD development. This article is part of the Virtual Special Issue titled COGNITIVE NEUROSCIENCE OF HEALTHY AND PATHOLOGICAL AGING. The full issue can be found on ScienceDirect at https://www.sciencedirect.com/journal/neurobiology-of-aging/special-issue/105379XPWJP.
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Affiliation(s)
- Sheida Rabipour
- Centre for Cerebral Imaging, Douglas Hospital Research Centre, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | | | - Stamatoula Pasvanis
- Centre for Cerebral Imaging, Douglas Hospital Research Centre, Montreal, Canada
| | - M Natasha Rajah
- Centre for Cerebral Imaging, Douglas Hospital Research Centre, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada.
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22
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Shan G, Bernick C, Caldwell JZK, Ritter A. Machine learning methods to predict amyloid positivity using domain scores from cognitive tests. Sci Rep 2021; 11:4822. [PMID: 33649452 PMCID: PMC7921140 DOI: 10.1038/s41598-021-83911-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/09/2021] [Indexed: 01/31/2023] Open
Abstract
Amyloid-[Formula: see text] (A[Formula: see text]) is the target in many clinical trials for Alzheimer's disease (AD). Preclinical AD patients are heterogeneous with regards to different backgrounds and diagnosis. Accurately predicting A[Formula: see text] status of participants by using machine learning (ML) models based on easily accessible data, could improve the effectiveness of AD clinical trials. We will develop optimal ML models for each subpopulation stratified by sex and disease stages using sub scores from screening neurological tests. Data from the AD Neuroimaging Initiative (ADNI) were used to build the ML models, for three groups: individuals with significant memory concern, early mild cognitive impairment (MCI), and late MCI. Data were further separated into 6 groups by disease stage (3 levels) and sex (2 categories). The outcome was defined as the A[Formula: see text] status confirmed by the PET imaging, and the features include demographic data, newly identified risk factors, screening tests, and the domain scores from screening tests. Monte Carlo simulation studies were used together with k-fold cross-validation technique to compute model performance metric. We also develop a new feature selection method based on the stochastic ordering to avoiding searching all possible combinations of features. Accuracy of the identified optimal model for SMC male was over 90% by using domain scores, and accuracy for LMCI female was above 86%. Domain scores can improve the ML model prediction as compared to the total scores. Accurate ML prediction models can identify the proper population for AD clinical trials.
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Affiliation(s)
- Guogen Shan
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, 89154, USA.
| | - Charles Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville Avenue, Las Vegas, NV, 89106, USA
| | - Jessica Z K Caldwell
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville Avenue, Las Vegas, NV, 89106, USA
| | - Aaron Ritter
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville Avenue, Las Vegas, NV, 89106, USA
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23
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Banks SJ, Qiu Y, Fan CC, Dale AM, Zou J, Askew B, Feldman HH. Enriching the design of Alzheimer's disease clinical trials: Application of the polygenic hazard score and composite outcome measures. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12071. [PMID: 32999917 PMCID: PMC7507583 DOI: 10.1002/trc2.12071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/09/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Selecting individuals at high risk of Alzheimer's disease (AD) dementia and using the most sensitive outcome measures are important aspects of trial design. METHODS We divided participants from Alzheimer's Disease Neuroimaging Initiative at the 50th percentile of the predicted absolute risk of the polygenic hazard score (PHS). Outcome measures were the Alzheimer's Disease Assessment Schedule-Cognitive Subscale (ADAS-Cog), ADNI-Mem, Clinical Dementia Rating-Sum of Boxes (CDR SB), and Cognitive Function Composite 2 (CFC2). In addition to modeling, we use a power analysis compare numbers needed with each technique. RESULTS Data from 188 cognitively normal and 319 mild cognitively impaired (MCI) participants were analyzed. Using the ADAS-Cog to estimate sample sizes, without stratification over 24 months, would require 930 participants with MCI, while using the CFC2 and restricting participants to those in the upper 50th percentile would require only 284 participants. DISCUSSION Combining stratification by PHS and selection of a sensitive combined outcome measure in a cohort of patients with MCI can allow trial design that is more efficient, potentially less burdensome on participants, and more cost effective.
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Affiliation(s)
- Sarah J. Banks
- University of California San DiegoSan DiegoCaliforniaUSA
| | - Yuqi Qiu
- University of California San DiegoSan DiegoCaliforniaUSA
| | - Chun Chieh Fan
- University of California San DiegoSan DiegoCaliforniaUSA
| | - Anders M. Dale
- University of California San DiegoSan DiegoCaliforniaUSA
| | - Jingjing Zou
- University of California San DiegoSan DiegoCaliforniaUSA
| | - Brianna Askew
- University of California San DiegoSan DiegoCaliforniaUSA
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24
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Zhao K, Ding Y, Han Y, Fan Y, Alexander-Bloch AF, Han T, Jin D, Liu B, Lu J, Song C, Wang P, Wang D, Wang Q, Xu K, Yang H, Yao H, Zheng Y, Yu C, Zhou B, Zhang X, Zhou Y, Jiang T, Zhang X, Liu Y. Independent and reproducible hippocampal radiomic biomarkers for multisite Alzheimer's disease: diagnosis, longitudinal progress and biological basis. Sci Bull (Beijing) 2020; 65:1103-1113. [PMID: 36659162 DOI: 10.1016/j.scib.2020.04.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/31/2020] [Accepted: 03/17/2020] [Indexed: 01/21/2023]
Abstract
Hippocampal morphological change is one of the main hallmarks of Alzheimer's disease (AD). However, whether hippocampal radiomic features are robust as predictors of progression from mild cognitive impairment (MCI) to AD dementia and whether these features provide any neurobiological foundation remains unclear. The primary aim of this study was to verify whether hippocampal radiomic features can serve as robust magnetic resonance imaging (MRI) markers for AD. Multivariate classifier-based support vector machine (SVM) analysis provided individual-level predictions for distinguishing AD patients (n = 261) from normal controls (NCs; n = 231) with an accuracy of 88.21% and intersite cross-validation. Further analyses of a large, independent the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset (n = 1228) reinforced these findings. In MCI groups, a systemic analysis demonstrated that the identified features were significantly associated with clinical features (e.g., apolipoprotein E (APOE) genotype, polygenic risk scores, cerebrospinal fluid (CSF) Aβ, CSF Tau), and longitudinal changes in cognition ability; more importantly, the radiomic features had a consistently altered pattern with changes in the MMSE scores over 5 years of follow-up. These comprehensive results suggest that hippocampal radiomic features can serve as robust biomarkers for clinical application in AD/MCI, and further provide evidence for predicting whether an MCI subject would convert to AD based on the radiomics of the hippocampus. The results of this study are expected to have a substantial impact on the early diagnosis of AD/MCI.
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Affiliation(s)
- Kun Zhao
- Brainnetome Center & National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China; School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China; School of Information Science and Engineering, Shandong Normal University, Ji'nan 250358, China
| | - Yanhui Ding
- School of Information Science and Engineering, Shandong Normal University, Ji'nan 250358, China
| | - Ying Han
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing 100053, China; Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing 100069, China; Beijing Institute of Geriatrics, Beijing 100053, China; National Clinical Research Center for Geriatric Disorders, Beijing 100053, China
| | - Yong Fan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Tong Han
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin 300350, China
| | - Dan Jin
- Brainnetome Center & National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Bing Liu
- Brainnetome Center & National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing 100049, China; Center for Excellence in Brain Science and Intelligence Technology, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Jie Lu
- Department of Radiology, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Chengyuan Song
- Department of Neurology, Qilu Hospital of Shandong University, Ji'nan 250012, China
| | - Pan Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin University, Tianjin 300350, China; Department of Neurology, The Secondary Medical Center, National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing 100853, China
| | - Dawei Wang
- Department of Radiology, Qilu Hospital of Shandong University, Ji'nan 250012, China
| | - Qing Wang
- Department of Radiology, Qilu Hospital of Shandong University, Ji'nan 250012, China
| | - Kaibin Xu
- Brainnetome Center & National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Hongwei Yang
- Department of Radiology, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Hongxiang Yao
- Department of Radiology, The Secondary Medical Center, National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing 100853, China
| | - Yuanjie Zheng
- School of Information Science and Engineering, Shandong Normal University, Ji'nan 250358, China
| | - Chunshui Yu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Bo Zhou
- Department of Neurology, The Secondary Medical Center, National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing 100853, China
| | - Xinqing Zhang
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Yuying Zhou
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin University, Tianjin 300350, China
| | - Tianzi Jiang
- Brainnetome Center & National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing 100049, China; Center for Excellence in Brain Science and Intelligence Technology, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Xi Zhang
- Department of Neurology, The Secondary Medical Center, National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing 100853, China.
| | - Yong Liu
- Brainnetome Center & National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing 100049, China; Center for Excellence in Brain Science and Intelligence Technology, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China.
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25
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Fan CC, Banks SJ, Thompson WK, Chen CH, McEvoy LK, Tan CH, Kukull W, Bennett DA, Farrer LA, Mayeux R, Schellenberg GD, Andreassen OA, Desikan R, Dale AM. Sex-dependent autosomal effects on clinical progression of Alzheimer's disease. Brain 2020; 143:2272-2280. [PMID: 32591829 PMCID: PMC7364740 DOI: 10.1093/brain/awaa164] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/27/2020] [Accepted: 03/31/2020] [Indexed: 11/15/2022] Open
Abstract
Sex differences in the manifestations of Alzheimer's disease are under intense investigation. Despite the emerging importance of polygenic predictions for Alzheimer's disease, sex-dependent polygenic effects have not been demonstrated. Here, using a sex crossover analysis, we show that sex-dependent autosomal genetic effects on Alzheimer's disease can be revealed by characterizing disease progress via the hazard function. We first performed sex-stratified genome-wide associations, and then applied derived sex-dependent weights to two independent cohorts. Relative to sex-mismatched scores, sex-matched polygenic hazard scores showed significantly stronger associations with age-at-disease-onset, clinical progression, amyloid deposition, neurofibrillary tangles, and composite neuropathological scores, independent of apolipoprotein E. Models without using hazard weights, i.e. polygenic risk scores, showed lower predictive power than polygenic hazard scores with no evidence for sex differences. Our results indicate that revealing sex-dependent genetic architecture requires the consideration of temporal processes of Alzheimer's disease. This has strong implications not only for the genetic underpinning of Alzheimer's disease but also for how we estimate sex-dependent polygenic effects for clinical use.
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Affiliation(s)
- Chun Chieh Fan
- Center for Human Development, University of California, San Diego, USA
| | - Sarah J Banks
- Department of Neuroscience, University of California, San Diego, USA
| | - Wesley K Thompson
- Family Medicine and Public Health, University of California, San Diego, USA
| | - Chi-Hua Chen
- Department of Radiology, University of California, San Diego, USA
| | - Linda K McEvoy
- Family Medicine and Public Health, University of California, San Diego, USA
- Department of Radiology, University of California, San Diego, USA
| | - Chin Hong Tan
- Department of Psychology, Nanyang Technological University, Singapore
| | - Walter Kukull
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA
| | - David A Bennett
- Department of Neurological Science, Rush Medical College, Chicago, USA
| | | | - Richard Mayeux
- Department of Neurology and the Taub Institute at Columbia University, New York, USA
| | - Gerard D Schellenberg
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Ole A Andreassen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Rahul Desikan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Anders M Dale
- Department of Radiology, University of California, San Diego, USA
- Center for Multimodal Imaging and Genetics, University of California, San Diego, USA
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26
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Digma LA, Madsen JR, Rissman RA, Jacobs DM, Brewer JB, Banks SJ. Women can bear a bigger burden: ante- and post-mortem evidence for reserve in the face of tau. Brain Commun 2020; 2:fcaa025. [PMID: 32337508 PMCID: PMC7166251 DOI: 10.1093/braincomms/fcaa025] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/28/2019] [Accepted: 01/23/2020] [Indexed: 01/08/2023] Open
Abstract
In this study, we aimed to assess whether women are able to withstand more tau before exhibiting verbal memory impairment. Using data from 121 amyloid-β-positive Alzheimer’s Disease Neuroimaging Initiative participants, we fit a linear model with Rey Auditory Verbal Learning Test score as the response variable and tau-PET standard uptake value ratio as the predictor and took the residuals as an estimate of verbal memory reserve for each subject. Women demonstrated higher reserve (i.e. residuals), whether the Learning (t = 2.78, P = 0.006) or Delay (t = 2.14, P = 0.03) score from the Rey Auditory Verbal Learning Test was used as a measure of verbal memory ability. To validate these findings, we examined 662 National Alzheimer’s Coordinating Center participants with a C2/C3 score (Consortium to Establish a Registry for Alzheimer’s Disease) at autopsy. We stratified our National Alzheimer’s Coordinating Center sample into Braak 1/2, Braak 3/4 and Braak 5/6 subgroups. Within each subgroup, we compared Logical Memory scores between men and women. Men had worse verbal memory scores within the Braak 1/2 (Logical Memory Immediate: β = −5.960 ± 1.517, P < 0.001, Logical Memory Delay: β = −5.703 ± 1.677, P = 0.002) and Braak 3/4 (Logical Memory Immediate: β = −2.900 ± 0.938, P = 0.002, Logical Memory Delay: β = −2.672 ± 0.955, P = 0.006) subgroups. There were no sex differences in Logical Memory performance within the Braak 5/6 subgroup (Logical Memory Immediate: β = −0.314 ± 0.328, P = 0.34, Logical Memory Delay: β = −0.195 ± 0.287, P = 0.50). Taken together, our results point to a sex-related verbal memory reserve.
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Affiliation(s)
- Leonardino A Digma
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA
| | - John R Madsen
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA
| | - Robert A Rissman
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA.,Veteran's Administration San Diego Healthcare System, La Jolla, CA 92093, USA
| | - Diane M Jacobs
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA
| | - James B Brewer
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA.,Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Sarah J Banks
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
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27
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Abstract
PURPOSE OF REVIEW Epidemiological evidence suggests that higher reserve significantly delays the dementia onset in Alzheimer's disease. Yet, confusion in terminology of reserve and related concepts exists and the lack of quantitative measures and unclear neural substrates of reserve have hampered progress. We review here the latest advances in the concept, measures and functional brain mechanisms of reserve, as well as their moderating factors including sex and gender. RECENT FINDINGS The definition of reserve has been revised towards a more simplified concept, and the development of quantitative measurements of a cognitive advantage in disease has been advanced. Functional MRI and FDG-PET studies have provided for the first time converging evidence for the involvement of the cognitive control and salience network and temporal pole in reserve. Women tend to show lower resilience than men at advanced stages of AD. SUMMARY Neuroimaging studies have provided substantial evidence for putative brain mechanisms supporting reserve in Alzheimer's disease. However, the findings are still somewhat disparate and call for the development of unifying and testable theory of functional and structural brain properties that subserve reserve. Sex differences emerged as a moderating factor of reserve in Alzheimer's disease and need to be made a major research focus in Alzheimer's disease.
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28
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Caldwell JZK, Cummings JL, Banks SJ, Palmqvist S, Hansson O. Cognitively normal women with Alzheimer's disease proteinopathy show relative preservation of memory but not of hippocampal volume. ALZHEIMERS RESEARCH & THERAPY 2019; 11:109. [PMID: 31878968 PMCID: PMC6933621 DOI: 10.1186/s13195-019-0565-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 12/04/2019] [Indexed: 12/30/2022]
Abstract
Background We examined interactive effects of sex, diagnosis, and cerebrospinal fluid (CSF) amyloid beta/phosphorylated tau ratio (Aβ/P-tau) on verbal memory and hippocampal volumes. Methods We assessed 682 participants (350 women) from BioFINDER (250 cognitively normal [CN]; and 432 symptomatic: 186 subjective cognitive decline [SCD], 246 mild cognitive impairment [MCI]). General linear models evaluated effects of Alzheimer’s disease (AD) proteinopathy (CSF Aß/p-tau ratio), diagnosis, and sex on verbal memory (ADAS-cog 10-word recall), semantic fluency (animal naming fluency), visuospatial skills (cube copy), processing speed/attention functions (Symbol Digit Modalities Test and Trail Making Part A), and hippocampal volumes. Results Amyloid-positive (Aβ/P-tau+) CN women (women with preclinical AD) showed memory equivalent to amyloid-negative (Aβ/P-tau−) CN women. In contrast, Aβ/P-tau+ CN men (men with preclinical AD) showed poorer memory than Aβ/P-tau− CN men. Symptomatic groups showed no sex differences in effect of AD proteinopathy on memory. There was no interactive effect of sex, diagnosis, and Aβ/P-tau on other measures of cognition or on hippocampal volume. Conclusions CN women show relatively preserved verbal memory, but not general cognitive reserve or preserved hippocampal volume in the presence of Aβ/P-tau+. Results have implications for diagnosing AD in women, and for clinical trials.
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Affiliation(s)
- Jessica Z K Caldwell
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville Ave, Las Vegas, NV, 89106, USA.
| | - Jeffrey L Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville Ave, Las Vegas, NV, 89106, USA.,UNLV Department of Brain Health, School of Integrated Health Sciences, Box 453019, 4505 S. Maryland Pkwy, Las Vegas, Nevada, 89154, USA
| | - Sarah J Banks
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville Ave, Las Vegas, NV, 89106, USA.,University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Sebastian Palmqvist
- Clinical Memory Research Unit, Department of Clinical Sciences in Malmö, Lund University, PO Box 188, 221, Lund, Sweden.,Department of Neurology, Skåne University Hospital, 221 85, Lund, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences in Malmö, Lund University, PO Box 188, 221, Lund, Sweden.,Memory Clinic, Skåne University Hospital, 205 05, Malmö, Sweden
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29
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Sundermann EE, Maki P, Biegon A, Lipton RB, Mielke MM, Machulda M, Bondi MW. Sex-specific norms for verbal memory tests may improve diagnostic accuracy of amnestic MCI. Neurology 2019; 93:e1881-e1889. [PMID: 31597708 DOI: 10.1212/wnl.0000000000008467] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 06/05/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To examine whether the use of sex-specific norms and cut scores to identify memory impairment improves diagnostic accuracy of amnestic mild cognitive impairment (aMCI) compared to non-sex-specific (typical) norms/cut scores given the female advantage in verbal memory. METHODS We calculated sex-specific and typical norms/cut scores (age and education specific) for impairment on the Rey Auditory Verbal Learning Test in the Mayo Clinic Study of Aging. Norms/cut scores were applied to 453 women and 532 men from the Alzheimer's Disease Neuroimaging Initiative. We compared sex differences in rates of aMCI (Jak/Bondi criteria) for sex-specific vs typical norms/cut scores. Using sex-specific cut scores as the true condition and typical cut scores as the predicted condition, we categorized participants as true positives (TPs), false positives (FPs), true negative (TNs), or false negative (FNs). In cross-sectional analyses within sex, we compared positivity rates of CSF hyperphosphorylated tau/β-amyloid (Aβ) and cortical Aβ deposition ([18F]AV45 PET) and APOE ε4 frequency among diagnostic comparison groups. RESULTS The frequency of aMCI was higher in men when using typical norms/cut scores. Using sex-adjusted norms/cut scores led to the identification of 10% FNs (missed aMCI cases) among women and 10% FPs among men. Biomarker analyses supported the hypothesis that sex-specific diagnostic criteria improves diagnostic accuracy. Biomarkers rates were higher in FNs vs TNs and similar in FNs and TPs. Biomarker rates were lower in FPs vs TPs and similar between FPs and TNs. CONCLUSION Results suggest that non-sex-specific aMCI diagnostic criteria led to a 20% diagnostic error rate. Accounting for sex differences in verbal memory performance may improve aMCI classification.
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Affiliation(s)
- Erin E Sundermann
- From the Department of Psychiatry (E.E.S., M.W.B.), University of California, San Diego; Departments of Psychiatry, Psychology, and Obstetrics & Gynecology (P.M.), University of Illinois at Chicago; Department of Radiology and Neurology (A.B.), State University of New York, Stony Brook; Einstein Aging Study and Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; Departments of Health Sciences Research and Neurology (M.M.M.) and Departments of Psychiatry and Psychology (M.M.), Mayo Clinic, Rochester, MN; and Veterans Affairs San Diego Healthcare System (M.W.B.), CA.
| | - Pauline Maki
- From the Department of Psychiatry (E.E.S., M.W.B.), University of California, San Diego; Departments of Psychiatry, Psychology, and Obstetrics & Gynecology (P.M.), University of Illinois at Chicago; Department of Radiology and Neurology (A.B.), State University of New York, Stony Brook; Einstein Aging Study and Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; Departments of Health Sciences Research and Neurology (M.M.M.) and Departments of Psychiatry and Psychology (M.M.), Mayo Clinic, Rochester, MN; and Veterans Affairs San Diego Healthcare System (M.W.B.), CA
| | - Anat Biegon
- From the Department of Psychiatry (E.E.S., M.W.B.), University of California, San Diego; Departments of Psychiatry, Psychology, and Obstetrics & Gynecology (P.M.), University of Illinois at Chicago; Department of Radiology and Neurology (A.B.), State University of New York, Stony Brook; Einstein Aging Study and Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; Departments of Health Sciences Research and Neurology (M.M.M.) and Departments of Psychiatry and Psychology (M.M.), Mayo Clinic, Rochester, MN; and Veterans Affairs San Diego Healthcare System (M.W.B.), CA
| | - Richard B Lipton
- From the Department of Psychiatry (E.E.S., M.W.B.), University of California, San Diego; Departments of Psychiatry, Psychology, and Obstetrics & Gynecology (P.M.), University of Illinois at Chicago; Department of Radiology and Neurology (A.B.), State University of New York, Stony Brook; Einstein Aging Study and Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; Departments of Health Sciences Research and Neurology (M.M.M.) and Departments of Psychiatry and Psychology (M.M.), Mayo Clinic, Rochester, MN; and Veterans Affairs San Diego Healthcare System (M.W.B.), CA
| | - Michelle M Mielke
- From the Department of Psychiatry (E.E.S., M.W.B.), University of California, San Diego; Departments of Psychiatry, Psychology, and Obstetrics & Gynecology (P.M.), University of Illinois at Chicago; Department of Radiology and Neurology (A.B.), State University of New York, Stony Brook; Einstein Aging Study and Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; Departments of Health Sciences Research and Neurology (M.M.M.) and Departments of Psychiatry and Psychology (M.M.), Mayo Clinic, Rochester, MN; and Veterans Affairs San Diego Healthcare System (M.W.B.), CA
| | - Mary Machulda
- From the Department of Psychiatry (E.E.S., M.W.B.), University of California, San Diego; Departments of Psychiatry, Psychology, and Obstetrics & Gynecology (P.M.), University of Illinois at Chicago; Department of Radiology and Neurology (A.B.), State University of New York, Stony Brook; Einstein Aging Study and Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; Departments of Health Sciences Research and Neurology (M.M.M.) and Departments of Psychiatry and Psychology (M.M.), Mayo Clinic, Rochester, MN; and Veterans Affairs San Diego Healthcare System (M.W.B.), CA
| | - Mark W Bondi
- From the Department of Psychiatry (E.E.S., M.W.B.), University of California, San Diego; Departments of Psychiatry, Psychology, and Obstetrics & Gynecology (P.M.), University of Illinois at Chicago; Department of Radiology and Neurology (A.B.), State University of New York, Stony Brook; Einstein Aging Study and Department of Neurology (R.B.L.), Albert Einstein College of Medicine, Bronx, NY; Departments of Health Sciences Research and Neurology (M.M.M.) and Departments of Psychiatry and Psychology (M.M.), Mayo Clinic, Rochester, MN; and Veterans Affairs San Diego Healthcare System (M.W.B.), CA
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Sex-specific composite scales for longitudinal studies of incipient Alzheimer's disease. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2019; 5:508-514. [PMID: 31650007 PMCID: PMC6804506 DOI: 10.1016/j.trci.2019.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction The impact of Alzheimer's disease (AD) on cognitive decline differs by sex. Composite scores are useful as singular outcomes in clinical trials, yet to date these have not been developed to measure sex-specific change. Method We derived optimal composites from component scales available in the AD Neuroimaging Initiative (ADNI) database among cognitively normal and mild cognitively impaired subjects who are cerebrospinal fluid amyloid-β positive for early AD. Maximally sensitive composites were constructed separately for men and women using standard formulas. We compared the statistical power of the composites with the ADNI Prodromal Alzheimer's Cognitive Composite. Results Among 9 cognitive measures and clinical dementia rating sum of boxes, the optimal sex-specific composites included 5 measures, including the clinical dementia rating and 4 distinct cognitive measures. The sex-specific composites consistently outperformed sex-agnostic composites and the ADNI Prodromal Alzheimer's Cognitive Composite. Discussion Sex-specific composite scales may improve the power of longitudinal studies of early AD and clinical trials.
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Caldwell JZK, Zhuang X, Leavitt MJ, Banks SJ, Cummings J, Cordes D. Sex Moderates Amyloid and Apolipoprotein ε4 Effects on Default Mode Network Connectivity at Rest. Front Neurol 2019; 10:900. [PMID: 31481928 PMCID: PMC6710397 DOI: 10.3389/fneur.2019.00900] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/02/2019] [Indexed: 12/12/2022] Open
Abstract
Women are more likely to have Alzheimer's disease (AD) and decline more rapidly once diagnosed despite greater verbal memory early in the disease compared to men—an advantage that has been termed “memory reserve.” Resting state functional MRI (fMRI) investigations demonstrate interactions between sex and AD risk factors in default mode network (DMN) connectivity, a network of brain regions showing progressive dysfunction in AD. Separate work suggests connectivity of left prefrontal cortex (PFC) may correlate with more general cognitive reserve in healthy aging. It is unknown whether left prefrontal functional connectivity with anterior and posterior default mode network (aDMN, pDMN) might differ by sex in AD. This study employed group independent component analysis (ICA) to analyze resting state fMRI data from 158 participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI) with baseline diagnoses of normal cognition or early mild cognitive impairment (eMCI). pDMN and aDMN were defined on a subject-specific basis; prefrontal areas were selected from the Brodmann atlas (BA 6, 44, 8, and 9). Moderation regression analyses examined whether sex and amyloid PET positivity (A+/–) moderated effects of apolipoprotein ε4 (APOE ε4) on connectivity between left PFC, aDMN, and pDMN; and between aDMN and pDMN. Significant analyses were followed up with partial correlations assessing relationship of connectivity to verbal memory on the Rey Auditory Verbal Learning Test (RAVLT), and with preliminary analyses within NC and eMCI groups separately. Results showed no sex moderation of effects of A+ and APOE ε4 on left prefrontal/DMN connectivity in the full sample. However, sex significantly moderated impact of A+ and APOE ε4 on connectivity between aDMN and pDMN (p < 0.01). Women with an APOE allele (ε4+) and A+ showed greater aDMN/pDMN connectivity than their ε4- counterparts. No significant results were observed in men. Subgroup analyses suggested the aDMN/pDMN finding was true for those with NC, not eMCI. Partial correlations controlling for age and education showed increased aDMN/pDMN connectivity related to better verbal learning in women (p < 0.01) and not men (p = 0.18). In women at risk for AD or in early symptomatic stages who also have evidence of amyloid burden, stronger aDMN/pDMN connectivity may support verbal learning.
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Affiliation(s)
| | - Xiaowei Zhuang
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | - MacKenzie J Leavitt
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | - Sarah J Banks
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States.,UNLV School of Allied Health Sciences, Las Vegas, NV, United States
| | - Dietmar Cordes
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
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Identifying an Optimal Cutoff of the Montreal Cognitive Assessment to Predict Amyloid-PET Positivity in a Referral Memory Clinic. Alzheimer Dis Assoc Disord 2019; 33:194-199. [PMID: 31305321 DOI: 10.1097/wad.0000000000000330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Brain amyloid- positron emission tomography (PET) imaging is highly sensitive for identifying Alzheimer disease. Currently, there is a lack of insight on the association between amyloid-PET status and the widely used Montreal cognitive assessment (MoCA). Studying this relationship may optimize the clinical use of amyloid-PET imaging. OBJECTIVES To evaluate the relationship between amyloid-PET status and MoCA scores and to identify a MoCA score cutoff that translates to amyloid-PET positivity. METHODS Using retrospective chart review, patients from 2010 to 2017 with amyloid-PET scans (positive or negative) and MoCA test scores were included. We studied the relationship between amyloid-PET status and MoCA scores and the influence of age, sex, education, and race. A MoCA score cutoff for amyloid-PET positivity was estimated. RESULTS Among the 684 clinic patients with dementia, 99 fulfilled inclusion criteria. Amyloid-PET positivity was associated significantly with lower MoCA scores (median=19, U=847, P=0.01). The MoCA score cutoff (25) used for minimal cognitive impairment (MCI) predicted amyloid-PET positivity suboptimally (sensitivity=94.6%, specificity=13.9%). A MoCA score cutoff of 20 patients had optimal sensitivity (64.2%) and specificity (67.4%). CONCLUSIONS Amyloid-PET positivity is associated with lower MoCA scores. Clinical utility of amyloid-PET scan is likely to be suboptimal at the MoCA score cutoff for minimal cognitive impairment.
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Caldwell JZK, Berg JL, Shan G, Cummings JL, Banks SJ. Sex Moderates the Impact of Diagnosis and Amyloid PET Positivity on Hippocampal Subfield Volume. J Alzheimers Dis 2019; 64:79-89. [PMID: 29865063 PMCID: PMC6004904 DOI: 10.3233/jad-180028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We examined moderation effects of sex and diagnosis on the effect of positive florbetapir positron emission tomography (PET) amyloid-β (Aβ) scan (A+) on hippocampus subfield volumes in 526 normal control (NC) and early mild cognitive impairment (eMCI) participants from the Alzheimer’s Disease Neuroimaging Initiative (ADNI2; ADNI-GO). Regression moderation models showed that women— but not men— with NC designation did not show reduced subiculum volumes despite A+. At the eMCI stage, A+ was detrimental across sexes. Findings were significant while accounting for the effects of age, cognition at screening, education, and APOE4 carrier status. These findings suggest that women with A+ have early neural resistance to Alzheimer’s disease-related amyloid burden.
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Affiliation(s)
| | - Jody-Lynn Berg
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Guogen Shan
- University of Nevada Las Vegas, School of Community Health Sciences, Las Vegas, NV, USA
| | | | - Sarah J Banks
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
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Brunet HE, Caldwell JZK, Brandt J, Miller JB. Influence of sex differences in interpreting learning and memory within a clinical sample of older adults. AGING NEUROPSYCHOLOGY AND COGNITION 2019; 27:18-39. [PMID: 30663493 DOI: 10.1080/13825585.2019.1566433] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sex is an important factor to consider when evaluating memory with older adults. This present study aimed to examine sex differences in memory within a clinical sample of older adults (N = 1084). Raw learning and recall scores on the Hopkins Verbal Learning Test, Revised (HVLT-R) and Brief Visuospatial Memory Test, Revised (BVMT-R) were compared between sexes within the entire sample and cohorts stratified by age. Within the entire sample, women outperformed men in HVLT-R learning and recall, and there were no sex differences in BVMT-R performance. These sex differences, however, were absent or reversed for those with impaired HVLT-R performance and functional deficits, indicating that women retain an early advantage in verbal memory, which is lost with greater indication of disease severity. These findings indicate that women retain an advantage in verbal learning and memory, at least before significant levels of impairment, within a sample of older adults seen at an outpatient neurology clinic, which may have implications for diagnosing memory disorders.
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Affiliation(s)
- Hannah E Brunet
- Neurological Institute, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, USA
| | - Jessica Z K Caldwell
- Neurological Institute, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, USA
| | - Jason Brandt
- Department of Psychiatry and Behavioral Sciences, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Justin B Miller
- Neurological Institute, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, USA
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Yagi S, Galea LAM. Sex differences in hippocampal cognition and neurogenesis. Neuropsychopharmacology 2019; 44:200-213. [PMID: 30214058 PMCID: PMC6235970 DOI: 10.1038/s41386-018-0208-4] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 12/27/2022]
Abstract
Sex differences are reported in hippocampal plasticity, cognition, and in a number of disorders that target the integrity of the hippocampus. For example, meta-analyses reveal that males outperform females on hippocampus-dependent tasks in rodents and in humans, furthermore women are more likely to experience greater cognitive decline in Alzheimer's disease and depression, both diseases characterized by hippocampal dysfunction. The hippocampus is a highly plastic structure, important for processing higher order information and is sensitive to the environmental factors such as stress. The structure retains the ability to produce new neurons and this process plays an important role in pattern separation, proactive interference, and cognitive flexibility. Intriguingly, there are prominent sex differences in the level of neurogenesis and the activation of new neurons in response to hippocampus-dependent cognitive tasks in rodents. However, sex differences in spatial performance can be nuanced as animal studies have demonstrated that there are task, and strategy choice dependent sex differences in performance, as well as sex differences in the subregions of the hippocampus influenced by learning. This review discusses sex differences in pattern separation, pattern completion, spatial learning, and links between adult neurogenesis and these cognitive functions of the hippocampus. We emphasize the importance of including both sexes when studying genomic, cellular, and structural mechanisms of the hippocampal function.
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Affiliation(s)
- Shunya Yagi
- Department of Psychology, Graduate Program in Neuroscience, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Liisa A M Galea
- Department of Psychology, Graduate Program in Neuroscience, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada.
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Veitch DP, Weiner MW, Aisen PS, Beckett LA, Cairns NJ, Green RC, Harvey D, Jack CR, Jagust W, Morris JC, Petersen RC, Saykin AJ, Shaw LM, Toga AW, Trojanowski JQ. Understanding disease progression and improving Alzheimer's disease clinical trials: Recent highlights from the Alzheimer's Disease Neuroimaging Initiative. Alzheimers Dement 2018; 15:106-152. [PMID: 30321505 DOI: 10.1016/j.jalz.2018.08.005] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The overall goal of the Alzheimer's Disease Neuroimaging Initiative (ADNI) is to validate biomarkers for Alzheimer's disease (AD) clinical trials. ADNI is a multisite, longitudinal, observational study that has collected many biomarkers since 2004. Recent publications highlight the multifactorial nature of late-onset AD. We discuss selected topics that provide insights into AD progression and outline how this knowledge may improve clinical trials. METHODS We used standard methods to identify nearly 600 publications using ADNI data from 2016 and 2017 (listed in Supplementary Material and searchable at http://adni.loni.usc.edu/news-publications/publications/). RESULTS (1) Data-driven AD progression models supported multifactorial interactions rather than a linear cascade of events. (2) β-Amyloid (Aβ) deposition occurred concurrently with functional connectivity changes within the default mode network in preclinical subjects and was followed by specific and progressive disconnection of functional and anatomical networks. (3) Changes in functional connectivity, volumetric measures, regional hypometabolism, and cognition were detectable at subthreshold levels of Aβ deposition. 4. Tau positron emission tomography imaging studies detailed a specific temporal and spatial pattern of tau pathology dependent on prior Aβ deposition, and related to subsequent cognitive decline. 5. Clustering studies using a wide range of modalities consistently identified a "typical AD" subgroup and a second subgroup characterized by executive impairment and widespread cortical atrophy in preclinical and prodromal subjects. 6. Vascular pathology burden may act through both Aβ dependent and independent mechanisms to exacerbate AD progression. 7. The APOE ε4 allele interacted with cerebrovascular disease to impede Aβ clearance mechanisms. 8. Genetic approaches identified novel genetic risk factors involving a wide range of processes, and demonstrated shared genetic risk for AD and vascular disorders, as well as the temporal and regional pathological associations of established AD risk alleles. 9. Knowledge of early pathological changes guided the development of novel prognostic biomarkers for preclinical subjects. 10. Placebo populations of randomized controlled clinical trials had highly variable trajectories of cognitive change, underscoring the importance of subject selection and monitoring. 11. Selection criteria based on Aβ positivity, hippocampal volume, baseline cognitive/functional measures, and APOE ε4 status in combination with improved cognitive outcome measures were projected to decrease clinical trial duration and cost. 12. Multiple concurrent therapies targeting vascular health and other AD pathology in addition to Aβ may be more effective than single therapies. DISCUSSION ADNI publications from 2016 and 2017 supported the idea of AD as a multifactorial disease and provided insights into the complexities of AD disease progression. These findings guided the development of novel biomarkers and suggested that subject selection on the basis of multiple factors may lower AD clinical trial costs and duration. The use of multiple concurrent therapies in these trials may prove more effective in reversing AD disease progression.
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Affiliation(s)
- Dallas P Veitch
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA; Northern California Institute for Research and Education (NCIRE), Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Michael W Weiner
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA; Department of Neurology, University of California, San Francisco, CA, USA.
| | - Paul S Aisen
- Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA
| | - Laurel A Beckett
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Nigel J Cairns
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, Saint Louis, MO, USA; Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | | | - William Jagust
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, USA
| | - John C Morris
- Knight Alzheimer's Disease Research Center, Washington University School of Medicine, Saint Louis, MO, USA
| | | | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leslie M Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Arthur W Toga
- Laboratory of Neuroimaging, Institute of Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Alzheimer's Disease Core Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Udall Parkinson's Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Feng F, Wang P, Zhao K, Zhou B, Yao H, Meng Q, Wang L, Zhang Z, Ding Y, Wang L, An N, Zhang X, Liu Y. Radiomic Features of Hippocampal Subregions in Alzheimer's Disease and Amnestic Mild Cognitive Impairment. Front Aging Neurosci 2018; 10:290. [PMID: 30319396 PMCID: PMC6167420 DOI: 10.3389/fnagi.2018.00290] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/03/2018] [Indexed: 12/27/2022] Open
Abstract
Alzheimer's disease (AD) is characterized by progressive dementia, especially in episodic memory, and amnestic mild cognitive impairment (aMCI) is associated with a high risk of developing AD. Hippocampal atrophy/shape changes are believed to be the most robust magnetic resonance imaging (MRI) markers for AD and aMCI. Radiomics, a method of texture analysis, can quantitatively examine a large set of features and has previously been successfully applied to evaluate imaging biomarkers for AD. To test whether radiomic features in the hippocampus can be employed for early classification of AD and aMCI, 1692 features from the caudal and head parts of the bilateral hippocampus were extracted from 38 AD patients, 33 aMCI patients and 45 normal controls (NCs). One way analysis of variance (ANOVA) showed that 111 features exhibited statistically significant group differences (P < 0.01, Bonferroni corrected). Among these features, 98 were significantly correlated with Mini-Mental State Examination (MMSE) scores in AD and aMCI subjects (P < 0.01). The support vector machine (SVM) model demonstrated that radiomic features allowed us to distinguish AD from NC with an accuracy of 86.75% (specificity = 88.89% and sensitivity = 84.21%) and an area under curve (AUC) of 0.93. In conclusion, these findings provide evidence showing that radiomic features are beneficial in detecting early cognitive decline, and SVM classification analysis provides encouraging evidence for using hippocampal radiomic features as a potential biomarker for clinical applications in AD.
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Affiliation(s)
- Feng Feng
- Department of Neurology, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China
- Department of Neurology, The General Hospital of the PLA Rocket Force, Beijing, China
| | - Pan Wang
- Department of Neurology, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Kun Zhao
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- School of Information Science and Engineering, Shandong Normal University, Jinan, China
| | - Bo Zhou
- Department of Neurology, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Hongxiang Yao
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Qingqing Meng
- Department of Neurology, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Lei Wang
- Department of Neurology, The General Hospital of the PLA Rocket Force, Beijing, China
| | - Zengqiang Zhang
- Department of Neurology, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China
- Hainan Branch of Chinese PLA General Hospital, Sanya, China
| | - Yanhui Ding
- School of Information Science and Engineering, Shandong Normal University, Jinan, China
| | - Luning Wang
- Department of Neurology, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Ningyu An
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Xi Zhang
- Department of Neurology, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Yong Liu
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- School of Information Science and Engineering, Shandong Normal University, Jinan, China
- National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
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Son HJ, Jeong YJ, Yoon HJ, Lee SY, Choi GE, Park JA, Kim MH, Lee KC, Lee YJ, Kim MK, Cho K, Kang DY. Assessment of brain beta-amyloid deposition in transgenic mouse models of Alzheimer's disease with PET imaging agents 18F-flutemetamol and 18F-florbetaben. BMC Neurosci 2018; 19:45. [PMID: 30053803 PMCID: PMC6063010 DOI: 10.1186/s12868-018-0447-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 07/23/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although amyloid beta (Aβ) imaging is widely used for diagnosing and monitoring Alzheimer's disease in clinical fields, paralleling comparison between 18F-flutemetamol and 18F-florbetaben was rarely attempted in AD mouse model. We performed a comparison of Aβ PET images between 18F-flutemetamol and 18F-florbetaben in a recently developed APPswe mouse model, C57BL/6-Tg (NSE-hAPPsw) Korl. RESULTS After an injection (0.23 mCi) of 18F-flutemetamol and 18F-florbetaben at a time interval of 2-3 days, we compared group difference of SUVR and kinetic parameters between the AD (n = 7) and control (n = 7) mice, as well as between 18F-flutemetamol and 18F-florbetaben image. In addition, bio-distribution and histopathology were conducted. With visual image and VOI-based SUVR analysis, the AD group presented more prominent uptake than did the control group in both the 18F-florbetaben and 18F-flutemetamol images. With kinetic analysis, the 18F-florbetaben images showed differences in K1 and k4 between the AD and control groups, although 18F-flutemetamol images did not show significant difference. 18F-florbetaben images showed more prominent cortical uptake and matched well to the thioflavin S staining images than did the 18F-flutemetamol image. In contrast, 18F-flutemetamol images presented higher K1, k4, K1/k2 values than those of 18F-florbetaben images. Also, 18F-flutemetamol images presented prominent uptake in the bowel and bladder, consistent with higher bio-distribution in kidney, lung, blood and heart. CONCLUSIONS Compared with 18F-flutemetamol images, 18F-florbetaben images showed prominent visual uptake intensity, SUVR, and higher correlations with the pathology. In contrast, 18F-flutemetamol was more actively metabolized than was 18F-florbetaben (Son et al. in J Nucl Med 58(Suppl 1):S278, 2017].
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Affiliation(s)
- Hye Joo Son
- Department of Nuclear Medicine, Dong-A University Medical Center, Dong-A University College of Medicine, 26 Daesingongwon-ro, Seo-gu, Busan, 602-812 Korea
| | - Young Jin Jeong
- Department of Nuclear Medicine, Dong-A University Medical Center, Dong-A University College of Medicine, 26 Daesingongwon-ro, Seo-gu, Busan, 602-812 Korea
| | - Hyun Jin Yoon
- Department of Nuclear Medicine, Dong-A University Medical Center, Dong-A University College of Medicine, 26 Daesingongwon-ro, Seo-gu, Busan, 602-812 Korea
| | - Sang Yoon Lee
- Department of Nuclear Medicine, Dong-A University Medical Center, Dong-A University College of Medicine, 26 Daesingongwon-ro, Seo-gu, Busan, 602-812 Korea
| | - Go-Eun Choi
- Institute of Convergence Bio-Health, Dong-A University, Busan, Korea
| | - Ji-Ae Park
- Division of RI-Convergence Research, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Min Hwan Kim
- Division of RI-Convergence Research, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Kyo Chul Lee
- Division of RI-Convergence Research, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Yong Jin Lee
- Division of RI-Convergence Research, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Mun Ki Kim
- Pohang Center of Evolution of Biomaterials, Pohang Technopark, Pohang, Korea
| | - Kook Cho
- Institute of Convergence Bio-Health, Dong-A University, Busan, Korea
| | - Do-Young Kang
- Department of Nuclear Medicine, Dong-A University Medical Center, Dong-A University College of Medicine, 26 Daesingongwon-ro, Seo-gu, Busan, 602-812 Korea
- Institute of Convergence Bio-Health, Dong-A University, Busan, Korea
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Precision medicine and drug development in Alzheimer's disease: the importance of sexual dimorphism and patient stratification. Front Neuroendocrinol 2018; 50:31-51. [PMID: 29902481 DOI: 10.1016/j.yfrne.2018.06.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/29/2018] [Accepted: 06/07/2018] [Indexed: 12/23/2022]
Abstract
Neurodegenerative diseases (ND) are among the leading causes of disability and mortality. Considerable sex differences exist in the occurrence of the various manifestations leading to cognitive decline. Alzheimer's disease (AD) exhibits substantial sexual dimorphisms and disproportionately affects women. Women have a higher life expectancy compared to men and, consequently, have more lifespan to develop AD. The emerging precision medicine and pharmacology concepts - taking into account the individual genetic and biological variability relevant for disease risk, prevention, detection, diagnosis, and treatment - are expected to substantially enhance our knowledge and management of AD. Stratifying the affected individuals by sex and gender is an important basic step towards personalization of scientific research, drug development, and care. We hypothesize that sex and gender differences, extending from genetic to psychosocial domains, are highly relevant for the understanding of AD pathophysiology, and for the conceptualization of basic/translational research and for clinical therapy trial design.
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