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Yang X, Wang Z, Li H, Qin W, Liu N, Liu Z, Wang S, Xu J, Wang J. Polygenic Score for Conscientiousness Is a Protective Factor for Reversion from Mild Cognitive Impairment to Normal Cognition. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2309889. [PMID: 38838096 PMCID: PMC11304237 DOI: 10.1002/advs.202309889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 05/21/2024] [Indexed: 06/07/2024]
Abstract
Spontaneous reversion from mild cognitive impairment (MCI) to normal cognition (NC) is little known. Based on the data of the Genetics of Personality Consortium and MCI participants from Alzheimer's Disease Neuroimaging Initiative, the authors investigate the effect of polygenic scores (PGS) for personality traits on the reversion of MCI to NC and its underlying neurobiology. PGS analysis reveals that PGS for conscientiousness (PGS-C) is a protective factor that supports the reversion from MCI to NC. Gene ontology enrichment analysis and tissue-specific enrichment analysis indicate that the protective effect of PGS-C may be attributed to affecting the glutamatergic synapses of subcortical structures, such as hippocampus, amygdala, nucleus accumbens, and caudate nucleus. The structural covariance network (SCN) analysis suggests that the left whole hippocampus and its subfields, and the left whole amygdala and its subnuclei show significantly stronger covariance with several high-cognition relevant brain regions in the MCI reverters compared to the stable MCI participants, which may help illustrate the underlying neural mechanism of the protective effect of PGS-C.
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Affiliation(s)
- Xuan Yang
- Department of RadiologyTianjin Key Lab of Functional Imaging & Tianjin Institute of RadiologyTianjin Medical University General HospitalTianjin300052P. R. China
- Department of RadiologyJining No.1 People's HospitalJiningShandong272000P. R. China
| | - Zirui Wang
- Department of RadiologyTianjin Key Lab of Functional Imaging & Tianjin Institute of RadiologyTianjin Medical University General HospitalTianjin300052P. R. China
| | - Haonan Li
- Department of RadiologyTianjin Key Lab of Functional Imaging & Tianjin Institute of RadiologyTianjin Medical University General HospitalTianjin300052P. R. China
| | - Wen Qin
- Department of RadiologyTianjin Key Lab of Functional Imaging & Tianjin Institute of RadiologyTianjin Medical University General HospitalTianjin300052P. R. China
| | - Nana Liu
- Department of RadiologyTianjin Key Lab of Functional Imaging & Tianjin Institute of RadiologyTianjin Medical University General HospitalTianjin300052P. R. China
| | - Zhixuan Liu
- Department of RadiologyTianjin Key Lab of Functional Imaging & Tianjin Institute of RadiologyTianjin Medical University General HospitalTianjin300052P. R. China
| | - Siqi Wang
- Department of RadiologyTianjin Key Lab of Functional Imaging & Tianjin Institute of RadiologyTianjin Medical University General HospitalTianjin300052P. R. China
| | - Jiayuan Xu
- Department of RadiologyTianjin Key Lab of Functional Imaging & Tianjin Institute of RadiologyTianjin Medical University General HospitalTianjin300052P. R. China
| | - Junping Wang
- Department of RadiologyTianjin Key Lab of Functional Imaging & Tianjin Institute of RadiologyTianjin Medical University General HospitalTianjin300052P. R. China
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Stephan Y, Sutin AR, Luchetti M, Aschwanden D, Terracciano A. Personality and Transition From Mild Cognitive Impairment to Normal Cognition vs Dementia. J Am Med Dir Assoc 2024; 25:105175. [PMID: 39074784 DOI: 10.1016/j.jamda.2024.105175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVES Mild cognitive impairment (MCI) is a critical stage preceding incident dementia, but not all individuals with MCI progress to dementia and some revert to normal cognition. This study examined whether personality is associated with the probability of transition from MCI to normal cognition or dementia. DESIGN Longitudinal observational study. SETTING AND PARTICIPANTS Older adults with MCI from the Health and Retirement Study (N = 1608, 56% female, mean age = 72.29, SD = 9.91). Personality traits; cognitive status; and demographic (age, sex, education, race, and ethnicity), clinical (diabetes, hypertension), behavioral (smoking, physical activity), psychological (depressive symptoms), and genetic (apolipoprotein E ε4) covariates were obtained in 2006/2008. Follow-up data on cognitive status were collected every 2 years up to the 2020 wave. METHODS Cox regression analyses tested the association between personality and reversion from MCI to normal cognition and progression to dementia, controlling for demographic, clinical, behavioral, psychological, and genetic covariates. RESULTS Controlling for demographic factors, lower neuroticism and higher openness and conscientiousness were associated with a higher likelihood of reversion from MCI to normal cognition and a lower risk of progression to dementia over time. Higher agreeableness was related to a lower risk of progression to dementia. Clinical, behavioral, psychological, and genetic factors partially accounted for these associations. There was little evidence that demographic, genetic factors, or baseline cognition moderated these associations. CONCLUSIONS AND IMPLICATIONS Personality traits can help identify individuals who are more likely to revert from MCI and not progress to dementia. These findings suggest that even during mild impairment, personality may modulate dementia risk and thus inform targeted interventions.
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Affiliation(s)
| | - Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Martina Luchetti
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Damaris Aschwanden
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland; Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Antonio Terracciano
- Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, FL, USA
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Wertman E. Essential New Complexity-Based Themes for Patient-Centered Diagnosis and Treatment of Dementia and Predementia in Older People: Multimorbidity and Multilevel Phenomenology. J Clin Med 2024; 13:4202. [PMID: 39064242 PMCID: PMC11277671 DOI: 10.3390/jcm13144202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Dementia is a highly prevalent condition with devastating clinical and socioeconomic sequela. It is expected to triple in prevalence by 2050. No treatment is currently known to be effective. Symptomatic late-onset dementia and predementia (SLODP) affects 95% of patients with the syndrome. In contrast to trials of pharmacological prevention, no treatment is suggested to remediate or cure these symptomatic patients. SLODP but not young onset dementia is intensely associated with multimorbidity (MUM), including brain-perturbating conditions (BPCs). Recent studies showed that MUM/BPCs have a major role in the pathogenesis of SLODP. Fortunately, most MUM/BPCs are medically treatable, and thus, their treatment may modify and improve SLODP, relieving suffering and reducing its clinical and socioeconomic threats. Regrettably, the complex system features of SLODP impede the diagnosis and treatment of the potentially remediable conditions (PRCs) associated with them, mainly due to failure of pattern recognition and a flawed diagnostic workup. We suggest incorporating two SLODP-specific conceptual themes into the diagnostic workup: MUM/BPC and multilevel phenomenological themes. By doing so, we were able to improve the diagnostic accuracy of SLODP components and optimize detecting and favorably treating PRCs. These revolutionary concepts and their implications for remediability and other parameters are discussed in the paper.
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Affiliation(s)
- Eli Wertman
- Department of Neurology, Hadassah University Hospital, The Hebrew University, Jerusalem 9190500, Israel;
- Section of Neuropsychology, Department of Psychology, The Hebrew University, Jerusalem 9190500, Israel
- Or’ad: Organization for Cognitive and Behavioral Changes in the Elderly, Jerusalem 9458118, Israel
- Merhav Neuropsychogeriatric Clinics, Nehalim 4995000, Israel
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Lee TL, Guo L, Chan AS. fNIRS as a biomarker for individuals with subjective memory complaints and MCI. Alzheimers Dement 2024. [PMID: 38837656 DOI: 10.1002/alz.13897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Identifying individuals at risk of developing dementia is crucial for early intervention. Mild cognitive impairment (MCI) and subjective memory complaints (SMCs) are considered its preceding stages. This study aimed to assess the utility of functional near-infrared spectroscopy (fNIRS) in identifying individuals with MCI and SMC. METHODS One hundred fifty-one participants were categorized into normal cognition (NC); amnestic MCI (aMCI); non-amnestic MCI (naMCI); and mild, moderate, and severe SMC groups. Task-related prefrontal hemodynamics were measured using fNIRS during a visual memory span task. RESULTS Results showed significantly lower oxyhemoglobin (HbO) levels in aMCI, but not in naMCI, compared to the NC. In addition, severe SMC had lower HbO levels than the NC, mild, and moderate SMC. Receiver operating characteristic analysis demonstrated 69.23% and 69.70% accuracy in differentiating aMCI and severe SMC from NC, respectively. DISCUSSION FNIRS may serve as a potential non-invasive biomarker for early detection of dementia. HIGHLIGHTS Only amnestic mild cognitive impairment (aMCI), but not non-amnestic MCI, showed lower oxyhemoglobin (HbO) than normal individuals. Reduced HbO was observed in those with severe subjective memory complaints (SMCs) compared to normal cognition (NC), mild, and moderate SMCs. Functional near-infrared spectroscopy measures were associated with performance in memory assessments. Prefrontal hemodynamics could distinguish aMCI and severe SMC from NC.
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Affiliation(s)
- Tsz-Lok Lee
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Lizhi Guo
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Agnes S Chan
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
- Research Centre for Neuropsychological Well-Being, The Chinese University of Hong Kong, Shatin, Hong Kong
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Fan K, Seah B, Lu Z, Wang T, Zhou Y. Association between loneliness and mild cognitive impairment in older adults: a meta-analysis of longitudinal studies. Aging Ment Health 2024:1-9. [PMID: 38825970 DOI: 10.1080/13607863.2024.2358079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 05/12/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVES Prior studies reporting the effects of loneliness on mild impairment cognitive (MCI) have generated inconsistent results. This meta-analysis aimed to investigate the longitudinal association between loneliness and risk of MCI among community-dwelling middle-aged and older adults. METHOD Five electronic databases were searched from inception to 9 May 2023. Eligible studies examined the longitudinal association between loneliness and cognitive outcomes, including incident MCI, cognitive impairment, and cognitive decline. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated using random-effects or fixed-effects meta-analysis. Sensitivity analysis and subgroup analysis were conducted. Publication bias was examined using Egger's and Begg tests. RESULTS Eight studies were included. Among the 45,032 participants, 10,570 were diagnosed with MCI/cognitive decline. Loneliness was positively associated with an increased risk of MCI (overall OR = 1.14; 95% CI = 1.05, 1.23), with moderate heterogeneity (I2 = 44.2%). Sensitivity analysis have minimal influence on the aforementioned pooled effect. Subgroup analyses indicated stronger associations in studies which employed incident MCI as cognitive outcome (OR = 2.55, 95%CI = 1.31, 1.83), were conducted in non-Asia countries (OR = 1.52, 95%CI = 0.95, 1.20), and reported no depression adjustment (OR = 1.51, 95%CI = 1.04, 1.25). The association between loneliness and MCI was stronger among males compare to females. The Egger test and Begg test showed no evidence of significant publication bias (p = .493; p = .474). CONCLUSION The findings indicated that loneliness was associated with an increased risk of MCI. Future longitudinal studies should evaluate potential cases of MCI through comprehensive clinical assessments by practitioners to draw robust findings on the association of loneliness with MCI.
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Affiliation(s)
- Kexin Fan
- School of Nursing, Qingdao University, Qingdao, Shandong, P.R. China
| | - Betsy Seah
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zhiyuan Lu
- School of Nursing, Qingdao University, Qingdao, Shandong, P.R. China
| | - Tao Wang
- School of Health and Life Sciences, University of Health and Rehabilitation Sciences, Qingdao, Shandong, P.R. China
| | - Yunping Zhou
- School of Nursing, Qingdao University, Qingdao, Shandong, P.R. China
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Yu HH, Tan CC, Huang SJ, Zhang XH, Tan L, Xu W. Predicting the reversion from mild cognitive impairment to normal cognition based on magnetic resonance imaging, clinical, and neuropsychological examinations. J Affect Disord 2024; 353:90-98. [PMID: 38452935 DOI: 10.1016/j.jad.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Reversion from mild cognitive impairment (MCI) to normal cognition (NC) is not uncommon and indicates a better cognitive trajectory. This study aims to identify predictors of MCI reversion and develop a predicting model. METHOD A total of 391 MCI subjects (mean age = 74.3 years, female = 61 %) who had baseline data of magnetic resonance imaging, clinical, and neuropsychological measurements were followed for two years. Multivariate logistic analyses were used to identify the predictors of MCI reversion after adjusting for age and sex. A stepwise backward logistic regression model was used to construct a predictive nomogram for MCI reversion. The nomogram was validated by internal bootstrapping and in an independent cohort. RESULT In the training cohort, the 2-year reversion rate was 19.95 %. Predictors associated with reversion to NC were higher education level (p = 0.004), absence of APOE4 allele (p = 0.001), larger brain volume (p < 0.005), better neuropsychological measurements performance (p < 0.001), higher glomerular filtration rate (p = 0.035), and lower mean arterial pressure (p = 0.060). The nomogram incorporating five predictors (education, hippocampus volume, the Alzheimer's Disease Assessment Scale-Cognitive score, the Rey Auditory Verbal Learning Test-immediate score, and mean arterial pressure) achieved good C-indexes of 0.892 (95 % confidence interval [CI], 0.859-0.926) and 0.806 (95 % CI, 0.709-0.902) for the training and validation cohort. LIMITATION Observational duration is relatively short; The predicting model warrant further validation in larger samples. CONCLUSION This prediction model could facilitate risk stratification and early management for the MCI population.
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Affiliation(s)
- Hai-Hong Yu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China; Medical College, Qingdao University, Qingdao, China
| | - Chen-Chen Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Shu-Juan Huang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xin-Hao Zhang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Wei Xu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
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Leung Y, Eramudugolla R, Cherbuin N, Peters R, Mortby ME, Kiely KM, Anstey KJ. Estimating Gender Differences in the Association between Cognitive Resilience and Mild Cognitive Impairment Incidence. Gerontology 2024; 70:776-784. [PMID: 38697040 DOI: 10.1159/000538615] [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: 09/20/2023] [Accepted: 03/22/2024] [Indexed: 05/04/2024] Open
Abstract
INTRODUCTION Recent evidence suggests that the influence of verbal intelligence and education on the onset of subjective cognitive decline may be modulated by gender, where education contributes less to cognitive resilience (CR) in women than in men. This study aimed to examine gender differences in the association between CR and mild cognitive impairment (MCI) incidence in an Australian population-based cohort. METHODS We included 1,806 participants who had completed at least the first two waves and up to four waves of assessments in the Personality and Total Health (PATH) Through Life study (baseline: 49% female, male = 62.5, SD = 1.5, age range = 60-66 years). CR proxies included measures of educational attainment, occupation skill, verbal intelligence, and leisure activity. Discrete-time survival analyses were conducted to examine gender differences in the association between CR proxies and MCI risk, adjusting for age and apolipoprotein E4 status. RESULTS Gender differences were only found in the association between occupation and MCI risk, where lower occupation skill was more strongly associated with higher risk in men than in women (odds ratio [OR] = 1.30, 95% confidence interval [CI] [1.07, 1.57]). In both genders, after adjusting for education and occupation, one SD increase in leisure activity was associated with lower MCI risk by 32% (OR = 0.76, 95% CI [0.65, 0.89]). Higher scores in verbal intelligence assessment were associated with reduced risk of MCI by 28% (OR = 0.78, 95% CI [0.69, 0.89]). CONCLUSION Occupational experience may contribute to CR differently between genders. Life course cognitive engagement and verbal intelligence may be more protective against MCI than education and occupation for both men and women.
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Affiliation(s)
- Yvonne Leung
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Ranmalee Eramudugolla
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Nicolas Cherbuin
- Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ruth Peters
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
- George Institute for Global Health, Sydney, New South Wales, Australia
| | - Moyra E Mortby
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Kim M Kiely
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
- School of Health and Society, and School of Mathematics and Applied Statistics, University of Wollongong, Sydney, New South Wales, Australia
| | - Kaarin J Anstey
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
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Chantanachai T, Sturnieks DL, Lord SR, Menant J, Delbaere K, Sachdev PS, Brodaty H, Humburg P, Taylor ME. Cognitive and physical declines and falls in older people with and without mild cognitive impairment: a 7-year longitudinal study. Int Psychogeriatr 2024; 36:306-316. [PMID: 37078463 DOI: 10.1017/s1041610223000315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVES We examined longitudinal changes in cognitive and physical function and associations between change in function and falls in people with and without mild cognitive impairment (MCI). DESIGN Prospective cohort study with assessments every 2 years (for up to 6 years). SETTING Community, Sydney, Australia. PARTICIPANTS Four hundred and eighty one people were classified into three groups: those with MCI at baseline and MCI or dementia at follow-up assessments (n = 92); those who fluctuated between cognitively normal and MCI throughout follow-up (cognitively fluctuating) (n = 157), and those who were cognitively normal at baseline and all reassessments (n = 232). MEASUREMENTS Cognitive and physical function measured over 2-6 years follow-up. Falls in the year following participants' final assessment. RESULTS In summary, 27.4%, 38.5%, and 34.1% of participants completed 2, 4, and 6 years follow-up of cognitive and physical performance, respectively. The MCI and cognitive fluctuating groups demonstrated cognitive decline, whereas the cognitively normal group did not. The MCI group had worse physical function than the cognitively normal group at baseline but decline over time in physical performance was similar across all groups. Decline in global cognitive function and sensorimotor performance were associated with multiple falls in the cognitively normal group and decline in mobility (timed-up-and-go test) was associated with multiple falls across the whole sample. CONCLUSIONS Cognitive declines were not associated with falls in people with MCI and fluctuating cognition. Declines in physical function were similar between groups and decline in mobility was associated with falls in the whole sample. As exercise has multiple health benefits including maintaining physical function, it should be recommended for all older people. Programs aimed at mitigating cognitive decline should be encouraged in people with MCI.
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Affiliation(s)
- Thanwarat Chantanachai
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Daina L Sturnieks
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Jasmine Menant
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Peter Humburg
- Stats Central, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, NSW, Australia
| | - Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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Bergkamp MI, Jacob MA, Cai M, Claassen JA, Kessels RPC, Esselink R, Tuladhar AM, De Leeuw FE. Long-Term Longitudinal Course of Cognitive and Motor Symptoms in Patients With Cerebral Small Vessel Disease. Neurology 2024; 102:e209148. [PMID: 38382000 DOI: 10.1212/wnl.0000000000209148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/27/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with cerebral small vessel disease (SVD) show a heterogenous clinical course. The aim of the current study was to investigate the longitudinal course of cognitive and motor function in patients who developed parkinsonism, dementia, both, or none. METHODS Participants were from the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort study, a prospective cohort of patients with SVD. Parkinsonism and dementia were, respectively, diagnosed according to the UK Parkinson's Disease Society brain bank criteria and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for major neurocognitive disorder. Linear and generalized linear mixed-effect analyses were used to study the longitudinal course of motor and cognitive tasks. RESULTS After a median follow-up of 12.8 years (interquartile range 10.2-15.3), 132 of 501 (26.3%) participants developed parkinsonism, dementia, or both. Years before diagnosis of these disorders, participants showed distinct clinical trajectories from those who developed none: Participant who developed parkinsonism had an annual percentage of 22% (95% CI 18%-27%) increase in motor part of the Unified Parkinson's Disease Rating Scale score. This was significantly higher than the 16% (95% CI 14%-18%) of controls, mainly because of a steep increase in bradykinesia and posture and gait disturbances. When they developed dementia as well, the increase in Timed Up and Go Test time of 0.73 seconds per year (95% CI 0.58-0.87) was significantly higher than the 0.20 seconds per year increase (95% CI 0.16-0.23) of controls. All groups, including the participants who developed parkinsonism without dementia, showed a faster decline in executive function compared with controls: Annual decline in Z-score was -0.07 (95% CI -0.10 to -0.05), -0.09 (95% CI -0.11 to -0.08), and -0.11 (95% CI -0.14 to -0.08) for participants who developed, respectively, parkinsonism, dementia, and both parkinsonism and dementia. These declines were all significantly faster than the annual decline in Z-score of 0.07 (95% CI -0.10 to -0.05) of controls. DISCUSSION A distinct pattern in deterioration of clinical markers is visible in patients with SVD, years before the diagnosis of parkinsonism and dementia. This knowledge aids early identification of patients with a high risk of developing these disorders.
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Affiliation(s)
- Mayra I Bergkamp
- From the Departments of Neurology (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), of Medical Psychology (R.P.C.K.), Geriatrics (J.A.C.), and Radboudumc Alzheimer Center (J.A.C., R.P.C.K.), Radboud University Medical Center; Donders Center for Medical Neuroscience (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), and Donders Institute for Brain (J.A.C., R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China; Department of Cardiovascular Sciences (J.A.C.), University of Leicester, United Kingdom; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray, the Netherlands
| | - Mina A Jacob
- From the Departments of Neurology (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), of Medical Psychology (R.P.C.K.), Geriatrics (J.A.C.), and Radboudumc Alzheimer Center (J.A.C., R.P.C.K.), Radboud University Medical Center; Donders Center for Medical Neuroscience (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), and Donders Institute for Brain (J.A.C., R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China; Department of Cardiovascular Sciences (J.A.C.), University of Leicester, United Kingdom; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray, the Netherlands
| | - Mengfei Cai
- From the Departments of Neurology (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), of Medical Psychology (R.P.C.K.), Geriatrics (J.A.C.), and Radboudumc Alzheimer Center (J.A.C., R.P.C.K.), Radboud University Medical Center; Donders Center for Medical Neuroscience (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), and Donders Institute for Brain (J.A.C., R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China; Department of Cardiovascular Sciences (J.A.C.), University of Leicester, United Kingdom; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray, the Netherlands
| | - Jurgen A Claassen
- From the Departments of Neurology (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), of Medical Psychology (R.P.C.K.), Geriatrics (J.A.C.), and Radboudumc Alzheimer Center (J.A.C., R.P.C.K.), Radboud University Medical Center; Donders Center for Medical Neuroscience (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), and Donders Institute for Brain (J.A.C., R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China; Department of Cardiovascular Sciences (J.A.C.), University of Leicester, United Kingdom; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray, the Netherlands
| | - Roy P C Kessels
- From the Departments of Neurology (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), of Medical Psychology (R.P.C.K.), Geriatrics (J.A.C.), and Radboudumc Alzheimer Center (J.A.C., R.P.C.K.), Radboud University Medical Center; Donders Center for Medical Neuroscience (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), and Donders Institute for Brain (J.A.C., R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China; Department of Cardiovascular Sciences (J.A.C.), University of Leicester, United Kingdom; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray, the Netherlands
| | - Rianne Esselink
- From the Departments of Neurology (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), of Medical Psychology (R.P.C.K.), Geriatrics (J.A.C.), and Radboudumc Alzheimer Center (J.A.C., R.P.C.K.), Radboud University Medical Center; Donders Center for Medical Neuroscience (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), and Donders Institute for Brain (J.A.C., R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China; Department of Cardiovascular Sciences (J.A.C.), University of Leicester, United Kingdom; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray, the Netherlands
| | - Anil Man Tuladhar
- From the Departments of Neurology (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), of Medical Psychology (R.P.C.K.), Geriatrics (J.A.C.), and Radboudumc Alzheimer Center (J.A.C., R.P.C.K.), Radboud University Medical Center; Donders Center for Medical Neuroscience (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), and Donders Institute for Brain (J.A.C., R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China; Department of Cardiovascular Sciences (J.A.C.), University of Leicester, United Kingdom; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray, the Netherlands
| | - Frank-Erik De Leeuw
- From the Departments of Neurology (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), of Medical Psychology (R.P.C.K.), Geriatrics (J.A.C.), and Radboudumc Alzheimer Center (J.A.C., R.P.C.K.), Radboud University Medical Center; Donders Center for Medical Neuroscience (M.I.B., M.A.J., M.C., R.E., A.M.T., F.-E.D.L.), and Donders Institute for Brain (J.A.C., R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, China; Department of Cardiovascular Sciences (J.A.C.), University of Leicester, United Kingdom; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray, the Netherlands
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Wilks H, Benzinger TLS, Schindler SE, Cruchaga C, Morris JC, Hassenstab J. Predictors and outcomes of fluctuations in the clinical dementia rating scale. Alzheimers Dement 2024; 20:2080-2088. [PMID: 38224146 PMCID: PMC10984446 DOI: 10.1002/alz.13679] [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: 09/08/2023] [Revised: 11/15/2023] [Accepted: 12/03/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Reversion, or change in cognitive status from impaired to normal, is common in aging and dementia studies, but it remains unclear what factors predict reversion. METHODS We investigated whether reverters, defined as those who revert from a Clinical Dementia Rating® (CDR®) scale score of 0.5 to CDR 0) differed on cognition and biomarkers from unimpaired participants (always CDR 0) and impaired participants (converted to CDR > 0 and had no reversion events). Models evaluated relationships between biomarker status, apolipoprotein E (APOE) ε4 status, and cognition. Additional models described predictors of reversion and predictors of eventual progression to CDR > 0. RESULTS CDR reversion was associated with younger age, better cognition, and negative amyloid biomarker status. Reverters that eventually progressed to CDR > 0 had more visits, were older, and were more likely to have an APOE ε4 allele. DISCUSSION CDR reversion occupies a transitional phase in disease progression between cognitive normality and overt dementia. Reverters may be ideal candidates for secondary prevention Alzheimer's disease (AD) trials. HIGHLIGHTS Reverters had more longitudinal cognitive decline than those who remained cognitively normal. Predictors of reversion: younger age, better cognition, and negative amyloid biomarker status. Reverting from CDR 0.5 to 0 is a risk factor for future conversion to CDR > 0. CDR reversion may be a transitional phase in Alzheimer's Disease progression. CDR reverters may be ideal for Alzheimer's disease secondary prevention trials.
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Affiliation(s)
- Hannah Wilks
- Department of Psychological & Brain SciencesWashington University in St. LouisSt. LouisMissouriUSA
- Charles F. and Joanne Knight Alzheimer Disease Research CenterDepartment of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Tammie L. S. Benzinger
- Charles F. and Joanne Knight Alzheimer Disease Research CenterDepartment of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
- Department of RadiologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Suzanne E. Schindler
- Charles F. and Joanne Knight Alzheimer Disease Research CenterDepartment of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Carlos Cruchaga
- Charles F. and Joanne Knight Alzheimer Disease Research CenterDepartment of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
- Department of PsychiatryWashington University School of Medicine1 Barnes Jewish Hospital PlazaSt. LouisMissouriUSA
| | - John C. Morris
- Charles F. and Joanne Knight Alzheimer Disease Research CenterDepartment of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Jason Hassenstab
- Department of Psychological & Brain SciencesWashington University in St. LouisSt. LouisMissouriUSA
- Charles F. and Joanne Knight Alzheimer Disease Research CenterDepartment of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
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11
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Sun R, Ge B, Wu S, Li H, Lin L. Optimal cut-off MoCA score for screening for mild cognitive impairment in elderly individuals in China: A systematic review and meta-analysis. Asian J Psychiatr 2023; 87:103691. [PMID: 37499366 DOI: 10.1016/j.ajp.2023.103691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/16/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023]
Abstract
AIM To evaluate the optimal cut-off MoCA score for elderly individuals with MCI. DESIGN A systematic review and meta-analysis. METHOD Articles were retrieved from PubMed, Ovid, Embase, The Cochrane Library, PsycINFO, CBM, CNKI, WanFang and CQVIP and were assessed by using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Figures of the assessment were made by using Review Manager 5.3, and a meta-analysis of the data was conducted by using Bivariate Random-effects Meta-Analysis (BRMA) via Stata 14.0. RESULTS Seventeen articles were retrieved from the database, and when the cut-offs were 24/25 and 25/26, they represented the same diagnostic value; in addition, the AUC was 0.96, which demonstrated high predictive validity for mild cognitive impairment screening. However, the sensitivity was higher with 25/26 (se=0.95, sp=0.80), whereas the specificity was higher with 24/25 (se=0.92, sp=0.89).
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Affiliation(s)
- Rui Sun
- International Medical Services, Peking Union Medical College Hospital, Beijing, China
| | - Binqian Ge
- School of Nursing, Suzhou Vocational Health College, Suzhou, China
| | - Shiyu Wu
- International Medical Services, Peking Union Medical College Hospital, Beijing, China
| | - Huiling Li
- School of Nursing, Soochow University and The First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Lu Lin
- The First Affiliated Hospital of Soochow University, Suzhou, China.
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12
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Abe T, Yamashita M, Fujiwara Y, Sasai H, Obuchi SP, Ishizaki T, Awata S, Toba K. Fluctuations in Cognitive Test Scores and Loss to Follow-Up in Community-Dwelling Older Adults: The IRIDE Cohort Study. Dement Geriatr Cogn Disord 2023; 52:296-303. [PMID: 37562370 DOI: 10.1159/000531764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/19/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION We examined the relationship between previous fluctuations in Mini-Mental State Examination (MMSE) scores, future changes in MMSE scores, and attrition from follow-up surveys, which helps in a more comprehensive interpretation of repeatedly collected MMSE scores. METHODS This 4-year longitudinal study included 2,073 community-dwelling older adults aged ≥65 years in Japan. The MMSE was administered at baseline (T0), 2 years (T1), and 4 years (T2) follow-up. We performed multinomial logistic regression analysis with the dependent variable, indicating the change in MMSE score from T1 to T2 (categorized as increase, no change [reference category], and decrease) and attrition at T2. The independent variables included the change in MMSE scores from T0 to T1 and MMSE scores at T0 and T1. RESULTS The mean MMSE score was 29 across the three time points. A one-point decrease in MMSE score from T0 to T1 was associated with 79% (95% confidence interval: 1.62, 1.97) higher odds of an increase in MMSE score from T1 to T2 and 28% (1.17, 1.40) higher odds of attrition at T2. A one-point decrement in the MMSE score at T0 and T1 was also associated with an increase in the MMSE score from T1 to T2 and attrition at T2. CONCLUSION Focusing on cognitive fluctuation for 2 years, rather than cognitive function at a point in time, would have no remarkable advantage when focusing on future cognitive function and attrition. Our results emphasize the need for further studies to identify factors that distinguish between those who continue to attend follow-up surveys and show improvements in cognitive test scores and those who drop out.
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Affiliation(s)
- Takumi Abe
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
- Integrated Research Initiative for Living Well with Dementia, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Mari Yamashita
- Integrated Research Initiative for Living Well with Dementia, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
- Integrated Research Initiative for Living Well with Dementia, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hiroyuki Sasai
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Shuichi P Obuchi
- Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Shuichi Awata
- Integrated Research Initiative for Living Well with Dementia, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Kenji Toba
- Integrated Research Initiative for Living Well with Dementia, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
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13
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Pilozzi A, Foster S, Mischoulon D, Fava M, Huang X. A Brief Review on the Potential of Psychedelics for Treating Alzheimer's Disease and Related Depression. Int J Mol Sci 2023; 24:12513. [PMID: 37569888 PMCID: PMC10419627 DOI: 10.3390/ijms241512513] [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: 01/06/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023] Open
Abstract
Alzheimer's disease (AD), the most common form of senile dementia, is poised to place an even greater societal and healthcare burden as the population ages. With few treatment options for the symptomatic relief of the disease and its unknown etiopathology, more research into AD is urgently needed. Psychedelic drugs target AD-related psychological pathology and symptoms such as depression. Using microdosing, psychedelic drugs may prove to help combat this devastating disease by eliciting psychiatric benefits via acting through various mechanisms of action such as serotonin and dopamine pathways. Herein, we review the studied benefits of a few psychedelic compounds that may show promise in treating AD and attenuating its related depressive symptoms. We used the listed keywords to search through PubMed for relevant preclinical, clinical research, and review articles. The putative mechanism of action (MOA) for psychedelics is that they act mainly as serotonin receptor agonists and induce potential beneficial effects for treating AD and related depression.
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Affiliation(s)
- Alexander Pilozzi
- Neurochemistry Laboratory, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Simmie Foster
- Neurochemistry Laboratory, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
- Depression Clinical & Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - David Mischoulon
- Depression Clinical & Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Maurizio Fava
- Depression Clinical & Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Xudong Huang
- Neurochemistry Laboratory, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
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López-Pérez J, García-Herranz S, Díaz-Mardomingo MDC. Acquisition and consolidation of verbal learning and episodic memory as predictors of the conversion from mild cognitive impairment to probable Alzheimer's disease. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2023; 30:638-653. [PMID: 35475773 DOI: 10.1080/13825585.2022.2069670] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Verbal episodic memory tests assess memory performance using total learning scores. The analysis of inter-trial indices such as gained (GA) and lost (LA) access can provide additional information on the acquisition and consolidation processes. The main objetive was to determine whether the GA and LA indices, derived from a word-list verbal episodic memory test are useful for predicting cognitive impairment in aging. 60 older people aged was divided into 3 groups: cognitively healthy, stable Mild Cognitive Impairment (MCI) and MCI converting to probable Alzheimer's disease (MCI-conv). The results showed that GA and LA measures are independent from the traditional measures -total score of correct answers-. Logistic regression showed that these values are predictive of the conversion over time and could be a cognitive marker of conversion from MCI to AD. This suggests that the GA index, which shows acquisition processes in word-list tests, may be a marker of cognitive impairment.
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Affiliation(s)
- Jorge López-Pérez
- Department of Basic Psychology I, Faculty of Psychology, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Sara García-Herranz
- Department of Basic Psychology II, Faculty of Psychology, Universidad Nacional de Educación a Distancia, Madrid, Spain
- Instituto Mixto de Investigación-Escuela Nacional de Sanidad (IMIENS), Madrid, Spain
| | - María Del Carmen Díaz-Mardomingo
- Department of Basic Psychology I, Faculty of Psychology, Universidad Nacional de Educación a Distancia, Madrid, Spain
- Instituto Mixto de Investigación-Escuela Nacional de Sanidad (IMIENS), Madrid, Spain
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15
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Gonzalez J, Wilson A, Byrd D, Cortes EP, Crary JF, Morgello S. Neuronal accumulation of hyperphosphorylated tau protein predicts stable memory impairment in people living with HIV. AIDS 2023; 37:1247-1256. [PMID: 36988209 PMCID: PMC10539475 DOI: 10.1097/qad.0000000000003556] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
OBJECTIVES As lifespans increase in people with HIV (PWH), there is concern that age-related neurodegenerative disorders may contribute to cognitive decline. We asked whether brain accumulation of Alzheimer's disease (AD)-associated proteins amyloid-beta (Aβ) and hyperphosphorylated tau (p-tau) predicted cognitive performance in middle-aged PWH. METHODS In a prospectively followed, cognitively-characterized autopsy sample of 135 PWH, we used immunohistochemistry to assess Aβ plaques and neuronal p-tau in medial temporal and lateral frontal lobes. These pathologies were tested for associations with cognitive performance in seven domains: motor, speed of information processing, working memory, memory encoding, memory retrieval, verbal fluency, and abstraction/executive function. Univariate and multivariate analyses accounting for HIV-associated variables, reading level, and comorbidities were conducted. Longitudinal trajectories of memory functions were evaluated in 60 individuals with a median follow-up of 6.0 years. RESULTS In this population with mean age 51.4 ± 0.9 years, 58% displayed neuronal p-tau and 29% Aβ plaques. Neuronal p-tau, but not Aβ, predicted worse memory encoding and retrieval, but not other cognitive functions. With an ordinal hierarchy of neuronal p-tau locations (entorhinal, hippocampal, neocortical), decreased memory performance correlated with neocortical distribution. Memory function trajectories could not be distinguished between individuals with and without neuronal p-tau, and over 80% of the sample showed no change over time. CONCLUSION In this middle-aged sample, neuronal p-tau accumulation contributes to memory deficits, but is not associated with accelerated decline in function over time. In the absence of AD-like deterioration, other etiologies for neuronal p-tau in cognitively impaired PWH must be considered.
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Affiliation(s)
| | - Alyssa Wilson
- Department of Neurology
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai
| | - Desiree Byrd
- Department of Neurology
- Department of Psychology, Queens College and the Graduate Center, City University of New York
| | | | - John F Crary
- Department of Pathology
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Susan Morgello
- Department of Neurology
- Department of Pathology
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Dang M, Yang C, Chen K, Lu P, Li H, Zhang Z. Hippocampus-centred grey matter covariance networks predict the development and reversion of mild cognitive impairment. Alzheimers Res Ther 2023; 15:27. [PMID: 36732782 PMCID: PMC9893696 DOI: 10.1186/s13195-023-01167-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/09/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mild cognitive impairment (MCI) has been thought of as the transitional stage between normal ageing and Alzheimer's disease, involving substantial changes in brain grey matter structures. As most previous studies have focused on single regions (e.g. the hippocampus) and their changes during MCI development and reversion, the relationship between grey matter covariance among distributed brain regions and clinical development and reversion of MCI remains unclear. METHODS With samples from two independent studies (155 from the Beijing Aging Brain Rejuvenation Initiative and 286 from the Alzheimer's Disease Neuroimaging Initiative), grey matter covariance of default, frontoparietal, and hippocampal networks were identified by seed-based partial least square analyses, and random forest models were applied to predict the progression from normal cognition to MCI (N-t-M) and the reversion from MCI to normal cognition (M-t-N). RESULTS With varying degrees, the grey matter covariance in the three networks could predict N-t-M progression (AUC = 0.692-0.792) and M-t-N reversion (AUC = 0.701-0.809). Further analyses indicated that the hippocampus has emerged as an important region in reversion prediction within all three brain networks, and even though the hippocampus itself could predict the clinical reversion of M-t-N, the grey matter covariance showed higher prediction accuracy for early progression of N-t-M. CONCLUSIONS Our findings are the first to report grey matter covariance changes in MCI development and reversion and highlight the necessity of including grey matter covariance changes along with hippocampal degeneration in the early detection of MCI and Alzheimer's disease.
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Affiliation(s)
- Mingxi Dang
- grid.20513.350000 0004 1789 9964State Key Laboratory of Cognitive Neuroscience and Learning, Faculty of Psychology, Beijing Normal University, Beijing, 100875 China
| | - Caishui Yang
- grid.20513.350000 0004 1789 9964State Key Laboratory of Cognitive Neuroscience and Learning, Faculty of Psychology, Beijing Normal University, Beijing, 100875 China ,grid.20513.350000 0004 1789 9964School of Systems Science, Beijing Normal University, Beijing, 100875 China
| | - Kewei Chen
- grid.418204.b0000 0004 0406 4925Banner Alzheimer’s Institute, Phoenix, AZ 85006 USA
| | - Peng Lu
- grid.20513.350000 0004 1789 9964State Key Laboratory of Cognitive Neuroscience and Learning, Faculty of Psychology, Beijing Normal University, Beijing, 100875 China
| | - He Li
- grid.410318.f0000 0004 0632 3409Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700 China
| | - Zhanjun Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning, Faculty of Psychology, Beijing Normal University, Beijing, 100875, China.
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Leroy V, Martinet V, Nunkessore O, Dentel C, Durand H, Mockler D, Puisieux F, Fougère B, Chen Y. The Nebulous Association between Cognitive Impairment and Falls in Older Adults: A Systematic Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2628. [PMID: 36767992 PMCID: PMC9915123 DOI: 10.3390/ijerph20032628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND In older people, dementia is a well-established risk factor for falls. However, the association and the causal relationship between falls and the earlier stages of cognitive impairment remains unclear. The purpose of the study was to review the literature data on the association between falls and cognitive impairment, no dementia, including Mild Cognitive Impairment. METHODS According to PRISMA guidelines, we searched five electronic databases (EMBASE, Web of Science, Medline, CINAHL, and PsychINFO) for articles published between January 2011 and August 2022 on observational studies of older people with a cognitive assessment and/or cognitive impairment diagnosis and a recording of falls. Their quality was reviewed according to the STROBE checklist. RESULTS We selected 42 of the 4934 initially retrieved publications. In 24 retrospective studies, a statistically significant association between falls and cognitive status was found in only 15 of the 32 comparisons (47%). Of the 27 cross-sectional analyses in prospective studies, only eight (30%) were positive and significant. We counted four longitudinal analyses, half of which suggested a causal relationship between falls and cognitive impairment. The investigational methods varied markedly from one study to another. CONCLUSION It is still not clear whether falls are associated with cognitive impairment, no dementia. Data in favor of a causal relationship are scarce. Further studies are needed to clarify their relationship.
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Affiliation(s)
- Victoire Leroy
- Division of Geriatric Medicine, Tours University Hospital, 37000 Tours, France
- EA 7505 (Education, Ethics, Health), University of Medicine of Tours, 37000 Tours, France
- Memory Clinic, Tours University Hospital, 37000 Tours, France
| | - Valérie Martinet
- Department of Geriatrics, Saint-Pierre Hospital, ULB, 1000 Brussels, Belgium
| | | | | | - Hélène Durand
- Department of Neurology, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France
| | - David Mockler
- Medical Library, Trinity Centre for the Health Sciences, St James’ Hospital, D08 W9RT Dublin, Ireland
| | - François Puisieux
- Department of Gerontology, Lille University Hospital, 59000 Lille, France
- EA2694, Lille University, 59000 Lille, France
| | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Hospital, 37000 Tours, France
- EA 7505 (Education, Ethics, Health), University of Medicine of Tours, 37000 Tours, France
| | - Yaohua Chen
- Department of Gerontology, Lille University Hospital, 59000 Lille, France
- INSERM UMR-S 1172, Vascular and Degenerative Cognitive Disorders, University of Lille, 59000 Lille, France
- Global Brain Health Institute, Trinity College Dublin, D02 PN40 Dublin, Ireland
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Overton M, Sjögren B, Elmståhl S, Rosso A. Mild Cognitive Impairment, Reversion Rates, and Associated Factors: Comparison of Two Diagnostic Approaches. J Alzheimers Dis 2023; 91:585-601. [PMID: 36463443 PMCID: PMC9912719 DOI: 10.3233/jad-220597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND As mild cognitive impairment (MCI) is typically used to identify prodromal stages of dementia, it is essential to identify MCI criteria with high diagnostic stability and prediction of dementia. Moreover, further investigation into pinpointing key factors for reversion is required to foresee future prognosis of MCI patients accurately. OBJECTIVE To explore disparities in diagnostic stability by examining reversion rates produced by two operationalizations of the MCI definition: the widely applied Petersen criteria and a version of the Neuropsychological (NP) criteria and to identify cognitive, lifestyle, and health related factors for reversion. METHODS MCI was retrospectively classified in a sample from the Swedish community-based study Good Aging in Skåne with the Petersen criteria (n = 744, median follow-up = 7.0 years) and the NP criteria (n = 375, median follow-up, 6.7 years), respectively. Poisson regression models estimated the effect of various factors on the likelihood of incident reversion. RESULTS Reversion rates were 323/744 (43.4%, 95% confidence intervals (CI): 39.8; 47.0) and 181/375 (48.3% 95% CI: 43.2; 53.5) for the Petersen criteria and NP criteria, respectively. Participants with impairment in a single cognitive domain, regular alcohol consumption, living with someone, older age, and lower body mass index had a higher likelihood of reverting to normal. CONCLUSION Reversion rates were similar for Petersen and NP criteria indicating that one definition is not superior to the other regarding diagnostic stability. Additionally, the results highlight important aspects such as multiple domain MCI, cohabitation, and the role of alcohol on predicting the trajectory of those diagnosed with MCI.
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Affiliation(s)
- Marieclaire Overton
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden,Correspondence to: Marieclaire Overton, Jan Waldenströms gata 35, CRC, Building 28, fl.13,
Skåne University Hospital, SE-205 02, Malmö, Sweden. Tel.: +46 709420138;
E-mail:
| | - Benjamin Sjögren
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Sölve Elmståhl
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Aldana Rosso
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
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19
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Korthauer LE, Goveas JS, Rapp SR, Espeland MA, Shumaker SA, Garcia KR, Rossom RC, Garcia L, Tindle HA, Salmoirago-Blotcher E, Wassertheil-Smoller S, Zaslavsky O, Cochrane B, Sink KM, Masaki K, Driscoll I. The relationship between depressive symptoms and subtypes of mild cognitive impairment in post-menopausal women: Results from the Women's Health Initiative Memory Study. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5817. [PMID: 36205005 PMCID: PMC9616073 DOI: 10.1002/gps.5817] [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: 05/24/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Depressive symptoms are associated with age-related cognitive impairment, but the relative risk of specific subtypes of mild cognitive impairment (MCI) conferred by depressive symptoms is unclear. The purpose of this exploratory study was to determine the longitudinal association between baseline depressive symptoms and incident cases of MCI subtypes (amnestic vs. non-amnestic) and probable dementia (PD) (Alzheimer's disease, vascular, mixed) among postmenopausal women. METHODS Depressive symptoms were assessed at study baseline using an 8-item Burnam algorithm in 7043 postmenopausal women who participated in the Women's Health Initiative Memory Study (WHIMS) and the WHIMS-Epidemiology of Cognitive Health Outcomes (WHIMS-ECHO) extension study. During the median 9.4-year follow-up interval, the presence of MCI and PD was classified by a central adjudication committee. Classification of participants by MCI subtype (amnestic single and multi-domain, non-amnestic single and multi-domain) was done algorithmically based on established criteria using data from annual cognitive testing. RESULTS At baseline, 557 women (7.9%) had clinically significant depressive symptoms based on Burnam algorithm cut-point of 0.06. Depressive symptoms at baseline were associated with an increased risk of incident amnestic MCI (hazard ratio [HR] = 1.91, 95% confidence interval [CI] 1.32-2.78, p < 0.0001), but not non-amnestic MCI (HR = 1.39, 95% CI 0.91-2.14, p = 0.13) after controlling for demographic factors. This relationship between depressive symptoms and amnestic MCI remained consistent after controlling for lifestyle variables, cardiovascular risk factors, antidepressant use, and history of hormone therapy. There were no significant associations between depressive symptoms and incidence of PD. CONCLUSION Depressive symptoms at baseline among postmenopausal older women are associated with higher incidence of amnestic MCI, suggesting that they may be an independent risk factor or part of the early prodrome of dementia.
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Affiliation(s)
- Laura E Korthauer
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Joseph S Goveas
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Stephen R Rapp
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mark A Espeland
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Sally A Shumaker
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Katelyn R Garcia
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Lorena Garcia
- Department of Public Health Sciences, University of California-Davis, Davis, California, USA
| | - Hilary A Tindle
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elena Salmoirago-Blotcher
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York, USA
| | - Oleg Zaslavsky
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington, USA
| | - Barbara Cochrane
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
| | | | - Kamal Masaki
- Department of Geriatric Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Ira Driscoll
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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20
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Gong CH, Sato S. Can mild cognitive impairment with depression be improved merely by exercises of recall memories accompanying everyday conversation? A longitudinal study 2016-2019. QUALITY IN AGEING AND OLDER ADULTS 2022. [DOI: 10.1108/qaoa-09-2021-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study is to find out a simple cognitive intervention method to use MCI and suffering people with depression. As the elderly society increases around the world, the number of elderly people with diseases and dementia is increasing rapidly. Mild cognitive impairment (MCI), a pre-stage to dementia, is a critical treatment time to slow disease progression. However, there is currently no appropriate medication. Furthermore, MCI patients with depression are more difficult to treat.
Design/methodology/approach
To overcome these problems, the authors confirmed improvements and delayed effects in MCI patients in this study for three years through cognitive intervention, demonstrating its effectiveness. Cognitive interventions were conducted for memory retrieval and steadily stimulated the brain by performing tasks to solve problems during daily conversations.
Findings
As a result, the intervention group retained mini-mental state examination and Montreal cognitive assessment scores on the domains of cognitive function and also instrumental activities of daily living in the domain of motion compared to the non-intervention group. Moreover, significant improvements in geriatric depression scales-15 and quality-of-life scales enabled the patients to maintain stable living compared to before the intervention. In addition, the intervention group showed a change in patterns that allowed them to voluntarily devote time to going out at the end of the study.
Research limitations/implications
This study was originally planned to compare the rates of transmission from MCI to dementia by tracking over five years (2016–2021). However, due to the impact of COVID-19, which began to spread around the world in 2020, further face-to-face visits and cognitive intervention became impossible. Thus, only half of the data in the existing plans were collected. Although it is difficult to present accurate results for the rate of transmission from MCI to dementia, the tendency was confirmed, indicating sufficient implications as an intervention.
Originality/value
This study was originally planned to compare the rates of transmission from MCI to dementia by tracking three years (2016–2019). The authors had studied for long-term effect.
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21
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Deardorff WJ, Lee SJ. Mild cognitive impairment as a clinical and research outcome: Ready for prime time? J Am Geriatr Soc 2022; 70:1361-1364. [PMID: 35293612 PMCID: PMC9714338 DOI: 10.1111/jgs.17744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022]
Affiliation(s)
- William James Deardorff
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.,Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Sei J Lee
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.,Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
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22
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Jester DJ, Vyhnálek M, Andel R, Marková H, Nikolai T, Laczó J, Matusková V, Cechová K, Sheardova K, Hort J. Progression from Subjective Cognitive Decline to Mild Cognitive Impairment or Dementia: The Role of Baseline Cognitive Performance. J Alzheimers Dis 2022; 86:1763-1774. [DOI: 10.3233/jad-215291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Older adults with subjective cognitive decline (SCD) are at an increased risk of progression to mild cognitive impairment (MCI) or dementia. However, few have examined the specific cognitive tests that are associated with progression. Objective: This study examined performance on 18 neuropsychological tests among participants with SCD who later progressed to MCI or dementia. Methods: We included 131 participants from the Czech Brain Aging Study that had SCD at baseline. They completed a comprehensive neuropsychological battery including cognitive tests from the Uniform Data Set 2.0 enriched by the verbal memory test Rey Auditory Verbal Learning Test (RAVLT) and Rey-Osterrieth Complex Figure Test (ROCFT). Results: Fifty-five participants progressed: 53% to non-amnestic MCI (naMCI), 44% to amnestic MCI (aMCI), and 4% to dementia. Scoring one SD below the mean at baseline on the RAVLT 1 and RAVLT 1–5 was associated with 133% (RAVLT 1; HR: 2.33 [1.50, 3.62]) and 122% (RAVLT 1–5; HR: 2.22 [1.55, 3.16]) greater risk of progression to MCI or dementia over 3.84 years on average. Worse performance on the RAVLT 5, RAVLT 1–5, RAVLT 30, and ROCFT–Recall was associated with progression to aMCI whereas worse performance on the RAVLT 1, TMT B, and Boston Naming Test was associated with progression to naMCI. Conclusion: At baseline, lower verbal memory performance was most strongly associated with progression to aMCI whereas lower executive or language performance was most strongly associated with progression to naMCI.
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Affiliation(s)
- Dylan J. Jester
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA
| | - Martin Vyhnálek
- Memory Clinic, Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Ross Andel
- Memory Clinic, Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Hana Marková
- Memory Clinic, Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Tomás Nikolai
- Memory Clinic, Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Jan Laczó
- Memory Clinic, Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Veronika Matusková
- Memory Clinic, Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Katerina Cechová
- Memory Clinic, Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Katerina Sheardova
- Memory Clinic, Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
- First Department of Neurology, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jakub Hort
- Memory Clinic, Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
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23
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Gaussoin SA, Pajewski NM, Chelune G, Cleveland ML, Crowe MG, Launer LJ, Lerner AJ, Martindale-Adams J, Nichols LO, Ogrocki PK, Sachs BC, Sink KM, Supiano MA, Wadley VG, Wilson VM, Wright CB, Williamson JD, Reboussin DM, Rapp SR. Effect of intensive blood pressure control on subtypes of mild cognitive impairment and risk of progression from SPRINT study. J Am Geriatr Soc 2021; 70:1384-1393. [PMID: 34826341 PMCID: PMC9106821 DOI: 10.1111/jgs.17583] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND To examine the effect of intensive blood pressure control on the occurrence of subtypes of mild cognitive impairment (MCI) and determine the risk of progression to dementia or death. METHODS Secondary analysis of a randomized trial of community-dwelling adults (≥50 years) with hypertension. Participants were randomized to a systolic blood pressure (SBP) goal of <120 mm Hg (intensive treatment; n = 4678) or <140 mm Hg (Standard treatment; n = 4683). Outcomes included adjudicated MCI, MCI subtype (amnestic, non-amnestic, multi-domain, single domain), and probable dementia. Multistate survival models were used to examine transitions in cognitive status accounting for the competing risk of death. RESULTS Among 9361 randomized participants (mean age, 67.9 years; 3332 women [35.6%]), 640 participants met the protocol definition for MCI, with intensive treatment reducing the risk of MCI overall (hazard ratio [HR], 0.81 [95% confidence interval {CI}, 0.69-0.94]), as previously reported. This effect was largely reflected in amnestic subtypes (HR, 0.78 [95% CI, 0.66-0.92]) and multi-domain subtypes (HR, 0.78 [95% CI, 0.65-0.93]). An adjudication of MCI, as compared with normal cognitive function, substantially increased the probability of progressing to probable dementia (5.9% [95% CI: 4.5%-7.7%] vs. 0.6% [95% CI: 0.3%-0.9%]) and to death (10.0% [95% CI: 8.3%-11.9%] vs. 2.3% [95% CI: 2.0%-2.7%]) within 2 years. CONCLUSIONS Intensive treatment reduced the risk for amnestic and multi-domain subtypes of MCI. An adjudication of MCI was associated with increased risk of progression to dementia and death, highlighting the relevance of MCI as a primary outcome in clinical and research settings.
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Affiliation(s)
- Sarah A Gaussoin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Gordon Chelune
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Maryjo L Cleveland
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael G Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lenore J Launer
- Neuroepidemiology Section, Intramural Research Program, National Institute on Aging, Bethesda, Maryland, USA
| | - Alan J Lerner
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jennifer Martindale-Adams
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Paula K Ogrocki
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Bonnie C Sachs
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Mark A Supiano
- Division of Geriatrics, University of Utah School of Medicine, Salt Lake City, Ohio, USA.,VA Geriatric Research, Education and Clinical Center, Salt Lake City, Ohio, USA
| | - Virginia G Wadley
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Valerie M Wilson
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Clinton B Wright
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Jeff D Williamson
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David M Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Stephen R Rapp
- Department of Social Sciences and Health Policy, Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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24
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Abstract
This study investigated the effects of vortioxetine on cognitive function in adults with mild cognitive impairment (MCI). This single-arm, open-label, phase II study enrolled 111 adults with MCI without depressive symptoms to receive 5-10 mg/day vortioxetine for 6 months. Main outcomes assessed: cognitive function [Montreal Cognitive Assessment (MoCA); Digit Symbol Substitution Test (DSST)], disease severity [Clinical Dementia Rating (CDR)], clinician-assessed improvement and safety. Mean MoCA score increased from 24.2 points (baseline) to 29.7 points (month 6), placing most subjects within the cognitively normal range (≥26 points). Compared with baseline, MoCA and DSST scores were significantly improved at months 1, 3 and 6 (P < 0.001 for all). Global CDR scores significantly improved from baseline to month 6 (mean change -0.37 points; P < 0.001), representing an improvement from very mild impairment (0.50 points) to cognitively normal status (0.13 points), mainly in CDR memory scores. At month 6, 89.6% of subjects had improved disease severity. Adverse events and adverse drug reactions were reported in 9.9% (n = 11) and 2.7% (n = 3) of subjects, respectively. Vortioxetine treatment was associated with significant improvement in cognitive function and a favorable safety profile in community-dwelling older adults with MCI. Given the lack of evidence for efficacious pharmacologic interventions for MCI, our results are encouraging and warrant further investigation.
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Affiliation(s)
- Sheng Neng Tan
- The Good Life Medical Center, Mount Alvernia Hospital, Singapore, Singapore
| | - Carol Tan
- The Good Life Medical Center, Mount Alvernia Hospital, Singapore, Singapore
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25
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Doborjeh M, Doborjeh Z, Merkin A, Bahrami H, Sumich A, Krishnamurthi R, Medvedev ON, Crook-Rumsey M, Morgan C, Kirk I, Sachdev PS, Brodaty H, Kang K, Wen W, Feigin V, Kasabov N. Personalised predictive modelling with brain-inspired spiking neural networks of longitudinal MRI neuroimaging data and the case study of dementia. Neural Netw 2021; 144:522-539. [PMID: 34619582 DOI: 10.1016/j.neunet.2021.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 08/11/2021] [Accepted: 09/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Longitudinal neuroimaging provides spatiotemporal brain data (STBD) measurement that can be utilised to understand dynamic changes in brain structure and/or function underpinning cognitive activities. Making sense of such highly interactive information is challenging, given that the features manifest intricate temporal, causal relations between the spatially distributed neural sources in the brain. METHODS The current paper argues for the advancement of deep learning algorithms in brain-inspired spiking neural networks (SNN), capable of modelling structural data across time (longitudinal measurement) and space (anatomical components). The paper proposes a methodology and a computational architecture based on SNN for building personalised predictive models from longitudinal brain data to accurately detect, understand, and predict the dynamics of an individual's functional brain state. The methodology includes finding clusters of similar data to each individual, data interpolation, deep learning in a 3-dimensional brain-template structured SNN model, classification and prediction of individual outcome, visualisation of structural brain changes related to the predicted outcomes, interpretation of results, and individual and group predictive marker discovery. RESULTS To demonstrate the functionality of the proposed methodology, the paper presents experimental results on a longitudinal magnetic resonance imaging (MRI) dataset derived from 175 older adults of the internationally recognised community-based cohort Sydney Memory and Ageing Study (MAS) spanning 6 years of follow-up. SIGNIFICANCE The models were able to accurately classify and predict 2 years ahead of cognitive decline, such as mild cognitive impairment (MCI) and dementia with 95% and 91% accuracy, respectively. The proposed methodology also offers a 3-dimensional visualisation of the MRI models reflecting the dynamic patterns of regional changes in white matter hyperintensity (WMH) and brain volume over 6 years. CONCLUSION The method is efficient for personalised predictive modelling on a wide range of neuroimaging longitudinal data, including also demographic, genetic, and clinical data. As a case study, it resulted in finding predictive markers for MCI and dementia as dynamic brain patterns using MRI data.
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Affiliation(s)
- Maryam Doborjeh
- Computer Science and Software Engineering Department, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, New Zealand.
| | - Zohreh Doborjeh
- Department of Audiology, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - Alexander Merkin
- The National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, New Zealand
| | - Helena Bahrami
- School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, New Zealand
| | - Alexander Sumich
- NTU Psychology, Nottingham Trent University, Nottingham, United Kingdom
| | - Rita Krishnamurthi
- The National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, New Zealand
| | - Oleg N Medvedev
- University of Waikato, School of Psychology, Hamilton, New Zealand
| | - Mark Crook-Rumsey
- NTU Psychology, Nottingham Trent University, Nottingham, United Kingdom; School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, New Zealand
| | - Catherine Morgan
- School of Psychology and Centre for Brain Research, University of Auckland, New Zealand; Brain Research New Zealand - Rangahau Roro Aotearoa, Centre of Research Excellence, New Zealand
| | - Ian Kirk
- School of Psychology and Centre for Brain Research, University of Auckland, New Zealand; Brain Research New Zealand - Rangahau Roro Aotearoa, Centre of Research Excellence, New Zealand
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia; Neuropsychiatric Institute, the Prince of Wales Hospital, Sydney, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Kristan Kang
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Wei Wen
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia; Neuropsychiatric Institute, the Prince of Wales Hospital, Sydney, Australia
| | - Valery Feigin
- The National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, New Zealand; Research Center of Neurology, Moscow, Russia
| | - Nikola Kasabov
- School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, New Zealand; George Moore Chair, Ulster University, Londonderry, United Kingdom
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26
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Langhough Koscik R, Hermann BP, Allison S, Clark LR, Jonaitis EM, Mueller KD, Betthauser TJ, Christian BT, Du L, Okonkwo O, Birdsill A, Chin N, Gleason C, Johnson SC. Validity Evidence for the Research Category, "Cognitively Unimpaired - Declining," as a Risk Marker for Mild Cognitive Impairment and Alzheimer's Disease. Front Aging Neurosci 2021; 13:688478. [PMID: 34381351 PMCID: PMC8350058 DOI: 10.3389/fnagi.2021.688478] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/16/2021] [Indexed: 12/11/2022] Open
Abstract
While clinically significant cognitive impairment is the key feature of the symptomatic stages of the Alzheimer's disease (AD) continuum, subtle cognitive decline is now known to occur years before a clinical diagnosis of mild cognitive impairment (MCI) or dementia due to AD is made. The primary aim of this study was to examine criterion validity evidence for an operational definition of "cognitively unimpaired-declining" (CU-D) in the Wisconsin Registry for Alzheimer's Prevention (WRAP), a longitudinal cohort study following cognition and risk factors from mid-life and on. Cognitive status was determined for each visit using a consensus review process that incorporated internal norms and published norms; a multi-disciplinary panel reviewed cases first to determine whether MCI or dementia was present, and subsequently whether CU-D was present, The CU-D group differed from CU-stable (CU-S) and MCI on concurrent measures of cognition, demonstrating concurrent validity. Participants who changed from CU-S to CU-D at the next study visit demonstrated greater declines than those who stayed CU-S. In addition, those who were CU-D were more likely to progress to MCI or dementia than those who were CU-S (predictive validity). In a subsample with positron emission tomography (PET) imaging, the CU-D group also differed from the CU-S and MCI/Dementia groups on measures of amyloid and tau burden, indicating that biomarker evidence of AD was elevated in those showing sub-clinical (CU-D) decline. Together, the results corroborate other studies showing that cognitive decline begins long before a dementia diagnosis and indicate that operational criteria can detect subclinical decline that may signal AD or other dementia risk.
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Affiliation(s)
- Rebecca Langhough Koscik
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
| | - Bruce P Hermann
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
- Department of Neurology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Samantha Allison
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
- Madison VA GRECC, William S. Middleton Memorial Hospital, Madison, WI, United States
| | - Lindsay R Clark
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
- Madison VA GRECC, William S. Middleton Memorial Hospital, Madison, WI, United States
| | - Erin M Jonaitis
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
| | - Kimberly D Mueller
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
- Department of Communication Sciences and Disorders, University of Wisconsin, Madison, WI, United States
| | - Tobey J Betthauser
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
| | - Bradley T Christian
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
- Department of Medical Physics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Lianlian Du
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Ozioma Okonkwo
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
| | - Alex Birdsill
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
- Madison VA GRECC, William S. Middleton Memorial Hospital, Madison, WI, United States
| | - Nathaniel Chin
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
| | - Carey Gleason
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
- Madison VA GRECC, William S. Middleton Memorial Hospital, Madison, WI, United States
- Department of Geriatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Sterling C Johnson
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
- Madison VA GRECC, William S. Middleton Memorial Hospital, Madison, WI, United States
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27
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Microstructural white matter alterations in Alzheimer's disease and amnestic mild cognitive impairment and its diagnostic value based on diffusion kurtosis imaging: a tract-based spatial statistics study. Brain Imaging Behav 2021; 16:31-42. [PMID: 33895943 DOI: 10.1007/s11682-021-00474-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
This prospective study aimed to explore the white matter microstructural alterations in Alzheimer's disease (AD) and amnestic mild cognitive impairment (aMCI) using the Tract-based Spatial Statistics (TBSS) method of diffusion kurtosis imaging (DKI).Diffusion images were collected from 45 AD patients, 42 aMCI patients, and 35 healthy controls (HC). The differences of DKI-derived parameters, including kurtosis fractional anisotropy (KFA), mean kurtosis (MK), fractional anisotropy (FA), and mean diffusivity (MD), were compared across the three groups using the TBSS method. Correlation between the altered DKI-derived parameters and the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores were analyzed. A receiver operating characteristic curve (ROC) was used to evaluate the diagnostic performance of different white matter parameters with the strongest correlations. As a result, compared with the HC group, KFA values decreased significantly in the aMCI group. Compared with both the HC and aMCI groups, the FA, KFA, and MK values decreased significantly and the MD value increased significantly in the AD group. FA, MD, KFA, and MK values of many white matter fiber tracts were significantly correlated with MMSE and MoCA scores. The area under the ROC curve (AUC) for the splenium of corpus callosum KFA values were highest for the diagnosis of aMCI and AD patients. In conclusion, the compactness and complexity of white matter microstructures were reduced in AD and aMCI patients. DKI can provide information about the severity of AD progression, and KFA might be more sensitive for the detection of white matter microstructural alterations.
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Daniels RD, Clouston SAP, Hall CB, Anderson KR, Bennett DA, Bromet EJ, Calvert GM, Carreón T, DeKosky ST, Diminich ED, Finch CE, Gandy S, Kreisl WC, Kritikos M, Kubale TL, Mielke MM, Peskind ER, Raskind MA, Richards M, Sano M, Santiago-Colón A, Sloan RP, Spiro A, Vasdev N, Luft BJ, Reissman DB. A Workshop on Cognitive Aging and Impairment in the 9/11-Exposed Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E681. [PMID: 33466931 PMCID: PMC7830144 DOI: 10.3390/ijerph18020681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 12/11/2022]
Abstract
The terrorist attacks on 11 September 2001 potentially exposed more than 400,000 responders, workers, and residents to psychological and physical stressors, and numerous hazardous pollutants. In 2011, the World Trade Center Health Program (WTCHP) was mandated to monitor and treat persons with 9/11-related adverse health conditions and conduct research on physical and mental health conditions related to the attacks. Emerging evidence suggests that persons exposed to 9/11 may be at increased risk of developing mild cognitive impairment. To investigate further, the WTCHP convened a scientific workshop that examined the natural history of cognitive aging and impairment, biomarkers in the pathway of neurodegenerative diseases, the neuropathological changes associated with hazardous exposures, and the evidence of cognitive decline and impairment in the 9/11-exposed population. Invited participants included scientists actively involved in health-effects research of 9/11-exposed persons and other at-risk populations. Attendees shared relevant research results from their respective programs and discussed several options for enhancements to research and surveillance activities, including the development of a multi-institutional collaborative research network. The goal of this report is to outline the meeting's agenda and provide an overview of the presentation materials and group discussion.
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Affiliation(s)
- Robert D. Daniels
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - Sean A. P. Clouston
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.A.P.C.); (E.J.B.); (E.D.D.); (M.K.); (B.J.L.)
| | - Charles B. Hall
- Department of Epidemiology & Population Health (Biostatistics), Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Kristi R. Anderson
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - David A. Bennett
- Department of Neurological Sciences, Rush Medical College, Rush University, Chicago, IL 60612, USA;
| | - Evelyn J. Bromet
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.A.P.C.); (E.J.B.); (E.D.D.); (M.K.); (B.J.L.)
| | - Geoffrey M. Calvert
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - Tania Carreón
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - Steven T. DeKosky
- McKnight Brain Institute, University of Florida, Gainesville, FL 32611, USA;
| | - Erica D. Diminich
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.A.P.C.); (E.J.B.); (E.D.D.); (M.K.); (B.J.L.)
| | - Caleb E. Finch
- USC Leonard Davis School of Gerontology, Los Angeles, CA 90089, USA;
| | - Sam Gandy
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (S.G.); (M.S.)
| | - William C. Kreisl
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, New York, NY 10032, USA;
| | - Minos Kritikos
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.A.P.C.); (E.J.B.); (E.D.D.); (M.K.); (B.J.L.)
| | - Travis L. Kubale
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - Michelle M. Mielke
- Division of Epidemiology and Department of Neurology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA;
| | - Elaine R. Peskind
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA;
| | - Murray A. Raskind
- Northwest Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA 98108, USA;
| | - Marcus Richards
- Faculty of Population Health Sciences, University College London, London WC1E 6BT, UK;
| | - Mary Sano
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (S.G.); (M.S.)
| | - Albeliz Santiago-Colón
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
| | - Richard P. Sloan
- Division of Behavioral Medicine, Columbia University, New York, NY 10027, USA;
| | - Avron Spiro
- Boston University Schools of Public Health and Medicine and Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA;
| | - Neil Vasdev
- Azrieli Centre for Neuro-Radiochemistry, Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH) & Department of Psychiatry, University of Toronto, Toronto, ON M5S, Canada;
| | - Benjamin J. Luft
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (S.A.P.C.); (E.J.B.); (E.D.D.); (M.K.); (B.J.L.)
| | - Dori B. Reissman
- World Trade Center Health Program, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC 20201, USA; (K.R.A.); (G.M.C.); (T.C.); (T.L.K.); (A.S.-C.); (D.B.R.)
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29
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Thomas KR, Cook SE, Bondi MW, Unverzagt FW, Gross AL, Willis SL, Marsiske M. Application of neuropsychological criteria to classify mild cognitive impairment in the active study. Neuropsychology 2020; 34:862-873. [PMID: 33197199 PMCID: PMC8376229 DOI: 10.1037/neu0000694] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objective: Comprehensive neuropsychological criteria (NP criteria) for mild cognitive impairment (MCI) has reduced diagnostic errors and better predicted progression to dementia than conventional MCI criteria that rely on a single impaired score and/or subjective report. This study aimed to implement an actuarial approach to classifying MCI in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study. Method: ACTIVE study participants (N = 2,755) were classified as cognitively normal (CN) or as having MCI using NP criteria. Estimated proportion of MCI participants and reversion rates were examined as well as baseline characteristics by MCI subtype. Mixed effect models examined associations of MCI subtype with 10-year trajectories of self-reported independence and difficulty performing instrumental activities of daily living (IADLs). Results: The proportion of MCI participants was estimated to be 18.8%. Of those with MCI at baseline, 19.2% reverted to CN status for all subsequent visits. At baseline, the multidomain-amnestic MCI group generally had the greatest breadth and depth of cognitive impairment and reported the most IADL difficulty. Longitudinally, MCI participants showed faster IADL decline than CN participants (multidomain-amnestic MCI > single domain-amnestic MCI > nonamnestic MCI). Conclusion: NP criteria identified a proportion of MCI and reversion rate within ACTIVE that is consistent with prior studies involving community-dwelling samples. The pattern of everyday functioning change suggests that being classified as MCI, particularly amnestic MCI, is predictive of future loss of independence. Future work will apply these classifications in ACTIVE to better understand the relationships between MCI and health, social, and cognitive intervention-related factors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Kelsey R. Thomas
- Veterans Affairs San Diego Healthcare System, San Diego, CA,Department of Psychiatry, University of California, San Diego School of Medicine, La Jolla, CA
| | - Sarah E. Cook
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Mark W. Bondi
- Veterans Affairs San Diego Healthcare System, San Diego, CA,Department of Psychiatry, University of California, San Diego School of Medicine, La Jolla, CA
| | | | - Alden L. Gross
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Sherry L. Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
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30
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Jin R, Pilozzi A, Huang X. Current Cognition Tests, Potential Virtual Reality Applications, and Serious Games in Cognitive Assessment and Non-Pharmacological Therapy for Neurocognitive Disorders. J Clin Med 2020; 9:E3287. [PMID: 33066242 PMCID: PMC7602094 DOI: 10.3390/jcm9103287] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 12/13/2022] Open
Abstract
As the global population ages, the incidence of major neurocognitive disorders (major NCDs), such as the most common geriatric major NCD, Alzheimer's disease (AD), has grown. Thus, the need for more definitive cognitive assessment or even effective non-pharmacological intervention for age-related NCDs is becoming more and more pressing given that no definitive diagnostics or efficacious therapeutics are currently unavailable for them. We evaluate the current state of the art of cognitive assessment for major NCDs, and then briefly glance ahead at potential application of virtual reality (VR) technologies in major NCD assessment and in cognition training of visuospatial reasoning in a 3D environment, as well as in the alleviation of depression and other symptoms of cognitive disorders. We believe that VR-based technologies have tremendous potentials in cognitive assessment and non-pharmacological therapy for major NCDs.
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Affiliation(s)
| | | | - Xudong Huang
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA; (R.J.); (A.P.)
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31
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Mild Cognitive Impairment in Retired Professional Football Players With a History of Mild Traumatic Brain Injury: A Pilot Investigation. Cogn Behav Neurol 2020; 33:208-217. [PMID: 32889953 DOI: 10.1097/wnn.0000000000000240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a known risk factor for neurodegenerative dementias such as Alzheimer disease (AD); however, the potential risk of mild cases of TBI, such as concussions, remains unclear. OBJECTIVE To explore whether a small sample of retired professional athletes with a diagnosis of mild cognitive impairment (MCI)-the prodromal stage of AD-and a history of multiple mild TBIs exhibit greater neuropsychological impairment than age-matched nonathletes with MCI and no history of TBI. METHOD Ten retired National Football League players diagnosed with MCI and reporting multiple mild TBIs, and 10 nonathletes, also diagnosed with MCI but with no history of TBI, completed a standard neurologic examination and neuropsychological testing. Independent samples t tests were conducted to examine differences in neuropsychological performance between the two groups. RESULTS The retired athletes with a history of mild TBI obtained generally similar scores to the nonathlete controls on measures of verbal learning and memory, verbal fluency, and processing speed. However, the retired athletes scored lower than the controls on tests of confrontation naming and speeded visual attention. CONCLUSION Retired athletes with MCI and a history of mild TBI demonstrated similar neuropsychological profiles as nonathlete controls despite lower scores on measures of confrontation naming and speeded visual attention. These findings suggest that a history of multiple mild TBIs does not significantly alter the overall neuropsychological profile of individuals with MCI; confirmation of this will require longitudinal research with larger sample sizes.
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32
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Overton M, Pihlsgård M, Elmståhl S. Diagnostic Stability of Mild Cognitive Impairment, and Predictors of Reversion to Normal Cognitive Functioning. Dement Geriatr Cogn Disord 2020; 48:317-329. [PMID: 32224608 DOI: 10.1159/000506255] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 01/23/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Studies that investigate predictive factors for spontaneous recovery (reversion) from mild cognitive impairment (MCI) are only beginning to emerge, and the long-term course of MCI is not properly understood. We aimed to investigate stability of the MCI diagnosis, predictors for reversion, as well as the trajectory of MCI over the course of 12 years. MATERIALS AND METHODS Data were drawn from the Swedish population study: Good Aging in Skåne with MCI defined according to the expanded Mayo Clinic criteria. A total of 331 participants, aged 60-95 years with MCI, were used to investigate 6-year MCI stability and reversion, and 410 participants were used to inspect 12-year MCI trajectory. Predictors for reversion included demographical factors, psychological status, and factors tied to the cognitive testing session and the operationalization of the MCI criteria. RESULTS Over half (58%, 95% CI 52.7-63.3) of the participants reverted back to normal cognitive functioning at 6-year follow-up. Of those with stable MCI, 56.5% (95% CI 48.2-64.8) changed subtype. A total of 23.9% (95% CI 13.7-34.1) of the 6-year follow-up reverters re-transitioned back to MCI at 12-year follow-up. ORs for reversion were significantly higher in participants with lower age (60-year-olds: OR 2.19, 95% CI 1.08-4.43, 70-year-olds: OR 3.11, 95% CI 1.27-7.62), better global cognitive functioning (OR 1.15, 95% CI 1.03-1.29), good concentration (OR 2.53, 95% CI 1.06-6.05), and single-domain subtype (OR 2.68, 95% CI 1.51-4.75). CONCLUSION Our findings provide further support that MCI reversion to normal cognitive functioning as well as re-transitioning to MCI is fairly common, suggesting that the MCI trajectory does not necessarily lead straight to dementia. Additionally, assessment of factors associated with reversion can aid clinicians to make accurate MCI progression prognosis.
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Affiliation(s)
- Marieclaire Overton
- Division of Geriatric Medicine, Lund University, Skånes University Hospital, Malmö, Sweden,
| | - Mats Pihlsgård
- Division of Geriatric Medicine, Lund University, Skånes University Hospital, Malmö, Sweden
| | - Sölve Elmståhl
- Division of Geriatric Medicine, Lund University, Skånes University Hospital, Malmö, Sweden
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33
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Machine Learning Analysis of Digital Clock Drawing Test Performance for Differential Classification of Mild Cognitive Impairment Subtypes Versus Alzheimer's Disease. J Int Neuropsychol Soc 2020; 26:690-700. [PMID: 32200771 DOI: 10.1017/s1355617720000144] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine how well machine learning algorithms can classify mild cognitive impairment (MCI) subtypes and Alzheimer's disease (AD) using features obtained from the digital Clock Drawing Test (dCDT). METHODS dCDT protocols were administered to 163 patients diagnosed with AD(n = 59), amnestic MCI (aMCI; n = 26), combined mixed/dysexecutive MCI (mixed/dys MCI; n = 43), and patients without MCI (non-MCI; n = 35) using standard clock drawing command and copy procedures, that is, draw the face of the clock, put in all of the numbers, and set the hands for "10 after 11." A digital pen and custom software recorded patient's drawings. Three hundred and fifty features were evaluated for maximum information/minimum redundancy. The best subset of features was used to train classification models to determine diagnostic accuracy. RESULTS Neural network employing information theoretic feature selection approaches achieved the best 2-group classification results with 10-fold cross validation accuracies at or above 83%, that is, AD versus non-MCI = 91.42%; AD versus aMCI = 91.49%; AD versus mixed/dys MCI = 84.05%; aMCI versus mixed/dys MCI = 84.11%; aMCI versus non-MCI = 83.44%; and mixed/dys MCI versus non-MCI = 85.42%. A follow-up two-group non-MCI versus all MCI patients analysis yielded comparable results (83.69%). Two-group classification analyses were achieved with 25-125 dCDT features depending on group classification. Three- and four-group analyses yielded lower but still promising levels of classification accuracy. CONCLUSION Early identification of emergent neurodegenerative illness is criterial for better disease management. Applying machine learning to standard neuropsychological tests promises to be an effective first line screening method for classification of non-MCI and MCI subtypes.
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34
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Chen Q, Wang Y, Qiu Y, Wu X, Zhou Y, Zhai G. A Deep Learning-Based Model for Classification of Different Subtypes of Subcortical Vascular Cognitive Impairment With FLAIR. Front Neurosci 2020; 14:557. [PMID: 32625048 PMCID: PMC7315844 DOI: 10.3389/fnins.2020.00557] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/06/2020] [Indexed: 11/17/2022] Open
Abstract
Deep learning methods have shown their great capability of extracting high-level features from image and have been used for effective medical imaging classification recently. However, training samples of medical images are restricted by the amount of patients as well as medical ethics issues, making it hard to train the neural networks. In this paper, we propose a novel end-to-end three-dimensional (3D) attention-based residual neural network (ResNet) architecture to classify different subtypes of subcortical vascular cognitive impairment (SVCI) with single-shot T2-weighted fluid-attenuated inversion recovery (FLAIR) sequence. Our aim is to develop a convolutional neural network to provide a convenient and effective way to assist doctors in the diagnosis and early treatment of the different subtypes of SVCI. The experiment data in this paper are collected from 242 patients from the Neurology Department of Renji Hospital, including 78 amnestic mild cognitive impairment (a-MCI), 70 nonamnestic MCI (na-MCI), and 94 no cognitive impairment (NCI). The accuracy of our proposed model has reached 98.6% on a training set and 97.3% on a validation set. The test accuracy on an untrained testing set reaches 93.8% with robustness. Our proposed method can provide a convenient and effective way to assist doctors in the diagnosis and early treatment.
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Affiliation(s)
- Qi Chen
- Institute of Image Communication and Network Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yao Wang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yage Qiu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaowei Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Zhou
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guangtao Zhai
- Institute of Image Communication and Network Engineering, Shanghai Jiao Tong University, Shanghai, China
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35
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Machulda MM, Lundt ES, Albertson SM, Spychalla AJ, Schwarz CG, Mielke MM, Jack CR, Kremers WK, Vemuri P, Knopman DS, Jones DT, Bondi MW, Petersen RC. Cortical atrophy patterns of incident MCI subtypes in the Mayo Clinic Study of Aging. Alzheimers Dement 2020; 16:1013-1022. [PMID: 32418367 PMCID: PMC7383989 DOI: 10.1002/alz.12108] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 03/13/2020] [Accepted: 03/23/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION We examined differences in cortical thickness in empirically derived mild cognitive impairment (MCI) subtypes in the Mayo Clinic Study of Aging. METHODS We compared cortical thickness of four incident MCI subtypes (n = 192) to 1257 cognitive unimpaired individuals. RESULTS The subtle cognitive impairment cluster had atrophy in the entorhinal and parahippocampal cortex. The amnestic, dysnomic, and dysexecutive clusters also demonstrated entorhinal cortex atrophy as well as thinning in temporal, parietal, and frontal isocortex in somewhat different patterns. DISCUSSION We found patterns of atrophy in each of the incident MCI clusters that corresponded to their patterns of cognitive impairment. The identification of MCI subtypes based on cognitive and structural features may allow for more efficient trial and study designs. Given individuals in the subtle cognitive impairment cluster have less structural changes and cognitive decline and may represent the earliest group, this could be a unique group to target with early interventions.
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Affiliation(s)
- Mary M Machulda
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Emily S Lundt
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Sabrina M Albertson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Michelle M Mielke
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Walter K Kremers
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, California, USA.,Veterans Affairs San Diego Healthcare System, San Diego, California, USA
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Qin T, Prins S, Groeneveld GJ, Van Westen G, de Vries HE, Wong YC, Bischoff LJ, de Lange EC. Utility of Animal Models to Understand Human Alzheimer's Disease, Using the Mastermind Research Approach to Avoid Unnecessary Further Sacrifices of Animals. Int J Mol Sci 2020; 21:ijms21093158. [PMID: 32365768 PMCID: PMC7247586 DOI: 10.3390/ijms21093158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/18/2022] Open
Abstract
To diagnose and treat early-stage (preclinical) Alzheimer’s disease (AD) patients, we need body-fluid-based biomarkers that reflect the processes that occur in this stage, but current knowledge on associated processes is lacking. As human studies on (possible) onset and early-stage AD would be extremely expensive and time-consuming, we investigate the potential value of animal AD models to help to fill this knowledge gap. We provide a comprehensive overview of processes associated with AD pathogenesis and biomarkers, current knowledge on AD-related biomarkers derived from on human and animal brains and body fluids, comparisons of biomarkers obtained in human AD and frequently used animal AD models, and emerging body-fluid-based biomarkers. In human studies, amyloid beta (Aβ), hyperphosphorylated tau (P-tau), total tau (T-tau), neurogranin, SNAP-25, glial fibrillary acidic protein (GFAP), YKL-40, and especially neurofilament light (NfL) are frequently measured. In animal studies, the emphasis has been mostly on Aβ. Although a direct comparison between human (familial and sporadic) AD and (mostly genetic) animal AD models cannot be made, still, in brain, cerebrospinal fluid (CSF), and blood, a majority of similar trends are observed for human AD stage and animal AD model life stage. This indicates the potential value of animal AD models in understanding of the onset and early stage of AD. Moreover, animal studies can be smartly designed to provide mechanistic information on the interrelationships between the different AD processes in a longitudinal fashion and may also include the combinations of different conditions that may reflect comorbidities in human AD, according to the Mastermind Research approach.
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Affiliation(s)
- Tian Qin
- Predictive Pharmacology, Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre of Drug Research, Leiden University, 2333 CC Leiden, The Netherlands; (T.Q.); (L.J.M.B.)
| | - Samantha Prins
- Centre for Human Drug Research (CHDR), 2333 CL Leiden, The Netherlands; (S.P.); (G.J.G.)
| | - Geert Jan Groeneveld
- Centre for Human Drug Research (CHDR), 2333 CL Leiden, The Netherlands; (S.P.); (G.J.G.)
| | - Gerard Van Westen
- Computational Drug Discovery, Division of Drug Discovery and Safety, Leiden Academic Centre of Drug Research, Leiden University, 2333 CC Leiden, The Netherlands;
| | - Helga E. de Vries
- Neuro-immunology research group, Department of Molecular Cell Biology and Immunology, Amsterdam Neuroscience, Amsterdam UMC, 1081 HZ Amsterdam, The Netherlands;
| | - Yin Cheong Wong
- Advanced Modelling and Simulation, UCB Celltech, Slough SL1 3WE, UK;
| | - Luc J.M. Bischoff
- Predictive Pharmacology, Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre of Drug Research, Leiden University, 2333 CC Leiden, The Netherlands; (T.Q.); (L.J.M.B.)
| | - Elizabeth C.M. de Lange
- Predictive Pharmacology, Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre of Drug Research, Leiden University, 2333 CC Leiden, The Netherlands; (T.Q.); (L.J.M.B.)
- Correspondence: ; Tel.: +31-71-527-6330
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The MemClin project: a prospective multi memory clinics study targeting early stages of cognitive impairment. BMC Geriatr 2020; 20:93. [PMID: 32138686 PMCID: PMC7059672 DOI: 10.1186/s12877-020-1478-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/17/2020] [Indexed: 12/17/2022] Open
Abstract
Background There remains a lack of large-scale clinical studies of cognitive impairment that aim to increase diagnostic and prognostic accuracy as well as validate previous research findings. The MemClin project will amass large quantities of cross-disciplinary data allowing for the construction of robust models to improve diagnostic accuracy, expand our knowledge on differential diagnostics, strengthen longitudinal prognosis, and harmonise examination protocols across centres. The current article describes the Memory Clinic (MemClin) project’s study-design, materials and methods, and patient characteristics. In addition, we present preliminary descriptive data from the ongoing data collection. Methods Nine out of ten memory clinics in the greater Stockholm area, which largely use the same examination methods, are included. The data collection of patients with different stages of cognitive impairment and dementia is coordinated centrally allowing for efficient and secure large-scale database construction. The MemClin project rest directly on the memory clinics examinations with cognitive measures, health parameters, and biomarkers. Results Currently, the MemClin project has informed consent from 1543 patients. Herein, we present preliminary data from 835 patients with confirmed cognitive diagnosis and neuropsychological test data available. Of those, 239 had dementia, 487 mild cognitive impairment (MCI), and 104 subjective cognitive impairment (SCI). In addition, we present descriptive data on visual ratings of brain atrophy and cerebrospinal fluid markers. Conclusions Based on our current progress and preliminary data, the MemClin project has a high potential to provide a large-scale database of 1200–1500 new patients annually. This coordinated data collection will allow for the construction of improved diagnostic and prognostic models for neurodegenerative disorders and other cognitive conditions in their naturalistic setting.
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Overton M, Pihlsgård M, Elmståhl S. Prevalence and Incidence of Mild Cognitive Impairment across Subtypes, Age, and Sex. Dement Geriatr Cogn Disord 2020; 47:219-232. [PMID: 31311017 DOI: 10.1159/000499763] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/20/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The purpose of this study was to report on the prevalence and incidence of mild cognitive impairment (MCI) across age, sex, and subtypes according to various criteria in a population-based sample. METHODS The sample was drawn from the Swedish Good Aging in Skåne (GÅS) population study, and data from 3,752 participants aged 60 years and more were used to calculate the MCI prevalence. The incidence was calculated using 2,093 participants with 6-year follow-up data. MCI was defined according to the expanded Mayo Clinic criteria: cognitive complaint, objective cognitive impairment (two different criteria depending on the severity of impairment), preserved functional abilities, and no dementia. RESULTS The prevalence estimates ranged from 5.13 to 29.9% depending on age and severity of impairment. The incidence rates of overall MCI were 22.6 (95% confidence interval [CI]: 19.6-25.9) and 8.67 (95% CI: 7.0-10.7) per 1,000 person-years for less severe and severe cognitive impairment, respectively. The highest prevalence and incidence estimates were found for "non-amnestic MCI single domain." The older age groups had a higher prevalence, and no sex or age differences in MCI incidence were detected. CONCLUSION Our findings concur with previous research advocating that MCI is a heterogeneous concept, since the prevalence and incidence estimates differed substantially according to age, MCI subtype, and severity of cognitive impairment.
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Affiliation(s)
- Marieclaire Overton
- Division of Geriatric Medicine, Lund University, Skåne University Hospital, Malmö, Sweden,
| | - Mats Pihlsgård
- Division of Geriatric Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Sölve Elmståhl
- Division of Geriatric Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
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Sun P, Lou W, Liu J, Shi L, Li K, Wang D, Mok VC, Liang P. Mapping the patterns of cortical thickness in single- and multiple-domain amnestic mild cognitive impairment patients: a pilot study. Aging (Albany NY) 2019; 11:10000-10015. [PMID: 31756169 PMCID: PMC6914405 DOI: 10.18632/aging.102362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/05/2019] [Indexed: 01/26/2023]
Abstract
Amnestic mild cognitive impairment (aMCI) is considered as a transitional stage between the expected cognitive decline of normal aging and Alzheimer’s disease (AD). Structural brain difference has shown the potential in cognitive related diagnosis, however cortical thickness patterns transferred from aMCI to AD, especially in the subtypes of aMCI, is still unclear. In this study, we investigated the cortical thickness discrepancies among AD, aMCI and normal control (NC) entities, especially for two subtypes of aMCI - multiple-domain aMCI (aMCI-m) and single-domain aMCI (aMCI-s). Both region of interest (ROI)-based and vertex-based statistical strategies were performed for group-level cortical thickness comparison. Spearman correlation was utilized to identify the correlation between cortical thickness and clinical neuropsychological scores. The result demonstrated that there was a significant cortical thickness decreasing tendency in fusiform gyrus from NC to aMCI-s to aMCI-m to finally AD in both left and right hemispheres. Meanwhile, the two subtypes of aMCI showed cortical thickness difference in middle temporal gyrus in left hemisphere. Spearman correlation indicated that neuropsychological scores had significant correlations with entorhinal, inferior temporal and middle temporal gyrus. The findings suggested that cortical thickness might serve as a potential imaging biomarker for the differential diagnosis of cognitive impairment.
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Affiliation(s)
- Pan Sun
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Wutao Lou
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Jianghong Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lin Shi
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China.,BrainNow Research Institute, Shenzhen, China
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Lab of MRI and Brain Informatics, Beijing, China
| | - Defeng Wang
- School of Instrumentation Science and Opto-electronics Engineering, Beihang University, Beijing, China
| | - Vincent Ct Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Peipeng Liang
- Beijing Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
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Mayburd AL, Koivogui M, Baranova A. Pharmacological signatures of the reduced incidence and the progression of cognitive decline in ageing populations suggest the protective role of beneficial polypharmacy. PLoS One 2019; 14:e0224315. [PMID: 31693707 PMCID: PMC6834256 DOI: 10.1371/journal.pone.0224315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/10/2019] [Indexed: 12/13/2022] Open
Abstract
Preventive treatments for dementia are warranted. Here we show that utilization of certain combinations of prescription medications and supplements correlates with reduced rates of cognitive decline. More than 1,900 FDA-approved agents and supplements were collapsed into 53 mechanism-based groups and traced in electronic medical records (EMRs) for >50,000 patients. These mechanistic groups were aligned with the data presented in more than 300 clinical trials, then regression model was built to fit the signals from EMRs to clinical trial performance. While EMR signals of each single agents correlated with clinical performance relatively weakly, the signals produced by combinations of active compounds were highly correlated with the clinical trial performance (R = 0.93, p = 3.8 x10^-8). Higher ranking pharmacological modalities were traced in patient profiles as their combinations, producing protective complexity estimates reflecting degrees of exposure to beneficial polypharmacy. For each age strata, the higher was the protective complexity score, the lower was the prevalence of dementia, with maximized life-long effects for the highest regression score /diversity compositions. The connection was less strong in individuals already diagnosed with cognitive impairment. Confounder analysis confirmed an independent effect of protective complexity in multivariate context. A sub-cohort with lifelong odds of dementia decreased > 5-folds was identified; this sub-cohort should be studied in further details, including controlled clinical trials. In short, our study systematically explored combinatorial preventive treatment regimens for age-associated multi-morbidity, with an emphasis on neurodegeneration, and provided extensive evidence for their feasibility.
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Affiliation(s)
- Anatoly L. Mayburd
- Neurocombinatorix, Alexandria, Virginia, United States of America
- George Mason University, School of Systems Biology, Colgan Hall, MSN 3E1 George Mason University, Manassas, Virginia, United States of America
| | | | - Ancha Baranova
- George Mason University, School of Systems Biology, Colgan Hall, MSN 3E1 George Mason University, Manassas, Virginia, United States of America
- Research Centre for Medical Genetics, Moscow, Russia
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Rovner BW, Casten RJ, Leiby B. Memory improvement in African Americans with amnestic mild cognitive impairment. Int J Geriatr Psychiatry 2019; 34:1447-1454. [PMID: 31087388 PMCID: PMC6742531 DOI: 10.1002/gps.5141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/04/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Amnestic mild cognitive impairment (aMCI) has an uncertain course. Valid methods to evaluate memory change will best identify predictors of course. This issue is especially relevant to older persons in minority groups, who may have encountered life course factors that adversely affect cognition. METHODS/DESIGN Growth curve mixture models were used to identify trajectories of memory test scores obtained every 6 months over 2 years in 221 African Americans with aMCI. RESULTS Participants sorted into two classes, with clinically and statistically significant differences in memory scores over time. Class 1 (n = 28 [14.7%]) had sustained improved scores. Class 2 (n = 162 [85.3%]) scores remained low, fluctuated, or declined. Class 1 had better baseline cognition and daily function than class 2. CONCLUSIONS The observed rate of improved memory is lower than reported reversion rates from aMCI to normal cognition. Evaluating trajectories of memory test scores rather than changes in categorical diagnoses of aMCI, which may depend on recalling (or not recalling) one or two words, may yield a more valid indicator of cognitive change. These approaches require further study in minority groups.
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Affiliation(s)
- Barry W. Rovner
- Jefferson Hospital for Neuroscience, 900 Walnut Street, Suite 200, Philadelphia, PA 19107
| | - Robin J. Casten
- Jefferson Hospital for Neuroscience, 900 Walnut Street, Suite 200, Philadelphia, PA 19107
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Pennington C, Ball H, Swirski M. Functional Cognitive Disorder: Diagnostic Challenges and Future Directions. Diagnostics (Basel) 2019; 9:diagnostics9040131. [PMID: 31569352 PMCID: PMC6963804 DOI: 10.3390/diagnostics9040131] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 01/01/2023] Open
Abstract
Functional cognitive disorder describes patients with persistent, troublesome subjective cognitive complaints that are inconsistent with a recognized disease process, and where significant discrepancies are found between subjective and objectively observed cognitive functioning. The etiology is heterogeneous and potentially related to underlying psychological factors. Making a diagnosis of functional cognitive disorder can be challenging and there is the potential for misdiagnosis of early-stage neurodegeneration. We compared neuropsychological findings in three groups: functional cognitive disorder (FCD), mild cognitive impairment (MCI), and healthy controls. Participants were recruited from the ReMemBr Group Clinic, North Bristol NHS Trust, and via Join Dementia Research. Both the FCD and MCI groups showed elevated prospective and retrospective memory symptom scores. Performance on the Montreal cognitive assessment was equivalent in the FCD and MCI groups, both being impaired compared with the controls. The FCD group was younger than those with MCI. We discuss challenges and controversies in the diagnosis of functional cognitive disorder, alongside illustrative cases and proposals for areas of research priority.
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Affiliation(s)
- Catherine Pennington
- ReMemBr Group, University of Bristol, Bristol Brain Centre, Southmead Hospital, Southmead Road, Bristol BS10 5NB, UK.
- Centre for Dementia Prevention, University of Edinburgh, 9A Bioquarter, 9 Little France Road, Edinburgh EH16 4UX, UK.
| | - Harriet Ball
- ReMemBr Group, University of Bristol, Bristol Brain Centre, Southmead Hospital, Southmead Road, Bristol BS10 5NB, UK.
| | - Marta Swirski
- ReMemBr Group, University of Bristol, Bristol Brain Centre, Southmead Hospital, Southmead Road, Bristol BS10 5NB, UK.
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Thomas KR, Edmonds EC, Eppig JS, Wong CG, Weigand AJ, Bangen KJ, Jak AJ, Delano-Wood L, Galasko DR, Salmon DP, Edland SD, Bondi MW. MCI-to-normal reversion using neuropsychological criteria in the Alzheimer's Disease Neuroimaging Initiative. Alzheimers Dement 2019; 15:1322-1332. [PMID: 31495605 DOI: 10.1016/j.jalz.2019.06.4948] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 05/06/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The low mild cognitive impairment (MCI) to cognitively normal (CN) reversion rate in the Alzheimer's Disease Neuroimaging Initiative (2-3%) suggests the need to examine reversion by other means. We applied comprehensive neuropsychological criteria (NP criteria) to determine the resulting MCI to CN reversion rate. METHODS Participants with CN (n = 641) or MCI (n = 569) were classified at baseline and year 1 using NP criteria. Demographic, neuropsychological, and Alzheimer's disease biomarker variables as well as progression to dementia were examined across stable CN, reversion, and stable MCI groups. RESULTS NP criteria produced a one-year reversion rate of 15.8%. Reverters had demographics, Alzheimer's disease biomarkers, and risk-of-progression most similar to the stable CN group and showed the most improvement on neuropsychological measures from baseline to year 1. DISCUSSION NP criteria produced a reversion rate that is consistent with, albeit modestly improved from, reversion rates in meta-analyses. Reverters' biomarker profiles and progression rates suggest that NP criteria accurately tracked with underlying pathophysiologic status.
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Affiliation(s)
- Kelsey R Thomas
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Veteran Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Emily C Edmonds
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Veteran Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Joel S Eppig
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Christina G Wong
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Veteran Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Alexandra J Weigand
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Katherine J Bangen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Veteran Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Amy J Jak
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Veteran Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Lisa Delano-Wood
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Veteran Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Douglas R Galasko
- Veteran Affairs San Diego Healthcare System, San Diego, CA, USA; Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - David P Salmon
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Steven D Edland
- Department of Biostatistics, University of California, San Diego, La Jolla, CA, USA; Department of Family and Preventative Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Veteran Affairs San Diego Healthcare System, San Diego, CA, USA.
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Effects of Anserine/Carnosine Supplementation on Mild Cognitive Impairment with APOE4. Nutrients 2019; 11:nu11071626. [PMID: 31319510 PMCID: PMC6683059 DOI: 10.3390/nu11071626] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/12/2019] [Accepted: 07/15/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Oral supplementation of anserine/carnosine helps preserve cognitive functions in healthy older adults. Mild cognitive impairment (MCI) is a transition between cognitive-normal and dementia. Therefore, it needs to investigate whether anserine/carnosine supplementation (ACS) has effects on subjects with MCI. Methods: A randomized, double-blind, placebo-controlled 12-week trial was performed. Fifty-four subjects with MCI were randomized to an active group ingesting 750 mg of anserine and 250 mg of carnosine per day or a placebo (1:1). Evaluation of cognitive change was conducted utilizing a psychometric test battery. Results: The score improvement in the global Clinical Dementia Rating (gloCDR) was superior in the active group than placebo (p = 0.023). No beneficial effect in the active group was detected in the other psychometric tests including the Mini-Mental State Examination (MMSE), the Wechsler Memory Scale, and the Alzheimer’s Disease Assessment Scale (ADAS). When APOE4 positive (APOE4 (+)) or negative (APOE4 (-)) subjects were separately analyzed, beneficial change in the APOE4 (+) subjects was observed in MMSE (p = 0.025) as well as in gloCDR (p = 0.026). Conclusions: The present study might suggest that protective effects against cognitive decline in APOE4 (+) MCI subjects exist.
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Bentvelzen AC, Crawford JD, Theobald A, Maston K, Slavin MJ, Reppermund S, Kang K, Numbers K, Brodaty H, Sachdev P, Kochan NA. Validation and Normative Data for the Modified Telephone Interview for Cognitive Status: The Sydney Memory and Ageing Study. J Am Geriatr Soc 2019; 67:2108-2115. [PMID: 31290146 DOI: 10.1111/jgs.16033] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Telephone-based cognitive screens, such as the Telephone Interview for Cognitive Status (TICS), can potentially reduce the barriers and costs of assessing older adults. However, validation of clinically relevant psychometric properties is lacking in a large and comprehensively assessed sample of older adults. Furthermore, published normative data may lack sensitivity as they have not used regression-based demographic corrections or accounted for cases with subsequent dementia. We address these gaps using the modified TICS (TICS-M; a modified, 13-item, 39-point version) and provide an online norms calculator for clinicians and researchers. DESIGN Prospective longitudinal study. SETTING Sydney, Australia. PARTICIPANTS A total of 617 community-living older adults, aged from 71 to 91 years. MEASUREMENTS The measures used included the TICS-M, the Mini-Mental State Examination (MMSE), Addenbrooke's Cognitive Examination-Revised (ACE-R), and a comprehensive neuropsychological test battery. Descriptive statistics, correlations, area under the curve, and regression analyses were used to determine the validity and normative properties of the TICS-M. RESULTS TICS-M total scores (mean = 24.20; SD = 3.76) correlated well with the MMSE (0.70) and ACE-R (0.80) and moderately with neuropsychological tests tested noncontemporaneously. A cutoff score of 21 or lower reliably distinguished between those with and without incident dementia after 1 year (sensitivity = 77%; specificity = 88%) but was less reliable at distinguishing mild cognitive impairment from normal cognition. TICS-M scores decreased with age and increased with higher education levels. The robust normative sample, which excluded incident dementia cases, scored higher on the TICS-M and with less variability than the whole sample. An online calculator is provided to compute regression-based norms and reliable change statistics. CONCLUSIONS In a large sample of community-dwelling older adults, the TICS-M performed well in terms of construct validity against typical screening tools and neuropsychological measures and diagnostic validity for incident dementia. The comprehensive, regression-based, and robust normative data provided will help improve the sensitivity, accessibility, and cost-effectiveness of cognitive testing with older adults. J Am Geriatr Soc 67:2108-2115, 2019.
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Affiliation(s)
- Adam C Bentvelzen
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Adam Theobald
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Kate Maston
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Melissa J Slavin
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Simone Reppermund
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Kristan Kang
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Katya Numbers
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
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Harvey L, Toson B, Brodaty H, Draper B, Kochan N, Sachdev P, Mitchell R, Close J. Injury-related hospitalisation in community-dwelling older people across the cognitive spectrum: A population based study. Arch Gerontol Geriatr 2019; 83:155-160. [DOI: 10.1016/j.archger.2019.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/27/2019] [Accepted: 03/31/2019] [Indexed: 10/27/2022]
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Machulda MM, Lundt ES, Albertson SM, Kremers WK, Mielke MM, Knopman DS, Bondi MW, Petersen RC. Neuropsychological subtypes of incident mild cognitive impairment in the Mayo Clinic Study of Aging. Alzheimers Dement 2019; 15:878-887. [PMID: 31128864 PMCID: PMC6646057 DOI: 10.1016/j.jalz.2019.03.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 03/12/2019] [Accepted: 03/25/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION We evaluated whether incident mild cognitive impairment (MCI) subtypes could be empirically derived in the Mayo Clinic Study of Aging. METHODS We performed cluster analysis on neuropsychological data from 506 participants with incident MCI. RESULTS The 3-cluster solution resulted in (1) amnestic, (2) dysexecutive, (3) dysnomic subtypes. The 4-cluster solution produced these same three groups and a fourth group with subtle cognitive impairment (SCI). The SCI cluster was a subset of the amnestic cluster and distinct from well-matched cognitively unimpaired participants based on memory and global z-score area under the receiver operating characteristic curve analyses and probability of progression to MCI/dementia. DISCUSSION We empirically identified three neuropsychological subtypes of MCI that share some features with MCI subtypes identified in the Alzheimer's Disease Neuroimaging Initiative. The fourth subtype with SCI in the Mayo Clinic Study of Aging differed from the fourth cluster-derived normal group in Alzheimer's Disease Neuroimaging Initiative and could represent a group to target with early interventions.
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Affiliation(s)
- Mary M Machulda
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
| | - Emily S Lundt
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Sabrina M Albertson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Walter K Kremers
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Michelle M Mielke
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; Department of Neurology, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - David S Knopman
- Department of Neurology, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California San Diego, School of Medicine, La Jolla, CA, USA; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Ronald C Petersen
- Department of Neurology, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
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Vermunt L, van Paasen AJL, Teunissen CE, Scheltens P, Visser PJ, Tijms BM. Alzheimer disease biomarkers may aid in the prognosis of MCI cases initially reverted to normal. Neurology 2019; 92:e2699-e2705. [PMID: 31068481 PMCID: PMC6556092 DOI: 10.1212/wnl.0000000000007609] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/01/2019] [Indexed: 02/07/2023] Open
Abstract
Objective To identify potential predictors for outcome in individuals with mild cognitive impairment (MCI) who have reverted to normal cognition (NC). Methods We selected individuals with MCI, who reverted at follow-up to NC, with follow-up after reversion from Alzheimer's Disease Neuroimaging Initiative. Common clinical markers, Alzheimer disease (AD) biomarkers, and neurodegeneration imaging markers were used to compare MCI reverters based on subsequent clinical outcome (i.e., subsequent decline or stable reversion). For independent comparison, findings of the clinical Amsterdam Dementia Cohort are presented. Results Seventy-seven (10%) out of 757 individuals with MCI reverted to NC and 61 of these individuals had follow-up data available. After 3.2 ± 2.2 years, 16 (24%) progressed to MCI, and 3 (5%) to dementia. Those who declined were older and had a higher amyloid PET burden and higher CSF tau levels. Conclusion In MCI reverters, abnormal biomarkers for AD pathology are associated with subsequent decline. AD biomarkers may aid in the prognosis of reverting MCI.
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Affiliation(s)
- Lisa Vermunt
- From Alzheimer Center Amsterdam, Department of Neurology (L.V., A.J.L.v.P., P.S., P.J.V., B.M.T.), and Neurochemistry Lab and Biobank, Department of Clinical Chemistry (C.E.T.), Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC; and Department of Psychiatry and Neuropsychology (P.J.V.), School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, the Netherlands.
| | - Alegría J L van Paasen
- From Alzheimer Center Amsterdam, Department of Neurology (L.V., A.J.L.v.P., P.S., P.J.V., B.M.T.), and Neurochemistry Lab and Biobank, Department of Clinical Chemistry (C.E.T.), Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC; and Department of Psychiatry and Neuropsychology (P.J.V.), School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, the Netherlands
| | - Charlotte E Teunissen
- From Alzheimer Center Amsterdam, Department of Neurology (L.V., A.J.L.v.P., P.S., P.J.V., B.M.T.), and Neurochemistry Lab and Biobank, Department of Clinical Chemistry (C.E.T.), Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC; and Department of Psychiatry and Neuropsychology (P.J.V.), School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, the Netherlands
| | - Philip Scheltens
- From Alzheimer Center Amsterdam, Department of Neurology (L.V., A.J.L.v.P., P.S., P.J.V., B.M.T.), and Neurochemistry Lab and Biobank, Department of Clinical Chemistry (C.E.T.), Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC; and Department of Psychiatry and Neuropsychology (P.J.V.), School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, the Netherlands
| | - Pieter Jelle Visser
- From Alzheimer Center Amsterdam, Department of Neurology (L.V., A.J.L.v.P., P.S., P.J.V., B.M.T.), and Neurochemistry Lab and Biobank, Department of Clinical Chemistry (C.E.T.), Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC; and Department of Psychiatry and Neuropsychology (P.J.V.), School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, the Netherlands
| | - Betty M Tijms
- From Alzheimer Center Amsterdam, Department of Neurology (L.V., A.J.L.v.P., P.S., P.J.V., B.M.T.), and Neurochemistry Lab and Biobank, Department of Clinical Chemistry (C.E.T.), Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC; and Department of Psychiatry and Neuropsychology (P.J.V.), School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, the Netherlands
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Shimada H, Doi T, Lee S, Makizako H. Reversible predictors of reversion from mild cognitive impairment to normal cognition: a 4-year longitudinal study. ALZHEIMERS RESEARCH & THERAPY 2019; 11:24. [PMID: 30867057 PMCID: PMC6416893 DOI: 10.1186/s13195-019-0480-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/28/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although previous studies have revealed many factors related to mild cognitive impairment (MCI) reversion, information about reversible factors related MCI reversion is limited, impeding the development of intervention strategies. The aim of the present study was to examine whether reversible factors such as lifestyle activities are associated with MCI reversion in elderly individuals using the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes database. A total of 396 community-living older adults (age ≥ 65 years) participated in the study. They were classified as reverters or non-reverters from mild cognitive impairment to normal cognition. We assessed lifestyle activities, potential confounding factors of cognitive decline, and reversion of mild cognitive impairment. RESULTS In a completed data set of 396 participants, 202 participants (51.0%) reverted from MCI to normal cognition. The reversion rate in participants for whom we imputed data was 34.3%. In the imputed group, a logistic regression model showed that the odds ratios (ORs) for reversion were significantly higher in participants who drove a car (OR 1.50, 95% confidence interval (CI) 1.41-1.60), used a map to travel to unfamiliar places (OR 1.12, 95% CI 1.06-1.18), read books or newspapers (OR 1.54, 95% CI 1.37-1.73), took cultural classes (OR 1.10, 95% CI 1.04-1.15), attended meetings in the community (OR 1.22, 95% CI 1.16-1.28), participated in hobbies or sports activities (OR 1.09, 95% CI 1.03-1.16), and engaged in fieldwork or gardening (OR 1.14, 95% CI 1.08-1.21). The imputed sample showed that non-reverters were more likely to discontinue fieldwork or gardening (11.0% vs. 6.1%) than reverters during the follow-up period. CONCLUSIONS Specific lifestyle activities may play important roles in MCI reversion in older adults. The longitudinal data indicate that it is reasonable to recommend that individuals continue to engage in fieldwork or gardening to increase their chance of recovery from MCI.
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Affiliation(s)
- Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, Aichi Prefecture, 474-8511, Japan.
| | - Takehiko Doi
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, Aichi Prefecture, 474-8511, Japan
| | - Sangyoon Lee
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, Aichi Prefecture, 474-8511, Japan
| | - Hyuma Makizako
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima City, Japan
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50
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Chung SJ, Park YH, Yoo HS, Lee YH, Ye BS, Sohn YH, Lee JM, Lee PH. Mild cognitive impairment reverters have a favorable cognitive prognosis and cortical integrity in Parkinson's disease. Neurobiol Aging 2019; 78:168-177. [PMID: 30947112 DOI: 10.1016/j.neurobiolaging.2019.02.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 01/16/2023]
Abstract
This study aimed to investigate whether reversion to cognitively normal status (CogN) is related to a favorable cognitive prognosis in Parkinson's disease with mild cognitive impairment (PD-MCI). We recruited 217 patients with PD-MCI who underwent serial neuropsychological assessments 3-5 times (mean interval, 1.84 years). Thirty-six patients reverted to CogN (reverters) during follow-up, whereas the other 181 did not (nonreverters). We assessed the risk of cognitive worsening in PD-MCI reverters, nonreverters, and patients with PD-CogN (n = 88). In addition, we performed comparative analyses of comprehensive neuroimaging studies between the PD-MCI reverter (n = 17) and nonreverter (n = 34) subgroups. PD-MCI reverters had a lower risk of dementia conversion than nonreverters. In addition, PD-MCI reverters had similar risks of cognitive worsening with patients with PD-CogN. PD-MCI reverters exhibited greater cortical thickness in the right parahippocampal gyrus and less severely decreased functional connectivity in the default mode and executive control networks relative to nonreverters. Our results suggest that PD-MCI reverters have relatively preserved structural and functional integrity and a favorable cognitive prognosis compared with nonreverters.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Yeong-Hun Park
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea.
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
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