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Ungvari Z, Muranyi M, Gulej R, Negri S, Nyul-Toth A, Csik B, Patai R, Conley S, Milan M, Bagwell J, O'Connor D, Tarantini A, Yabluchanskiy A, Toth P, Csiszar A, Ungvari A, Mukli P, Tarantini S. Longitudinal detection of gait alterations associated with hypertension-induced cerebral microhemorrhages in mice: predictive role of stride length and stride time asymmetry and increased gait entropy. GeroScience 2024; 46:4743-4760. [PMID: 38914916 PMCID: PMC11335995 DOI: 10.1007/s11357-024-01210-3] [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: 03/27/2024] [Accepted: 05/16/2024] [Indexed: 06/26/2024] Open
Abstract
Cerebral microhemorrhages (CMHs) are of paramount importance as they not only signify underlying vascular pathology but also have profound implications for cognitive function and neurological health, serving as a critical indicator for the early detection and management of vascular cognitive impairment (VCI). This study aimed to investigate the effects of hypertension-induced CMHs on gait dynamics in a mouse model, focusing on the utility of advanced gait metrics as sensitive indicators of subclinical neurological alterations associated with CMHs. To induce CMHs, we employed a hypertensive mouse model, using a combination of Angiotensin II and L-NAME to elevate blood pressure, further supplemented with phenylephrine to mimic transient blood pressure fluctuations. Gait dynamics were analyzed using the CatWalk system, with emphasis on symmetry indices for Stride Length (SL), Stride Time (ST), and paw print area, as well as measures of gait entropy and regularity. The study spanned a 30-day experimental period, capturing day-to-day variations in gait parameters to assess the impact of CMHs. Temporary surges in gait asymmetry, detected as deviations from median gait metrics, suggested the occurrence of subclinical neurological signs associated with approximately 50% of all histologically verified CMHs. Our findings also demonstrated that increases in gait entropy correlated with periods of increased gait asymmetry, providing insights into the complexity of gait dynamics in response to CMHs. Significant correlations were found between SL and ST symmetry indices and between these indices and the paw print area symmetry index post-hypertension induction, indicating the interdependence of spatial and temporal aspects of gait affected by CMHs. Collectively, advanced gait metrics revealed sensitive, dynamic alterations in gait regulation associated with CMHs, resembling the temporal characteristics of transient ischemic attacks (TIAs). This underscores their potential as non-invasive indicators of subclinical neurological impacts. This study supports the use of detailed gait analysis as a valuable tool for detecting subtle neurological changes, with implications for the early diagnosis and monitoring of cerebral small vessel disease (CSVD) in clinical settings.
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Affiliation(s)
- Zoltan Ungvari
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
| | - Mihaly Muranyi
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Rafal Gulej
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sharon Negri
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Adam Nyul-Toth
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Boglarka Csik
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Roland Patai
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Shannon Conley
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Madison Milan
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jonathan Bagwell
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Daniel O'Connor
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Amber Tarantini
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
| | - Peter Toth
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Neurosurgery, Medical School, University of Pecs, Pecs, Hungary
| | - Anna Csiszar
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Anna Ungvari
- Department of Public Health, Semmelweis University, Budapest, Hungary.
| | - Peter Mukli
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Stefano Tarantini
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
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2
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Sur S, Lin Z, Li Y, Yasar S, Rosenberg PB, Moghekar A, Hou X, Jiang D, Kalyani RR, Hazel K, Pottanat G, Xu C, Pillai JJ, Liu P, Albert M, Lu H. CO 2 cerebrovascular reactivity measured with CBF-MRI in older individuals: Association with cognition, physical function, amyloid and tau proteins. J Cereb Blood Flow Metab 2024; 44:1618-1628. [PMID: 38489769 DOI: 10.1177/0271678x241240582] [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: 03/17/2024]
Abstract
Vascular pathology is the second leading cause of cognitive impairment and represents a major contributing factor in mixed dementia. However, biomarkers for vascular cognitive impairment and dementia (VCID) are under-developed. Here we aimed to investigate the potential role of CO2 Cerebrovascular Reactivity (CVR) measured with phase-contrast quantitative flow MRI in cognitive impairment and dementia. Forty-five (69 ± 7 years) impaired (37 mild-cognitive-impairment and 8 mild-dementia by syndromic diagnosis) and 22 cognitively-healthy-control (HC) participants were recruited and scanned on a 3 T MRI. Biomarkers of AD pathology were measured in cerebrospinal fluid. We found that CBF-CVR was lower (p = 0.027) in the impaired (mean±SE, 3.70 ± 0.15%/mmHg) relative to HC (4.28 ± 0.21%/mmHg). After adjusting for AD pathological markers (Aβ42/40, total tau, and Aβ42/p-tau181), higher CBF-CVR was associated with better cognitive performance, including Montreal Cognitive Assessment, MoCA (p = 0.001), composite cognitive score (p = 0.047), and language (p = 0.004). Higher CBF-CVR was also associated with better physical function, including gait-speed (p = 0.006) and time for five chair-stands (p = 0.049). CBF-CVR was additionally related to the Clinical-Dementia-Rating, CDR, including global CDR (p = 0.026) and CDR Sum-of-Boxes (p = 0.015). CBF-CVR was inversely associated with hemoglobin A1C level (p = 0.017). In summary, CBF-CVR measured with phase-contrast MRI shows associations with cognitive performance, physical function, and disease-severity, independent of AD pathological markers.
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Affiliation(s)
- Sandeepa Sur
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Zixuan Lin
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Yang Li
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Sevil Yasar
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Paul B Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Xirui Hou
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Dengrong Jiang
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Rita R Kalyani
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Kaisha Hazel
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - George Pottanat
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Cuimei Xu
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Jay J Pillai
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Division of Neuroradiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Peiying Liu
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center, Kennedy Krieger Institute, Baltimore, MD, USA
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Palmer JA, Morris JK, Billinger SA, Lepping RJ, Martin L, Green Z, Vidoni ED. Hippocampal blood flow rapidly and preferentially increases after a bout of moderate-intensity exercise in older adults with poor cerebrovascular health. Cereb Cortex 2023; 33:5297-5306. [PMID: 36255379 PMCID: PMC10152056 DOI: 10.1093/cercor/bhac418] [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] [Received: 07/15/2022] [Revised: 09/02/2022] [Accepted: 09/25/2022] [Indexed: 11/14/2022] Open
Abstract
Over the course of aging, there is an early degradation of cerebrovascular health, which may be attenuated with aerobic exercise training. Yet, the acute cerebrovascular response to a single bout of exercise remains elusive, particularly within key brain regions most affected by age-related disease processes. We investigated the acute global and region-specific cerebral blood flow (CBF) response to 15 minutes of moderate-intensity aerobic exercise in older adults (≥65 years; n = 60) using arterial spin labeling magnetic resonance imaging. Within 0-6 min post-exercise, CBF decreased across all regions, an effect that was attenuated in the hippocampus. The exercise-induced CBF drop was followed by a rebound effect over the 24-minute postexercise assessment period, an effect that was most robust in the hippocampus. Individuals with low baseline perfusion demonstrated the greatest hippocampal-specific CBF effect post-exercise, showing no immediate drop and a rapid increase in CBF that exceeded baseline levels within 6-12 minutes postexercise. Gains in domain-specific cognitive performance postexercise were not associated with changes in regional CBF, suggesting dissociable effects of exercise on acute neural and vascular plasticity. Together, the present findings support a precision-medicine framework for the use of exercise to target brain health that carefully considers age-related changes in the cerebrovascular system.
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Affiliation(s)
- Jacqueline A Palmer
- Department of Neurology, School of Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, United States
| | - Jill K Morris
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, School of Health Professions, University of Kansas Medical Center, 3901 Rainbow Blvd. Kansas City, KS, 66160, United States
- University of Kansas Alzheimer’s Disease Research Center, 4350 Shawnee Mission Parkway, Fairway, KS, 66205, United States
| | - Sandra A Billinger
- Department of Neurology, School of Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, United States
- University of Kansas Alzheimer’s Disease Research Center, 4350 Shawnee Mission Parkway, Fairway, KS, 66205, United States
- Department of Molecular & Integrative Physiology, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, United States
| | - Rebecca J Lepping
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, School of Health Professions, University of Kansas Medical Center, 3901 Rainbow Blvd. Kansas City, KS, 66160, United States
| | - Laura Martin
- University of Kansas Alzheimer’s Disease Research Center, 4350 Shawnee Mission Parkway, Fairway, KS, 66205, United States
| | - Zachary Green
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, School of Health Professions, University of Kansas Medical Center, 3901 Rainbow Blvd. Kansas City, KS, 66160, United States
- University of Kansas Alzheimer’s Disease Research Center, 4350 Shawnee Mission Parkway, Fairway, KS, 66205, United States
| | - Eric D Vidoni
- University of Kansas Alzheimer’s Disease Research Center, 4350 Shawnee Mission Parkway, Fairway, KS, 66205, United States
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Montero-Odasso M. Are falls a manifestation of brain failure? Revisited 40 years later. Age Ageing 2023; 52:afac321. [PMID: 36626324 PMCID: PMC9831260 DOI: 10.1093/ageing/afac321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Manuel Montero-Odasso
- Departments of Medicine (Geriatric Medicine), and Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
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5
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Hussain SM, Ernst ME, Barker AL, Margolis KL, Reid CM, Neumann JT, Tonkin AM, Phuong TLT, Beilin LJ, Pham T, Chowdhury EK, Cicuttini FM, Gilmartin-Thomas JFM, Carr PR, McNeil JJ. Variation in Mean Arterial Pressure Increases Falls Risk in Elderly Physically Frail and Prefrail Individuals Treated With Antihypertensive Medication. Hypertension 2022; 79:2051-2061. [PMID: 35722878 PMCID: PMC9378722 DOI: 10.1161/hypertensionaha.122.19356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Impaired cerebral blood flow has been associated with an increased risk of falls. Mean arterial pressure (MAP) and variability in MAP have been reported to affect cerebral blood flow but their relationships to the risk of falls have not previously been reported. METHODS Utilising data from the Aspirin in Reducing Events in the Elderly trial participants, we estimated MAP and variability in MAP, defined as within-individual SD of MAP from baseline and first 2 annual visits. The relationship with MAP was studied in 16 703 participants amongst whom 1539 falls were recorded over 7.3 years. Variability in MAP was studied in 14 818 of these participants who experienced 974 falls over 4.1 years. Falls were confined to those involving hospital presentation. Cox regression was used to calculate hazard ratio and 95% CI for associations with falls. RESULTS Long-term variability in MAP was not associated with falls except amongst frail or prefrail participants using antihypertensive medications. Within this group each 5 mm Hg increase in long-term variability in MAP increased the risk of falls by 16% (hazard ratio, 1.16 [95% CI, 1.02-1.33]). Amongst the antihypertensive drugs studied, beta-blocker monotherapy (hazard ratio, 1.93 [95% CI, 1.17-3.18]) was associated with an increased risk of falls compared with calcium channel blockers. CONCLUSIONS Higher levels of long-term variability in MAP increase the risk of serious falls in older frail and prefrail individuals taking antihypertensive medications. The observation that the relationship was limited to frail and prefrail individuals might explain some of the variability of previous studies linking blood pressure indices and falls.
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Affiliation(s)
- Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Victoria 3010 Australia
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy; and, Department of Family Medicine, Carver College of Medicine. The University of Iowa, Iowa City, Iowa. USA
| | - Anna L Barker
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | | | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Johannes T Neumann
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
- Department of Cardiology, University Heart & Vascular Center Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Thao Le Thi Phuong
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Lawrence J Beilin
- Medical School, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Thao Pham
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Enayet K Chowdhury
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Flavia M Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Julia FM Gilmartin-Thomas
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
- College of Health and Biomedicine, and Institute for Health & Sport, Victoria University, Victoria, Australia
- Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Victoria, Australia
| | - Prudence R Carr
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
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Could salt intake directly affect the cerebral microvasculature in hypertension? J Stroke Cerebrovasc Dis 2022; 31:106632. [PMID: 35870266 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106632] [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: 04/08/2022] [Revised: 06/26/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Excess dietary salt and chronic kidney disease (CKD) are acknowledged stroke risk factors. The development of small vessel disease, similarly affecting the cerebral and renal microvasculatures, may be an important mechanistic link underlying this interaction. Therefore, we aimed to evaluate if the dietary salt intake and markers of CKD (estimated glomerular filtration rate, albuminuria) relate to transcranial Doppler (TCD) markers of cerebral small vessel disease (CSVD) in hypertensive patients. MATERIALS AND METHODS Fifty-six hypertensive patients (57% with diabetes) underwent TCD monitoring in the middle (MCA) and posterior (PCA) cerebral arteries for evaluating neurovascular coupling (NVC), dynamic cerebral autoregulation (dCA), and vasoreactivity to carbon dioxide (VRCO2). We investigated the relation between renal parameters and TCD studies using Pearson's correlation coefficient and linear regression analyses. RESULTS There were no associations between dCA, VRCO2, NVC, and renal function tests. However, there was a negative association between the daily salt intake and the natural frequency during visual stimulation (r2=0.101, ß=-0.340, p=0.035), indicative of increased rigidity of the cerebral resistance vessels that react to cognitive activation. CONCLUSIONS In this cross-sectional study, we found an association between excess dietary salt consumption and CSVD in hypertensive patients. Future research is needed to evaluate whether the natural frequency could be an early, non-invasive, surrogate marker for microvascular dysfunction in hypertension.
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Postural disorders of neurological genesis in elderly patients: pathogenesis and features of diagnostics (literature review). ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.2.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Walking and balance disorders in elderly patients are the most common manifestations of various diseases of the nervous system. Balance imbalance is the leading cause of injuries in the elderly, leading to a limitation of both the patient’s ability to work and communication in the social environment, which in particular cases leads to a loss of independence, reducing the quality of life. Walking disorders are an important, difficult to resolve medical and social problem. The aim of the study was to identify the physiological and clinical aspects of age-related gait disorders with an emphasis on neurological pathogenetic causes. A detailed study of modern foreign medical literature and current international clinical guidelines was carried out with further systematization of the data obtained. Falls in the elderly are a common and major factor that threatens the independence of older people. The frequency of falls increases with age. Treatment for fall injuries does not always include identifying the cause of the fall. In the elderly, loss of balance is most commonly due to multiple causes, including impending threat to the homeostatic mechanisms that maintain postural stability combined with age-related impairments in balance, gait stability, and cardiovascular function. Gait disorders are a major cause of functional impairment and morbidity in the elderly. Most gait disorders in the elderly are multifactorial and have neurological components. In developed countries, there is a trend towards aging of the population: the percentage component of the elderly part of the population is growing. It is violations of balance, stability and walking, to a large extent, that lead to the inability of the patient to provide his quality of life at a satisfactory level on his own, to disability and failure in the workplace. Early diagnosis of gait disorders can prevent premature disability and limit the independence of elderly patients. It is important to note that a history of falls is a predictor of the risk of new falls.
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8
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A new paradigm in sarcopenia: Cognitive impairment caused by imbalanced myokine secretion and vascular dysfunction. Biomed Pharmacother 2022; 147:112636. [DOI: 10.1016/j.biopha.2022.112636] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 12/11/2022] Open
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9
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Nyul-Toth A, DelFavero J, Mukli P, Tarantini A, Ungvari A, Yabluchanskiy A, Csiszar A, Ungvari Z, Tarantini S. Early manifestation of gait alterations in the Tg2576 mouse model of Alzheimer's disease. GeroScience 2021; 43:1947-1957. [PMID: 34160781 PMCID: PMC8492885 DOI: 10.1007/s11357-021-00401-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/07/2021] [Indexed: 01/04/2023] Open
Abstract
There is strong clinical evidence that multifaceted gait abnormalities may be manifested at early stages of Alzheimer's disease (AD), are related to cognitive decline, and can be used as an early biomarker to identify patients at risk of progressing to full-blown dementia. Despite their importance, gait abnormalities have not been investigated in mouse models of AD, which replicate important aspects of the human disease. The Tg2576 is frequently used in AD research to test therapeutic interventions targeting cellular mechanisms contributing to the genesis of AD. This transgenic mouse strain overexpresses a mutant form of the 695 amino acid isoform of human amyloid precursor protein with K670N and M671L mutations (APPK670/671L) linked to early-onset familial AD. Tg2576 mice exhibit impaired cognitive functions and increased cortical and hippocampal soluble β-amyloid levels starting from 5 months of age and increased insoluble β-amyloid levels and amyloid plaques that resemble senile plaques associated with human AD by 13 months of age. To demonstrate early manifestations of gait dysfunction in this relevant preclinical model, we characterized gait and motor performance in 10-month-old Tg2576 mice and age-matched littermate controls using the semi-automated, highly sensitive, Catwalk XT system. We found that Tg2576 mice at the pre-plaque stage exhibited significantly altered duty cycle and step patterns and decreased stride length and stride time. Base-of-support, stride time variability, stride length variability, cadence, phase dispersions and gait symmetry indices were unaltered. The presence of measurable early gait abnormalities during the pre-plaque stages of AD in this relevant preclinical mouse model has direct translational relevance and supports the view that longitudinal monitoring of gait performance could be used in addition to behavioral testing to evaluate progression of the disease and to assess treatment efficacy.
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Affiliation(s)
- Adam Nyul-Toth
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Institute of Biophysics, Biological Research Centre, Eötvös Loránd Research Network (ELKH), Szeged, Hungary
| | - Jordan DelFavero
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA
| | - Peter Mukli
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Physiology, Semmelweis University, Budapest, Hungary
| | - Amber Tarantini
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA
| | - Anna Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA
| | - Anna Csiszar
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA.
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary.
| | - Stefano Tarantini
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA.
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary.
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10
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O'Connor JD, O'Connell MDL, Knight SP, Newman L, Donoghue OA, Kenny RA. Impaired Stabilisation of Orthostatic Cerebral Oxygenation is Associated with Slower Gait Speed: Evidence from The Irish Longitudinal Study on Ageing. J Gerontol A Biol Sci Med Sci 2021; 77:1216-1221. [PMID: 34331759 PMCID: PMC9159662 DOI: 10.1093/gerona/glab219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Indexed: 11/25/2022] Open
Abstract
Background Cerebral autoregulation (CAR) systems maintain blood flow to the brain across a wide range of blood pressures. Deficits in CAR have been linked to gait speed (GS) but previous studies had small sample sizes and used specialized equipment which impede clinical translation. The purpose of this work was to assess the association between GS and orthostatic cerebral oxygenation in a large, community-dwelling sample of older adults. Method Data for this study came from the Irish Longitudinal Study on Ageing. A near-infrared spectroscopy (NIRS) device attached to the forehead of each participant (n = 2 708) was used to track tissue saturation index (TSI; the ratio of oxygenated to total hemoglobin) during standing. GS was assessed using a portable walkway. Results Recovery was impaired in slower GS participants with a TSI value at 20 seconds (after standing) of −0.55% (95% CI: −0.67, −0.42) below baseline in the slowest GS quartile versus −0.14% (95% CI: −0.25, −0.04) in the fastest quartile. Slower GS predicted a lower TSI throughout the 3-minute monitoring period. Results were not substantially altered by adjusting for orthostatic hypotension. Adjustment for clinical and demographic covariates attenuated the association between but differences remained between GS quartiles from 20 seconds to 3 minutes after standing. Conclusion This study reported evidence for impaired recovery of orthostatic cerebral oxygenation depending on GS in community-dwelling older adults. Future work assessing NIRS as a clinical tool for monitoring the relationship between GS and cerebral regulation is warranted.
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Affiliation(s)
- John D O'Connor
- The Irish Longitudinal Study on Ageing, University of Dublin, Trinity College, Ireland.,The Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, UK
| | - Matthew D L O'Connell
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, UK
| | - Silvin P Knight
- The Irish Longitudinal Study on Ageing, University of Dublin, Trinity College, Ireland
| | - Louise Newman
- The Irish Longitudinal Study on Ageing, University of Dublin, Trinity College, Ireland
| | - Orna A Donoghue
- The Irish Longitudinal Study on Ageing, University of Dublin, Trinity College, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, University of Dublin, Trinity College, Ireland
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11
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Donoghue OA, Leahy S, Kenny RA. Longitudinal Associations Between Gait, Falls, and Disability in Community-Dwelling Older Adults With Type II Diabetes Mellitus: Findings From The Irish Longitudinal Study on Ageing (TILDA). J Gerontol A Biol Sci Med Sci 2021; 76:906-913. [PMID: 33049045 DOI: 10.1093/gerona/glaa263] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Diabetes is associated with gait deficits, future falls, and disability; however, it is unclear if associations remain after controlling for relevant confounders. This study investigated (i) the effects of type II diabetes on spatiotemporal gait parameters in community-dwelling older adults and (ii) if diabetes status was independently associated with future falls and disability, after controlling for gait and other confounders. METHOD Baseline data were obtained from 2608 community-dwelling adults (≥60 years) participating in The Irish Longitudinal Study on Ageing (TILDA). Diabetes was identified from self-reported doctors' diagnosis, medications, and glycated hemoglobin levels. Gait characteristics were obtained during single- and dual-task walking using a GAITRite mat (n = 2560). Incident falls and disability were collected over 4 years follow-up (n = 2473). Associations between diabetes status and gait (cross-sectional) and falls and disability (longitudinal) were investigated using regression analysis, adjusting for medications, cardiovascular health, neuropsychological function, and fall-related factors. RESULTS Diabetes (prevalence = 9.1%) was cross-sectionally associated with shorter dual-task step length after adjusting for covariates (β = -1.59, 95% CI: -3.10, -0.08, p < .05). Diabetes was independently associated with increased risk of future instrumental activity of daily living (IADL) difficulty in those with no prior difficulty (incidence rate ratio [IRR] = 1.51, 95% CI: 1.08, 2.11, p < .05) although dual-task step length was an important confounder in all disability models. No independent associations between diabetes and falls were observed. CONCLUSIONS Diabetes was independently associated with shorter dual-task step length and increased risk of future IADL difficulty. Multidimensional interventions addressing poor health and function in those with diabetes may help reduce the risk of gait deficits and future disability.
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Affiliation(s)
- Orna A Donoghue
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland
| | - Siobhan Leahy
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland.,Ageing Research Centre, Health Research Institute, School of Allied Health, University of Limerick, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland.,Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
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12
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Stevens D, Jackson B, Carberry J, McLoughlin J, Barr C, Mukherjee S, Oh A, McEvoy RD, Crotty M, Vakulin A. The Impact of Obstructive Sleep Apnea on Balance, Gait, and Falls Risk: A Narrative Review of the Literature. J Gerontol A Biol Sci Med Sci 2021; 75:2450-2460. [PMID: 32039438 DOI: 10.1093/gerona/glaa014] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Indexed: 12/24/2022] Open
Abstract
Falls-related hospitalization and injury rates are steadily increasing globally due to a growth in the aging population, and the associated health problems that increase risk of falls. One such associated health problem is sleep disturbances and disorders. Recent cohort studies have shown that subjectively reported poor quality sleep is associated with an increased risk of falls. Obstructive sleep apnea (OSA) is a common sleep disorder characterized by the repetitive reductions, or cessation, of airflow. Some studies have shown that OSA impairs posture/balance and gait with nocturnal hypoxemia the likely main cause. Emerging evidence suggests that treating OSA by continuous positive airway pressure (CPAP) can improve gait, but no studies to date have examined the effect of CPAP on posture/balance. The overall control of balance relies on a complex interaction between several physiological functions including vestibular, muscle, visual, and cognitive functions. We postulate that OSA impacts balance by affecting these different systems to various degrees, with the nocturnal hypoxic burden likely playing an important role. Importantly, these impairments in balance/posture and possible falls risk may be alleviated by OSA treatment. Larger mechanistic studies are needed to properly elucidate how OSA affects falls risk and future large-scale randomized control trials are needed to determine the effectiveness of OSA treatment in reducing the risk of falls.
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Affiliation(s)
- David Stevens
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Brianna Jackson
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Jayne Carberry
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - James McLoughlin
- College of Nursing and Health Science, Flinders University, South Australia, Australia
| | - Chris Barr
- College of Nursing and Health Science, Flinders University, South Australia, Australia
| | - Sutapa Mukherjee
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, South Australia, Australia.,Sleep Health Service, Sleep and Respiratory Services, Flinders Medical Centre, Southern Adelaide Local Health Network, South Australia, Australia
| | - Aaron Oh
- Sleep Health Service, Sleep and Respiratory Services, Flinders Medical Centre, Southern Adelaide Local Health Network, South Australia, Australia
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged, and Extended Aged Care, College of Medicine and Public Health, Flinders University, South Australia, Australia.,4th Generation Rehabilitation Clinic, Flinders Medical Centre, Southern Adelaide Local Health Network, South Australia, Australia
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, South Australia, Australia.,Neurosleep CRE, Woolcock Institute of Medical Research, New South Wales, Australia
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13
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Khan AA, Patel J, Desikan S, Chrencik M, Martinez-Delcid J, Caraballo B, Yokemick J, Gray VL, Sorkin JD, Cebral J, Sikdar S, Lal BK. Asymptomatic carotid artery stenosis is associated with cerebral hypoperfusion. J Vasc Surg 2020; 73:1611-1621.e2. [PMID: 33166609 DOI: 10.1016/j.jvs.2020.10.063] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/03/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We have shown that almost 50% of patients with asymptomatic carotid stenosis (ACS) will demonstrate cognitive impairment. Recent evidence has suggested that cerebral hypoperfusion is an important cause of cognitive impairment. Carotid stenosis can restrict blood flow to the brain, with consequent cerebral hypoperfusion. In contrast, cross-hemispheric collateral compensation through the Circle of Willis, and cerebrovascular vasodilation can also mitigate the effects of flow restriction. It is, therefore, critical to develop a clinically relevant measure of net brain perfusion in patients with ACS that could help in risk stratification and in determining the appropriate treatment. To determine whether ACS results in cerebral hypoperfusion, we developed a novel approach to quantify interhemispheric cerebral perfusion differences, measured as the time to peak (TTP) and mean transit time (MTT) delays using perfusion-weighted magnetic resonance imaging (PWI) of the whole brain. To evaluate the utility of using clinical duplex ultrasonography (DUS) to infer brain perfusion, we also assessed the relationship between the PWI findings and ultrasound-based peak systolic velocity (PSV). METHODS Structural and PWI of the brain and magnetic resonance angiography of the carotid arteries were performed in 20 patients with ≥70% ACS. DUS provided the PSV, and magnetic resonance angiography provided plaque geometric measures at the stenosis. Volumetric perfusion maps of the entire brain from PWI were analyzed to obtain the mean interhemispheric differences for the TTP and MTT delays. In addition, the proportion of brain volume that demonstrated a delay in TTP and MTT was also measured. These proportions were measured for increasing severity of perfusion delays (0.5, 1.0, and 2.0 seconds). Finally, perfusion asymmetries on PWI were correlated with the PSV and stenosis features on DUS using Pearson's correlation coefficients. RESULTS Of the 20 patients, 18 had unilateral stenosis (8 right and 10 left) and 2 had bilateral stenoses. The interhemispheric (left-right) TTP delays measured for the whole brain volume identified impaired perfusion in the hemisphere ipsilateral to the stenosis in 16 of the 18 patients. More than 45% of the patients had had ischemia in at least one half of their brain volume, with a TTP delay >0.5 second. The TTP and MTT delays showed strong correlations with PSV. In contrast, the correlations with the percentage of stenosis were weaker. The correlations for the PSV were strongest with the perfusion deficits (TTP and MTT delays) measured for the whole brain using our proposed algorithm (r = 0.80 and r = 0.74, respectively) rather than when measured on a single magnetic resonance angiography slice as performed in current clinical protocols (r = 0.31 and r = 0.58, respectively). CONCLUSIONS Interhemispheric TTP and MTT delay measured for the whole brain using PWI has provided a new tool for assessing cerebral perfusion deficits in patients with ACS. Carotid stenosis was associated with a detectable reduction in ipsilateral brain perfusion compared with the opposite hemisphere in >80% of patients. The PSV measured at the carotid stenosis using ultrasonography correlated with TTP and MTT delays and might serve as a clinically useful surrogate to brain hypoperfusion in these patients.
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Affiliation(s)
- Amir A Khan
- Department of Bioengineering, George Mason University, Fairfax, Va
| | - Jigar Patel
- Imaging Service, Veterans Affairs Maryland Health Care System, Baltimore, Md
| | - Sarasijhaa Desikan
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - Matthew Chrencik
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - Janice Martinez-Delcid
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - Brian Caraballo
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - John Yokemick
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - Vicki L Gray
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Md
| | - John D Sorkin
- Geriatric Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center, Baltimore, Md; Claude D. Pepper Older Americans Independence Center, University of Maryland School of Medicine, Baltimore, Md
| | - Juan Cebral
- Department of Bioengineering, George Mason University, Fairfax, Va
| | | | - Brajesh K Lal
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md.
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14
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Montero-Odasso M, Speechley M, Muir-Hunter SW, Pieruccini-Faria F, Sarquis-Adamson Y, Hachinski V, Bherer L, Borrie M, Wells J, Garg AX, Tian Q, Ferrucci L, Bray NW, Cullen S, Mahon J, Titus J, Camicioli R. Dual decline in gait speed and cognition is associated with future dementia: evidence for a phenotype. Age Ageing 2020; 49:995-1002. [PMID: 32559288 PMCID: PMC7583522 DOI: 10.1093/ageing/afaa106] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND concurrent declines in gait speed and cognition have been associated with future dementia. However, the clinical profile of 'dual decliners', those with concomitant decline in both gait speed and cognition, has not been yet described. We aimed to describe the phenotype and the risk for incident dementia of those who present with dual decline in comparison with non-dual decliners. METHODS prospective cohort of community-dwelling older adults free of dementia at baseline. We evaluated participants' gait speed, cognition, medical status, functionality, incidence of adverse events and dementia, biannually over 7 years. Gait speed was assessed with a 6-m electronic walkway and global cognition using the MoCA test. We compared characteristics between dual decliners and non-dual decliners using t-test, chi-square and hierarchical regression models. We estimated incident dementia using Cox models. RESULTS among 144 participants (mean age 74.23 ± 6.72 years, 54% women), 17% progressed to dementia. Dual decliners had a 3-fold risk (HR: 3.12, 95%CI: 1.23-7.93, P = 0.017) of progression to dementia compared with non-dual decliners. Dual decliners were significantly older with a higher prevalence of hypertension and dyslipidemia (P = 0.002). Hierarchical regression models show that age and sex alone explained 3% of the variation in the dual decliners group. Adding hypertension and dyslipidemia increased the explained variation by 8 and 10%, respectively. The risk of becoming a dual decliner was 4-fold higher if hypertension was present. CONCLUSION older adults with a concurrent decline in gait speed and cognition represent a group at the highest risk of progression to dementia. Older adults with dual decline have a distinct phenotype with a higher prevalence of hypertension, a treatable condition.
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Affiliation(s)
- Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Department of Medicine and Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada
| | - Mark Speechley
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada
| | - Susan W Muir-Hunter
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Department of Medicine and Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Frederico Pieruccini-Faria
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Department of Medicine and Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Yanina Sarquis-Adamson
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
| | - Vladimir Hachinski
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada
- Department of Clinical Neurological Sciences, The University of Western Ontario, London, ON, Canada
| | - Louis Bherer
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
- Montreal Heart Institute, and Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
| | - Michael Borrie
- Department of Medicine and Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Jennie Wells
- Department of Medicine and Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Amit X Garg
- Department of Medicine and Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada
| | - Qu Tian
- Translational Gerontology Branch Longitudinal Studies Section, National Institute on Aging, Baltimore, MD, USA
| | - Luigi Ferrucci
- Translational Gerontology Branch Longitudinal Studies Section, National Institute on Aging, Baltimore, MD, USA
| | - Nick W Bray
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- School of Kinesiology, The University of Western Ontario, London, ON, Canada
| | - Stephanie Cullen
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- School of Kinesiology, The University of Western Ontario, London, ON, Canada
| | - Joel Mahon
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- School of Kinesiology, The University of Western Ontario, London, ON, Canada
| | - Josh Titus
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- School of Kinesiology, The University of Western Ontario, London, ON, Canada
| | - Richard Camicioli
- Division of Neurology and Department of Medicine, University of Alberta, Edmonton, AB, Canada
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15
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Taneja K, Liu P, Xu C, Turner M, Zhao Y, Abdelkarim D, Thomas BP, Rypma B, Lu H. Quantitative Cerebrovascular Reactivity in Normal Aging: Comparison Between Phase-Contrast and Arterial Spin Labeling MRI. Front Neurol 2020; 11:758. [PMID: 32849217 PMCID: PMC7411174 DOI: 10.3389/fneur.2020.00758] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/19/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose: Cerebrovascular reactivity (CVR) is an index of the dilatory function of cerebral blood vessels and has shown great promise in the diagnosis of risk factors in cerebrovascular disease. Aging is one such risk factor; thus, it is important to characterize age-related differences in CVR. CVR can be measured by BOLD MRI but few studies have measured quantitative cerebral blood flow (CBF)-based CVR in the context of aging. This study aims to determine the age effect on CVR using two quantitative CBF techniques, phase-contrast (PC), and arterial spin labeling (ASL) MRI. Methods: In 49 participants (32 younger and 17 older), CVR was measured with PC, ASL, and BOLD MRI. These CVR methods were compared across young and older groups to determine their dependence on age. PC and ASL CVR were also studied for inter-correlation and mean differences. Gray and white matter CVR values were also studied. Results: PC CVR was higher in younger participants than older participants (by 17%, p = 0.046). However, there were no age differences in ASL or BOLD CVR. ASL CVR was significantly correlated with PC CVR (p = 0.042) and BOLD CVR (p = 0.016), but its values were underestimated compared to PC CVR (p = 0.045). ASL CVR map revealed no difference between gray matter and white matter tissue types, whereas gray matter was significantly higher than white matter in the BOLD CVR map. Conclusion: This study compared two quantitative CVR techniques in the context of brain aging and revealed that PC CVR is a more sensitive method for detection of age differences, despite the absence of spatial information. The ASL method showed a significant correlation with PC and BOLD, but it tends to underestimate CVR due to confounding factors associated with this technique. Importantly, our data suggest that there is not a difference in CBF-based CVR between the gray and white matter, in contrast to previous observation using BOLD MRI.
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Affiliation(s)
- Kamil Taneja
- The Russel H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Peiying Liu
- The Russel H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Cuimei Xu
- The Russel H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Monroe Turner
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, United States
| | - Yuguang Zhao
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, United States
| | - Dema Abdelkarim
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, United States
| | - Binu P Thomas
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Bart Rypma
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, United States.,Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Hanzhang Lu
- The Russel H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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16
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Tarantini S, Yabluchanskiy A, Fülöp GA, Kiss T, Perz A, O'Connor D, Johnson E, Sorond F, Ungvari ZI, Csiszar A. Age-Related Alterations in Gait Function in Freely Moving Male C57BL/6 Mice: Translational Relevance of Decreased Cadence and Increased Gait Variability. J Gerontol A Biol Sci Med Sci 2020; 74:1417-1421. [PMID: 30383221 DOI: 10.1093/gerona/gly242] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Indexed: 11/14/2022] Open
Abstract
Age-related gait dysfunction and balance disorders are a major cause of falls and injury in the elderly population. Epidemiological studies have shown that disturbances in gait coordination which manifest with age are associated with increased morbidity and mortality, impaired cognitive capacity, as well as reduced level of function and loss of independence. In geroscience, mice are the most frequently used model system to test efficiency of antiaging interventions. Despite the clinical importance of age-related gait abnormalities in older adults, the impact of aging on mouse gait coordination is not well documented in the literature. To characterize the effect of aging on mouse gait, we assessed gait function in young (3-month-old) and aged (24-month-old) freely moving C57BL/6 mice using the semiautomated, highly sensitive CatWalk XT system for quantitative assessment of footfall and motor performance. We found that aged mice exhibited significantly decreased cadence and increased stride time variability. Aging also tended to alter footfall patterns. In aged mice, speed, swing speed, stride length, duty cycle, base of support, terminal dual stance, the regularity index, and the gait symmetry index were unaltered. Thus, aging is associated with characteristic alterations in gait function in C57BL/6 mice, which could potentially be assessed as clinically relevant endpoints in geroscience studies testing the effects of antiaging interventions.
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Affiliation(s)
- Stefano Tarantini
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience, University of Oklahoma Health Sciences Center.,Translational Geroscience Laboratory, Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience, University of Oklahoma Health Sciences Center.,Translational Geroscience Laboratory, Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center
| | - Gábor A Fülöp
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience, University of Oklahoma Health Sciences Center.,Translational Geroscience Laboratory, Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center.,Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Hungary
| | - Tamas Kiss
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience, University of Oklahoma Health Sciences Center
| | - Aleksandra Perz
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience, University of Oklahoma Health Sciences Center
| | - Daniel O'Connor
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience, University of Oklahoma Health Sciences Center
| | - Emily Johnson
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience, University of Oklahoma Health Sciences Center
| | - Farzaneh Sorond
- Department of Neurology, Northwestern University, Chicago, Illinois
| | - Zoltan I Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience, University of Oklahoma Health Sciences Center.,Translational Geroscience Laboratory, Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center.,Department of Medical Physics and Informatics, Faculty of Medicine and Faculty of Science and Informatics, University of Szeged, Hungary
| | - Anna Csiszar
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience, University of Oklahoma Health Sciences Center.,Translational Geroscience Laboratory, Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center.,Department of Medical Physics and Informatics, Faculty of Medicine and Faculty of Science and Informatics, University of Szeged, Hungary
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17
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Gray VL, Goldberg AP, Rogers MW, Anthony L, Terrin ML, Guralnik JM, Blackwelder WC, Lam DFH, Sikdar S, Lal BK. Asymptomatic carotid stenosis is associated with mobility and cognitive dysfunction and heightens falls in older adults. J Vasc Surg 2020; 71:1930-1937. [PMID: 31699511 PMCID: PMC7196504 DOI: 10.1016/j.jvs.2019.09.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 09/02/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Atherosclerosis of the carotid bifurcation with plaque formation causes asymptomatic carotid artery stenosis (ACAS), which may also be associated with cerebral hypoperfusion. Cerebral hypoperfusion adversely affects multiple aspects of mobility and cognition. This study tests the hypothesis that community-dwelling older adults with a 50% or greater diameter-reducing ACAS will have mobility and cognitive impairments that heighten their risk for falls. METHODS Eighty community-dwelling adults completed a mobility assessment (Short Physical Performance Battery, Berg Balance Scale, Four Square Step Test, Dynamic Gait Index, Timed Up and Go, and gait speed), self-reported physical function (Activities-Specific Balance Confidence, SF-12 Physical Function Component), and cognitive tests (Mini-Mental State Examination). Falls were recorded for the past 6 months. Standardized carotid ultrasound examination classified participants into no stenosis (<50% diameter reduction) (n = 54), moderate stenosis (50%-69%) (n = 17), and high-grade stenosis (70%-99%) (n = 9) groups. Linear and logistic regression analyses determined the associations between these measures and the degree of stenosis (three groups). RESULTS Logistic regression analysis showed their degree of stenosis was associated with reductions in mobility (Short Physical Performance Battery [P = .008], Berg Balance Scale [P = .0008], Four Square Step Test [P = .005], DGI [P = .0001], TUG [P = .0004], gait speed [P = .02]), perceived physical function (ABC [P < .0001], SF-12 Physical Function Component [P < .0001]), and cognition (MMSE [P = .003]). Adults with moderate- and high-grade stenosis had a greater incidence of falls compared with those without stenosis (relative risk, 2.86; P = .01). Results remained unchanged after adjustment for age, sex and cardiovascular risk factors. CONCLUSIONS ACAS is associated with impaired mobility and cognition that are accompanied with increased fall risk. These impairments increased with worsening severity.
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Affiliation(s)
- Vicki L Gray
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Md
| | - Andrew P Goldberg
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, and Department of Veterans Affairs Baltimore VA Geriatric Research Education and Clinical Center, Baltimore, Md
| | - Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Md
| | - Laila Anthony
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - Michael L Terrin
- Department of Epidemiology and Public Health, and Department of Medicine, University of Maryland School of Medicine, Baltimore, Md
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Md
| | | | - Diana F H Lam
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Md
| | | | - Brajesh K Lal
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md.
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18
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Wilson JC, Kirkwood MW, Potter MN, Wilson PE, Provance AJ, Howell DR. Early physical activity and clinical outcomes following pediatric sport-related concussion. J Clin Transl Res 2020; 5:161-168. [PMID: 33029564 PMCID: PMC7534529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/17/2020] [Accepted: 03/16/2020] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE The objective of the study was to evaluate the clinical outcomes among patients who did and did not report engaging in early physical activity (PA) following sport-related concussion. METHODS We evaluated pediatric patients seen within 21 days of concussion. The independent variable was early PA engagement (since the injury and before initial clinical evaluation). Dependent variables included demographics, injury details, medical history, Health and Behavior Inventory (HBI) score, and balance, vestibular, and oculomotor function tests. RESULTS We examined data from 575 pediatric patients: Sixty-nine (12%) reported engaging in early PA (mean age=14.3±2.4 years; 30% female). The no PA group (mean age=14.5±2.4 years; 35% female) had significantly longer symptom resolution times than the early PA group (median= 16 [interquartile range (IQR)=8-24] vs. 10.5 [IQR=4-17] days; p=0.02). When controlling for pre-existing headache history and time from injury-evaluation time, the early PA group demonstrated lower odds of reporting current headache (adjusted odds ratio=0.14; 95% CI=0.07, 0.26), and reported lower symptom frequency ratings than the no PA group (b=-5.58, 95% CI=-8.94, -2.22). CONCLUSIONS Patients who did not engage in early PA had longer symptom duration, greater odds of post-injury headache, and greater symptoms at initial clinical evaluation. We cannot determine if patients engaged in early PA due to the lower symptom burden and higher functioning at the time of assessment, or if early PA positively affected outcomes. However, as early PA was associated with better post-injury outcomes, clinicians may consider supervised and structured early PA programs as a method to improve clinical outcomes following concussion. RELEVANCE FOR PATIENTS Children and adolescents who were engaged in PA after concussion presented to a clinic with less severe symptoms and had symptoms that resolved sooner compared to those who did not engage in early PA after concussion.
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Affiliation(s)
- Julie C. Wilson
- 1Sports Medicine Center, Children’s Hospital Colorado, Aurora, Colorado, United States,2Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, United States,3Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Michael W. Kirkwood
- 4Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, United States,5Rehabilitation Medicine, Children’s Hospital Colorado, Aurora, Colorado, United States
| | - Morgan N. Potter
- 6Department of Physical Therapy, University of Delaware, Newark, Delaware, United States
| | - Pamela E. Wilson
- 4Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, United States,5Rehabilitation Medicine, Children’s Hospital Colorado, Aurora, Colorado, United States
| | - Aaron J. Provance
- 1Sports Medicine Center, Children’s Hospital Colorado, Aurora, Colorado, United States,2Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - David R. Howell
- 1Sports Medicine Center, Children’s Hospital Colorado, Aurora, Colorado, United States,2Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, United States,
Corresponding author: David R. Howell, PhD, ATC ATC. Sports Medicine Center, Children’s Hospital Colorado Department of Orthopedics, University of Colorado School of Medicine, 13123 E. 16th Avenue, B060 Aurora, Colorado - 80045, United States Phone: 720-777-1502
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19
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Rosenberg AJ, Schroeder EC, Grigoriadis G, Wee SO, Bunsawat K, Heffernan KS, Fernhall B, Baynard T. Aging reduces cerebral blood flow regulation following an acute hypertensive stimulus. J Appl Physiol (1985) 2020; 128:1186-1195. [PMID: 32240012 DOI: 10.1152/japplphysiol.00137.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aging increases arterial stiffness, which has a negative impact on cerebral blood flow (CBF) regulation (decreases CBF and increases CBF pulsatility). The association between arterial stiffness and CBF pulsatility may, in part, explain the relationship between elevated blood pressure (BP) fluctuations and end-organ disease with aging. To understand the mechanisms by which large BP alterations influence cerebral blood flow regulation in both young and old, we examined the effects of age on central and cerebral blood flow regulation following an acute hypertensive stimulus [resistance-exercise (RE)]. Measurements were obtained pre and immediately, 5, and 30 min post-RE in young (n = 35) and older (n = 26) adults. Measurements included cerebral blood velocity (CBv), CBv pulsatility, central pulse-wave velocity (PWV), beta-stiffness index (β), and carotid blood flow pulsatility. Central hemodynamics and BP were continuously recorded. Mean CBv increased immediately post-RE only in the young and decreased below baseline at 5 min post-RE in both groups (interaction, P < 0.05). Older adults had a greater increase in CBv pulsatility immediately post-RE compared with the young (interaction, P < 0.05). Mean BP was higher and carotid pulsatility was lower in the older group and increased immediately post-RE in both groups (P < 0.05). PWV increased immediately post-RE (P < 0.05). There were no changes in β. In conclusion, with aging, greater central arterial stiffness leads to a greater transmission of pulsatile blood velocity from the systemic circulation to the cerebral circulation following an acute hypertensive stress.NEW & NOTEWORTHY Reductions in cerebral blood flow and increases in flow pulsatility with aging are associated to cerebrovascular disease; however, little is known about how an acute hypertensive stimulus effects cerebral blood flow regulation in an aged population. Following the hypertensive stimulus, older adults elicit an attenuated increase in cerebral blood velocity and greater transmission of pulsatile velocity to the brain compared with young adults, demonstrating reduced cerebral blood flow regulation to elevated blood pressure responses with aging.
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Affiliation(s)
- Alexander J Rosenberg
- Department of Kinesiology and Nutrition, Integrative Physiology Laboratory, University of Illinois, Chicago, Illinois
| | - Elizabeth C Schroeder
- Department of Kinesiology and Nutrition, Integrative Physiology Laboratory, University of Illinois, Chicago, Illinois
| | - Georgios Grigoriadis
- Department of Kinesiology and Nutrition, Integrative Physiology Laboratory, University of Illinois, Chicago, Illinois
| | - Sang Ouk Wee
- Department of Kinesiology and Nutrition, Integrative Physiology Laboratory, University of Illinois, Chicago, Illinois.,Department of Kinesiology, California State University, San Bernardino, California
| | - Kanokwan Bunsawat
- Department of Kinesiology and Nutrition, Integrative Physiology Laboratory, University of Illinois, Chicago, Illinois.,Department of Internal Medicine, Division of Geriatrics, University of Utah; Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Kevin S Heffernan
- Department of Exercise Science, Human Performance Laboratory, Syracuse University, Syracuse, New York
| | - Bo Fernhall
- Department of Kinesiology and Nutrition, Integrative Physiology Laboratory, University of Illinois, Chicago, Illinois
| | - Tracy Baynard
- Department of Kinesiology and Nutrition, Integrative Physiology Laboratory, University of Illinois, Chicago, Illinois
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20
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Newman L, Nolan H, Carey D, Reilly RB, Kenny RA. Age and sex differences in frontal lobe cerebral oxygenation in older adults—Normative values using novel, scalable technology: Findings from the Irish Longitudinal Study on Ageing (TILDA). Arch Gerontol Geriatr 2020; 87:103988. [DOI: 10.1016/j.archger.2019.103988] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/10/2019] [Accepted: 11/17/2019] [Indexed: 01/06/2023]
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21
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Amelard R, Murray KR, Hedge ET, Cleworth TW, Noguchi M, Laing AC, Hughson RL. Monocular 3D Sway Tracking for Assessing Postural Instability in Cerebral Hypoperfusion During Quiet Standing. IEEE Trans Neural Syst Rehabil Eng 2020; 28:720-729. [PMID: 32012020 DOI: 10.1109/tnsre.2020.2971340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Postural instability is prevalent in aging and neurodegenerative disease, decreasing quality of life and independence. Quantitatively monitoring balance control is important for assessing treatment efficacy and rehabilitation progress. However, existing technologies for assessing postural sway are complex and expensive, limiting their widespread utility. Here, we propose a monocular imaging system capable of assessing sub-millimeter 3D sway dynamics during quiet standing. Two anatomical targets with known feature geometries were placed on the lumbar and shoulder. Upper and lower trunk 3D kinematic motion were automatically assessed from a set of 2D frames through geometric feature tracking and an inverse motion model. Sway was tracked in 3D and compared between control and hypoperfusion conditions in 14 healthy young adults. The proposed system demonstrated high agreement with a commercial motion capture system (error [Formula: see text], [-0.52, 0.52]). Between-condition differences in sway dynamics were observed in anterior-posterior sway during early and mid stance, and medial-lateral sway during mid stance commensurate with decreased cerebral perfusion, followed by recovered sway dynamics during late stance with cerebral perfusion recovery. This inexpensive single-camera system enables quantitative 3D sway monitoring for assessing neuromuscular balance control in weakly constrained environments.
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22
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Mol A, Reijnierse EM, Trappenburg MC, van Wezel RJA, Maier AB, Meskers CGM. Rapid Systolic Blood Pressure Changes After Standing Up Associate With Impaired Physical Performance in Geriatric Outpatients. J Am Heart Assoc 2019; 7:e010060. [PMID: 30608209 PMCID: PMC6404215 DOI: 10.1161/jaha.118.010060] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background Orthostatic hypotension is a prevalent condition in older adults and is associated with impaired physical performance and falls. The ability of older adults to compensate for rapid changes in systolic blood pressure (SBP; ie, SBP decline rate and SBP variability) may be important for physical performance. This study investigates the association of rapid SBP changes after standing up with physical performance. Methods and Results Consecutive patients who visited the Center of Geriatrics Amsterdam in 2014 and 2015 were included. The following SBP parameters were computed in 2 intervals (0–15 and 15–180 seconds) after standing up: steepness of steepest SBP decline; ratio of standing/supine SBP variability; and magnitude of largest SBP decline. Physical performance was assessed using the following measures: chair stand time, timed up and go time, walking speed, handgrip strength, and tandem stance performance. A total of 109 patients (45% men; age, mean, 81.7 years [standard deviation, 7.0 years]) were included. Steepness of steepest SBP decline (0–15 seconds) was associated with slower chair stand time (P<0.001), timed up and go time (P=0.022), and walking speed (P=0.024). Ratio of standing/supine SBP variability (0–15 seconds) was associated with slower chair stand time (P=0.005). Magnitude of largest SBP decline was not associated with physical performance. Conclusions SBP parameters reflecting rapid SBP changes were more strongly associated with physical performance compared with SBP decline magnitude in geriatric outpatients. These results support the hypothesis of an inadequate cerebral autoregulation during rapid SBP changes and advocate the use of continuous blood pressure measurements.
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Affiliation(s)
- Arjen Mol
- 1 Department of Human Movement Sciences @AgeAmsterdam Amsterdam Movement Sciences Vrije Universiteit Amsterdam Amsterdam the Netherlands.,2 Department of Biophysics Donders Institute for Brain, Cognition and Behaviour Radboud University Nijmegen the Netherlands
| | - Esmee M Reijnierse
- 3 Department of Medicine and Aged Care @AgeMelbourne The Royal Melbourne Hospital The University of Melbourne Australia
| | - Marijke C Trappenburg
- 4 Section of Gerontology and Geriatrics Department of Internal Medicine VU University Medical Center Amsterdam Amsterdam the Netherlands.,5 Department of Internal Medicine Amstelland Hospital Amstelveen the Netherlands
| | - Richard J A van Wezel
- 2 Department of Biophysics Donders Institute for Brain, Cognition and Behaviour Radboud University Nijmegen the Netherlands.,6 Biomedical Signals and Systems Technical Medical Centre, University of Twente Enschede the Netherlands
| | - Andrea B Maier
- 1 Department of Human Movement Sciences @AgeAmsterdam Amsterdam Movement Sciences Vrije Universiteit Amsterdam Amsterdam the Netherlands.,3 Department of Medicine and Aged Care @AgeMelbourne The Royal Melbourne Hospital The University of Melbourne Australia
| | - Carel G M Meskers
- 1 Department of Human Movement Sciences @AgeAmsterdam Amsterdam Movement Sciences Vrije Universiteit Amsterdam Amsterdam the Netherlands.,7 Department of Rehabilitation Medicine VU University Medical Center Amsterdam Amsterdam the Netherlands
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23
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Howell DR, Brilliant AN, Oldham JR, Berkstresser B, Wang F, Meehan WP. Exercise in the first week following concussion among collegiate athletes: Preliminary findings. J Sci Med Sport 2019; 23:112-117. [PMID: 31522997 DOI: 10.1016/j.jsams.2019.08.294] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/30/2019] [Accepted: 08/31/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Our purpose was to examine the association between exercise after concussion with symptom severity, postural control, and time to symptom-resolution. DESIGN Longitudinal cohort. METHODS Collegiate athletes (n = 72; age = 20.2 ± 1.3 years; 46% female) with concussion completed a symptom questionnaire at initial (0.6 ± 0.8 days post-injury) and follow-up (2.9 ± 1.4 days post-injury) evaluations, and a postural control assessment at follow-up. Participants were grouped into those who exercised in between the time of injury and the follow-up evaluation and those who did not. Decisions regarding post-concussion exercise were made by a sports medicine team consisting of a single team physician and athletic trainers. RESULTS Thirteen athletes were not included in the current study, resulting in an 85% response rate. Thirteen of the athletes who completed the study exercised between evaluations (18%). There was no symptom resolution time difference between groups (median = 13 [IQR = 7-18] days vs. 13 [7-23] days; p = 0.83). Symptom ratings were similar between groups at the acute post-injury assessment (median PCSS = 18.5 [7.5-26] vs. 17 [14-40]; p = 0.21), but a main effect of group after adjusting for time from injury to assessment indicated the exercise group reported lower symptom severity than the no exercise group across both assessments (p = 0.044). The dual-task gait speed of the exercise group was higher than the no exercise group (0.90 ± 0.15 vs. 0.78 ± 0.16 m/s; p = 0.02). CONCLUSIONS Athletes who were recommended aerobic exercise after concussion did not have worse outcomes than those who were not. Exercise within the first week after concussion does not appear to be associated with detrimental clinical outcomes.
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Affiliation(s)
- David R Howell
- Sports Medicine Center, Children's Hospital Colorado, USA; Department of Orthopedics, University of Colorado School of Medicine, USA; The Micheli Center for Sports Injury Prevention, USA.
| | - Anna N Brilliant
- The Micheli Center for Sports Injury Prevention, USA; Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, USA
| | - Jessie R Oldham
- The Micheli Center for Sports Injury Prevention, USA; Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, USA
| | | | | | - William P Meehan
- The Micheli Center for Sports Injury Prevention, USA; Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, USA; Departments of Pediatrics and Orthopaedics, Harvard Medical School, USA
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24
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Peeters G, Feeney J, Carey D, Kennelly S, Kenny RA. Fear of falling: A manifestation of executive dysfunction? Int J Geriatr Psychiatry 2019; 34:1275-1282. [PMID: 31034696 DOI: 10.1002/gps.5133] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 04/05/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Fear of falling (FoF) may be an early marker of decline in global cognitive functioning, but associations with specific domains of cognitive functioning are unclear. The aim was to examine associations between FoF and 4-year decline in memory, processing speed, and executive functioning in adults aged 50 years and older. METHODS Data were from 5174 participants (mean age = 62.6 ± 8.9 years, range = 50-91, 54.5% female) in The Irish Longitudinal Study on Ageing, a population-based study. MEASUREMENTS FoF was self-reported in 2009 to 2011. Immediate and delayed recall, Colour Trails 1 and 2, choice reaction time, sustained attention to response task, and verbal fluency were measured in 2009 to 2011 and 2014 to 2015. Prospective associations between FoF and domains of cognitive functioning were examined using linear mixed modelling. Adjustment was made for demographic and health factors. Interactions with age were examined. RESULTS In 2009 to 2011, 20.6% of participants reported FoF. No statistically significant interaction of FoF with age was found for any of the associations (P ≥ .06). Participants with FoF had greater decline on delayed recall (B = -0.19; 95% CI, -0.32 to -0.06), verbal fluency (B = -0.52; 95% CI, -0.88 to -0.18); and the ln-transformed scores for the Colour Trails 1 test (B = -0.04; 95% CI, -0.07 to -0.01) and the Colour Trails 2 test (B = -0.04; 95% CI, -0.06 to -0.02) than participants without FoF. No statistically significant associations were found for any of the other outcomes. CONCLUSIONS FoF may be an indicator of decline in domains of cognitive functioning, particularly those related to executive function and processing speed. However, studies with longer follow-up and/or higher average age are required to confirm this.
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Affiliation(s)
- Geeske Peeters
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Joanne Feeney
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Daniel Carey
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Sean Kennelly
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Department of Age-Related Health Care, Tallaght Hospital, Tallaght, Dublin, Ireland
| | - Rose Anne Kenny
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland.,Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
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25
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Lipecz A, Csipo T, Tarantini S, Hand RA, Ngo BTN, Conley S, Nemeth G, Tsorbatzoglou A, Courtney DL, Yabluchanska V, Csiszar A, Ungvari ZI, Yabluchanskiy A. Age-related impairment of neurovascular coupling responses: a dynamic vessel analysis (DVA)-based approach to measure decreased flicker light stimulus-induced retinal arteriolar dilation in healthy older adults. GeroScience 2019; 41:341-349. [PMID: 31209739 DOI: 10.1007/s11357-019-00078-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/06/2019] [Indexed: 12/21/2022] Open
Abstract
Aging is a major risk factor for vascular cognitive impairment and dementia (VCID). Recent studies demonstrate that cerebromicrovascular dysfunction plays a causal role in the development of age-related cognitive impairment, in part via disruption of neurovascular coupling (NVC) responses. NVC (functional hyperemia) is responsible for adjusting cerebral blood flow to the increased energetic demands of activated neurons, and in preclinical animal models of aging, pharmacological restoration of NVC is associated with improved cognitive performance. To translate these findings, there is an increasing need to develop novel and sensitive tools to assess cerebromicrovascular function and NVC to assess risk for VCID and evaluate treatment efficacy. Due to shared developmental origins, anatomical features, and physiology, assessment of retinal vessel function may serve as an important surrogate outcome measure to study neurovascular dysfunction. The present study was designed to compare NVC responses in young (< 45 years of age; n = 18) and aged (> 65 years of age; n = 11) healthy human subjects by assessing flicker light-induced changes in the diameter of retinal arterioles using a dynamic vessel analyzer (DVA)-based approach. We found that NVC responses in retinal arterioles were significantly decreased in older adults as compared with younger subjects. We propose that the DVA-based approach can be used to assess NVC, as a surrogate cerebromicrovascular outcome measure, to evaluate the effects of therapeutic interventions in older individuals.
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Affiliation(s)
- Agnes Lipecz
- Translational Geroscience Laboratory, Reynolds Oklahoma Center on Aging/Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA.,Department of Ophthalmology, Josa Andras Hospital, Nyiregyhaza, Hungary
| | - Tamas Csipo
- Translational Geroscience Laboratory, Reynolds Oklahoma Center on Aging/Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA.,Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary.,Department of Cardiology, Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Stefano Tarantini
- Translational Geroscience Laboratory, Reynolds Oklahoma Center on Aging/Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
| | - Rachel A Hand
- Translational Geroscience Laboratory, Reynolds Oklahoma Center on Aging/Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
| | - Bich-Thy N Ngo
- Translational Geroscience Laboratory, Reynolds Oklahoma Center on Aging/Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
| | - Shannon Conley
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Gabor Nemeth
- Department of Ophthalmology, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, Miskolc, Hungary
| | | | - Donald L Courtney
- Translational Geroscience Laboratory, Reynolds Oklahoma Center on Aging/Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
| | - Valeriya Yabluchanska
- Translational Geroscience Laboratory, Reynolds Oklahoma Center on Aging/Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA.,Bon Secours St. Francis Family Medicine Center, Midlothian, VA, USA
| | - Anna Csiszar
- Translational Geroscience Laboratory, Reynolds Oklahoma Center on Aging/Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA.,Department of Cardiology, Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltan I Ungvari
- Translational Geroscience Laboratory, Reynolds Oklahoma Center on Aging/Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA.,Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary.,Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary.,Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andriy Yabluchanskiy
- Translational Geroscience Laboratory, Reynolds Oklahoma Center on Aging/Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA.
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Roca F, Lang PO, Chassagne P. Chronic neurological disorders and related comorbidities: Role of age-associated physiological changes. HANDBOOK OF CLINICAL NEUROLOGY 2019; 167:105-122. [PMID: 31753128 DOI: 10.1016/b978-0-12-804766-8.00007-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Current knowledge indicates that the physiological aging process starts with subclinical changes at the molecular and cellular level, which affect nearly all physiological systems. For example, the age-associated remodeling of the immune system (i.e., immunosenescence) and vascular aging per se can contribute to frailty and vulnerability among older adults. They are also described as being implicated in the pathophysiology of some major chronic comorbid conditions such as age-associated diseases of the central (e.g., stroke, Parkinson's disease, Alzheimer's disease, and related disorders) and peripheral (e.g., polyneuropathy) nervous systems. These neurologic disorders are also among the greatest contributors to geriatric syndromes, which refer to highly prevalent and chronic conditions among aged people of multifactorial origin, such as delirium, falls, incontinence, and frailty. Neurologic disorders can also occur in patients with one or more geriatric syndromes and thus further interfere with the quality of life, physical function, morbidity, and mortality. This chapter presents and discusses in three sections the complex interrelationships between the main determinants of aging with a specific focus on vascular aging, chronic neurologic disorders, and the specific clinical presentation of geriatric syndromes in older people.
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Affiliation(s)
- Frédéric Roca
- Geriatric Internal Medicine Division, Rouen University Hospital, Rouen, France
| | | | - Philippe Chassagne
- Geriatric Internal Medicine Division, Rouen University Hospital, Rouen, France.
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27
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Campbell AM, Coley KC, Corbo JM, DeLellis TM, Joseph M, Thorpe CT, McGivney MS, Klatt P, Cox-Vance L, Balestrino V, Sakely H. Pharmacist-Led Drug Therapy Problem Management in an Interprofessional Geriatric Care Continuum: A Subset of the PIVOTS Group. AMERICAN HEALTH & DRUG BENEFITS 2018; 11:469-478. [PMID: 30746018 PMCID: PMC6322592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 08/01/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Drug therapy problems, which are adverse events involving medications that can ultimately interfere with a patient's therapeutic goals, occur frequently in older adults. If not identified, resolved, and prevented through clinical decision-making, drug therapy problems may negatively affect patient health outcomes. OBJECTIVE To quantify the impact of pharmacist interventions on the care of older adults by identifying the most common drug therapy problems, the medications most often involved in these problems, and the actions taken by pharmacists to resolve these problems. METHODS This retrospective chart review included individuals seen by a geriatric pharmacist in one geriatric practice, where 4 pharmacists provide continuous, comprehensive medication management across 2 outpatient geriatric clinics, skilled-nursing facilities, and assisted-living facilities. The individuals were seen between August 2014 and November 2015. For all patient care encounters during this time frame, pharmacists used the Assurance System to document each drug therapy problem, the medications involved, the patient's care setting (ie, outpatient clinic, assisted-living facility, skilled-nursing facility), the actions taken to resolve any drug therapy problems, and the estimated 90-day impact on the patient and the healthcare system. RESULTS A total of 3100 drug therapy problems were identified during 3309 patient-pharmacist encounters for 452 patients (mean age, 81.4 years), 48.7% of whom were seen in the skilled-nursing facility. The most common drug therapy problem was dose too low, followed by dose too high, and warfarin was the most common drug associated with drug therapy problems. Pharmacists provided 4921 interventions, often more than 1 intervention per drug therapy problem, for 275 different medications. Laboratory monitoring and dose change were the most common interventions, with an estimated annual financial savings between $268,690 and $270,591. CONCLUSION Older patients are a vulnerable patient population who often receive unsafe medication regimens, which can result in adverse drug reactions and other critical problems. When integrated into interprofessional geriatric care teams, pharmacists' interventions provide an invaluable qualitative and monetary resource to the medication-based management of patients with well-recognized, high-risk geriatric syndromes as they transition to and through various levels of care.
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Affiliation(s)
- Ashley M Campbell
- Assistant Professor, Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson
| | - Kim C Coley
- Professor, Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, PA
| | - Jason M Corbo
- Clinical Pharmacy Specialist, South Texas Veterans Health Care System, San Antonio
| | - Teresa M DeLellis
- Assistant Professor, Pharmacy Practice, Manchester University College of Pharmacy, Natural & Health Sciences, Fort Wayne, IN
| | - Matthew Joseph
- Clinical Pharmacist, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center (UPMC)
| | - Carolyn T Thorpe
- Associate Professor, Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, and Research Health Scientist, VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
| | - Melissa S McGivney
- Associate Dean for Community Partnerships and Associate Professor, Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy
| | | | - Lora Cox-Vance
- Chief, Geriatrics and Extended Care, Chillicothe VA Medical Center, OH
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Chung CC, Pimentel Maldonado DA, Jor'dan AJ, Alfaro FJ, Lioutas VA, Núñez MZ, Novak V. Lower cerebral vasoreactivity as a predictor of gait speed decline in type 2 diabetes mellitus. J Neurol 2018; 265:2267-2276. [PMID: 30062523 PMCID: PMC6162165 DOI: 10.1007/s00415-018-8981-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 01/27/2023]
Abstract
Gait speed is an indicator of overall functional health and is correlated with survival in older adults. We prospectively evaluated the long-term association between cerebral vasoreactivity and gait speed during normal walking (NW) and dual-task walking (DTW) in older adults with and without type 2 diabetes mellitus (T2DM). 40 participants (aged 67.3 ± 8.8 years, 20 with T2DM) completed a 2-year prospective study consisting of MRI, blood sampling, and gait assessments. The whole brain vasoreactivity was quantified using continuous arterial spin labeling MRI. Gait speed during DTW was assessed by subtracting serial sevens. Dual-task cost was calculated as the percent change in gait speed from NW to DTW. In the entire cohort, higher glycemic profiles were associated with a slower gait speed. In the diabetic group, lower vasoreactivity was associated with a slower gait speed during NW ([Formula: see text] = 0.30, p = 0.019) and DTW ([Formula: see text] = 0.35, p = 0.01) and a higher dual-task cost ([Formula: see text] = 0.69, p = 0.009) at 2-year follow-up. The participants with T2DM and lower cerebral vasoreactivity had a greater decrease in gait speed during NW and DTW after the 2-year follow-up ([Formula: see text] = 0.17, p = 0.04 and [Formula: see text] = 0.28, p = 0.03, respectively). Longer diabetes duration was associated with a higher dual-task cost ([Formula: see text] = 0.19, p = 0.04) and a greater decrease in gait speed during NW ([Formula: see text] = 0.17, p = 0.02). These findings indicate that in older adults with type 2 diabetes, gait performance is highly dependent on the integrity of cerebrovascular regulation.
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Affiliation(s)
- Chen-Chih Chung
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 127, Boston, MA, 02215, USA
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, Republic of China
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Daniela A Pimentel Maldonado
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 127, Boston, MA, 02215, USA
- Department of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Neurology, University of Massachusetts Medical School, Worcester, USA
| | - Azizah J Jor'dan
- Department of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, USA
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
| | - Freddy J Alfaro
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 127, Boston, MA, 02215, USA
| | - Vasileios-Arsenios Lioutas
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 127, Boston, MA, 02215, USA
| | - Maria Zunilda Núñez
- Biomedical and Clinical Research Center (CINBIOCLI), Santiago, Dominican Republic
| | - Vera Novak
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 127, Boston, MA, 02215, USA.
- Department of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Castro P, Azevedo E, Rocha I, Sorond F, Serrador JM. Chronic kidney disease and poor outcomes in ischemic stroke: is impaired cerebral autoregulation the missing link? BMC Neurol 2018; 18:21. [PMID: 29499637 PMCID: PMC5834853 DOI: 10.1186/s12883-018-1025-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 02/21/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chronic kidney disease increases stroke incidence and severity but the mechanisms behind this cerebro-renal interaction are mostly unexplored. Since both vascular beds share similar features, microvascular dysfunction could be the possible missing link. Therefore, we examined the relationship between renal function and cerebral autoregulation in the early hours post ischemia and its impact on outcome. METHODS We enrolled 46 ischemic strokes (middle cerebral artery). Dynamic cerebral autoregulation was assessed by transfer function (coherence, phase and gain) of spontaneous blood pressure oscillations to blood flow velocity within 6 h from symptom-onset. Estimated glomerular filtration rate (eGFR) was calculated. Hemorrhagic transformation (HT) and white matter lesions (WML) were collected from computed tomography performed at presentation and 24 h. Outcome was evaluated with modified Rankin Scale at 3 months. RESULTS High gain (less effective autoregulation) was correlated with lower eGFR irrespective of infarct side (p < 0.05). Both lower eGFR and higher gain correlated with WML grade (p < 0.05). Lower eGFR and increased gain, alone and in combination, progressively reduced the odds of a good functional outcome [ipsilateral OR = 4.39 (CI95% 3.15-25.6), p = 0.019; contralateral OR = 8.15 (CI95% 4.15-15.6), p = 0.002] and increased risk of HT [ipsilateral OR = 3.48 (CI95% 0.60-24.0), p = 0.132; contralateral OR = 6.43 (CI95% 1.40-32.1), p = 0.034]. CONCLUSIONS Lower renal function correlates with less effective dynamic cerebral autoregulation in acute ischemic stroke, both predicting a bad outcome. The evaluation of serum biomarkers of renal dysfunction could have interest in the future for assessing cerebral microvascular risk and relationship with stroke complications.
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Affiliation(s)
- Pedro Castro
- Department Neurology, São João Hospital Center, Faculty of Medicine of University of Porto, Alameda Professor Hernani Monteiro, 4200-319, Porto, Portugal.
| | - Elsa Azevedo
- Department Neurology, São João Hospital Center, Faculty of Medicine of University of Porto, Alameda Professor Hernani Monteiro, 4200-319, Porto, Portugal
| | - Isabel Rocha
- Cardiovascular Autonomic Function Lab, Institute of Physiology, Faculty of Medicine of University of Lisbon, Lisbon, Portugal
| | - Farzaneh Sorond
- Department of Neurology, Division of Stroke and Neurocritical, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jorge M Serrador
- Department of Pharmacology, Physiology and Neuroscience, Rutgers Biomedical Health Sciences, Newark, NJ, USA.,Veterans Biomedical Research Institute and War Related Illness and Injury Study Center, Department of Veterans Affairs, East Orange, USA.,Cardiovascular Electronics, National University of Ireland Galway, Galway, Ireland
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Ezzati A, Rundek T, Verghese J, Derby CA. Transcranial Doppler and Lower Extremity Function in Older Adults: Einstein Aging Study. J Am Geriatr Soc 2017; 65:2659-2664. [PMID: 29130477 PMCID: PMC5729099 DOI: 10.1111/jgs.15181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To determine whether transcranial Doppler ultrasound (TCD) measures of mean blood flow velocity (MBFV) in the major cerebral arteries are associated with measures of lower extremity function in community-dwelling older adults. DESIGN Cross-sectional study. SETTING Community sample. PARTICIPANTS Individuals aged 70 and older (mean 79.5, 54% female) without dementia participating in the Einstein Aging Study (N = 200). MEASUREMENTS All participants underwent TCD assessments and tests of lower extremity function at an annual clinic visit. Average MBFV for anterior (left and right anterior and middle cerebral arteries (MCAs)) and posterior (vertebral (VA) and basilar (BA) artery) circulation was measured using a standardized TCD protocol. Lower extremity function was characterized according to gait speed (cm/s) measured using an instrumented walkway, balance according to unipedal stance time (UPST, seconds), and lower extremity strength according to timed repeated chair rise (seconds). RESULTS Multiple regression models adjusted for age, sex, race, education, and medical comorbidities showed that lower MBFV in the MCA was associated with slower gait speed and chair rise time but not with UPST. Ordinal regression models showed that lower MBFV in the VA and BA is associated with shorter UPST. CONCLUSION Low MBFV in the anterior and posterior cerebral circulation was associated with worse lower extremity function and balance in older adults. This might be indicative of the importance of age-related changes in cerebral hemodynamics in the function of brain regions involved in specific aspects of physical performance.
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Affiliation(s)
- Ali Ezzati
- Saul B. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neurology, Montefiore Medical Center, Bronx, NY, USA
- Departments of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tatjana Rundek
- Department of Neurology, Miller school of Medicine, University of Miami, Miami, Florida, USA
| | - Joe Verghese
- Saul B. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neurology, Montefiore Medical Center, Bronx, NY, USA
- Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carol A. Derby
- Saul B. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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Tarantini S, Yabluchanksiy A, Fülöp GA, Hertelendy P, Valcarcel-Ares MN, Kiss T, Bagwell JM, O'Connor D, Farkas E, Sorond F, Csiszar A, Ungvari Z. Pharmacologically induced impairment of neurovascular coupling responses alters gait coordination in mice. GeroScience 2017; 39:601-614. [PMID: 29243191 PMCID: PMC5745218 DOI: 10.1007/s11357-017-0003-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/01/2017] [Indexed: 12/20/2022] Open
Abstract
There is correlative evidence that impaired cerebral blood flow (CBF) regulation, in addition to promoting cognitive impairment, is also associated with alterations in gait and development of falls in elderly people. CBF is adjusted to neuronal activity via neurovascular coupling (NVC) and this mechanism becomes progressively impaired with age. To establish a direct cause-and-effect relationship between impaired NVC and gait abnormalities, we induced neurovascular uncoupling pharmacologically in young C57BL/6 mice by inhibiting the synthesis of vasodilator mediators involved in NVC. Treatment of mice with the epoxygenase inhibitor MSPPOH, the NO synthase inhibitor L-NAME, and the COX inhibitor indomethacin significantly decreased NVC mimicking the aging phenotype. Pharmacologically induced neurovascular uncoupling significantly decreased the dynamic gait parameter duty cycle, altered footfall patterns, and significantly increased phase dispersion, indicating impaired interlimb coordination. Impaired NVC also tended to increase gait variability. Thus, selective experimental disruption of NVC causes subclinical gait abnormalities, supporting the importance of CBF in both cognitive function and gait regulation.
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Affiliation(s)
- Stefano Tarantini
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andriy Yabluchanksiy
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Gábor A Fülöp
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Peter Hertelendy
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - M Noa Valcarcel-Ares
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Tamas Kiss
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jonathan M Bagwell
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Veterinary Pathobiology, Oklahoma State University, Stillwater, OK, USA
| | - Daniel O'Connor
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Eszter Farkas
- Department of Medical Physics and Informatics, Faculty of Medicine and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Farzaneh Sorond
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Anna Csiszar
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Medical Physics and Informatics, Faculty of Medicine and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Zoltan Ungvari
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Department of Medical Physics and Informatics, Faculty of Medicine and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary.
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Jor’dan AJ, Poole VN, Iloputaife I, Milberg W, Manor B, Esterman M, Lipsitz LA. Executive Network Activation is Linked to Walking Speed in Older Adults: Functional MRI and TCD Ultrasound Evidence From the MOBILIZE Boston Study. J Gerontol A Biol Sci Med Sci 2017; 72:1669-1675. [PMID: 28449077 PMCID: PMC5861979 DOI: 10.1093/gerona/glx063] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/29/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Changes in cerebral blood flow velocity (CBF) in response to a cognitive task (task-related ΔCBF) have been shown by Transcranial Doppler ultrasonography (TCD) to be reduced in slow walkers. However, it is unknown whether reduced task-related ΔCBF is associated with reduced neural activity in specific brain regions, as measured by blood-oxygen-level dependent (BOLD) functional magnetic resonance imaging (fMRI). METHODS We assessed the regional changes in neural activity associated with reduced middle cerebral artery (MCA) task-related ΔCBF to an executive task and slow walking speed in 67 community-dwelling older adults from the MOBILIZE Boston Study. Participants underwent walking assessments and TCD ultrasonography measures of MCA ΔCBF during the n-back task of executive function. A subset of participants (n = 27) completed the same task during fMRI. Individual BOLD activation maps for the n-back task were correlated with TCD measures and network-level averages were associated with TCD and preferred walking speed. RESULTS Participants with diminished task-related ΔCBF walked more slowly (β = .39, p = .001). fMRI revealed significant associations between task-related ΔCBF and regional BOLD activation in several brain regions/networks supplied by the MCA. Of these regions and networks, those within the executive network were most strongly associated with walking speed (β = .36, p = .01). CONCLUSIONS Task-related ΔCBF during an executive function task is related to activation in several neural networks and impairment in the ability to recruit the executive network in particular is associated with slow walking speed in older adults.
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Affiliation(s)
- Azizah J Jor’dan
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Geriatric Research, Education, and Clinical Center (GRECC)
| | - Victoria N Poole
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Massachusetts
| | - Ikechukwu Iloputaife
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - William Milberg
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Geriatric Research, Education, and Clinical Center (GRECC)
| | - Brad Manor
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Michael Esterman
- Geriatric Research, Education, and Clinical Center (GRECC)
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Massachusetts
| | - Lewis A Lipsitz
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Rye Hanton C, Kwon YJ, Aung T, Whittington J, High RR, Goulding EH, Schenk AK, Bonasera SJ. Mobile Phone-Based Measures of Activity, Step Count, and Gait Speed: Results From a Study of Older Ambulatory Adults in a Naturalistic Setting. JMIR Mhealth Uhealth 2017; 5:e104. [PMID: 28974482 PMCID: PMC5645644 DOI: 10.2196/mhealth.5090] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 01/05/2016] [Indexed: 11/13/2022] Open
Abstract
Background Cellular mobile telephone technology shows much promise for delivering and evaluating healthcare interventions in cost-effective manners with minimal barriers to access. There is little data demonstrating that these devices can accurately measure clinically important aspects of individual functional status in naturalistic environments outside of the laboratory. Objective The objective of this study was to demonstrate that data derived from ubiquitous mobile phone technology, using algorithms developed and previously validated by our lab in a controlled setting, can be employed to continuously and noninvasively measure aspects of participant (subject) health status including step counts, gait speed, and activity level, in a naturalistic community setting. A second objective was to compare our mobile phone-based data against current standard survey-based gait instruments and clinical physical performance measures in order to determine whether they measured similar or independent constructs. Methods A total of 43 ambulatory, independently dwelling older adults were recruited from Nebraska Medicine, including 25 (58%, 25/43) healthy control individuals from our Engage Wellness Center and 18 (42%, 18/43) functionally impaired, cognitively intact individuals (who met at least 3 of 5 criteria for frailty) from our ambulatory Geriatrics Clinic. The following previously-validated surveys were obtained on study day 1: (1) Late Life Function and Disability Instrument (LLFDI); (2) Survey of Activities and Fear of Falling in the Elderly (SAFFE); (3) Patient Reported Outcomes Measurement Information System (PROMIS), short form version 1.0 Physical Function 10a (PROMIS-PF); and (4) PROMIS Global Health, short form version 1.1 (PROMIS-GH). In addition, clinical physical performance measurements of frailty (10 foot Get up and Go, 4 Meter walk, and Figure-of-8 Walk [F8W]) were also obtained. These metrics were compared to our mobile phone-based metrics collected from the participants in the community over a 24-hour period occurring within 1 week of the initial assessment. Results We identified statistically significant differences between functionally intact and frail participants in mobile phone-derived measures of percent activity (P=.002, t test), active versus inactive status (P=.02, t test), average step counts (P<.001, repeated measures analysis of variance [ANOVA]) and gait speed (P<.001, t test). In functionally intact individuals, the above mobile phone metrics assessed aspects of functional status independent (Bland-Altman and correlation analysis) of both survey- and/or performance battery-based functional measures. In contrast, in frail individuals, the above mobile phone metrics correlated with submeasures of both SAFFE and PROMIS-GH. Conclusions Continuous mobile phone-based measures of participant community activity and mobility strongly differentiate between persons with intact functional status and persons with a frailty phenotype. These measures assess dimensions of functional status independent of those measured using current validated questionnaires and physical performance assessments to identify functional compromise. Mobile phone-based gait measures may provide a more readily accessible and less-time consuming measure of gait, while further providing clinicians with longitudinal gait measures that are currently difficult to obtain.
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Affiliation(s)
- Cassia Rye Hanton
- Department of Internal Medicine, Division of Geriatrics, University of Nebraska Medical Center, Omaha, NE, United States
| | - Yong-Jun Kwon
- Department of Physics, Randolph College, Lynchburg, VA, United States
| | - Thawda Aung
- Department of Physics, Randolph College, Lynchburg, VA, United States
| | - Jackie Whittington
- Department of Internal Medicine, Division of Geriatrics, University of Nebraska Medical Center, Omaha, NE, United States
| | - Robin R High
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Evan H Goulding
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, United States
| | - A Katrin Schenk
- Department of Physics, Randolph College, Lynchburg, VA, United States
| | - Stephen J Bonasera
- Department of Internal Medicine, Division of Geriatrics, University of Nebraska Medical Center, Omaha, NE, United States
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Toth P, Tarantini S, Csiszar A, Ungvari Z. Functional vascular contributions to cognitive impairment and dementia: mechanisms and consequences of cerebral autoregulatory dysfunction, endothelial impairment, and neurovascular uncoupling in aging. Am J Physiol Heart Circ Physiol 2017; 312:H1-H20. [PMID: 27793855 PMCID: PMC5283909 DOI: 10.1152/ajpheart.00581.2016] [Citation(s) in RCA: 324] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/10/2016] [Accepted: 10/26/2016] [Indexed: 12/16/2022]
Abstract
Increasing evidence from epidemiological, clinical and experimental studies indicate that age-related cerebromicrovascular dysfunction and microcirculatory damage play critical roles in the pathogenesis of many types of dementia in the elderly, including Alzheimer's disease. Understanding and targeting the age-related pathophysiological mechanisms that underlie vascular contributions to cognitive impairment and dementia (VCID) are expected to have a major role in preserving brain health in older individuals. Maintenance of cerebral perfusion, protecting the microcirculation from high pressure-induced damage and moment-to-moment adjustment of regional oxygen and nutrient supply to changes in demand are prerequisites for the prevention of cerebral ischemia and neuronal dysfunction. This overview discusses age-related alterations in three main regulatory paradigms involved in the regulation of cerebral blood flow (CBF): cerebral autoregulation/myogenic constriction, endothelium-dependent vasomotor function, and neurovascular coupling responses responsible for functional hyperemia. The pathophysiological consequences of cerebral microvascular dysregulation in aging are explored, including blood-brain barrier disruption, neuroinflammation, exacerbation of neurodegeneration, development of cerebral microhemorrhages, microvascular rarefaction, and ischemic neuronal dysfunction and damage. Due to the widespread attention that VCID has captured in recent years, the evidence for the causal role of cerebral microvascular dysregulation in cognitive decline is critically examined.
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Affiliation(s)
- Peter Toth
- Department of Geriatric Medicine, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Department of Neurosurgery and Szentagothai Research Center, University of Pecs, Pecs, Hungary; and
| | - Stefano Tarantini
- Department of Geriatric Medicine, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Anna Csiszar
- Department of Geriatric Medicine, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Zoltan Ungvari
- Department of Geriatric Medicine, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma;
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
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Tarantini S, Tran CHT, Gordon GR, Ungvari Z, Csiszar A. Impaired neurovascular coupling in aging and Alzheimer's disease: Contribution of astrocyte dysfunction and endothelial impairment to cognitive decline. Exp Gerontol 2016; 94:52-58. [PMID: 27845201 DOI: 10.1016/j.exger.2016.11.004] [Citation(s) in RCA: 274] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/02/2016] [Accepted: 11/10/2016] [Indexed: 12/11/2022]
Abstract
The importance of (micro)vascular contributions to cognitive impairment and dementia (VCID) in aging cannot be overemphasized, and the pathogenesis and prevention of age-related cerebromicrovascular pathologies are a subject of intensive research. In particular, aging impairs the increase in cerebral blood flow triggered by neural activation (termed neurovascular coupling or functional hyperemia), a critical mechanism that matches oxygen and nutrient delivery with the increased demands in active brain regions. From epidemiological, clinical and experimental studies the picture emerges of a complex functional impairment of cerebral microvessels and astrocytes, which likely contribute to neurovascular dysfunction and cognitive decline in aging and in age-related neurodegenerative diseases. This overview discusses age-related alterations in neurovascular coupling responses responsible for impaired functional hyperemia. The mechanisms and consequences of astrocyte dysfunction (including potential alteration of astrocytic endfeet calcium signaling, dysregulation of eicosanoid gliotransmitters and astrocyte energetics) and functional impairment of the microvascular endothelium are explored. Age-related mechanisms (cellular oxidative stress, senescence, circulating IGF-1 deficiency) impairing the function of cells of the neurovascular unit are discussed and the evidence for the causal role of neurovascular uncoupling in cognitive decline is critically examined.
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Affiliation(s)
- Stefano Tarantini
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Cam Ha T Tran
- Hotchkiss Brain Institute, Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Grant R Gordon
- Hotchkiss Brain Institute, Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zoltan Ungvari
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Anna Csiszar
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Evans HM, Howe PRC, Wong RHX. Clinical Evaluation of Effects of Chronic Resveratrol Supplementation on Cerebrovascular Function, Cognition, Mood, Physical Function and General Well-Being in Postmenopausal Women-Rationale and Study Design. Nutrients 2016; 8:150. [PMID: 27005658 PMCID: PMC4808879 DOI: 10.3390/nu8030150] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/24/2016] [Accepted: 03/01/2016] [Indexed: 11/16/2022] Open
Abstract
Background: This methodological paper presents both a scientific rationale and a methodological approach for investigating the effects of resveratrol supplementation on mood and cognitive performance in postmenopausal women. Postmenopausal women have an increased risk of cognitive decline and dementia, which may be at least partly due to loss of beneficial effects of estrogen on the cerebrovasculature. We hypothesise that resveratrol, a phytoestrogen, may counteract this risk by enhancing cerebrovascular function and improving regional blood flow in response to cognitive demands. A clinical trial was designed to test this hypothesis. Method: Healthy postmenopausal women were recruited to participate in a randomised, double-blind, placebo-controlled (parallel comparison) dietary intervention trial to evaluate the effects of resveratrol supplementation (75 mg twice daily) on cognition, cerebrovascular responsiveness to cognitive tasks and overall well-being. They performed the following tests at baseline and after 14 weeks of supplementation: Rey Auditory Verbal Learning Test, Cambridge Semantic Memory Battery, the Double Span and the Trail Making Task. Cerebrovascular function was assessed simultaneously by monitoring blood flow velocity in the middle cerebral arteries using transcranial Doppler ultrasound. Conclusion: This trial provides a model approach to demonstrate that, by optimising circulatory function in the brain, resveratrol and other vasoactive nutrients may enhance mood and cognition and ameliorate the risk of developing dementia in postmenopausal women and other at-risk populations.
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Affiliation(s)
- Hamish Michael Evans
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Peter Ranald Charles Howe
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Rachel Heloise Xiwen Wong
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia.
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Cardiovascular responses to orthostasis and their association with falls in older adults. BMC Geriatr 2015; 15:174. [PMID: 26703012 PMCID: PMC4690276 DOI: 10.1186/s12877-015-0168-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/11/2015] [Indexed: 11/18/2022] Open
Abstract
Background Orthostatic hypotension (OH) refers to a marked decline in blood pressure when upright. OH has a high incidence and prevalence in older adults and represents a potential intrinsic risk factor for falls in these individuals. Previous studies have not included more recent definitions for blood pressure responses to orthostasis, including initial, delayed, and recovery blood pressure responses. Furthermore, there is little research examining the relationships between cerebrovascular functioning and falling risk. Therefore, we aimed to: (i) test the association between different blood pressure responses to orthostatic stress and retrospective falling history and; (ii) test the association between cerebrovascular responses to orthostatic stress and falling history. Methods We tested 59 elderly residents in long term care facilities who underwent a passive seated orthostatic stress test. Beat-to-beat blood pressure and cerebral blood flow velocity (CBFV) responses were assessed throughout testing. Risk factors for falls and falling history were collected from facility records. Cardiovascular responses to orthostasis were compared between retrospective fallers (≥1 fall in the previous year) and non-fallers. Results Retrospective fallers had larger delayed declines in systolic arterial pressure (SAP) compared to non-fallers (p = 0.015). Fallers also showed poorer early (2 min) and late (15 min) recovery of SAP. Fallers had a greater decline in systolic CBFV. Conclusions Older adults with a positive falling history have impaired orthostatic control of blood pressure and CBFV. With better identification and understanding of orthostatic blood pressure impairments earlier intervention and management can be implemented, potentially reducing the associated risk of morbidity and mortality. Future studies should utilize the updated OH definitions using beat-to-beat technology, rather than conventional methods that may offer less accurate detection.
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De P, Bhuniya S. The Rotterdam study: why fall in COPD? Eur Respir J 2015; 46:1529-30. [PMID: 26521288 DOI: 10.1183/13993003.01220-2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Pampa De
- Dept of Physical Medicine and Rehabilitation, College of Medicine and Sagar Dutta Hospital, Kolkata, India
| | - Sourin Bhuniya
- Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
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Sorond FA, Cruz-Almeida Y, Clark DJ, Viswanathan A, Scherzer CR, De Jager P, Csiszar A, Laurienti PJ, Hausdorff JM, Chen WG, Ferrucci L, Rosano C, Studenski SA, Black SE, Lipsitz LA. Aging, the Central Nervous System, and Mobility in Older Adults: Neural Mechanisms of Mobility Impairment. J Gerontol A Biol Sci Med Sci 2015; 70:1526-32. [PMID: 26386013 DOI: 10.1093/gerona/glv130] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 07/14/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mobility is crucial for successful aging and is impaired in many older adults. We know very little about the subtle, subclinical age-related changes in the central nervous system (CNS) that mediate mobility impairment. METHODS A conference series focused on aging, the CNS, and mobility was launched. The second conference addressed major age-associated mechanisms of CNS-mediated mobility impairment. Speakers and conference attendees recommended key areas for future research, identified barriers to progress, and proposed strategies to overcome them. RESULTS Priorities identified for future research include (a) studying interactions among different mechanisms; (b) examining effects of interventions targeting these mechanisms; (c) evaluating the effect of genetic polymorphisms on risks and course of age-related mobility impairment; and (d) examining the effect of age on CNS repair processes, neuroplasticity, and neuronal compensatory mechanisms. Key strategies to promote research include (a) establish standard measures of mobility across species; (b) evaluate the effect of aging in the absence of disease on CNS and mobility; and (c) use advanced computational methods to better evaluate the interactions between CNS and other systems involved in mobility. CONCLUSIONS CNS is a major player in the process, leading to mobility decline with aging. Future research in this area has the potential to prolong independence in older persons. Better interactions among disciplines and shared research paradigms are needed to make progress. Research priorities include the development of innovative approaches to integrate research on aging, cognition, and movement with attention to neurovascular function, neuroplasticity, and neurophysiological reserve.
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Affiliation(s)
- Farzaneh A Sorond
- Department of Neurology, Stroke Division, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Yenisel Cruz-Almeida
- Institute on Aging, Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville
| | - David J Clark
- Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Health System, Department of Aging and Geriatric Research, University of Florida, Gainesville
| | - Anand Viswanathan
- Department of Neurology, Stroke Division, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Clemens R Scherzer
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Philip De Jager
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna Csiszar
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center
| | - Paul J Laurienti
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jeffery M Hausdorff
- Department of Medicine, Tel-Aviv University, Tel-Aviv Sourasky Medical Center, Israel
| | - Wen G Chen
- Sensory and Motor Disorders of Aging and
| | - Luiggi Ferrucci
- Longitudinal Studies Section, National Institute on Aging, Bethesda, Maryland
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Stephanie A Studenski
- Department of Medicine, Division of Geriatric Medicine, Pittsburgh Healthcare System, Pennsylvania
| | - Sandra E Black
- Department of Neurology, University of Toronto, Sunnybrook Research Institute, Canada
| | - Lewis A Lipsitz
- Institute for Aging Research, Research, Hebrew Senior Life, Harvard Medical School, Boston, Massachusetts
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Effects of Combined Aerobic and Resistance Exercise on Central Arterial Stiffness and Gait Velocity in Patients with Chronic Poststroke Hemiparesis. Am J Phys Med Rehabil 2015; 94:687-95. [DOI: 10.1097/phm.0000000000000233] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pan WC, Eliot MN, Koutrakis P, Coull BA, Sorond FA, Wellenius GA. Ambient Temperature and Cerebrovascular Hemodynamics in the Elderly. PLoS One 2015; 10:e0134034. [PMID: 26258469 PMCID: PMC4721538 DOI: 10.1371/journal.pone.0134034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 07/05/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Some prior studies have linked ambient temperature with risk of cerebrovascular events. If causal, the pathophysiologic mechanisms underlying this putative association remain unknown. Temperature-related changes in cerebral vascular function may play a role, but this hypothesis has not been previously evaluated. METHODS We evaluated the association between ambient temperature and cerebral vascular function among 432 participants ≥65 years old from the MOBILIZE Boston Study with data on cerebrovascular blood flow, cerebrovascular resistance, and cerebrovascular reactivity in the middle cerebral artery. We used linear regression models to assess the association of mean ambient temperature in the previous 1 to 28 days with cerebrovascular hemodynamics adjusting for potential confounding factors. RESULTS A 10°C increase in the 21-day moving average of ambient temperature was associated with a 10.1% (95% confidence interval [CI], 2.2%, 17.3%) lower blood flow velocity, a 9.0% (95% CI, 0.7%, 18.0%) higher cerebrovascular resistance, and a 15.3% (95%CI, 2.7%, 26.4%) lower cerebral vasoreactivity. Further adjustment for ozone and fine particulate matter (PM2.5) did not materially alter the results. However, we found statistically significant interactions between ambient temperature and PM2.5 such that the association between temperature and blood flow velocity was attenuated at higher levels of PM2.5. CONCLUSIONS In this elderly population, we found that ambient temperature was negatively associated with cerebral blood flow velocity and cerebrovascular vasoreactivity and positively associated with cerebrovascular resistance. Changes in vascular function may partly underlie the observed associations between ambient temperature and risk of cerebrovascular events.
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Affiliation(s)
- Wen-Chi Pan
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America
| | - Melissa N. Eliot
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America
| | - Petros Koutrakis
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, United States of America
| | - Brent A. Coull
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, United States of America
| | - Farzaneh A. Sorond
- Department of Neurology, Brigham and Women’s Hospital and Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States of America
| | - Gregory A. Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America
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Tchalla AE, Wellenius GA, Travison TG, Gagnon M, Iloputaife I, Dantoine T, Sorond FA, Lipsitz LA. Circulating vascular cell adhesion molecule-1 is associated with cerebral blood flow dysregulation, mobility impairment, and falls in older adults. Hypertension 2015; 66:340-6. [PMID: 26056332 PMCID: PMC4807019 DOI: 10.1161/hypertensionaha.115.05180] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/12/2015] [Indexed: 11/16/2022]
Abstract
Soluble vascular cell adhesion molecule-1 (sVCAM-1) is associated with hypertension, vascular inflammation, and systemic endothelial dysfunction. We evaluated whether elevated plasma sVCAM-1 is associated with impaired cerebrovascular function and mobility impairments in elderly people. We studied the cross-sectional relationships between plasma sVCAM-1 level, gait speed, and cerebrovascular hemodynamics, and its longitudinal relationship with falls in 680 community-dwelling participants aged ≥65 years in the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston Study. Falls were recorded prospectively for 1 year on daily calendars. sVCAM-1 was measured by ELISA assay and beat-to-beat blood flow velocity in the middle cerebral artery during rest and in response to changes in end-tidal CO2 was measured by transcranial Doppler ultrasound. sVCAM-1 concentration was 1094±340 ng/mL in normotensives, 1195±438 ng/mL in controlled hypertensives, and 1250±445 ng/mL in uncontrolled hypertensives (P=0.008). The mean resting blood flow velocity and cerebral vasomotor range were, respectively, 41.0±10.3 cm/s and 1.3±0.4 cm/s per millimeter of mercury. Elevated sVCAM-1 levels indicative of endothelial dysfunction were associated with reduced resting blood flow velocity (P=0.017) and cerebral vasomotor range (P=0.0048). Elevated sVCAM-1 levels were associated with slower gait speed (<0.8 m/s; odds ratio, 3.01; 95% confidence interval, 1.56-5.83; P=0.0011) and an increased odds of injurious falls (odds ratio, 2.4; 95% confidence interval, 1.4-4.2; P=0.0028). An elevated sVCAM-1 level may be a marker of cerebral blood flow dysregulation because of endothelial damage from hypertension. It may also signal the presence of cerebral microvascular disease and its clinical consequences, including slow gait speed and falls.
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Affiliation(s)
- Achille E Tchalla
- From the Institute for Aging Research, Hebrew SeniorLife, Boston, MA (A.E.T., T.G.T., M.G., L.A.L); Beth Israel Deaconess Medical Center, Boston, MA (A.E.T., T.G.T., L.A.L.); Harvard Medical School, Boston, MA (A.E.T., T.G.T., L.A.L.); Limoges University, Limoges, France (A.E.T., T.D.); IFR 145 GEIST; EA 6310 HAVAE (Disability, Activity, Aging, Autonomy and Environment), Geriatric Medicine Department, CHU Limoges, Limoges, France (A.E.T., T.D.); Brown University School of Public Health, Providence, MA (G.A.W.); and Stroke Division, Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.A.S.)
| | - Gregory A Wellenius
- From the Institute for Aging Research, Hebrew SeniorLife, Boston, MA (A.E.T., T.G.T., M.G., L.A.L); Beth Israel Deaconess Medical Center, Boston, MA (A.E.T., T.G.T., L.A.L.); Harvard Medical School, Boston, MA (A.E.T., T.G.T., L.A.L.); Limoges University, Limoges, France (A.E.T., T.D.); IFR 145 GEIST; EA 6310 HAVAE (Disability, Activity, Aging, Autonomy and Environment), Geriatric Medicine Department, CHU Limoges, Limoges, France (A.E.T., T.D.); Brown University School of Public Health, Providence, MA (G.A.W.); and Stroke Division, Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.A.S.)
| | - Thomas G Travison
- From the Institute for Aging Research, Hebrew SeniorLife, Boston, MA (A.E.T., T.G.T., M.G., L.A.L); Beth Israel Deaconess Medical Center, Boston, MA (A.E.T., T.G.T., L.A.L.); Harvard Medical School, Boston, MA (A.E.T., T.G.T., L.A.L.); Limoges University, Limoges, France (A.E.T., T.D.); IFR 145 GEIST; EA 6310 HAVAE (Disability, Activity, Aging, Autonomy and Environment), Geriatric Medicine Department, CHU Limoges, Limoges, France (A.E.T., T.D.); Brown University School of Public Health, Providence, MA (G.A.W.); and Stroke Division, Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.A.S.)
| | - Margaret Gagnon
- From the Institute for Aging Research, Hebrew SeniorLife, Boston, MA (A.E.T., T.G.T., M.G., L.A.L); Beth Israel Deaconess Medical Center, Boston, MA (A.E.T., T.G.T., L.A.L.); Harvard Medical School, Boston, MA (A.E.T., T.G.T., L.A.L.); Limoges University, Limoges, France (A.E.T., T.D.); IFR 145 GEIST; EA 6310 HAVAE (Disability, Activity, Aging, Autonomy and Environment), Geriatric Medicine Department, CHU Limoges, Limoges, France (A.E.T., T.D.); Brown University School of Public Health, Providence, MA (G.A.W.); and Stroke Division, Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.A.S.)
| | - Ikechukwu Iloputaife
- From the Institute for Aging Research, Hebrew SeniorLife, Boston, MA (A.E.T., T.G.T., M.G., L.A.L); Beth Israel Deaconess Medical Center, Boston, MA (A.E.T., T.G.T., L.A.L.); Harvard Medical School, Boston, MA (A.E.T., T.G.T., L.A.L.); Limoges University, Limoges, France (A.E.T., T.D.); IFR 145 GEIST; EA 6310 HAVAE (Disability, Activity, Aging, Autonomy and Environment), Geriatric Medicine Department, CHU Limoges, Limoges, France (A.E.T., T.D.); Brown University School of Public Health, Providence, MA (G.A.W.); and Stroke Division, Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.A.S.)
| | - Thierry Dantoine
- From the Institute for Aging Research, Hebrew SeniorLife, Boston, MA (A.E.T., T.G.T., M.G., L.A.L); Beth Israel Deaconess Medical Center, Boston, MA (A.E.T., T.G.T., L.A.L.); Harvard Medical School, Boston, MA (A.E.T., T.G.T., L.A.L.); Limoges University, Limoges, France (A.E.T., T.D.); IFR 145 GEIST; EA 6310 HAVAE (Disability, Activity, Aging, Autonomy and Environment), Geriatric Medicine Department, CHU Limoges, Limoges, France (A.E.T., T.D.); Brown University School of Public Health, Providence, MA (G.A.W.); and Stroke Division, Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.A.S.)
| | - Farzaneh A Sorond
- From the Institute for Aging Research, Hebrew SeniorLife, Boston, MA (A.E.T., T.G.T., M.G., L.A.L); Beth Israel Deaconess Medical Center, Boston, MA (A.E.T., T.G.T., L.A.L.); Harvard Medical School, Boston, MA (A.E.T., T.G.T., L.A.L.); Limoges University, Limoges, France (A.E.T., T.D.); IFR 145 GEIST; EA 6310 HAVAE (Disability, Activity, Aging, Autonomy and Environment), Geriatric Medicine Department, CHU Limoges, Limoges, France (A.E.T., T.D.); Brown University School of Public Health, Providence, MA (G.A.W.); and Stroke Division, Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.A.S.)
| | - Lewis A Lipsitz
- From the Institute for Aging Research, Hebrew SeniorLife, Boston, MA (A.E.T., T.G.T., M.G., L.A.L); Beth Israel Deaconess Medical Center, Boston, MA (A.E.T., T.G.T., L.A.L.); Harvard Medical School, Boston, MA (A.E.T., T.G.T., L.A.L.); Limoges University, Limoges, France (A.E.T., T.D.); IFR 145 GEIST; EA 6310 HAVAE (Disability, Activity, Aging, Autonomy and Environment), Geriatric Medicine Department, CHU Limoges, Limoges, France (A.E.T., T.D.); Brown University School of Public Health, Providence, MA (G.A.W.); and Stroke Division, Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.A.S.).
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Sorond FA, Tan CO, LaRose S, Monk AD, Fichorova R, Ryan S, Lipsitz LA. Deferoxamine, Cerebrovascular Hemodynamics, and Vascular Aging: Potential Role for Hypoxia-Inducible Transcription Factor-1-Regulated Pathways. Stroke 2015; 46:2576-83. [PMID: 26304864 DOI: 10.1161/strokeaha.115.009906] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 07/02/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Iron chelation therapy is emerging as a novel neuroprotective strategy. The mechanisms of neuroprotection are diverse and include both neuronal and vascular pathways. We sought to examine the effect of iron chelation on cerebrovascular function in healthy aging and to explore whether hypoxia-inducible transcription factor-1 activation may be temporally correlated with vascular changes. METHODS We assessed cerebrovascular function (autoregulation, vasoreactivity, and neurovascular coupling) and serum concentrations of vascular endothelial growth factor and erythropoietin, as representative measures of hypoxia-inducible transcription factor-1 activation, during 6 hours of deferoxamine infusion in 24 young and 24 older healthy volunteers in a randomized, blinded, placebo-controlled cross-over study design. Cerebrovascular function was assessed using the transcranial Doppler ultrasound. Vascular endothelial growth factor and erythropoietin serum protein assays were conducted using the Meso Scale Discovery platform. RESULTS Deferoxamine elicited a strong age- and time-dependent increase in the plasma concentrations of erythropoietin and vascular endothelial growth factor, which persisted ≤3 hours post infusion (age effect P=0.04; treatment×time P<0.01). Deferoxamine infusion also resulted in a significant time- and age-dependent improvement in cerebral vasoreactivity (treatment×time P<0.01; age P<0.01) and cerebral autoregulation (gain: age×time×treatment P=0.04). CONCLUSIONS Deferoxamine infusion improved cerebrovascular function, particularly in older individuals. The temporal association between improved cerebrovascular function and increased serum vascular endothelial growth factor and erythropoietin concentrations is supportive of shared hypoxia-inducible transcription factor-1-regulated pathways. Therefore, pharmacological activation of hypoxia-inducible transcription factor-1 to enhance cerebrovascular function may be a promising neuroprotective strategy in acute and chronic ischemic syndromes, especially in elderly patients. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT013655104.
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Affiliation(s)
- Farzaneh A Sorond
- From the Stroke Division, Department of Neurology (F.A.S., S.L.R., A.D.M.) and Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology (R.F., S.R.), Brigham and Women's Hospital, Boston, MA; Cardiovascular Research Laboratory, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA (C.O.T.); Department of Medicine, Hebrew SeniorLife Institute for Aging Research, Boston, MA (L.A.L.); Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L.); and Department of Neurology, Physical Medicine and Rehabilitation, Obstetrics and Gynecology, and Medicine, Harvard Medical School, Boston, MA (F.A.S., C.O.T., R.F., L.A.L.).
| | - Can Ozan Tan
- From the Stroke Division, Department of Neurology (F.A.S., S.L.R., A.D.M.) and Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology (R.F., S.R.), Brigham and Women's Hospital, Boston, MA; Cardiovascular Research Laboratory, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA (C.O.T.); Department of Medicine, Hebrew SeniorLife Institute for Aging Research, Boston, MA (L.A.L.); Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L.); and Department of Neurology, Physical Medicine and Rehabilitation, Obstetrics and Gynecology, and Medicine, Harvard Medical School, Boston, MA (F.A.S., C.O.T., R.F., L.A.L.)
| | - Sarah LaRose
- From the Stroke Division, Department of Neurology (F.A.S., S.L.R., A.D.M.) and Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology (R.F., S.R.), Brigham and Women's Hospital, Boston, MA; Cardiovascular Research Laboratory, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA (C.O.T.); Department of Medicine, Hebrew SeniorLife Institute for Aging Research, Boston, MA (L.A.L.); Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L.); and Department of Neurology, Physical Medicine and Rehabilitation, Obstetrics and Gynecology, and Medicine, Harvard Medical School, Boston, MA (F.A.S., C.O.T., R.F., L.A.L.)
| | - Andrew D Monk
- From the Stroke Division, Department of Neurology (F.A.S., S.L.R., A.D.M.) and Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology (R.F., S.R.), Brigham and Women's Hospital, Boston, MA; Cardiovascular Research Laboratory, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA (C.O.T.); Department of Medicine, Hebrew SeniorLife Institute for Aging Research, Boston, MA (L.A.L.); Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L.); and Department of Neurology, Physical Medicine and Rehabilitation, Obstetrics and Gynecology, and Medicine, Harvard Medical School, Boston, MA (F.A.S., C.O.T., R.F., L.A.L.)
| | - Raina Fichorova
- From the Stroke Division, Department of Neurology (F.A.S., S.L.R., A.D.M.) and Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology (R.F., S.R.), Brigham and Women's Hospital, Boston, MA; Cardiovascular Research Laboratory, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA (C.O.T.); Department of Medicine, Hebrew SeniorLife Institute for Aging Research, Boston, MA (L.A.L.); Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L.); and Department of Neurology, Physical Medicine and Rehabilitation, Obstetrics and Gynecology, and Medicine, Harvard Medical School, Boston, MA (F.A.S., C.O.T., R.F., L.A.L.)
| | - Stanthia Ryan
- From the Stroke Division, Department of Neurology (F.A.S., S.L.R., A.D.M.) and Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology (R.F., S.R.), Brigham and Women's Hospital, Boston, MA; Cardiovascular Research Laboratory, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA (C.O.T.); Department of Medicine, Hebrew SeniorLife Institute for Aging Research, Boston, MA (L.A.L.); Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L.); and Department of Neurology, Physical Medicine and Rehabilitation, Obstetrics and Gynecology, and Medicine, Harvard Medical School, Boston, MA (F.A.S., C.O.T., R.F., L.A.L.)
| | - Lewis A Lipsitz
- From the Stroke Division, Department of Neurology (F.A.S., S.L.R., A.D.M.) and Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology (R.F., S.R.), Brigham and Women's Hospital, Boston, MA; Cardiovascular Research Laboratory, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA (C.O.T.); Department of Medicine, Hebrew SeniorLife Institute for Aging Research, Boston, MA (L.A.L.); Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L.); and Department of Neurology, Physical Medicine and Rehabilitation, Obstetrics and Gynecology, and Medicine, Harvard Medical School, Boston, MA (F.A.S., C.O.T., R.F., L.A.L.)
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Haight TJ, Bryan RN, Erus G, Davatzikos C, Jacobs DR, D'Esposito M, Lewis CE, Launer LJ. Vascular risk factors, cerebrovascular reactivity, and the default-mode brain network. Neuroimage 2015; 115:7-16. [PMID: 25917517 PMCID: PMC4469180 DOI: 10.1016/j.neuroimage.2015.04.039] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/14/2015] [Accepted: 04/19/2015] [Indexed: 01/12/2023] Open
Abstract
Cumulating evidence from epidemiologic studies implicates cardiovascular health and cerebrovascular function in several brain diseases in late life. We examined vascular risk factors with respect to a cerebrovascular measure of brain functioning in subjects in mid-life, which could represent a marker of brain changes in later life. Breath-hold functional MRI (fMRI) was performed in 541 women and men (mean age 50.4 years) from the Coronary Artery Risk Development in Young Adults (CARDIA) Brain MRI sub-study. Cerebrovascular reactivity (CVR) was quantified as percentage change in blood-oxygen level dependent (BOLD) signal in activated voxels, which was mapped to a common brain template and log-transformed. Mean CVR was calculated for anatomic regions underlying the default-mode network (DMN) - a network implicated in AD and other brain disorders - in addition to areas considered to be relatively spared in the disease (e.g. occipital lobe), which were utilized as reference regions. Mean CVR was significantly reduced in the posterior cingulate/precuneus (β=-0.063, 95% CI: -0.106, -0.020), anterior cingulate (β=-0.055, 95% CI: -0.101, -0.010), and medial frontal lobe (β=-0.050, 95% CI: -0.092, -0.008) relative to mean CVR in the occipital lobe, after adjustment for age, sex, race, education, and smoking status, in subjects with pre-hypertension/hypertension compared to normotensive subjects. By contrast, mean CVR was lower, but not significantly, in the inferior parietal lobe (β=-0.024, 95% CI: -0.062, 0.014) and the hippocampus (β=-0.006, 95% CI: -0.062, 0.050) relative to mean CVR in the occipital lobe. Similar results were observed in subjects with diabetes and dyslipidemia compared to those without these conditions, though the differences were non-significant. Reduced CVR may represent diminished vascular functionality for the DMN for individuals with prehypertension/hypertension in mid-life, and may serve as a preclinical marker for brain dysfunction in later life.
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Affiliation(s)
- Thaddeus J Haight
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, 7201 Wisconsin Avenue, Room 3C309, Bethesda, MD 20814, USA.
| | - R Nick Bryan
- Department of Radiology, University of Pennsylvania, 3600 Market St., Philadelphia, PA 19104, USA
| | - Guray Erus
- Department of Radiology, University of Pennsylvania, 3600 Market St., Philadelphia, PA 19104, USA
| | - Christos Davatzikos
- Department of Radiology, University of Pennsylvania, 3600 Market St., Philadelphia, PA 19104, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN, USA
| | - Mark D'Esposito
- Helen Wills Neuroscience Institute, University of California-Berkeley, 132 Barker Hall, Berkeley, CA, USA
| | - Cora E Lewis
- Department of Medicine, Division of Preventive Medicine, University of Alabama, Medical Towers 614, 1717 11th Avenue South, Birmingham, AL, USA
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, 7201 Wisconsin Avenue, Room 3C309, Bethesda, MD 20814, USA
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Lipsitz LA, Habtemariam D, Gagnon M, Iloputaife I, Sorond F, Tchalla AE, Dantoine TF, Travison TG. Reexamining the Effect of Antihypertensive Medications on Falls in Old Age. Hypertension 2015; 66:183-9. [PMID: 25941341 DOI: 10.1161/hypertensionaha.115.05513] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/14/2015] [Indexed: 12/29/2022]
Abstract
Conflicting data on the relationship between antihypertensive medications and falls in elderly people may lead to inappropriate undertreatment of hypertension in an effort to prevent falls. We aimed to clarify the relationships between the chronic use of different classes of antihypertensive medications and different types of falls, to determine the effect of medication dose, and to assess whether the risk of falls is associated with differences in cerebral blood flow. We assessed demographics, clinical characteristics, and chronic antihypertensive medication use in 598 community-dwelling people with hypertension, aged 70 to 97 years, then followed them prospectively for self-reported falls using monthly calendar postcards and telephone interviews. Antihypertensive medication use was not associated with an increased risk of falls. Participants reporting use of angiotensin-converting enzyme inhibitors had a significantly decreased 1-year risk of injurious falls (odds ratio, 0.62; 95% confidence interval, 0.39-0.96), whereas those using calcium channel blockers had a decreased risk of all falls (odds ratio, 0.62; 95% confidence interval, 0.42-0.91) and indoor falls (odds ratio, 0.57; 95% confidence interval, 0.36-0.91), compared with participants not taking these drugs. Larger doses of these classes were associated with a lower fall risk. Participants taking calcium channel blockers had higher cerebral blood flow than those not taking these medications. In relatively healthy community-dwelling elderly people, high doses of antihypertensive agents are not associated with an increased risk of falls.
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Affiliation(s)
- Lewis A Lipsitz
- From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.).
| | - Daniel Habtemariam
- From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.)
| | - Margaret Gagnon
- From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.)
| | - Ikechukwu Iloputaife
- From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.)
| | - Farzaneh Sorond
- From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.)
| | - Achille E Tchalla
- From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.)
| | - Thierry F Dantoine
- From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.)
| | - Thomas G Travison
- From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.)
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Hajjar I, Sorond F, Lipsitz LA. Apolipoprotein E, carbon dioxide vasoreactivity, and cognition in older adults: effect of hypertension. J Am Geriatr Soc 2015; 63:276-81. [PMID: 25688603 PMCID: PMC4375955 DOI: 10.1111/jgs.13235] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To investigate the associations between the apolipoprotein E (APOE) ε4 allele, carbon dioxide (CO2 ) vasoreactivity, and cognitive performance and to explore the effect of CO2 vasoreactivity and hypertension on the associations between APOE and cognition. DESIGN Observational. SETTING Community. PARTICIPANTS Older adults (N = 625) enrolled in the Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly of Boston Study. MEASUREMENTS Change in cerebral blood flow velocity in response to CO2 challenge (CO2 ), measured using transcranial Doppler ultrasonography, Trail-Making Test Part B - A (TMT), Hopkins Verbal Learning Test delayed recall (HVLT). RESULTS APOE-ε4 was associated with lower CO2 vasoreactivity (P = .009) and poorer performance on the TMT (P < .001) and HVLT (P < .001). Having hypertension and APOE-ε4 was associated with worse cognitive and CO2 vasoreactivity measures than having neither or either alone (P < .001 for TMT and HVLT, P = .01 for CO2 vasoreactivity). The association between APOE-ε4 and cognition was only significant if it was present concurrent with low CO2 vasoreactivity, defined as below the median of the sample (APOE by CO2 vasoreactivity interaction: P = .04 for TMT, P = .04 for HVLT). In hypertension, the association between APOE-ε4 and executive function was also only significant in participants with lower CO2 vasoreactivity (P = .005 for APOE by CO2 vasoreactivity). CONCLUSION Individuals at risk of Alzheimer's disease (AD) because they have APOE-ε4 may have lower CO2 vasoreactivity, which in turn may be contributing to the observed lower cognitive performance associated with this allele. The cognitive effect of APOE-ε4 is magnified in hypertension and low CO2 vasoreactivity. This study offers evidence that APOE-ε4 may be associated with microvascular brain injury even in the absence of clinical AD.
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Affiliation(s)
- Ihab Hajjar
- Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Farzaneh Sorond
- Stroke Division, Department of Neurology, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Lewis A. Lipsitz
- Institute for Aging Research, Harvard Medical School, Boston, Massachusetts Hebrew SeniorLife, Boston, Massachusetts
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Jor’dan AJ, Manor B, Novak V. Slow gait speed - an indicator of lower cerebral vasoreactivity in type 2 diabetes mellitus. Front Aging Neurosci 2014; 6:135. [PMID: 25018729 PMCID: PMC4071640 DOI: 10.3389/fnagi.2014.00135] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/09/2014] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE Gait speed is an important predictor of health that is negatively affected by aging and type 2 diabetes. Diabetes has been linked to reduced vasoreactivity, i.e., the capacity to regulate cerebral blood flow in response to CO2 challenges. This study aimed to determine the relationship between cerebral vasoreactivity and gait speed in older adults with and without diabetes. RESEARCH DESIGN AND METHODS We studied 61 adults with diabetes (65 ± 8 years) and 67 without diabetes (67 ± 9 years) but with similar distribution of cardiovascular risk factors. Preferred gait speed was calculated from a 75 m walk. Global and regional perfusion, vasoreactivity and vasodilation reserve were measured using 3-D continuous arterial spin labeling MRI at 3 Tesla during normo-, hyper- and hypocapnia and normalized for end-tidal CO2. RESULTS Diabetic participants had slower gait speed as compared to non-diabetic participants (1.05 ± 0.15 m/s vs. 1.14 ± 0.14 m/s, p < 0.001). Lower global vasoreactivity (r (2) adj = 0.13, p = 0.007), or lower global vasodilation reserve (r (2) adj = 0.33, p < 0.001), was associated with slower walking in the diabetic group independently of age, BMI and hematocrit concentration. For every 1 mL/100 g/min/mmHg less vasodilation reserve, for example, gait speed was 0.05 m/s slower. Similar relationships between vasodilation reserve and gait speed were also observed regionally within the cerebellum, frontal, temporal, parietal, and occipital lobes (r (2) adj = 0.27-0.33, p < 0.0001). In contrast, vasoreactivity outcomes were not associated with walking speed in non-diabetic participants, despite similar vasoreactivity ranges across groups. CONCLUSION In the diabetic group only, lower global vasoreactivity was associated with slower walking speed. Slower walking in older diabetic adults may thus hallmark reduced vasomotor reserve and thus the inability to increase perfusion in response to greater metabolic demands during walking.
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Affiliation(s)
- Azizah J. Jor’dan
- Syncope and Falls in the Elderly Laboratory, Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical SchoolBoston, MA, USA
| | - Brad Manor
- Syncope and Falls in the Elderly Laboratory, Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical SchoolBoston, MA, USA
- Institute for Aging Research, Hebrew SeniorLife, Harvard Medical SchoolBoston, MA, USA
| | - Vera Novak
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical SchoolBoston, MA, USA
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List J, Hertel-Zens S, Kübke JC, Lesemann A, Schreiber SJ, Flöel A. Cortical reorganization due to impaired cerebral autoregulation in individuals with occlusive processes of the internal carotid artery. Brain Stimul 2014; 7:381-7. [PMID: 24656478 DOI: 10.1016/j.brs.2014.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 02/12/2014] [Accepted: 02/14/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND PURPOSE To study the impact of impaired cerebral autoregulation on cortical neurophysiology, long term potentiation (LTP)-like plasticity, motor learning and brain structure. METHODS 12 patients with unilateral occlusion or severe stenosis of the internal carotid artery were included. Impairment of cerebral autoregulation was determined by vasomotor reactivity in transcranial Doppler sonography. Corticomotor excitability, cortical silent period and LTP-like plasticity were assessed with transcranial magnetic stimulation, motor learning with a force production task, and brain structure with high-resolution MRI of the brain. RESULTS In the affected hemisphere, corticomotor excitability was significantly higher, cortical silent period and LTP-like plasticity significantly lower, compared to the contralateral side. No significant difference emerged for motor learning, cortical thickness and white matter integrity between the hemispheres. CONCLUSION Despite decreased LTP-like plasticity in the affected hemisphere, motor learning was comparable between hemispheres, possibly due to gamma-aminobutyric-acid (GABA)B-mediated corticomotor excitability changes within the affected hemisphere. Our results may help to develop interventions to beneficially modulate cortical physiology in the presence of cerebral hypoperfusion.
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Affiliation(s)
- Jonathan List
- Department of Neurology, Charité-University Hospital, Berlin, Germany; Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany.
| | - Susan Hertel-Zens
- Department of Neurology, Charité-University Hospital, Berlin, Germany
| | - Jan Carl Kübke
- Department of Neurology, Charité-University Hospital, Berlin, Germany
| | - Anne Lesemann
- Department of Neurology, Charité-University Hospital, Berlin, Germany; Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany
| | | | - Agnes Flöel
- Department of Neurology, Charité-University Hospital, Berlin, Germany; Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany; NeuroCure Cluster of Excellence, Charité-Universitätsmedizin Berlin, Germany.
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Impaired cerebrovascular hemodynamics are associated with cerebral white matter damage. J Cereb Blood Flow Metab 2014; 34:228-34. [PMID: 24129749 PMCID: PMC3915198 DOI: 10.1038/jcbfm.2013.180] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/11/2013] [Accepted: 09/12/2013] [Indexed: 11/09/2022]
Abstract
White matter hyperintensities (WMH) in elderly individuals with vascular diseases are presumed to be due to ischemic small vessel diseases; however, their etiology is unknown. We examined the cross-sectional relationship between cerebrovascular hemodynamics and white matter structural integrity in elderly individuals with vascular risk factors. White matter hyperintensity volumes, fractional anisotropy (FA), and mean diffusivity (MD) were obtained from MRI in 48 subjects (75±7years). Pulsatility index (PI) and dynamic cerebral autoregulation (dCA) was assessed using transcranial Doppler ultrasound of the middle cerebral artery. Dynamic cerebral autoregulation was calculated from transfer function analysis (phase and gain) of spontaneous blood pressure and flow velocity oscillations in the low (LF, 0.03 to 0.15 Hz) and high (HF, 0.16 to 0.5 Hz) frequency ranges. Higher PI was associated with greater WMH (P<0.005). Higher phase across all frequency ranges was associated with greater FA and lower MD (P<0.005). Lower gain was associated with higher FA in the LF range (P=0.001). These relationships between phase and FA were significant in the territories limited to the middle cerebral artery as well as across the entire brain. Our results show a strong relationship between impaired cerebrovascular hemodynamics (PI and dCA) and loss of cerebral white matter structural integrity (WMH and DTI metrics) in elderly individuals.
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