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Zhao D, Guallar E, Qiao Y, Knopman DS, Palatino M, Gottesman RF, Mosley TH, Wasserman BA. Intracranial Atherosclerotic Disease and Incident Dementia: The ARIC Study (Atherosclerosis Risk in Communities). Circulation 2024; 150:838-847. [PMID: 39087353 DOI: 10.1161/circulationaha.123.067003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 06/26/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Studies of the neurovascular contribution to dementia have largely focused on cerebral small vessel disease (CSVD), but the role of intracranial atherosclerotic disease (ICAD) remains unknown in the general population. The objective of this study was to determine the risk of incident dementia from ICAD after adjusting for CSVD and cardiovascular risk factors in a US community-based cohort. METHODS We acquired brain magnetic resonance imaging examinations from 2011 through 2013 in 1980 Black and White participants in the ARIC study (Atherosclerosis Risk in Communities), a prospective cohort conducted in 4 US communities. Magnetic resonance imaging examinations included high-resolution vessel wall magnetic resonance imaging and magnetic resonance angiography to identify ICAD. Of these participants, 1590 without dementia, without missing covariates, and with adequate magnetic resonance image quality were followed through 2019 for incident dementia. Associations between ICAD and incident dementia were assessed using Cox proportional hazard ratios adjusted for CSVD (characterized by white matter hyperintensities, lacunar infarctions, and microhemorrhages), APOE4 genotype (apolipoprotein E gene ε4), and cardiovascular risk factors. RESULTS The mean age (SD) of study participants was 77.4 (5.2) years. ICAD was detected in 34.6% of participants. After a median follow-up of 5.6 years, 286 participants developed dementia. Compared with participants without ICAD, the fully adjusted hazard ratios (95% CIs) for incident dementia in participants with any ICAD, with ICAD only causing stenosis ≤50%, and with ICAD causing stenosis >50% in ≥1 vessel were 1.57 (1.17-2.11), 1.41 (1.02-1.95), and 1.94 (1.32-2.84), respectively. ICAD was associated with dementia even among participants with low white matter hyperintensities burden, a marker of CSVD. CONCLUSIONS ICAD was associated with an increased risk of incident dementia, independent of CSVD, APOE4 genotype, and cardiovascular risk factors. The increased risk of dementia was evident even among participants with low CSVD burden, a group less likely to be affected by vascular dementia, and in participants with ICAD causing only low-grade stenosis. Our results suggest that ICAD may partially mediate the effect that cardiovascular risk factors have on the brain leading to dementia. Both ICAD and CSVD must be considered to understand the vascular contributions to cognitive decline.
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Affiliation(s)
- Di Zhao
- Department of Epidemiology, Bloomberg School of Public Health (D.Z., E.G.), Johns Hopkins University, Baltimore, MD
| | - Eliseo Guallar
- Department of Epidemiology, Bloomberg School of Public Health (D.Z., E.G.), Johns Hopkins University, Baltimore, MD
- Department of Epidemiology, School of Global Public Health, New York University, New York (E.G.)
| | - Ye Qiao
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine (Y.Q., B.A.W.), Johns Hopkins University, Baltimore, MD
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN (D.S.K.)
| | - Maylin Palatino
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore (M.P., B.A.W.)
| | - Rebecca F Gottesman
- Stroke Branch, Intramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD (R.F.G.)
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.)
| | - Bruce A Wasserman
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine (Y.Q., B.A.W.), Johns Hopkins University, Baltimore, MD
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore (M.P., B.A.W.)
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Warner NS, Hanson AC, Schulte PJ, Kara F, Reid RI, Schwarz CG, Benarroch EE, Graff-Radford J, Vemuri P, Jack CR, Petersen RC, Warner DO, Mielke MM, Kantarci K. Prescription Opioids and Brain Structure in Community-Dwelling Older Adults. Mayo Clin Proc 2024; 99:716-726. [PMID: 38702125 PMCID: PMC11081533 DOI: 10.1016/j.mayocp.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/22/2023] [Accepted: 01/30/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To evaluate the associations between prescription opioid exposures in community-dwelling older adults and gray and white matter structure by magnetic resonance imaging. METHODS Secondary analysis was conducted of a prospective, longitudinal population-based cohort study employing cross-sectional imaging of older adult (≥65 years) enrollees between November 1, 2004, and December 31, 2017. Gray matter outcomes included cortical thickness in 41 structures and subcortical volumes in 6 structures. White matter outcomes included fractional anisotropy in 40 tracts and global white matter hyperintensity volumes. The primary exposure was prescription opioid availability expressed as the per-year rate of opioid days preceding magnetic resonance imaging, with a secondary exposure of per-year total morphine milligram equivalents (MME). Multivariable models assessed associations between opioid exposures and brain structures. RESULTS The study included 2185 participants; median (interquartile range) age was 80 (75 to 85) years, 47% were women, and 1246 (57%) received opioids. No significant associations were found between opioids and gray matter. Increased opioid days and MME were associated with decreased white matter fractional anisotropy in 15 (38%) and 16 (40%) regions, respectively, including the corpus callosum, posterior thalamic radiation, and anterior limb of the internal capsule, among others. Opioid days and MME were also associated with greater white matter hyperintensity volume (1.02 [95% CI, 1.002 to 1.036; P=.029] and 1.01 [1.001 to 1.024; P=.032] increase in the geometric mean, respectively). CONCLUSION The duration and dose of prescription opioids were associated with decreased white matter integrity but not with gray matter structure. Future studies with longitudinal imaging and clinical correlation are warranted to further evaluate these relationships.
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Affiliation(s)
- Nafisseh S Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
| | - Andrew C Hanson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Firat Kara
- Department of Radiology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | | | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Michelle M Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC
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Lu Y, Pike JR, Hoogeveen R, Walker K, Raffield L, Selvin E, Avery C, Engel S, Mielke MM, Garcia T, Heiss G, Palta P. Nonalcoholic Fatty Liver Disease and Longitudinal Change in Imaging and Plasma Biomarkers of Alzheimer Disease and Vascular Pathology. Neurology 2024; 102:e209203. [PMID: 38471046 PMCID: PMC11033987 DOI: 10.1212/wnl.0000000000209203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/23/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Prospective measures of plasma and cerebral MRI biomarkers of Alzheimer disease (AD) and vascular neuropathology provide an opportunity to investigate possible mechanisms linking liver disease and dementia. We aimed to quantify the association of midlife nonalcoholic fatty liver disease (NAFLD) with change in plasma and brain MRI biomarkers of AD and vascular neuropathology. METHODS We included participants from the Atherosclerosis Risk in Communities Study with brain MRI measurements of white matter hyperintensity (WMH) volume and temporal-parietal lobe cortical thickness meta region of interest (ROI) at up to 2 different visits, in 2011-13 and 2016-19, and plasma biomarkers of β-amyloid (Aβ)42:40, phosphorylated tau at threonine 181, and neurofilament light (NfL) were measured up to 3 times in 1993-95, 2011-13, and 2016-19. NAFLD was categorized using the fatty liver index in 1990-92. Multivariate linear regression was performed for associations between midlife NAFLD and change in plasma and brain MRI biomarkers of AD and vascular neuropathology. The primary models adjusted for demographics, Apolipoprotein E, alcohol use, and kidney function. RESULTS Among 1,706 participants (mean age 56 years, 62% female, 28% Black), midlife NAFLD vs no NAFLD was associated with greater late-life WMH volume (difference per SD 0.19, 95% CI 0.06-0.31) and faster late-life WMH increase over 6 years (difference in annual change, SD 0.28, 95% CI 0.05-0.51), suggesting accumulating vascular pathology. Midlife NAFLD vs no NAFLD was also associated with AD biomarkers in midlife (lower Aβ42:40 [SD -0.21, 95% CI -0.39 to -0.04] measured in 1993-95) and late life (lower Aβ42:40 [SD -0.13, 95% CI -0.23 to -0.03] and lower temporal-parietal lobe cortical thickness meta ROI [SD -0.16, 95% CI -0.28 to -0.05] measured in 2011-13). Although midlife NfL was lower in individuals with vs without midlife NAFLD, those with NAFLD exhibited a faster rate of NfL increase that accelerated over time. DISCUSSION Midlife NAFLD shows associations with AD and accumulating vascular pathology, revealing potential pathways linking liver function to dementia. Plasma biomarkers of neuropathology and neuronal injury may serve as easily measurable and dynamic indicators for monitoring the impacts of impaired liver function on brain health.
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Affiliation(s)
- Yifei Lu
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - James R Pike
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Ron Hoogeveen
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Keenan Walker
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Laura Raffield
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Elizabeth Selvin
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Christy Avery
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Stephanie Engel
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Michelle M Mielke
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Tanya Garcia
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Gerardo Heiss
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Priya Palta
- From the Departments of Epidemiology (Y.L., C.A., S.E., G.H.) and Biostatistics (T.G.), Gillings School of Global Public Health and Departments of Genetics (L.R.) and Neurology (P.P.), School of Medicine, University of North Carolina at Chapel Hill, NC; Department of Epidemiology (J.R.P., E.S.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine (R.H.), Baylor College of Medicine, Houston, TX; Laboratory of Behavioral Neuroscience (K.W.), National Institute on Aging, Bethesda, MD; and Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC
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Gu Y, Han F, Xue M, Wang M, Huang Y. The benefits and risks of menopause hormone therapy for the cardiovascular system in postmenopausal women: a systematic review and meta-analysis. BMC Womens Health 2024; 24:60. [PMID: 38263123 PMCID: PMC10804786 DOI: 10.1186/s12905-023-02788-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/14/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Menopause hormone therapy (MHT), as an effective method to alleviate the menopause-related symptoms of women, its benefits, risks, and potential influencing factors for the cardiovascular system of postmenopausal women are not very clear. OBJECTIVES To evaluate cardiovascular benefits and risks of MHT in postmenopausal women, and analyze the underlying factors that affect both. SEARCH STRATEGY The EMBASE, MEDLINE, and CENTRAL databases were searched from 1975 to July 2022. SELECTION CRITERIA Randomized Clinical Trials (RCTs) that met pre-specified inclusion criteria were included. DATA COLLECTION AND ANALYSIS Two reviewers extracted data independently. A meta-analysis of random effects was used to analyze data. MAIN RESULTS This systematic review identified 33 RCTs using MHT involving 44,639 postmenopausal women with a mean age of 60.3 (range 48 to 72 years). There was no significant difference between MHT and placebo (or no treatment) in all-cause death (RR = 0.96, 95%CI 0.85 to 1.09, I2 = 14%) and cardiovascular events (RR = 0.97, 95%CI 0.82 to 1.14, I2 = 38%) in the overall population of postmenopausal women. However, MHT would increase the risk of stroke (RR = 1.23, 95%CI 1.08 to 1.41,I2 = 0%) and venous thromboembolism (RR = 1.86, 95%CI 1.39 to 2.50, I2 = 24%). Compared with placebo, MHT could improve flow-mediated arterial dilation (FMD) (SMD = 1.46, 95%CI 0.86 to 2.07, I2 = 90%), but it did not improve nitroglycerin-mediated arterial dilation (NMD) (SMD = 0.27, 95%CI - 0.08 to 0.62, I2 = 76%). Compared with women started MHT more than 10 years after menopause, women started MHT within 10 years after menopause had lower frequency of all-cause death (P = 0.02) and cardiovascular events (P = 0.002), and more significant improvement in FMD (P = 0.0003). Compared to mono-estrogen therapy, the combination therapy of estrogen and progesterone would not alter the outcomes of endpoint event. (all-cause death P = 0.52, cardiovascular events P = 0.90, stroke P = 0.85, venous thromboembolism P = 0.33, FMD P = 0.46, NMD P = 0.27). CONCLUSIONS MHT improves flow-mediated arterial dilation (FMD) but fails to lower the risk of all-cause death and cardiovascular events, and increases the risk of stroke and venous thrombosis in postmenopausal women. Early acceptance of MHT not only reduces the risk of all-cause death and cardiovascular events but also further improves FMD, although the risk of stroke and venous thrombosis is not reduced. There is no difference in the outcome of cardiovascular system endpoints between mono-estrogen therapy and combination therapy of estrogen and progesterone.
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Affiliation(s)
- Yimeng Gu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, 100091, China
| | - Fangfang Han
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Mei Xue
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, 100091, China
| | - Miyuan Wang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yuxiao Huang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
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Reynolds EL, Votruba K, Jack CR, Beare R, Reid RI, Preboske GM, Waseta C, Pop‐Busui R, Nelson RG, Callaghan BC, Feldman EL. Association between brain health outcomes and metabolic risk factors in persons with diabetes. Ann Clin Transl Neurol 2023; 10:1891-1898. [PMID: 37518982 PMCID: PMC10578900 DOI: 10.1002/acn3.51859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023] Open
Abstract
We performed a cross-sectional study to determine associations between cognition and MRI-derived brain outcomes, with obesity, diabetes duration, and metabolic risk factors in 51 Pima American Indians with longstanding type 2 diabetes (T2d) (mean [SD] age: 48.4 [11.3] years, T2d duration: 20.1 [9.1] years). Participants had similar cognition (NIH Toolbox Cognition Battery composite: 45.3 [9.8], p = 0.64, n = 51) compared to normative data. T2d duration, but not other metabolic risk factors, associated with decreased cortical thickness (Point Estimate (PE): -0.0061, 95%CI: -0.0113, -0.0009, n = 45), gray matter volume (PE: -830.39, 95%CI: -1503.14, -157.64, n = 45), and increased white matter hyperintensity volume (PE: 0.0389, 95%CI: 0.0049, 0.0729, n = 45).
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Affiliation(s)
- Evan L. Reynolds
- Department of NeurologyUniversity of MichiganAnn ArborMichiganUSA
| | - Kristen Votruba
- Department of PsychiatryUniversity of MichiganAnn ArborMichiganUSA
| | | | - Richard Beare
- Peninsula Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | | | | | - Camille Waseta
- Chronic Kidney Disease SectionNational Institute of Diabetes and Digestive and Kidney DiseasesPhoenixArizonaUSA
| | - Rodica Pop‐Busui
- Department of Internal Medicine, Division of Metabolism, Endocrinology and DiabetesUniversity of MichiganAnn ArborMichiganUSA
| | - Robert G. Nelson
- Chronic Kidney Disease SectionNational Institute of Diabetes and Digestive and Kidney DiseasesPhoenixArizonaUSA
| | | | - Eva L. Feldman
- Department of NeurologyUniversity of MichiganAnn ArborMichiganUSA
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Schwarz CG, Kremers WK, Weigand SD, Prakaashana CM, Senjem ML, Przybelski SA, Lowe VJ, Gunter JL, Kantarci K, Vemuri P, Graff-Radford J, Petersen RC, Knopman DS, Jack CR. Effects of de-facing software mri_reface on utility of imaging biomarkers used in Alzheimer's disease research. Neuroimage Clin 2023; 40:103507. [PMID: 37703605 PMCID: PMC10502400 DOI: 10.1016/j.nicl.2023.103507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/07/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
Brain imaging research studies increasingly use "de-facing" software to remove or replace facial imagery before public data sharing. Several works have studied the effects of de-facing software on brain imaging biomarkers by directly comparing automated measurements from unmodified vs de-faced images, but most research brain images are used in analyses of correlations with cognitive measurements or clinical statuses, and the effects of de-facing on these types of imaging-to-cognition correlations has not been measured. In this work, we focused on brain imaging measures of amyloid (A), tau (T), neurodegeneration (N), and vascular (V) measures used in Alzheimer's Disease (AD) research. We created a retrospective sample of participants from three age- and sex-matched clinical groups (cognitively unimpaired, mild cognitive impairment, and AD dementia, and we performed region- and voxel-wise analyses of: hippocampal volume (N), white matter hyperintensity volume (V), amyloid PET (A), and tau PET (T) measures, each from multiple software pipelines, on their ability to separate cognitively defined groups and their degrees of correlation with age and Clinical Dementia Rating (CDR)-Sum of Boxes (CDR-SB). We performed each of these analyses twice: once with unmodified images and once with images de-faced with leading de-facing software mri_reface, and we directly compared the findings and their statistical strengths between the original vs. the de-faced images. Analyses with original and with de-faced images had very high agreement. There were no significant differences between any voxel-wise comparisons. Among region-wise comparisons, only three out of 55 correlations were significantly different between original and de-faced images, and these were not significant after correction for multiple comparisons. Overall, the statistical power of the imaging data for AD biomarkers was almost identical between unmodified and de-faced images, and their analyses results were extremely consistent.
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Affiliation(s)
| | - Walter K Kremers
- Department of Quantitative Health Sciences, Division of Clinical Trials & Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Stephen D Weigand
- Department of Quantitative Health Sciences, Division of Clinical Trials & Biostatistics, Mayo Clinic, Rochester, MN, USA
| | | | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Scott A Przybelski
- Department of Quantitative Health Sciences, Division of Clinical Trials & Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Corkery AT, Miller KB, Loeper CA, Tetri LH, Pearson AG, Loggie NA, Howery AJ, Eldridge MW, Barnes JN. Association between serum prostacyclin and cerebrovascular reactivity in healthy young and older adults. Exp Physiol 2023; 108:1047-1056. [PMID: 37170828 PMCID: PMC10524213 DOI: 10.1113/ep090903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/17/2023] [Indexed: 05/13/2023]
Abstract
NEW FINDINGS What is the central question of this study? What is the relationship between prostacyclin and cerebrovascular reactivity to hypercapnia before and after administration of a cyclooxygenase inhibitor, indomethacin, in healthy young and older adults? What is the main finding and importance? Serum prostacyclin was not related to cerebrovascular reactivity to hypercapnia before or after administration of indomethacin. However, in older adults, serum prostacyclin was related to the magnitude of change in cerebrovascular reactivity from before to after indomethacin administration. This suggests that older adults with higher serum prostacyclin may rely more on cyclooxygenase products to mediate cerebrovascular reactivity. ABSTRACT Platelet activation may contribute to age-related cerebrovascular dysfunction by interacting with the endothelial cells that regulate the response to vasodilatory stimuli. This study evaluated the relationship between a platelet inhibitor, prostacyclin, and cerebrovascular reactivity (CVR) in healthy young (n = 35; 25 ± 4 years; 17 women, 18 men) and older (n = 12; 62 ± 2 years; 8 women, 4 men) adults, who were not daily aspirin users, before and after cyclooxygenase inhibition. Prostacyclin was determined by levels of 6-keto-prostaglandin F1α (6-keto PGF1α) in the blood. CVR was assessed by measuring the middle cerebral artery blood velocity response to hypercapnia using transcranial Doppler ultrasound before (CON) and 90 min after cyclooxygenase inhibition with indomethacin (INDO). In young adults, there were no associations between prostacyclin and middle cerebral artery CVR during CON (r = -0.14, P = 0.415) or INDO (r = 0.27, P = 0.118). In older adults, associations between prostacyclin and middle cerebral artery CVR during CON (r = 0.53, P = 0.075) or INDO (r = -0.45, P = 0.136) did not reach the threshold for significance. We also evaluated the relationship between prostacyclin and the change in CVR between conditions (ΔCVR). We found no association between ΔCVR and prostacyclin in young adults (r = 0.27, P = 0.110); however, in older adults, those with higher baseline prostacyclin levels demonstrated significantly greater ΔCVR (r = -0.74, P = 0.005). In conclusion, older adults with higher serum prostacyclin, a platelet inhibitor, may rely more on cyclooxygenase products for cerebrovascular reactivity to hypercapnia.
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Affiliation(s)
- Adam T Corkery
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin Madison, Madison, WI, USA
| | - Kathleen B Miller
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin Madison, Madison, WI, USA
| | - Carissa A Loeper
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin Madison, Madison, WI, USA
| | - Laura H Tetri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Andrew G Pearson
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin Madison, Madison, WI, USA
| | - Nicole A Loggie
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin Madison, Madison, WI, USA
| | - Anna J Howery
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin Madison, Madison, WI, USA
| | - Marlowe W Eldridge
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jill N Barnes
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin Madison, Madison, WI, USA
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8
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Schwarz CG, Kremers WK, Arani A, Savvides M, Reid RI, Gunter JL, Senjem ML, Cogswell PM, Vemuri P, Kantarci K, Knopman DS, Petersen RC, Jack CR. A face-off of MRI research sequences by their need for de-facing. Neuroimage 2023; 276:120199. [PMID: 37269958 PMCID: PMC10389782 DOI: 10.1016/j.neuroimage.2023.120199] [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: 02/08/2023] [Revised: 04/19/2023] [Accepted: 05/25/2023] [Indexed: 06/05/2023] Open
Abstract
It is now widely known that research brain MRI, CT, and PET images may potentially be re-identified using face recognition, and this potential can be reduced by applying face-deidentification ("de-facing") software. However, for research MRI sequences beyond T1-weighted (T1-w) and T2-FLAIR structural images, the potential for re-identification and quantitative effects of de-facing are both unknown, and the effects of de-facing T2-FLAIR are also unknown. In this work we examine these questions (where applicable) for T1-w, T2-w, T2*-w, T2-FLAIR, diffusion MRI (dMRI), functional MRI (fMRI), and arterial spin labelling (ASL) sequences. Among current-generation, vendor-product research-grade sequences, we found that 3D T1-w, T2-w, and T2-FLAIR were highly re-identifiable (96-98%). 2D T2-FLAIR and 3D multi-echo GRE (ME-GRE) were also moderately re-identifiable (44-45%), and our derived T2* from ME-GRE (comparable to a typical 2D T2*) matched at only 10%. Finally, diffusion, functional and ASL images were each minimally re-identifiable (0-8%). Applying de-facing with mri_reface version 0.3 reduced successful re-identification to ≤8%, while differential effects on popular quantitative pipelines for cortical volumes and thickness, white matter hyperintensities (WMH), and quantitative susceptibility mapping (QSM) measurements were all either comparable with or smaller than scan-rescan estimates. Consequently, high-quality de-facing software can greatly reduce the risk of re-identification for identifiable MRI sequences with only negligible effects on automated intracranial measurements. The current-generation echo-planar and spiral sequences (dMRI, fMRI, and ASL) each had minimal match rates, suggesting that they have a low risk of re-identification and can be shared without de-facing, but this conclusion should be re-evaluated if they are acquired without fat suppression, with a full-face scan coverage, or if newer developments reduce the current levels of artifacts and distortion around the face.
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Affiliation(s)
- Christopher G Schwarz
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Walter K Kremers
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Arvin Arani
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Marios Savvides
- CyLab Biometrics Center and Department of Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Robert I Reid
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Jeffrey L Gunter
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Matthew L Senjem
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Petrice M Cogswell
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Prashanthi Vemuri
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | | | - Clifford R Jack
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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9
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Cogswell PM, Lundt ES, Therneau TM, Mester CT, Wiste HJ, Graff-Radford J, Schwarz CG, Senjem ML, Gunter JL, Reid RI, Przybelski SA, Knopman DS, Vemuri P, Petersen RC, Jack CR. Evidence against a temporal association between cerebrovascular disease and Alzheimer's disease imaging biomarkers. Nat Commun 2023; 14:3097. [PMID: 37248223 PMCID: PMC10226977 DOI: 10.1038/s41467-023-38878-8] [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: 08/30/2022] [Accepted: 05/15/2023] [Indexed: 05/31/2023] Open
Abstract
Whether a relationship exists between cerebrovascular disease and Alzheimer's disease has been a source of controversy. Evaluation of the temporal progression of imaging biomarkers of these disease processes may inform mechanistic associations. We investigate the relationship of disease trajectories of cerebrovascular disease (white matter hyperintensity, WMH, and fractional anisotropy, FA) and Alzheimer's disease (amyloid and tau PET) biomarkers in 2406 Mayo Clinic Study of Aging and Mayo Alzheimer's Disease Research Center participants using accelerated failure time models. The model assumes a common pattern of progression for each biomarker that is shifted earlier or later in time for each individual and represented by a per participant age adjustment. An individual's amyloid and tau PET adjustments show very weak temporal association with WMH and FA adjustments (R = -0.07 to 0.07); early/late amyloid or tau timing explains <1% of the variation in WMH and FA adjustment. Earlier onset of amyloid is associated with earlier onset of tau (R = 0.57, R2 = 32%). These findings support a strong mechanistic relationship between amyloid and tau aggregation, but not between WMH or FA and amyloid or tau PET.
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Affiliation(s)
- Petrice M Cogswell
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - Emily S Lundt
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Terry M Therneau
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Carly T Mester
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Heather J Wiste
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | | | | | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
- Department of Information Technology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Jeffrey L Gunter
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Robert I Reid
- Department of Information Technology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Scott A Przybelski
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Prashanthi Vemuri
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Ronald C Petersen
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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10
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Sedaghat S, Ji Y, Empana JP, Hughes TM, Mosley TH, Gottesman RF, Griswold M, Jack CR, Lutsey PL, van Sloten TT. Changes in Cardiovascular Health Across Midlife and Late-Life and Magnetic Resonance Imaging Markers of Cerebral Vascular Disease in Late-Life. Stroke 2023; 54:1280-1288. [PMID: 36951053 PMCID: PMC10133201 DOI: 10.1161/strokeaha.122.041374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/17/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Cardiovascular health may be used for prevention of cerebral vascular disease; however, data on the association of cardiovascular health across midlife and late-life with late-life cerebral vascular disease are lacking. Our aim was to examine whether midlife or late-life cardiovascular health as well as changes of cardiovascular health within midlife and between midlife and late-life were associated with prevalence of magnetic resonance imaging markers of cerebral vascular disease at late-life. METHODS Prospective cohort study including 1638 participants from the Atherosclerosis Risk in Communities Study who took part in 2 visits at midlife (mean ages, 53 and 59 years), and a late-life visit (mean age, 76 years). A cardiovascular health Life's Simple 7 score (range, 0-12/0-14, depending on diet availability) including 6 out of 7 items was calculated at each visit, with weight assigned to each item as poor (0), intermediate (1), or ideal (2). Participants underwent 3T brain magnetic resonance imaging scans in late-life visit. Outcomes were white matter hyperintensity volume, microbleeds, and lacunar, subcortical, and cortical infarcts at late-life. Linear and logistic regression models were used to assess the associations of cardiovascular health in midlife and late-life, and improvement of cardiovascular health within midlife, and from midlife to late-life with magnetic resonance imaging markers of cerebral vascular disease, adjusting for potential confounders. RESULTS A higher cardiovascular health in midlife, improvement of cardiovascular health within midlife, higher cardiovascular health at late-life, and improvement of cardiovascular health from midlife to late-life were associated with a lower prevalence of cerebral vascular disease markers. For example, improvement in cardiovascular health (per point) from midlife to late-life was associated with smaller white matter hyperintensity volume (β, -0.07 [95% CI, -0.10 to -0.04]) and lower odds of microbleeds (odds ratio, 0.93 [0.90-0.97]), lacunar (odds ratio, 0.93 [0.89-0.97]), subcortical (odds ratio, 0.93 [0.89-0.97]), and cortical infarcts (odds ratio, 0.92 [0.87-0.97]). CONCLUSIONS Improving cardiovascular health within midlife and from midlife to late-life may prevent development of cerebral vascular disease.
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Affiliation(s)
- Sanaz Sedaghat
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN, USA
| | - Yuekai Ji
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN, USA
| | - Jean-Philippe Empana
- Université de Paris, INSERM, UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Paris, France
| | | | - Thomas H Mosley
- Division of Geriatrics, Department of Medicine, University of Mississippi Medical Center, MS, USA
| | - Rebecca F Gottesman
- Stroke Branch, Intramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Michael Griswold
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN, USA
| | - Thomas T van Sloten
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
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11
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Ducca EL, Gomez GT, Palta P, Sullivan KJ, Jack CR, Knopman DS, Gottesman RF, Walston J, Windham BG, Walker KA. Physical Frailty and Brain White Matter Abnormalities: The Atherosclerosis Risk in Communities Study. J Gerontol A Biol Sci Med Sci 2023; 78:357-364. [PMID: 35596270 PMCID: PMC9951053 DOI: 10.1093/gerona/glac111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Physical frailty is associated with increased risk for dementia and other neurologic sequelae. However, the neurobiological changes underlying frailty and frailty risk remain unknown. We examined the association of cerebral white matter structure with current and future frailty. METHODS Atherosclerosis Risk in Communities Study Neurocognitive Study participants who underwent 3T brain MRI were included. Frailty status was classified according to the Fried criteria. Cerebral white matter integrity was defined using white matter hyperintensity (WMH) volume and microstructure, measured using diffusion tensor imaging fractional anisotropy (FA) and mean diffusivity (MD). Multivariable linear regression was used to relate baseline frailty to white matter structure; multivariable logistic regression was used to relate baseline white matter to frailty risk among participants nonfrail at baseline. RESULTS In the cross-sectional analysis (N = 1 754; mean age: 76 years), frailty was associated with greater WMH volume, lower FA, and greater MD. These associations remained consistent after excluding participants with a history of stroke or dementia. Among participants nonfrail at baseline who completed follow-up frailty assessment (N = 1 379; 6.6-year follow-up period), each standard deviation increase in WMH volume was associated with 1.46 higher odds of frailty at follow-up. Composite FA and MD measures were not associated with future frailty; however, secondary analyses found several significant white matter tract-specific associations with frailty risk. CONCLUSION The current study demonstrates a robust association of WMH volume with current and future frailty. Although measures of white matter microstructure were altered in frail individuals, these measures were not generally associated with progression from nonfrail to frail status.
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Affiliation(s)
- Emma L Ducca
- Department of Psychology, St. John’s University, Jamaica, New York, USA
| | - Gabriela T Gomez
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Priya Palta
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Kevin J Sullivan
- Department of Medicine/Geriatrics, The Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rebecca F Gottesman
- Stroke Branch, Intramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Jeremy Walston
- Division of Geriatric Medicine and Gerontology, Center on Aging and Health, and Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - B Gwen Windham
- Department of Medicine/Geriatrics, The Memory Impairment and Neurodegenerative Dementia Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Keenan A Walker
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
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12
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Sprung J, Laporta ML, Knopman DS, Petersen RC, Mielke MM, Jack CR, Martin DP, Hanson AC, Schroeder DR, Schulte PJ, Przybelski SA, Valencia Morales DJ, Weingarten TN, Vemuri P, Warner DO. Association of Indication for Hospitalization With Subsequent Amyloid Positron Emission Tomography and Magnetic Resonance Imaging Biomarkers. J Gerontol A Biol Sci Med Sci 2023; 78:304-313. [PMID: 35279026 PMCID: PMC9951063 DOI: 10.1093/gerona/glac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hospitalization in older age is associated with accelerated cognitive decline, typically preceded by neuropathologic changes. We assess the association between indication for hospitalization and brain neurodegeneration. METHODS Included were participants from the Mayo Clinic Study of Aging, a population-based longitudinal study, with ≥1 brain imaging available in those older than 60 years of age between 2004 and 2017. Primary analyses used linear mixed-effects models to assess association of hospitalization with changes in longitudinal trajectory of cortical thinning, amyloid accumulation, and white matter hyperintensities (WMH). Additional analyses were performed with imaging outcomes dichotomized (normal vs abnormal) using Cox proportional hazards regression. RESULTS Of 2 480 participants, 1 966 had no hospitalization and 514 had ≥1 admission. Hospitalization was associated with accelerated cortical thinning (annual slope change -0.003 mm [95% confidence interval (CI) -0.005 to -0.001], p = .002), but not amyloid accumulation (0.003 [95% CI -0.001 to 0.006], p = .107), or WMH increase (0.011 cm3 [95% CI -0.001 to 0.023], p = .062). Interaction analyses assessing whether trajectory changes are dependent on admission type (medical vs surgical) found interactions for all outcomes. While surgical hospitalizations were not, medical hospitalizations were associated with accelerated cortical thinning (-0.004 mm [95% CI -0.008 to -0.001, p = .014); amyloid accumulation (0.010, [95% CI 0.002 to 0.017, p = .011), and WMH increase (0.035 cm3 [95% CI 0.012 to 0.058, p = .006). Hospitalization was not associated with developing abnormal cortical thinning (p = .407), amyloid accumulation (p = .596), or WMH/infarctions score (p = .565). CONCLUSIONS Medical hospitalizations were associated with accelerated cortical thinning, amyloid accumulation, and WMH increases. These changes were modest and did not translate to increased risk for crossing the abnormality threshold.
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Affiliation(s)
- Juraj Sprung
- Address correspondence to: Juraj Sprung, MD, PhD, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. E-mail:
| | - Mariana L Laporta
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Michelle M Mielke
- Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - David P Martin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew C Hanson
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Darrell R Schroeder
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Phillip J Schulte
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott A Przybelski
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Toby N Weingarten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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13
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Ferreira D, Przybelski SA, Lesnick TG, Schwarz CG, Diaz-Galvan P, Graff-Radford J, Senjem ML, Fields JA, Knopman DS, Jones DT, Savica R, Ferman TJ, Graff-Radford N, Lowe VJ, Jack CR, Petersen RC, Westman E, Boeve BF, Kantarci K. Cross-sectional Associations of β-Amyloid, Tau, and Cerebrovascular Biomarkers With Neurodegeneration in Probable Dementia With Lewy Bodies. Neurology 2023; 100:e846-e859. [PMID: 36443011 PMCID: PMC9984215 DOI: 10.1212/wnl.0000000000201579] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/06/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although alpha-synuclein-related pathology is the hallmark of dementia with Lewy bodies (DLB), cerebrovascular and Alzheimer disease pathologies are common in patients with DLB. Little is known about the contribution of these pathologies to neurodegeneration in DLB. We investigated associations of cerebrovascular, β-amyloid, and tau biomarkers with gray matter (GM) volume in patients with probable DLB. METHODS We assessed patients with probable DLB and cognitively unimpaired (CU) controls with 11C-Pittsburgh compound B (PiB) and 18F-flortaucipir PET as markers of β-amyloid and tau, respectively. MRI was used to assess white matter hyperintensity (WMH) volume (a marker of cerebrovascular lesion load) and regional GM volume (a marker of neurodegeneration). We used correlations and analysis of covariance (ANCOVA) in the entire cohort and structural equation models (SEMs) in patients with DLB to investigate associations of WMH volume and regional β-amyloid and tau PET standardized uptake value ratios (SUVrs) with regional GM volume. RESULTS We included 30 patients with DLB (69.3 ± 10.2 years, 87% men) and 100 CU controls balanced on age and sex. Compared with CU controls, patients with DLB showed a lower GM volume across all cortical and subcortical regions except for the cuneus, putamen, and pallidum. A larger WMH volume was associated with a lower volume in the medial and orbital frontal cortices, insula, fusiform cortex, and thalamus in patients with DLB. A higher PiB SUVr was associated with a lower volume in the inferior temporal cortex, while flortaucipir SUVr did not correlate with GM volume. SEMs showed that a higher age and absence of the APOE ε4 allele were significant predictors of higher WMH volume, and WMH volume in turn was a significant predictor of GM volume in medial and orbital frontal cortices, insula, and inferior temporal cortex. By contrast, we observed 2 distinct paths for the fusiform cortex, with age having an effect through PiB and flortaucipir SUVr on one path and through WMH volume on the other path. DISCUSSION Patients with probable DLB have widespread cortical atrophy, most of which is likely influenced by alpha-synuclein-related pathology. Although cerebrovascular, β-amyloid, and tau pathologies often coexist in probable DLB, their contributions to neurodegeneration seem to be region specific.
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Affiliation(s)
- Daniel Ferreira
- From the Division of Clinical Geriatrics (D.F., P.D.-G., E.W.), Center for Alzheimer's Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Departments of Radiology (D.F., C.G.S., P.D.-G., M.L.S., V.J.L., C.R.J., K.K.), Quantitative Health Sciences (S.A.P., T.G.L.), Neurology (J.G.-R., D.S.K., D.T.J., R.S., R.C.P., B.F.B.), Information Technology (M.L.S.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Departments of Psychiatry and Psychology (T.J.F.) and Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Scott A Przybelski
- From the Division of Clinical Geriatrics (D.F., P.D.-G., E.W.), Center for Alzheimer's Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Departments of Radiology (D.F., C.G.S., P.D.-G., M.L.S., V.J.L., C.R.J., K.K.), Quantitative Health Sciences (S.A.P., T.G.L.), Neurology (J.G.-R., D.S.K., D.T.J., R.S., R.C.P., B.F.B.), Information Technology (M.L.S.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Departments of Psychiatry and Psychology (T.J.F.) and Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Timothy G Lesnick
- From the Division of Clinical Geriatrics (D.F., P.D.-G., E.W.), Center for Alzheimer's Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Departments of Radiology (D.F., C.G.S., P.D.-G., M.L.S., V.J.L., C.R.J., K.K.), Quantitative Health Sciences (S.A.P., T.G.L.), Neurology (J.G.-R., D.S.K., D.T.J., R.S., R.C.P., B.F.B.), Information Technology (M.L.S.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Departments of Psychiatry and Psychology (T.J.F.) and Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Christopher G Schwarz
- From the Division of Clinical Geriatrics (D.F., P.D.-G., E.W.), Center for Alzheimer's Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Departments of Radiology (D.F., C.G.S., P.D.-G., M.L.S., V.J.L., C.R.J., K.K.), Quantitative Health Sciences (S.A.P., T.G.L.), Neurology (J.G.-R., D.S.K., D.T.J., R.S., R.C.P., B.F.B.), Information Technology (M.L.S.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Departments of Psychiatry and Psychology (T.J.F.) and Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Patricia Diaz-Galvan
- From the Division of Clinical Geriatrics (D.F., P.D.-G., E.W.), Center for Alzheimer's Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Departments of Radiology (D.F., C.G.S., P.D.-G., M.L.S., V.J.L., C.R.J., K.K.), Quantitative Health Sciences (S.A.P., T.G.L.), Neurology (J.G.-R., D.S.K., D.T.J., R.S., R.C.P., B.F.B.), Information Technology (M.L.S.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Departments of Psychiatry and Psychology (T.J.F.) and Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Jonathan Graff-Radford
- From the Division of Clinical Geriatrics (D.F., P.D.-G., E.W.), Center for Alzheimer's Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Departments of Radiology (D.F., C.G.S., P.D.-G., M.L.S., V.J.L., C.R.J., K.K.), Quantitative Health Sciences (S.A.P., T.G.L.), Neurology (J.G.-R., D.S.K., D.T.J., R.S., R.C.P., B.F.B.), Information Technology (M.L.S.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Departments of Psychiatry and Psychology (T.J.F.) and Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Matthew L Senjem
- From the Division of Clinical Geriatrics (D.F., P.D.-G., E.W.), Center for Alzheimer's Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Departments of Radiology (D.F., C.G.S., P.D.-G., M.L.S., V.J.L., C.R.J., K.K.), Quantitative Health Sciences (S.A.P., T.G.L.), Neurology (J.G.-R., D.S.K., D.T.J., R.S., R.C.P., B.F.B.), Information Technology (M.L.S.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Departments of Psychiatry and Psychology (T.J.F.) and Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Julie A Fields
- From the Division of Clinical Geriatrics (D.F., P.D.-G., E.W.), Center for Alzheimer's Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Departments of Radiology (D.F., C.G.S., P.D.-G., M.L.S., V.J.L., C.R.J., K.K.), Quantitative Health Sciences (S.A.P., T.G.L.), Neurology (J.G.-R., D.S.K., D.T.J., R.S., R.C.P., B.F.B.), Information Technology (M.L.S.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Departments of Psychiatry and Psychology (T.J.F.) and Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - David S Knopman
- From the Division of Clinical Geriatrics (D.F., P.D.-G., E.W.), Center for Alzheimer's Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Departments of Radiology (D.F., C.G.S., P.D.-G., M.L.S., V.J.L., C.R.J., K.K.), Quantitative Health Sciences (S.A.P., T.G.L.), Neurology (J.G.-R., D.S.K., D.T.J., R.S., R.C.P., B.F.B.), Information Technology (M.L.S.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Departments of Psychiatry and Psychology (T.J.F.) and Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - David T Jones
- From the Division of Clinical Geriatrics (D.F., P.D.-G., E.W.), Center for Alzheimer's Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Departments of Radiology (D.F., C.G.S., P.D.-G., M.L.S., V.J.L., C.R.J., K.K.), Quantitative Health Sciences (S.A.P., T.G.L.), Neurology (J.G.-R., D.S.K., D.T.J., R.S., R.C.P., B.F.B.), Information Technology (M.L.S.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Departments of Psychiatry and Psychology (T.J.F.) and Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Rodolfo Savica
- From the Division of Clinical Geriatrics (D.F., P.D.-G., E.W.), Center for Alzheimer's Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Departments of Radiology (D.F., C.G.S., P.D.-G., M.L.S., V.J.L., C.R.J., K.K.), Quantitative Health Sciences (S.A.P., T.G.L.), Neurology (J.G.-R., D.S.K., D.T.J., R.S., R.C.P., B.F.B.), Information Technology (M.L.S.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Departments of Psychiatry and Psychology (T.J.F.) and Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Tanis J Ferman
- From the Division of Clinical Geriatrics (D.F., P.D.-G., E.W.), Center for Alzheimer's Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Departments of Radiology (D.F., C.G.S., P.D.-G., M.L.S., V.J.L., C.R.J., K.K.), Quantitative Health Sciences (S.A.P., T.G.L.), Neurology (J.G.-R., D.S.K., D.T.J., R.S., R.C.P., B.F.B.), Information Technology (M.L.S.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Departments of Psychiatry and Psychology (T.J.F.) and Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Neill Graff-Radford
- From the Division of Clinical Geriatrics (D.F., P.D.-G., E.W.), Center for Alzheimer's Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Departments of Radiology (D.F., C.G.S., P.D.-G., M.L.S., V.J.L., C.R.J., K.K.), Quantitative Health Sciences (S.A.P., T.G.L.), Neurology (J.G.-R., D.S.K., D.T.J., R.S., R.C.P., B.F.B.), Information Technology (M.L.S.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Departments of Psychiatry and Psychology (T.J.F.) and Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Val J Lowe
- From the Division of Clinical Geriatrics (D.F., P.D.-G., E.W.), Center for Alzheimer's Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Departments of Radiology (D.F., C.G.S., P.D.-G., M.L.S., V.J.L., C.R.J., K.K.), Quantitative Health Sciences (S.A.P., T.G.L.), Neurology (J.G.-R., D.S.K., D.T.J., R.S., R.C.P., B.F.B.), Information Technology (M.L.S.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Departments of Psychiatry and Psychology (T.J.F.) and Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Clifford R Jack
- From the Division of Clinical Geriatrics (D.F., P.D.-G., E.W.), Center for Alzheimer's Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Departments of Radiology (D.F., C.G.S., P.D.-G., M.L.S., V.J.L., C.R.J., K.K.), Quantitative Health Sciences (S.A.P., T.G.L.), Neurology (J.G.-R., D.S.K., D.T.J., R.S., R.C.P., B.F.B.), Information Technology (M.L.S.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Departments of Psychiatry and Psychology (T.J.F.) and Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Ronald C Petersen
- From the Division of Clinical Geriatrics (D.F., P.D.-G., E.W.), Center for Alzheimer's Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Departments of Radiology (D.F., C.G.S., P.D.-G., M.L.S., V.J.L., C.R.J., K.K.), Quantitative Health Sciences (S.A.P., T.G.L.), Neurology (J.G.-R., D.S.K., D.T.J., R.S., R.C.P., B.F.B.), Information Technology (M.L.S.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Departments of Psychiatry and Psychology (T.J.F.) and Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Eric Westman
- From the Division of Clinical Geriatrics (D.F., P.D.-G., E.W.), Center for Alzheimer's Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Departments of Radiology (D.F., C.G.S., P.D.-G., M.L.S., V.J.L., C.R.J., K.K.), Quantitative Health Sciences (S.A.P., T.G.L.), Neurology (J.G.-R., D.S.K., D.T.J., R.S., R.C.P., B.F.B.), Information Technology (M.L.S.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Departments of Psychiatry and Psychology (T.J.F.) and Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Brad F Boeve
- From the Division of Clinical Geriatrics (D.F., P.D.-G., E.W.), Center for Alzheimer's Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Departments of Radiology (D.F., C.G.S., P.D.-G., M.L.S., V.J.L., C.R.J., K.K.), Quantitative Health Sciences (S.A.P., T.G.L.), Neurology (J.G.-R., D.S.K., D.T.J., R.S., R.C.P., B.F.B.), Information Technology (M.L.S.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Departments of Psychiatry and Psychology (T.J.F.) and Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Kejal Kantarci
- From the Division of Clinical Geriatrics (D.F., P.D.-G., E.W.), Center for Alzheimer's Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Departments of Radiology (D.F., C.G.S., P.D.-G., M.L.S., V.J.L., C.R.J., K.K.), Quantitative Health Sciences (S.A.P., T.G.L.), Neurology (J.G.-R., D.S.K., D.T.J., R.S., R.C.P., B.F.B.), Information Technology (M.L.S.), and Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Departments of Psychiatry and Psychology (T.J.F.) and Neurology (N.G.-R.), Mayo Clinic, Jacksonville, FL; and Department of Neuroimaging (E.W.), Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
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14
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Shir D, Mielke MM, Hofrenning EI, Lesnick TG, Knopman DS, Petersen RC, Jack CR, Algeciras-Schimnich A, Vemuri P, Graff-Radford J. Associations of Neurodegeneration Biomarkers in Cerebrospinal Fluid with Markers of Alzheimer's Disease and Vascular Pathology. J Alzheimers Dis 2023; 92:887-898. [PMID: 36806507 PMCID: PMC10193844 DOI: 10.3233/jad-221015] [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] [Indexed: 02/19/2023]
Abstract
BACKGROUND The National Institute on Aging-Alzheimer's Association Research Framework proposes defining Alzheimer's disease by grouping imaging and fluid biomarkers by their respective pathologic processes. The AT(N) structure proposes several neurodegenerative fluid biomarkers (N) including total tau (t-tau), neurogranin (Ng), and neurofilament light chain (NfL). However, pathologic drivers influencing each biomarker remain unclear. OBJECTIVE To determine whether cerebrospinal fluid (CSF)-neurodegenerative biomarkers (N) map differentially to Alzheimer's disease pathology measured by Aβ42 (an indicator of amyloidosis, [A]), p-tau (an indicator of tau deposition, [T]), and MRI vascular pathology indicators (measured by white-matter integrity, infarcts, and microbleeds [V]). METHODS Participants were from Mayo Clinic Study of Aging (MCSA) with CSF measures of NfL, Ng, t-tau, Aβ42, and p-tau and available MRI brain imaging. Linear models assessed associations between CSF neurodegeneration (N) markers, amyloid markers (A), tau (T), and vascular pathology (V). RESULTS Participants (n = 408) had a mean age of 69.2±10.7; male, 217 (53.2%); cognitively unimpaired, 359 (88%). All three neurodegeneration biomarkers correlated with age (p < 0.001 for NfL and t-tau, p = 0.018 for Ng). Men had higher CSF-NfL levels; women had higher Ng (p < 0.001). NfL and t-tau levels correlated with infarcts (p = 0.009, p = 0.034 respectively); no biomarkers correlated with white-matter integrity. N biomarkers correlated with p-tau levels (T, p < 0.001). Higher Aβ42 levels associated with higher N-biomarker levels but only among cognitively unimpaired (A, p < 0.001). CONCLUSION The influence of vascular pathology in the general population on CSF (N) biomarkers is modest, with greater influence of infarcts than white-matter disruption. Neurodegeneration markers more closely correlated with tau than amyloid markers.
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Affiliation(s)
- Dror Shir
- Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Michelle M. Mielke
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota 55905, USA
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, 27101
| | | | - Timothy G. Lesnick
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - David S. Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Ronald C. Petersen
- Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Clifford R. Jack
- Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | | | - Prashanthi Vemuri
- Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA
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15
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Choi JW, Lee KO, Jang YJ, Kim HK, Seo T, Roh YJ, Choo SO, Oh SH. High Mean Platelet Volume Is Associated with Cerebral White Matter Hyperintensities in Non-Stroke Individuals. Yonsei Med J 2023; 64:35-41. [PMID: 36579377 PMCID: PMC9826963 DOI: 10.3349/ymj.2022.0368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The mean platelet volume (MPV) is regarded as a marker for thrombosis, atherosclerosis, and inflammation in various vascular diseases. However, it still remains unclear whether plasma MPV is associated with cerebral white matter hyperintensities (WMH) and cerebral microvascular pathology in the elderly population. MATERIALS AND METHODS We examined whether MPV level is associated with the presence of cerebral WMH on brain magnetic resonance imaging from 870 non-stroke outpatient subjects. The subjects were divided into three groups according to the consecutive level of MPV (low T1, middle T2, and high T3 MPV tertile groups). To determine the association of MPV levels with the WMH, logistic regression and receiver operating characteristic curve analyses were conducted. RESULTS Subjects with higher MPV level were older and more likely to have hypertension, diabetes mellitus, and low renal function. Cerebral WMH were more prevalent in subjects with higher MPV level. After adjusting for confounding factors, moderate to severe cerebral WMH were significantly associated with high MPV tertile level. This association remained significant after adjusting for other cerebral vascular pathologies. T2 [odds ratio (OR): 1.49, 95% confidence interval (CI): 1.03-2.15] and T3 MPV tertile groups (OR: 1.51, 95%CI: 1.04-2.20) had more cerebral WMH lesions compared to T1 MPV tertile group. In addition, the subjects with higher Fazekas scores showed higher MPV level (p=0.020). CONCLUSION We found that high MPV level is independently associated with cerebral WMH. This result suggests that platelet activation plays a role in the development of cerebral WMH.
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Affiliation(s)
- Jung-Won Choi
- Department of Neurology, CHA Bundang Medical Center, School of Medicine CHA University, Seongnam, Korea
| | - Kee Ook Lee
- Department of Neurology, CHA Bundang Medical Center, School of Medicine CHA University, Seongnam, Korea.
| | - Ye-Ji Jang
- Department of Neurology, CHA Bundang Medical Center, School of Medicine CHA University, Seongnam, Korea
| | - Hyun-Kyung Kim
- Department of Neurology, CHA Bundang Medical Center, School of Medicine CHA University, Seongnam, Korea
| | - Taeho Seo
- Department of Neurology, CHA Bundang Medical Center, School of Medicine CHA University, Seongnam, Korea
| | - Yoo Jeong Roh
- Department of Neurology, CHA Bundang Medical Center, School of Medicine CHA University, Seongnam, Korea
| | - Seung-Ook Choo
- Department of Biomedical Laboratory Science, College of Natural Science Daejeon University, Daejeon, Korea
| | - Seung-Hun Oh
- Department of Neurology, CHA Bundang Medical Center, School of Medicine CHA University, Seongnam, Korea
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16
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Jochems ACC, Arteaga C, Chappell F, Ritakari T, Hooley M, Doubal F, Muñoz Maniega S, Wardlaw JM. Longitudinal Changes of White Matter Hyperintensities in Sporadic Small Vessel Disease: A Systematic Review and Meta-analysis. Neurology 2022; 99:e2454-e2463. [PMID: 36123130 PMCID: PMC9728036 DOI: 10.1212/wnl.0000000000201205] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 07/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES White matter hyperintensities (WMHs) are frequent imaging features of small vessel disease (SVD) and related to poor clinical outcomes. WMH progression over time is well described, but regression was also noted recently, although the frequency and associated factors are unknown. This systematic review and meta-analysis aims to assess longitudinal intraindividual WMH volume changes in sporadic SVD. METHODS We searched EMBASE and MEDLINE for articles up to 28 January 2022 on WMH volume changes using MRI on ≥2 time points in adults with sporadic SVD. We classified populations (healthy/community-dwelling, stroke, cognitive, other vascular risk factors, and depression) based on study characteristics. We performed random-effects meta-analyses with Knapp-Hartung adjustment to determine mean WMH volume change (change in milliliters, percentage of intracranial volume [%ICV], or milliliters per year), 95% CI, and prediction intervals (PIs, limits of increase and decrease) using unadjusted data. Risk of bias assessment tool for nonrandomized studies was used to assess risk of bias. We followed Preferred Reporting in Systematic Review and Meta-Analysis guidelines. RESULTS Forty-one articles, 12,284 participants, met the inclusion criteria. Thirteen articles had low risk of bias across all domains. Mean WMH volume increased over time by 1.74 mL (95% CI 1.23-2.26; PI -1.24 to 4.73 mL; 27 articles, N = 7,411, mean time interval 2.7 years, SD = 1.65); 0.25 %ICV (95% CI 0.14-0.36; PI -0.06 to 0.56; 6 articles, N = 1,071, mean time interval 3.5 years, SD = 1.54); or 0.58 mL/y (95% CI 0.35-0.81; PI -0.26 to 1.41; 8 articles, N = 3,802). In addition, 13 articles specifically mentioned and/or provided data on WMH regression, which occurred in asymptomatic, stroke, and cognitive disorders related to SVD. DISCUSSION Net mean WMH volume increases over time mask wide-ranging change (e.g., mean increase of 1.75 mL ranging from 1.25 mL decrease to 4.75 mL increase), with regression documented explicitly in up to one-third of participants. More knowledge on underlying mechanisms, associated factors, and clinical correlates is needed, as WMH regression could be an important intervention target.
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Affiliation(s)
- Angela C C Jochems
- From the Centre for Clinical Brain Sciences (A.C.C.J., C.A., F.C., T.R., F.D., S.M.M., J.M.W.), UK Dementia Research Institute (A.C.C.J., C.A., F.C., T.R., F.D., S.M.M., J.M.W.), and Centre for Discovery Brain Sciences (M.H.), University of Edinburgh, United Kingdom
| | - Carmen Arteaga
- From the Centre for Clinical Brain Sciences (A.C.C.J., C.A., F.C., T.R., F.D., S.M.M., J.M.W.), UK Dementia Research Institute (A.C.C.J., C.A., F.C., T.R., F.D., S.M.M., J.M.W.), and Centre for Discovery Brain Sciences (M.H.), University of Edinburgh, United Kingdom
| | - Francesca Chappell
- From the Centre for Clinical Brain Sciences (A.C.C.J., C.A., F.C., T.R., F.D., S.M.M., J.M.W.), UK Dementia Research Institute (A.C.C.J., C.A., F.C., T.R., F.D., S.M.M., J.M.W.), and Centre for Discovery Brain Sciences (M.H.), University of Edinburgh, United Kingdom
| | - Tuula Ritakari
- From the Centre for Clinical Brain Sciences (A.C.C.J., C.A., F.C., T.R., F.D., S.M.M., J.M.W.), UK Dementia Research Institute (A.C.C.J., C.A., F.C., T.R., F.D., S.M.M., J.M.W.), and Centre for Discovery Brain Sciences (M.H.), University of Edinburgh, United Kingdom
| | - Monique Hooley
- From the Centre for Clinical Brain Sciences (A.C.C.J., C.A., F.C., T.R., F.D., S.M.M., J.M.W.), UK Dementia Research Institute (A.C.C.J., C.A., F.C., T.R., F.D., S.M.M., J.M.W.), and Centre for Discovery Brain Sciences (M.H.), University of Edinburgh, United Kingdom
| | - Fergus Doubal
- From the Centre for Clinical Brain Sciences (A.C.C.J., C.A., F.C., T.R., F.D., S.M.M., J.M.W.), UK Dementia Research Institute (A.C.C.J., C.A., F.C., T.R., F.D., S.M.M., J.M.W.), and Centre for Discovery Brain Sciences (M.H.), University of Edinburgh, United Kingdom
| | - Susana Muñoz Maniega
- From the Centre for Clinical Brain Sciences (A.C.C.J., C.A., F.C., T.R., F.D., S.M.M., J.M.W.), UK Dementia Research Institute (A.C.C.J., C.A., F.C., T.R., F.D., S.M.M., J.M.W.), and Centre for Discovery Brain Sciences (M.H.), University of Edinburgh, United Kingdom
| | - Joanna M Wardlaw
- From the Centre for Clinical Brain Sciences (A.C.C.J., C.A., F.C., T.R., F.D., S.M.M., J.M.W.), UK Dementia Research Institute (A.C.C.J., C.A., F.C., T.R., F.D., S.M.M., J.M.W.), and Centre for Discovery Brain Sciences (M.H.), University of Edinburgh, United Kingdom.
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17
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Zeydan B, Schwarz CG, Przybelski SA, Lesnick TG, Kremers WK, Senjem ML, Kantarci OH, Min PH, Kemp BJ, Jack CR, Kantarci K, Lowe VJ. Comparison of 11C-Pittsburgh Compound B and 18F-Flutemetamol White Matter Binding in PET. J Nucl Med 2022; 63:1239-1244. [PMID: 34916245 PMCID: PMC9364341 DOI: 10.2967/jnumed.121.263281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/30/2021] [Indexed: 02/03/2023] Open
Abstract
PET imaging with β-amyloid ligands is emerging as a molecular imaging technique targeting white matter integrity and demyelination. β-amyloid PET ligands such as 11C-Pittsburgh compound B (11C-PiB) have been considered for quantitative measurement of myelin content changes in multiple sclerosis, but 11C-PiB is not commercially available given its short half-life. A 18F PET ligand such as flutemetamol with a longer half-life may be an alternative, but its ability to differentiate white matter hyperintensities (WMH) from normal-appearing white matter (NAWM) and its relationship with age remains to be investigated. Methods: Cognitively unimpaired (CU) older and younger adults (n = 61) were recruited from the community responding to a study advertisement for β-amyloid PET. Participants prospectively underwent MRI, 11C-PiB, and 18F-flutemetamol PET scans. MRI fluid-attenuated inversion recovery images were segmented into WMH and NAWM and registered to the T1-weighted MRI. 11C-PiB and 18F-flutemetamol PET images were also registered to the T1-weighted MRI. 11C-PiB and 18F-flutemetamol SUV ratios (SUVrs) from the WMH and NAWM were calculated using cerebellar crus uptake as a reference for both 11C-PiB and 18F-flutemetamol. Results: The median age was 38 y (range, 30-48 y) in younger adults and 67 y (range, 61-83 y) in older adults. WMH and NAWM SUVrs were higher with 18F-flutemetamol than with 11C-PiB in both older (P < 0.001) and younger (P < 0.001) CU adults. 11C-PiB and 18F-flutemetamol SUVrs were higher in older than in younger CU adults in both WMH (P < 0.001) and NAWM (P < 0.001). 11C-PiB and 18F-flutemetamol SUVrs were higher in NAWM than WMH in both older (P < 0.001) and younger (P < 0.001) CU adults. There was no apparent difference between 11C-PiB and 18F-flutemetamol SUVrs in differentiating WMH from NAWM in older and in younger adults. Conclusion:11C-PiB and 18F-flutemetamol show a similar topographic pattern of uptake in white matter with a similar association with age in WMH and NAWM. 11C-PiB and 18F-flutemetamol can also effectively distinguish between WMH and NAWM. However, given its longer half-life, commercial availability, and higher binding potential, 18F-flutemetamol can be an alternative to 11C-PiB in molecular imaging studies specifically targeting multiple sclerosis to evaluate white matter integrity.
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Affiliation(s)
- Burcu Zeydan
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | - Scott A Przybelski
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota; and
| | - Timothy G Lesnick
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota; and
| | - Walter K Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota; and
| | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
- Department of Information Technology, Mayo Clinic, Rochester, Minnesota
| | | | - Paul H Min
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Bradley J Kemp
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota;
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18
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Wang W, Norby FL, Alonso A, Gottesman RF, Jack CR, Meyer ML, Knopman DS, Sullivan KJ, Hughes TM, Lakshminarayan K, Lutsey PL. Association of Carotid Intima-Media Thickness with Brain MRI Markers in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS). J Stroke Cerebrovasc Dis 2022; 31:106388. [PMID: 35193028 PMCID: PMC9018472 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106388] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 01/24/2022] [Accepted: 01/31/2022] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Elevated carotid intima-media thickness (cIMT) and carotid plaque are markers of arterial injury and may be linked to structural brain injury. We hypothesized cIMT or presence of carotid plaque at midlife are associated with presence of infarcts and cerebral microbleeds, greater white matter hyperintensity (WMH) volume, and smaller regional brain volumes in late-life. METHODS We included 1,795 Atherosclerosis Risk in Communities (ARIC) Study participants (aged 57±6 years, 57% female, 23% Black) with carotid ultrasounds in 1990-1992 and brain MRI scans in 2011-2013. Weighted linear regression was used for brain volume outcomes, while logistic regression was used for infarcts and cerebral microbleeds. RESULTS After multivariable adjustments, the highest cIMT quintile was associated with smaller deep gray matter (β [95% CI]: -0.11 [-0.22, -0.01]) and cortical volume in a temporal-parietal meta region of interest (ROI) (β [95% CI]: -0.10 [-0.20, -0.01]) in late-life. Similarly, those with carotid plaque had smaller regional brain volumes than those without (βs [95% CIs]: -0.05 [-0.12, 0.03] and -0.06 [-0.13, 0.01] for deep gray matter and temporal-parietal meta ROI). No significant relations were observed with WMH volume, infarcts, or cerebral microbleeds. CONCLUSION Over a median follow-up of 21 years, greater midlife cIMT and presence of carotid plaque were associated with smaller deep gray matter volume and cortical volume in a meta ROI involving temporal and parietal lobe regions typically involved in neurodegeneration, including Alzheimer's disease, in later life. Contrary to our hypothesis, associations between measures of arterial injury and markers of vascular brain injury were null.
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Affiliation(s)
- Wendy Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States.
| | - Faye L Norby
- Center for Cardiac Arrest Prevention, Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, United States.
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States.
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States.
| | | | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, United States.
| | - Kevin J Sullivan
- Department of Medicine: The MIND Center, University of Mississippi Medical Center, Jackson, Mississippi, United States.
| | - Timothy M Hughes
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States.
| | | | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States.
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19
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Gomez GT, Gottesman RF, Gabriel KP, Palta P, Gross AL, Soldan A, Albert MS, Sullivan KJ, Jack CR, Knopman DS, Windham BG, Walker KA. The association of motoric cognitive risk with incident dementia and neuroimaging characteristics: The Atherosclerosis Risk in Communities Study. Alzheimers Dement 2022; 18:434-444. [PMID: 34786837 PMCID: PMC10064850 DOI: 10.1002/alz.12412] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/05/2021] [Accepted: 06/01/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Motoric cognitive risk (MCR), a clinical syndrome characterized by slow gait speed and subjective cognitive complaints, has been associated with dementia risk. The neuropathological features underlying MCR remain poorly understood. METHODS The Atherosclerosis Risk in Communities (ARIC) community-based cohort study classified participants using standardized criteria as MCR+/- and mild cognitive impairment (MCI)+/- at study baseline (2011-2013). We examined the 5-year dementia risk and baseline brain structural/molecular abnormalities associated with MCR+ and MCI+ status. RESULTS Of 5023 nondemented participants included, 204 were MCR+ and 1030 were MCI+. Both MCR+ and MCI+ participants demonstrated increased dementia risk. The pattern of structural brain abnormalities associated with MCR+ differed from that of MCI+. Whereas MCI+ was associated with comparatively smaller volumes in brain regions vulnerable to Alzheimer's disease pathology, MCR+ status was associated with smaller volumes in frontoparietal regions and greater white matter abnormalities. DISCUSSION MCR may represent a predementia syndrome characterized by prominent white matter abnormalities and frontoparietal atrophy.
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Affiliation(s)
- Gabriela T. Gomez
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca F. Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Priya Palta
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Alden L. Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Anja Soldan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marilyn S. Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kevin J. Sullivan
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, MS
| | | | | | - B. Gwen Windham
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, MS
| | - Keenan A. Walker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, Baltimore, MD
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20
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Machulda MM, Lundt ES, Mester CT, Albertson SM, Raghavan S, Reid RI, Schwarz CG, Graff‐Radford J, Jack CR, Knopman DS, Mielke MM, Kremers WK, Petersen RC, Bondi MW, Vemuri P. White matter changes in empirically derived incident MCI subtypes in the Mayo Clinic Study of Aging. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12269. [PMID: 35005199 PMCID: PMC8719426 DOI: 10.1002/dad2.12269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of this study was to examine white matter hyperintensities (WMH) and fractional anisotropy (FA) in empirically derived incident mild cognitive impairment (MCI) subtypes. METHODS We evaluated 188 participants with incident MCI in the Mayo Clinic Study of Aging (MCSA) identified as having one of four cluster-derived subtypes: subtle cognitive impairment, amnestic, dysnomic, and dysexecutive. We used linear regression models to evaluate whole brain and regional WMH volumes. We examined fractional anisotropy (FA) on a subset of 63 participants with diffusion tensor imaging. RESULTS Amnestic and dysexecutive subtypes had higher WMH volumes in differing patterns than cognitively unimpaired; the dysexecutive subtype had higher WMH than subtle cognitive impairment. There was widespread WM degeneration in long association and commissural fibers in the amnestic, dysnomic, and dysexecutive subtypes, and corpus callosum FA accounted for significant variability in global cognition. DISCUSSION White matter changes likely contribute to cognitive symptoms in incident MCI.
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Affiliation(s)
- Mary M. Machulda
- Division of Neurocognitive DisordersDepartment of Psychiatry and PsychologyMayo ClinicRochesterMinnesotaUSA
| | - Emily S. Lundt
- Division of Biomedical Statistics and InformaticsDepartment of Health Sciences ResearchMayo ClinicRochesterMinnesotaUSA
| | - Carly T. Mester
- Division of Biomedical Statistics and InformaticsDepartment of Health Sciences ResearchMayo ClinicRochesterMinnesotaUSA
| | - Sabrina M. Albertson
- Division of Biomedical Statistics and InformaticsDepartment of Health Sciences ResearchMayo ClinicRochesterMinnesotaUSA
| | | | - Robert I. Reid
- Department of Information TechnologyMayo ClinicRochesterMinnesotaUSA
| | | | | | | | | | - Michelle M. Mielke
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Division of Epidemiology, Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Walter K. Kremers
- Division of Biomedical Statistics and InformaticsDepartment of Health Sciences ResearchMayo ClinicRochesterMinnesotaUSA
| | | | - Mark W. Bondi
- Department of PsychiatryUniversity of California San DiegoSchool of MedicineLa JollaCaliforniaUSA
- Veterans Affairs San Diego Healthcare SystemSan DiegoCaliforniaUSA
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21
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Walker KA, Silverstein N, Zhou Y, Hughes TM, Jack CR, Knopman DS, Sharrett AR, Wong DF, Mosley TH, Gottesman RF. Brain White Matter Structure and Amyloid Deposition in Black and White Older Adults: The ARIC-PET Study. J Am Heart Assoc 2021; 10:e022087. [PMID: 34431373 PMCID: PMC8649279 DOI: 10.1161/jaha.121.022087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/26/2021] [Indexed: 12/30/2022]
Abstract
Background White matter abnormalities are a common feature of aging and Alzheimer disease, and tend to be more severe among Black individuals. However, the extent to which white matter abnormalities relate to amyloid deposition, a marker of Alzheimer pathology, remains unclear. This cross-sectional study examined the association of white matter abnormalities with cortical amyloid in a community sample of older adults without dementia and examined the moderating effect of race. Methods and Results Participants from the ARIC-PET (Atherosclerosis Risk in Communities-Positron Emission Tomography) study underwent brain magnetic resonance imaging, which quantified white matter hyperintensity volume and microstructural integrity using diffusion tensor imaging. Participants received florbetapir positron emission tomography imaging to measure brain amyloid. Associations between measures of white matter structure and elevated amyloid status were examined using multivariable logistic regression. Among 322 participants (43% Black), each SD increase in white matter hyperintensity volume was associated with a greater odds of elevated amyloid (odds ratio [OR], 1.37; 95% CI, 1.03-1.83) after adjusting for demographic and cardiovascular risk factors. In race-stratified analyses, a greater white matter hyperintensity volume was more strongly associated with elevated amyloid among Black participants (OR, 2.00; 95% CI, 1.15-3.50), compared with White participants (OR, 1.29; 95% CI, 0.89-1.89). However, the race interaction was not statistically significant (P interaction=0.09). We found no association between white matter microstructure and elevated amyloid. Conclusions The results suggest a modest positive relationship between white matter hyperintensity and elevated amyloid in older adults without dementia. Although the results indicate that this association is nonsignificantly stronger among Black participants, these findings will need to be confirmed or refuted using larger multiracial cohorts.
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Affiliation(s)
- Keenan A. Walker
- Laboratory of Behavioral NeuroscienceNational Institute on AgingIntramural Research ProgramBaltimoreMD
| | - Noah Silverstein
- Department of MedicineSUNY Downstate Health Sciences UniversityBrooklynNY
| | - Yun Zhou
- Mallinckrodt Institute of RadiologyWashington University School of Medicine in St. LouisMO
- United TechnologiesShanghaiChina
| | - Timothy M. Hughes
- Department of Internal MedicineSection on Gerontology and Geriatrics MedicineWake Forest School of MedicineWinston‐SalemNC
| | | | | | - A. Richey Sharrett
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Dean F. Wong
- Mallinckrodt Institute of RadiologyWashington University School of Medicine in St. LouisMO
| | - Thomas H. Mosley
- Department of MedicineDivision of GeriatricsUniversity of Mississippi Medical CenterJacksonMS
| | - Rebecca F. Gottesman
- Stroke BranchNational Institute of Neurological Disorders and Stroke Intramural Research ProgramNIHBethesdaMD
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22
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Ferreira D, Nedelska Z, Graff-Radford J, Przybelski SA, Lesnick TG, Schwarz CG, Botha H, Senjem ML, Fields JA, Knopman DS, Savica R, Ferman TJ, Graff-Radford NR, Lowe VJ, Jack CR, Petersen RC, Lemstra AW, van de Beek M, Barkhof F, Blanc F, Loureiro de Sousa P, Philippi N, Cretin B, Demuynck C, Hort J, Oppedal K, Boeve BF, Aarsland D, Westman E, Kantarci K. Cerebrovascular disease, neurodegeneration, and clinical phenotype in dementia with Lewy bodies. Neurobiol Aging 2021; 105:252-261. [PMID: 34130107 PMCID: PMC8338792 DOI: 10.1016/j.neurobiolaging.2021.04.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/29/2022]
Abstract
We investigated whether cerebrovascular disease contributes to neurodegeneration and clinical phenotype in dementia with Lewy bodies (DLB). Regional cortical thickness and subcortical gray matter volumes were estimated from structural magnetic resonance imaging (MRI) in 165 DLB patients. Cortical and subcortical infarcts were recorded and white matter hyperintensities (WMHs) were assessed. Subcortical only infarcts were more frequent (13.3%) than cortical only infarcts (3.1%) or both subcortical and cortical infarcts (2.4%). Infarcts, irrespective of type, were associated with WMHs. A higher WMH volume was associated with thinner orbitofrontal, retrosplenial, and posterior cingulate cortices, smaller thalamus and pallidum, and larger caudate volume. A higher WMH volume was associated with the presence of visual hallucinations and lower global cognitive performance, and tended to be associated with the absence of probable rapid eye movement sleep behavior disorder. Presence of infarcts was associated with the absence of parkinsonism. We conclude that cerebrovascular disease is associated with gray matter neurodegeneration in patients with probable DLB, which may have implications for the multifactorial treatment of probable DLB.
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Affiliation(s)
- Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Zuzana Nedelska
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | | | | | | | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Tanis J Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Afina W Lemstra
- Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, Netherlands
| | - Marleen van de Beek
- Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands; Queen Square Institute of Neurology, University College London, London, UK
| | - Frederic Blanc
- Day Hospital of Geriatrics, Memory Resource and Research Centre (CM2R) of Strasbourg, Department of Geriatrics, Hopitaux Universitaires de Strasbourg, Strasbourg, France; University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory and Federation de Medecine Translationnelle de Strasbourg (FMTS), Team Imagerie Multimodale Integrative en Sante (IMIS)/ICONE, Strasbourg, France
| | - Paulo Loureiro de Sousa
- Day Hospital of Geriatrics, Memory Resource and Research Centre (CM2R) of Strasbourg, Department of Geriatrics, Hopitaux Universitaires de Strasbourg, Strasbourg, France; University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory and Federation de Medecine Translationnelle de Strasbourg (FMTS), Team Imagerie Multimodale Integrative en Sante (IMIS)/ICONE, Strasbourg, France
| | - Nathalie Philippi
- Day Hospital of Geriatrics, Memory Resource and Research Centre (CM2R) of Strasbourg, Department of Geriatrics, Hopitaux Universitaires de Strasbourg, Strasbourg, France; University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory and Federation de Medecine Translationnelle de Strasbourg (FMTS), Team Imagerie Multimodale Integrative en Sante (IMIS)/ICONE, Strasbourg, France
| | - Benjamin Cretin
- Day Hospital of Geriatrics, Memory Resource and Research Centre (CM2R) of Strasbourg, Department of Geriatrics, Hopitaux Universitaires de Strasbourg, Strasbourg, France; University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory and Federation de Medecine Translationnelle de Strasbourg (FMTS), Team Imagerie Multimodale Integrative en Sante (IMIS)/ICONE, Strasbourg, France
| | - Catherine Demuynck
- Day Hospital of Geriatrics, Memory Resource and Research Centre (CM2R) of Strasbourg, Department of Geriatrics, Hopitaux Universitaires de Strasbourg, Strasbourg, France; University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory and Federation de Medecine Translationnelle de Strasbourg (FMTS), Team Imagerie Multimodale Integrative en Sante (IMIS)/ICONE, Strasbourg, France
| | - Jakub Hort
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic; International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Ketil Oppedal
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway; Stavanger Medical Imaging Laboratory (SMIL), Department of Radiology, Stavanger University Hospital, Stavanger, Norway; Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
| | | | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eric Westman
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
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23
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Caughey MC, Qiao Y, Meyer ML, Palta P, Matsushita K, Tanaka H, Wasserman BA, Heiss G. Relationship Between Central Artery Stiffness, Brain Arterial Dilation, and White Matter Hyperintensities in Older Adults: The ARIC Study-Brief Report. Arterioscler Thromb Vasc Biol 2021; 41:2109-2116. [PMID: 33882687 PMCID: PMC8478115 DOI: 10.1161/atvbaha.120.315692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/01/2021] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Melissa C. Caughey
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University; Chapel Hill, NC
| | - Ye Qiao
- Department of Radiology, Johns Hopkins School of Medicine; Baltimore, MD
| | - Michelle L. Meyer
- Department of Emergency Medicine, University of North Carolina School of Medicine; Chapel Hill, NC
| | - Priya Palta
- Department of Medicine, Columbia University School of Medicine; New York, NY
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Baltimore, MD
| | | | - Bruce A. Wasserman
- Department of Radiology, Johns Hopkins School of Medicine; Baltimore, MD
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health; Chapel Hill, NC
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24
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Cogswell PM, Weigand SD, Wiste HJ, Gunter JL, Graff-Radford J, Jones DT, Schwarz CG, Senjem ML, Knopman DS, Petersen RC, Jack CR. CSF dynamics as a predictor of cognitive progression. Neuroimage 2021; 232:117899. [PMID: 33631332 PMCID: PMC8237937 DOI: 10.1016/j.neuroimage.2021.117899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/17/2021] [Indexed: 11/25/2022] Open
Abstract
Disproportionately enlarged subarachnoid-space hydrocephalus (DESH), characterized by tight high convexity CSF spaces, ventriculomegaly, and enlarged Sylvian fissures, is thought to be an indirect marker of a CSF dynamics disorder. The clinical significance of DESH with regard to cognitive decline in a community setting is not yet well defined. The goal of this work is to determine if DESH is associated with cognitive decline. Participants in the population-based Mayo Clinic Study of Aging (MCSA) who met the following criteria were included: age ≥ 65 years, 3T MRI, and diagnosis of cognitively unimpaired or mild cognitive impairment at enrollment as well as at least one follow-up visit with cognitive testing. A support vector machine based method to detect the DESH imaging features on T1-weighted MRI was used to calculate a "DESH score", with positive scores indicating a more DESH-like imaging pattern. For the participants who were cognitively unimpaired at enrollment, a Cox proportional hazards model was fit with time defined as years from enrollment to first diagnosis of mild cognitive impairment or dementia, or as years to last known cognitively unimpaired diagnosis for those who did not progress. Linear mixed effects models were fit among all participants to estimate annual change in cognitive z scores for each domain (memory, attention, language, and visuospatial) and a global z score. For all models, covariates included age, sex, education, APOE genotype, cortical thickness, white matter hyperintensity volume, and total intracranial volume. The hazard of progression to cognitive impairment was an estimated 12% greater for a DESH score of +1 versus -1 (HR 1.12, 95% CI 0.97-1.31, p = 0.11). Global and attention cognition declined 0.015 (95% CI 0.005-0.025) and 0.016 (95% CI 0.005-0.028) z/year more, respectively, for a DESH score of +1 vs -1 (p = 0.01 and p = 0.02), with similar, though not statistically significant DESH effects in the other cognitive domains. Imaging features of disordered CSF dynamics are an independent predictor of subsequent cognitive decline in the MCSA, among other well-known factors including age, cortical thickness, and APOE status. Therefore, since DESH contributes to cognitive decline and is present in the general population, identifying individuals with DESH features may be important clinically as well as for selection in clinical trials.
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Affiliation(s)
- Petrice M Cogswell
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | - Stephen D Weigand
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Heather J Wiste
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Jeffrey L Gunter
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA; Department of Information Technology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | | | - David T Jones
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | | | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA; Department of Information Technology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Ronald C Petersen
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA; Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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25
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Walker KA, Chen J, Zhang J, Fornage M, Yang Y, Zhou L, Grams ME, Tin A, Daya N, Hoogeveen RC, Wu A, Sullivan KJ, Ganz P, Zeger SL, Gudmundsson EF, Emilsson V, Launer LJ, Jennings LL, Gudnason V, Chatterjee N, Gottesman RF, Mosley TH, Boerwinkle E, Ballantyne CM, Coresh J. Large-scale plasma proteomic analysis identifies proteins and pathways associated with dementia risk. NATURE AGING 2021; 1:473-489. [PMID: 37118015 PMCID: PMC10154040 DOI: 10.1038/s43587-021-00064-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 04/02/2021] [Indexed: 04/30/2023]
Abstract
The plasma proteomic changes that precede the onset of dementia could yield insights into disease biology and highlight new biomarkers and avenues for intervention. We quantified 4,877 plasma proteins in nondemented older adults in the Atherosclerosis Risk in Communities cohort and performed a proteome-wide association study of dementia risk over five years (n = 4,110; 428 incident cases). Thirty-eight proteins were associated with incident dementia after Bonferroni correction. Of these, 16 were also associated with late-life dementia risk when measured in plasma collected nearly 20 years earlier, during mid-life. Two-sample Mendelian randomization causally implicated two dementia-associated proteins (SVEP1 and angiostatin) in Alzheimer's disease. SVEP1, an immunologically relevant cellular adhesion protein, was found to be part of larger dementia-associated protein networks, and circulating levels were associated with atrophy in brain regions vulnerable to Alzheimer's pathology. Pathway analyses for the broader set of dementia-associated proteins implicated immune, lipid, metabolic signaling and hemostasis pathways in dementia pathogenesis.
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Affiliation(s)
- Keenan A Walker
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Intramural Research Program, Baltimore, MD, USA.
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Jingsha Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jingning Zhang
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School and Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yunju Yang
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School and Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Linda Zhou
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Morgan E Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adrienne Tin
- MIND Center and Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Natalie Daya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ron C Hoogeveen
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Aozhou Wu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kevin J Sullivan
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Peter Ganz
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Scott L Zeger
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD, USA
| | - Lori L Jennings
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- University of Iceland, Reykjavik, Iceland
| | - Nilanjan Chatterjee
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas H Mosley
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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26
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Jayachandran M, Miller VM, Lahr BD, Bailey KR, Lowe VJ, Fields JA, Mielke MM, Kantarci K. Peripheral Markers of Neurovascular Unit Integrity and Amyloid-β in the Brains of Menopausal Women. J Alzheimers Dis 2021; 80:397-405. [PMID: 33554914 PMCID: PMC8075395 DOI: 10.3233/jad-201410] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND The identification of blood-borne biomarkers for the diagnosis and prognosis of Alzheimer's disease and related dementias is more feasible at the population level than obtaining cerebrospinal fluid or neuroimaging markers. OBJECTIVE This study determined the association of blood microvesicles, derived from cells of the neurovascular unit, with brain amyloid-β deposition in menopausal women. METHODS A subset of women from the Kronos Early Estrogen Prevention Study underwent brain amyloid-β positron emission tomography three years following cessation of study treatment with placebo (PL, n = 29), transdermal 17β-estradiol (tE2; n = 21), or oral conjugated equine estrogen (oCEE; n = 17). Isolated peripheral venous blood microvesicles were analyzed by digital flow cytometry using fluorophore conjugated antibodies directed toward total tau, amyloid-β 1-42 (Aβ1-42), neuron specific class III β-tubulin (Tuj1), microglia ionized calcium -binding adaptor molecule 1(Iba1), glial fibrillary acid protein (GFAP), and low density lipoprotein receptor-related protein1 (LRP1). Principal components analysis reduced the dimensionality of these selected six markers to two principal components (PCs). Proportional odds ordinal logistic regression analysis was used with amyloid-β deposition regressed on these PCs. RESULTS Only the number of microvesicles positive for Aβ1-42 differed statistically among prior treatment groups (median [IQR]: 6.06 [2.11, 12.55] in PL; 2.49 [0.73, 3.59] in tE2; and 4.96 [0.83, 10.31] in oCEE; p = 0.032). The joint association between the 2 PCs and brain amyloid-β deposition was significant (p = 0.045). CONCLUSION Six selected markers expressing peripheral blood microvesicles derived from cells of the neurovascular unit, when summarized into two principal components, were associated with brain amyloid-β deposition.
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Affiliation(s)
- Muthuvel Jayachandran
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA.,Department of Internal Medicine, Divisions of Nephrology and Hypertension and Hematology Research, Mayo Clinic, Rochester, MN, USA
| | - Virginia M Miller
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA.,Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Brian D Lahr
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Kent R Bailey
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Val J Lowe
- Department of Radiology, Division of Nuclear Medicine, Mayo Clinic, Rochester, MN, USA
| | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Michelle M Mielke
- Department of Health Science Research, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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27
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Palta P, Sharrett AR, Gabriel KP, Gottesman RF, Folsom AR, Power MC, Evenson KR, Jack CR, Knopman DS, Mosley TH, Heiss G. Prospective Analysis of Leisure-Time Physical Activity in Midlife and Beyond and Brain Damage on MRI in Older Adults. Neurology 2021; 96:e964-e974. [PMID: 33408144 PMCID: PMC8055339 DOI: 10.1212/wnl.0000000000011375] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 10/07/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that greater levels of leisure-time moderate to vigorous intensity physical activity (MVPA) in midlife or late life are associated with larger gray matter volumes, less white matter disease, and fewer cerebrovascular lesions measured in late life, we utilized data from 1,604 participants enrolled in the Atherosclerosis Risk in Communities study. METHODS Leisure-time MVPA was quantified using a past-year recall, interviewer-administered questionnaire at baseline and 25 years later and classified as none, low, middle, and high at each time point. The presence of cerebrovascular lesions, white matter hyperintensities (WMH), white matter integrity (mean fractional anisotropy [FA] and mean diffusivity [MD]), and gray matter volumes were quantified with 3T MRI in late life. The odds of cerebrovascular lesions were estimated with logistic regression. Linear regression estimated the mean differences in WMH, mean FA and MD, and gray matter volumes. RESULTS Among 1,604 participants (mean age 53 years, 61% female, 27% Black), 550 (34%), 176 (11%), 250 (16%), and 628 (39%) reported no, low, middle, and high MVPA in midlife, respectively. Compared to no MVPA in midlife, high MVPA was associated with more intact white matter integrity in late life (mean FA difference 0.13 per SD [95% confidence interval (CI) 0.004, 0.26]; mean MD difference -0.11 per SD [95% CI -0.21, -0.004]). High MVPA in midlife was also associated with a lower odds of lacunar infarcts (odds ratio 0.68, 95% CI 0.46, 0.99). High MVPA was not associated with gray matter volumes. High MVPA compared to no MVPA in late life was associated with most brain measures. CONCLUSION Greater levels of physical activity in midlife may protect against cerebrovascular sequelae in late life.
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Affiliation(s)
- Priya Palta
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson.
| | - A Richey Sharrett
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson
| | - Kelley Pettee Gabriel
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson
| | - Rebecca F Gottesman
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson
| | - Aaron R Folsom
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson
| | - Melinda C Power
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson
| | - Kelly R Evenson
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson
| | - Clifford R Jack
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson
| | - David S Knopman
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson
| | - Thomas H Mosley
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson
| | - Gerardo Heiss
- From the Division of General Medicine, Department of Medicine (P.P.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, School of Public Health (K.P.G.), The University of Alabama at Birmingham; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; Division of Epidemiology and Community Health, School of Public Health (A.R.F.), University of Minnesota, Minneapolis; Department of Epidemiology (M.C.P.), Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Epidemiology (K.R.E., G.H.), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Departments of Radiology (C.R.J.) and Neurology (D.S.K.), Mayo Clinic, Rochester, MN; and The MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson
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28
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Jayachandran M, Lahr BD, Bailey KR, Miller VM, Kantarci K. Menopausal hormone therapy, blood thrombogenicity, and development of white matter hyperintensities in women of the Kronos Early Estrogen Prevention Study. ACTA ACUST UNITED AC 2021; 27:305-310. [PMID: 31934946 PMCID: PMC7050795 DOI: 10.1097/gme.0000000000001465] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Supplemental Digital Content is available in the text Objective: Development of white matter hyperintensities (WMH) in the brain is associated with blood thrombogenicity in recently menopausal women. This study examined the influence of menopausal hormone treatments (MHTs) on this association. Methods: Measures of blood thrombogenicity were examined in women of the Kronos Early Estrogen Prevention Study (n = 95) who had brain magnetic resonance imaging before and during the 48 months of randomization to transdermal 17β-estradiol (n = 30), oral conjugated equine estrogen (n = 29) both with progesterone for 12 days per month or placebo pills and patch (n = 36). Principal components (PCs) analysis was used to reduce the dimensionality of 14 markers of platelet activation and blood thrombogenicity. The first 5 PCs were assessed for association with treatment and changes in WMH. Within-person slopes were obtained to capture the extent of WMH change for each woman. Results: WMH increased in all groups over the 48 months (P = 0.044). The partial effect of PC1, representing an average of six thrombogenicity variables (microvesicles derived from endothelium, leukocytes, and monocytes, and positive for tissue factor and adhesion molecules) on WMH was significant (P = 0.003). PC3, reflecting a contrast of platelet microaggregates and adenosine triphosphate secretion versus total platelet count, differed across groups (P = 0.006) with higher scores in the oral conjugated equine estrogen group. The global association between PCs and WMH increase, however, did not differ significantly by MHT (P = 0.207 for interaction between MHT and PC's). Conclusion: In recently menopausal women, the type of MHT did not significantly influence the association of markers of blood thrombogenicity with development of WMH in the brain.
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Affiliation(s)
- Muthuvel Jayachandran
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN.,Department of Surgery, Mayo Clinic, Rochester, MN
| | - Brian D Lahr
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Kent R Bailey
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Virginia M Miller
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN.,Department of Surgery, Mayo Clinic, Rochester, MN
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29
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Walker KA, Chawla S, Nogueras-Ortiz C, Coresh J, Sharrett AR, Wong DF, Jack CR, Spychalla AJ, Gottesman RF, Kapogiannis D. Neuronal insulin signaling and brain structure in nondemented older adults: the Atherosclerosis Risk in Communities Study. Neurobiol Aging 2021; 97:65-72. [PMID: 33160263 PMCID: PMC7736127 DOI: 10.1016/j.neurobiolaging.2020.09.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/10/2020] [Accepted: 09/21/2020] [Indexed: 12/28/2022]
Abstract
We used plasma neuronal extracellular vesicles to examine how neuronal insulin signaling proteins relate cross-sectionally to brain structure in nondemented older adults with varying levels of cortical amyloid. Extracellular vesicles enriched for neuronal origin by anti-L1CAM immunoabsorption were isolated from plasma of Atherosclerosis Risk in Communities-Positron Emission Tomography study participants (n = 88; mean age: 77 years [standard deviation: 6]). Neuronal extracellular vesicle levels of phosphorylated insulin signaling cascade proteins were quantified. Brain volume and white matter hyperintensity (WMH) volume were assessed using 3T magnetic resonance imaging. After adjusting for demographic variables and extracellular vesicle marker Alix, higher levels of a neuronal insulin signaling composite measure were associated with lower WMH and greater temporal lobe volume. Secondary analyses found the levels of downstream protein kinases involved in cell survival (p70S6K) and tau phosphorylation/neuroinflammation (GSK-3β) to be most strongly associated with WMH and temporal lobe volume, respectively. Associations between neuronal insulin signaling and lower WMH volume were attenuated in participants with elevated cortical amyloid. These results suggest that enhanced neuronal proximal insulin signaling is associated with preserved brain structure in nondemented older adults.
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Affiliation(s)
- Keenan A Walker
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
| | - Sahil Chawla
- Laboratory of Clinical Investigation, National Institute on Aging, Intramural Research Program, Baltimore, MD, USA
| | - Carlos Nogueras-Ortiz
- Laboratory of Clinical Investigation, National Institute on Aging, Intramural Research Program, Baltimore, MD, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Dean F Wong
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MS, USA
| | | | | | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA; Laboratory of Clinical Investigation, National Institute on Aging, Intramural Research Program, Baltimore, MD, USA
| | - Dimitrios Kapogiannis
- Laboratory of Clinical Investigation, National Institute on Aging, Intramural Research Program, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
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30
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Sintini I, Graff-Radford J, Senjem ML, Schwarz CG, Machulda MM, Martin PR, Jones DT, Boeve BF, Knopman DS, Kantarci K, Petersen RC, Jack CR, Lowe VJ, Josephs KA, Whitwell JL. Longitudinal neuroimaging biomarkers differ across Alzheimer's disease phenotypes. Brain 2020; 143:2281-2294. [PMID: 32572464 DOI: 10.1093/brain/awaa155] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/11/2020] [Accepted: 03/27/2020] [Indexed: 11/12/2022] Open
Abstract
Alzheimer's disease can present clinically with either the typical amnestic phenotype or with atypical phenotypes, such as logopenic progressive aphasia and posterior cortical atrophy. We have recently described longitudinal patterns of flortaucipir PET uptake and grey matter atrophy in the atypical phenotypes, demonstrating a longitudinal regional disconnect between flortaucipir accumulation and brain atrophy. However, it is unclear how these longitudinal patterns differ from typical Alzheimer's disease, to what degree flortaucipir and atrophy mirror clinical phenotype in Alzheimer's disease, and whether optimal longitudinal neuroimaging biomarkers would also differ across phenotypes. We aimed to address these unknowns using a cohort of 57 participants diagnosed with Alzheimer's disease (18 with typical amnestic Alzheimer's disease, 17 with posterior cortical atrophy and 22 with logopenic progressive aphasia) that had undergone baseline and 1-year follow-up MRI and flortaucipir PET. Typical Alzheimer's disease participants were selected to be over 65 years old at baseline scan, while no age criterion was used for atypical Alzheimer's disease participants. Region and voxel-level rates of tau accumulation and atrophy were assessed relative to 49 cognitively unimpaired individuals and among phenotypes. Principal component analysis was implemented to describe variability in baseline tau uptake and rates of accumulation and baseline grey matter volumes and rates of atrophy across phenotypes. The capability of the principal components to discriminate between phenotypes was assessed with logistic regression. The topography of longitudinal tau accumulation and atrophy differed across phenotypes, with key regions of tau accumulation in the frontal and temporal lobes for all phenotypes and key regions of atrophy in the occipitotemporal regions for posterior cortical atrophy, left temporal lobe for logopenic progressive aphasia and medial and lateral temporal lobe for typical Alzheimer's disease. Principal component analysis identified patterns of variation in baseline and longitudinal measures of tau uptake and volume that were significantly different across phenotypes. Baseline tau uptake mapped better onto clinical phenotype than longitudinal tau and MRI measures. Our study suggests that optimal longitudinal neuroimaging biomarkers for future clinical treatment trials in Alzheimer's disease are different for MRI and tau-PET and may differ across phenotypes, particularly for MRI. Baseline tau tracer retention showed the highest fidelity to clinical phenotype, supporting the important causal role of tau as a driver of clinical dysfunction in Alzheimer's disease.
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Affiliation(s)
- Irene Sintini
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.,Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | | | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester MN, USA
| | - Peter R Martin
- Department of Health Science Research, Mayo Clinic, Rochester MN, USA
| | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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31
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Miller VM, Taylor HS, Naftolin F, Manson JE, Gleason CE, Brinton EA, Kling JM, Cedars MI, Dowling NM, Kantarci K, Harman SM. Lessons from KEEPS: the Kronos Early Estrogen Prevention Study. Climacteric 2020; 24:139-145. [PMID: 32880220 DOI: 10.1080/13697137.2020.1804545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Kronos Early Estrogen Prevention Study (KEEPS) was a randomized, double-blind, placebo-controlled trial designed to determine the effects of hormone treatments (menopausal hormone treatments [MHTs]) on the progression of carotid intima-medial thickness (CIMT) in recently menopausal women. Participants less than 3 years from menopause and without a history of overt cardiovascular disease (CVD), defined as no clinical CVD events and coronary artery calcium < 50 Agatston units, received either oral conjugated equine estrogens (0.45 mg/day) or transdermal 17β-estradiol (50 µg/day), both with progesterone (200 mg/day for 12 days/month), or placebo pills and patches for 4 years. Although MHT did not decrease the age-related increase in CIMT, KEEPS provided other important insights about MHT effects. Both MHTs versus placebo reduced the severity of menopausal symptoms and maintained bone density, but differed in efficacy regarding mood/anxiety, sleep, sexual function, and deposition of β-amyloid in the brain. Additionally, genetic variants in enzymes for metabolism and uptake of estrogen affected the efficacy of MHT for some aspects of symptom relief. KEEPS provides important information for use of MHT in clinical practice, including type, dose, and mode of delivery of MHT recently after menopause, and how genetic variants in hormone metabolism may affect MHT efficacy on specific outcomes.
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Affiliation(s)
- V M Miller
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - H S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - F Naftolin
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - J E Manson
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - C E Gleason
- Division of Geriatrics, Department of Medicine, Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - J M Kling
- Department of Internal Medicine, Division of Women's Health Internal Medicine, Mayo Clinic, AZ, USA
| | - M I Cedars
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - N M Dowling
- Department of Acute & Chronic Care, School of Nursing, Department of Epidemiology & Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington DC, USA
| | - K Kantarci
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - S M Harman
- Kronos Longevity Research Institute, Phoenix, AZ, USA.,Phoenix Veterans Administration Health Care System, Phoenix, AZ, USA
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Kling JM, Miller VM, Tosakulwong N, Lesnick T, Kantarci K. Associations of pituitary-ovarian hormones and white matter hyperintensities in recently menopausal women using hormone therapy. Menopause 2020; 27:872-878. [PMID: 32520900 PMCID: PMC7678409 DOI: 10.1097/gme.0000000000001557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Little is known about how menopausal hormone treatment (HT) may influence the development of white matter hyperintensities (WMHs) in the brain. This study evaluated the associations of changes in levels of pituitary-ovarian hormones during HT and changes in WMH. METHODS Women (n = 78 adherent to treatment) enrolled in the Kronos Early Estrogen Prevention Study underwent brain magnetic resonance imaging, and blood collection before and after 48 months of randomization to 0.45 mg/d oral conjugated equine estrogen (oCEE) daily, 50 μg/d transdermal 17β estradiol (tE2), or placebo pills and patches. Women in the active treatment groups also received oral 200 mg/d micronized progesterone the first 12 days of the month. Estradiol (E2), estrone (E1), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were measured in serum by high sensitivity liquid chromatography/mass spectrometry at baseline and following 48 months of HT. Longitudinal change in WMH volume was determined from fluid-attenuated inversion recovery magnetic resonance imaging using a semiautomated image segmentation algorithm. RESULTS Serum levels of FSH, LH, E1, or E2 did not associate with WMH volume at baseline. After 48 months of treatment, smaller increases in WMH associated with decreases in FSH from baseline in the tE2 group and increases in E1 in both tE2 and oCEE groups. Changes in LH did not associate with changes in WMH in any group. CONCLUSIONS Circulating levels of pituitary-ovarian hormones associate with changes in WMH volume in recently menopausal women using HT. Whether these relationships would be influenced by different doses of tE2 or oCEE remains to be determined. : Video Summary:http://links.lww.com/MENO/A590.
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Affiliation(s)
- Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, 13737 North 92nd Street, Scottsdale, AZ 85260
| | - Virginia M Miller
- Departments of Surgery and Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | | | - Timothy Lesnick
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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Graff-Radford J, Aakre JA, Knopman DS, Schwarz CG, Flemming KD, Rabinstein AA, Gunter JL, Ward CP, Zuk SM, Spychalla AJ, Preboske GM, Petersen RC, Kantarci K, Huston J, Jack CR, Mielke MM, Vemuri P. Prevalence and Heterogeneity of Cerebrovascular Disease Imaging Lesions. Mayo Clin Proc 2020; 95:1195-1205. [PMID: 32498775 PMCID: PMC7316133 DOI: 10.1016/j.mayocp.2020.01.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/24/2019] [Accepted: 01/08/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To report population age-specific prevalence of core cerebrovascular disease lesions (infarctions, cerebral microbleeds, and white-matter hyperintensities detected with magnetic resonance imaging); estimate cut points for white-matter hyperintensity positivity; investigate sex differences in prevalence; and estimate prevalence of any core cerebrovascular disease features. PATIENTS AND METHODS Participants in the population-based Mayo Clinic Study of Aging aged 50 to 89 years underwent fluid-attenuated inversion recovery and T2* gradient-recalled echo magnetic resonance imaging to assess cerebrovascular disease between October 10, 2011, and September 29, 2017. We characterized each participant as having infarct, normal versus abnormal white-matter hyperintensity, cerebral microbleed, or a combination of lesions. Prevalence of cerebrovascular disease biomarkers was derived through adjustment for nonparticipation and standardization to the population of Olmsted County, Minnesota. RESULTS Among 1462 participants without dementia (median [range] age, 68 [50 to 89] y; men, 52.7%), core cerebrovascular disease features increased with age. Prevalence (95% CI) of cerebral microbleeds was 13.6% (11.6%-15.6%); infarcts, 11.7% (9.7%-13.8%); and abnormal white-matter hyperintensity, 10.7% (8.7%-12.6%). Infarcts and cerebral microbleeds were more common among men. In contrast, abnormal white-matter hyperintensity was more common among women ages 60 to 79 y and men, ages 80 y and older. Prevalence of any core cerebrovascular disease feature determined by presence of at least one cerebrovascular disease feature increased from 9.5% (ages 50 to 59 y) to 73.8% (ages 80 to 89 y). CONCLUSION Whereas this study focused on participants without dementia, the high prevalence of cerebrovascular disease imaging lesions in elderly persons makes assignment of clinical relevance to cognition and other downstream manifestations more probabilistic than deterministic.
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Affiliation(s)
| | - Jeremiah A Aakre
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | | | | | | | | | | | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, MN
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Fu S, Carlson LA, Peterson KJ, Wang N, Zhou X, Peng S, Jiang J, Wang Y, Sauver JS, Liu H. Natural Language Processing for the Evaluation of Methodological Standards and Best Practices of EHR-based Clinical Research. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2020; 2020:171-180. [PMID: 32477636 PMCID: PMC7233049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The effective use of EHR data for clinical research is challenged by the lack of methodologic standards, transparency, and reproducibility. For example, our empirical analysis on clinical research ontologies and reporting standards found little-to-no informatics-related standards. To address these issues, our study aims to leverage natural language processing techniques to discover the reporting patterns and data abstraction methodologies for EHR-based clinical research. We conducted a case study using a collection of full articles of EHR-based population studies published using the Rochester Epidemiology Project infrastructure. Our investigation discovered an upward trend of reporting EHR-related research methodologies, good practice, and the use of informatics related methods. For example, among 1279 articles, 24.0% reported training for data abstraction, 6% reported the abstractors were blinded, 4.5% tested the inter-observer agreement, 5% reported the use of a screening/data collection protocol, 1.5% reported that team meetings were organized for consensus building, and 0.8% mentioned supervision activities by senior researchers. Despite that, the overall ratio of reporting/adoption of methodologic standards was still low. There was also a high variation regarding clinical research reporting. Thus, continuously developing process frameworks, ontologies, and reporting guidelines for promoting good data practice in EHR-based clinical research are recommended.
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Affiliation(s)
- Sunyang Fu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
- University of Minnesota - Twin Cities, Minneapolis, MN
| | - Luke A Carlson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Kevin J Peterson
- Department of Information Technology, Mayo Clinic, Rochester, MN
- University of Minnesota - Twin Cities, Minneapolis, MN
| | - Nan Wang
- University of Minnesota - Twin Cities, Minneapolis, MN
| | - Xin Zhou
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Suyuan Peng
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Jun Jiang
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Yanshan Wang
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Hongfang Liu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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Wei J, Palta P, Meyer ML, Kucharska-Newton A, Pence BW, Aiello AE, Power MC, Walker KA, Sharrett AR, Tanaka H, Jack CR, Mosley TH, Reid RI, Reyes DA, Heiss G. Aortic Stiffness and White Matter Microstructural Integrity Assessed by Diffusion Tensor Imaging: The ARIC-NCS. J Am Heart Assoc 2020; 9:e014868. [PMID: 32157957 PMCID: PMC7335527 DOI: 10.1161/jaha.119.014868] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Changes in white matter microstructural integrity are detectable before appearance of white matter lesions on magnetic resonance imaging as a manifestation of cerebral small‐vessel disease. The information relating poor white matter microstructural integrity to aortic stiffness, a hallmark of aging, is limited. We aimed to examine the association between aortic stiffness and white matter microstructural integrity among older adults. Methods and Results We conducted a cross‐sectional study to examine the association between aortic stiffness and white matter microstructural integrity among 1484 men and women (mean age, 76 years) at the 2011 to 2013 examination of the ARIC‐NCS (Atherosclerosis Risk in Communities Neurocognitive Study). Aortic stiffness was measured as carotid‐femoral pulse wave velocity. Cerebral white matter microstructural integrity was measured as fractional anisotropy and mean diffusivity using diffusion tensor imaging. Multivariable linear regression was used to examine the associations of carotid‐femoral pulse wave velocity with fractional anisotropy and mean diffusivity of the overall cerebrum and at regions of interest. Each 1‐m/s higher carotid‐femoral pulse wave velocity was associated with lower overall fractional anisotropy (β=−0.03; 95% CI, −0.05 to −0.02) and higher overall mean diffusivity (β=0.03; 95% CI, 0.02–0.04). High carotid‐femoral pulse wave velocity (upper 25th percentile) was associated with lower fractional anisotropy (β=−0.40; 95% CI, −0.61 to −0.20) and higher overall mean diffusivity (β=0.27; 95% CI, 0.10–0.43). Similar associations were observed at individual regions of interest. Conclusions High aortic stiffness is associated with low cerebral white matter microstructural integrity among older adults. Aortic stiffness may serve as a target for the prevention of poor cerebral white matter microstructural integrity.
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Affiliation(s)
- Jingkai Wei
- Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC
| | - Priya Palta
- School of Medicine Columbia University New York NY.,Department of Epidemiology Mailman School of Public Health Columbia University New York NY
| | - Michelle L Meyer
- Department of Emergency Medicine School of Medicine University of North Carolina at Chapel Hill Chapel Hill NC
| | - Anna Kucharska-Newton
- Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC.,Department of Epidemiology College of Public Health University of Kentucky Lexington KY
| | - Brian W Pence
- Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC
| | - Allison E Aiello
- Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC
| | - Melinda C Power
- Department of Epidemiology and Biostatistics Milken Institute School of Public Health Washington DC
| | - Keenan A Walker
- Department of Neurology Johns Hopkins University Baltimore MD
| | - A Richey Sharrett
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education University of Texas at Austin TX
| | | | | | - Robert I Reid
- Department of Information Technology Mayo Clinic Rochester MN
| | | | - Gerardo Heiss
- Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC
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Miller VM, Jayachandran M, Barnes JN, Mielke MM, Kantarci K, Rocca WA. Risk factors of neurovascular ageing in women. J Neuroendocrinol 2020; 32:e12777. [PMID: 31397036 PMCID: PMC6982564 DOI: 10.1111/jne.12777] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/24/2019] [Accepted: 08/06/2019] [Indexed: 12/14/2022]
Abstract
Biological sex and changes in sex hormones throughout life influence all aspects of health and disease. In women, changes in sex hormonal status reflect ovarian function, pregnancy and the use of exogenous hormonal treatments. Longitudinal data from defined cohorts of women will help to identify mechanisms by which the hormonal milieu contributes to cerebrovascular ageing, brain structure and ultimately cognition. This review summarises the phenotypes of three cohorts of women identified through the medical records-linkage system of the Rochester Epidemiology Project and the Mayo Clinic Specialized Center of Research Excellence (SCORE) on Sex Differences: (i) menopausal women with histories of normotensive or hypertensive pregnancies; (ii) women who had bilateral oophorectomy ≤45 years of age; and (iii) women who experienced natural menopause and used menopausal hormone treatments for 4 years. Data from these cohorts will influence the design of follow-up studies concerning how sex hormonal status affects neurovascular ageing in women.
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Affiliation(s)
- Virginia M. Miller
- Departments of Surgery and Physiology and Biomedical EngineeringMayo ClinicRochesterMNUSA
| | - Muthuvel Jayachandran
- Department of Physiology and Biomedical EngineeringMayo ClinicRochesterMNUSA
- Division of Nephrology and Hematology ResearchDepartment of Internal MedicineMayo ClinicRochesterMNUSA
| | - Jill N. Barnes
- Department of KinesiologyUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Michelle M. Mielke
- Division of EpidemiologyDepartment of Health Sciences Research and Department of NeurologyMayo ClinicRochesterMNUSA
| | | | - Walter A. Rocca
- Division of EpidemiologyDepartment of Health Sciences Research and Department of NeurologyMayo ClinicRochesterMNUSA
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Graff-Radford J, Gunter JL, Jones DT, Przybelski SA, Schwarz CG, Huston J, Lowe V, Elder BD, Machulda MM, Gunter NB, Petersen RC, Kantarci K, Vemuri P, Mielke MM, Knopman DS, Graff-Radford NR, Jack CR. Cerebrospinal fluid dynamics disorders: Relationship to Alzheimer biomarkers and cognition. Neurology 2019; 93:e2237-e2246. [PMID: 31719134 PMCID: PMC6937493 DOI: 10.1212/wnl.0000000000008616] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/19/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To determine the frequency of high-convexity tight sulci (HCTS) in a population-based sample and whether the presence of HCTS and related features influenced participants' cognitive status and classification within the new Alzheimer-biomarker framework. METHODS We analyzed 684 participants ≥50 years of age who were enrolled in the prospective population-based Mayo Clinic Study of Aging and underwent structural MRI, amyloid PET imaging, and tau PET imaging. A fully automated machine-learning algorithm that had been developed previously in house was used to detect neuroimaging features of HCTS. On the basis of PET and MRI measures, participants were classified as having normal (A-) or abnormal (A+) amyloid, normal (T-) or abnormal (T+) tau, and normal (N-) or abnormal (N+) neurodegeneration. The neuropsychological battery assessed domain-specific and global cognitive scores. Gait speed also was assessed. Analyses were adjusted for age and sex. RESULTS Of 684 participants, 45 (6.6%) were classified with HCTS according to the automated algorithm. Patients with HCTS were older than patients without HCTS (mean [SD] 78.0 [8.3] vs 71.9 [10.8] years; p < 0.001). More were cognitively impaired after age and sex adjustment (27% vs 9%; p = 0.005). Amyloid PET status was similar with and without HCTS, but tau PET standard uptake value ratio (SUVR) was lower for those with HCTS after age and sex adjustment (p < 0.001). Despite a lower tau SUVR, patients with HCTS had lower Alzheimer disease (AD) signature cortical thickness. With the amyloid-tau-neurodegeneration framework, HCTS was overrepresented in the T-(N)+ group, regardless of amyloid status. CONCLUSION The HCTS pattern represents a definable subgroup of non-AD pathophysiology (i.e., T-[N]+) that is associated with cognitive impairment. HCTS may confound clinical and biomarker interpretation in AD clinical trials.
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Affiliation(s)
- Jonathan Graff-Radford
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL.
| | - Jeffrey L Gunter
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - David T Jones
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Scott A Przybelski
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Christopher G Schwarz
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - John Huston
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Val Lowe
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Benjamin D Elder
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Mary M Machulda
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Nathaniel B Gunter
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Ronald C Petersen
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Kejal Kantarci
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Prashanthi Vemuri
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Michelle M Mielke
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - David S Knopman
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Neill R Graff-Radford
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
| | - Clifford R Jack
- From the Departments of Neurology (J.G.-R., D.T.J., R.C.P., D.S.K.), Radiology (J.L.G., C.G.S., J.H., V.L., N.B.G., K.K., P.V., C.R.J.), Health Sciences Research (S.A.P., M.M. Mielke), Neurologic Surgery (B.D.E.), and Psychiatry and Psychology (M.M. Machulda), Mayo Clinic, Rochester, MN; and Department of Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL
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Sprung J, Kruthiventi SC, Warner DO, Knopman DS, Petersen RC, Mielke MM, Jack CR, Graff-Radford J, Martin DP, Hanson AC, Schroeder DR, Przybelski SA, Schulte PJ, Weingarten TN, Vemuri P. Exposure to surgery under general anaesthesia and brain magnetic resonance imaging changes in older adults. Br J Anaesth 2019; 123:808-817. [PMID: 31587833 PMCID: PMC6883493 DOI: 10.1016/j.bja.2019.08.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/08/2019] [Accepted: 08/26/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Preclinical studies suggest that exposure to general anaesthesia (GA) could cause neurodegeneration consistent with Alzheimer's disease (AD) pathology. Brain magnetic resonance imaging (MRI) is useful to study structural brain changes. We tested the hypothesis that exposure to surgery with GA (surgery/GA) is associated with greater cortical thinning and increased frequency of white matter lesions. METHODS This is a cross-sectional analysis of 70-91-yr-old participants enrolled in the Mayo Clinic Study of Aging who had baseline MRI. The thickness of selected cortical regions, the volume of white matter hyperintensities, and the frequency of cortical infarctions were compared in participants who were and were not exposed to surgery/GA within 20 yr before the first MRI obtained after enrolment. RESULTS Of 1410 participants with MRI scans, 932 were exposed to surgery/GA before scanning. In adjusted analyses, cortical thickness in regions vulnerable to AD was significantly less in those exposed to surgery/GA in the prior 20 yr (difference -0.023 mm, [95% confidence interval (CI) -0.041 to -0.005], P=0.014). Those with surgery in the prior 20 yr were more likely to have 'abnormal thickness' compared with those without surgery (odds ratio=1.45, [95% CI 1.10-1.90], P=0.009). Exposure was not associated with white matter hyperintensities or the presence of brain infarcts. CONCLUSIONS This study suggests that exposure of older adults to surgical anaesthesia is associated with thinning in cortical regions implicated in AD. The pathogenesis and mechanisms driving these neurodegenerative changes, and the potential clinical significance of these findings, require further study.
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Affiliation(s)
- Juraj Sprung
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
| | - S Chandralekha Kruthiventi
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Ronald C Petersen
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jonathan Graff-Radford
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - David P Martin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Andrew C Hanson
- Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Darrell R Schroeder
- Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Scott A Przybelski
- Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Phillip J Schulte
- Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Toby N Weingarten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Prashanthi Vemuri
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Zeydan B, Tosakulwong N, Schwarz CG, Senjem ML, Gunter JL, Reid RI, Gazzuola Rocca L, Lesnick TG, Smith CY, Bailey KR, Lowe VJ, Roberts RO, Jack CR, Petersen RC, Miller VM, Mielke MM, Rocca WA, Kantarci K. Association of Bilateral Salpingo-Oophorectomy Before Menopause Onset With Medial Temporal Lobe Neurodegeneration. JAMA Neurol 2019; 76:95-100. [PMID: 30326011 PMCID: PMC6439881 DOI: 10.1001/jamaneurol.2018.3057] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Question Do women who underwent bilateral salpingo-oophorectomy before menopause show greater medial temporal lobe structural changes, β-amyloid accumulation, and white matter lesion load on neuroimaging later in life compared with a control group? Findings In this case-control study, women with bilateral salpingo-oophorectomy before menopause had smaller amygdala volumes, thinner parahippocampal-entorhinal cortices, and lower entorhinal white matter fractional anisotropy values compared with control participants. Meaning Abrupt hormonal changes associated with bilateral salpingo-oophorectomy in premenopausal women may lead to medial temporal lobe structural abnormalities later in life; because alterations in structural imaging biomarkers of the medial temporal lobe neurodegeneration may precede clinical symptoms of dementia, longitudinal follow-up of this cohort with cognitive testing is necessary. Importance There is an increased risk of cognitive impairment or dementia in women who undergo bilateral salpingo-oophorectomy (BSO) before menopause. However, data are lacking on the association of BSO before menopause with imaging biomarkers that indicate medial temporal lobe neurodegeneration and Alzheimer disease pathophysiology. Objective To investigate medial temporal lobe structure, white matter lesion load, and β-amyloid deposition in women who underwent BSO before age 50 years and before reaching natural menopause. Design, Setting, and Participants This nested case-control study of women in the population-based Mayo Clinic Cohort Study of Oophorectomy and Aging-2 (MOA-2) and in the Mayo Clinic Study of Aging (MCSA) in Olmsted County, Minnesota, included women who underwent BSO from 1988 through 2007 and a control group from the intersection of the 2 cohorts. Women who underwent BSO and control participants who underwent a neuropsychological evaluation, magnetic resonance imaging (MRI), and Pittsburgh compound B positron emission tomography (PiB-PET) were included in the analysis. Data analysis was performed from November 2017 to August 2018. Exposure Bilateral salpingo-oophorectomy in premenopausal women who were younger than 50 years. Main Outcomes and Measures Cortical β-amyloid deposition on PiB-PET scan was calculated using the standard uptake value ratio. White matter hyperintensity volume and biomarkers for medial temporal lobe neurodegeneration (eg, amygdala volume, hippocampal volume, and parahippocampal-entorhinal cortical thickness) on structural MRI and entorhinal white matter fractional anisotropy on diffusion tensor MRI were also measured. Results Forty-one women who underwent BSO and 49 control participants were recruited. One woman was excluded from the BSO group after diagnosis of an ovarian malignant condition, and 6 women were excluded from the control group after undergoing BSO after enrollment. Twenty control participants and 23 women who had undergone BSO completed all examinations. The median (interquartile range [IQR]) age at imaging was 65 (62-68) years in the BSO group and 63 (60-66) years in the control group. Amygdala volume was smaller in the BSO group (median [IQR], 1.74 [1.59-1.91] cm3) than the control group (2.15 [2.05-2.37] cm3; P < .001). The parahippocampal-entorhinal cortex was thinner in the BSO group (median [IQR], 3.91 [3.64-4.00] mm) than the control group (3.97 [3.89-4.28] mm; P = .046). Entorhinal white matter fractional anisotropy was lower in the BSO group (median [IQR], 0.19 [0.18-0.22]) than the control group (0.22 [0.20-0.23]; P = .03). Women were treated with estrogen in both groups (BSO, n = 22 of 23 [96%]; control, n = 10 of 19 [53%]). Global cognitive status test results did not differ between the groups. Conclusions and Relevance Abrupt hormonal changes associated with BSO in premenopausal women may lead to medial temporal lobe structural abnormalities later in life. Longitudinal evaluation is needed to determine whether cognitive decline follows.
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Affiliation(s)
- Burcu Zeydan
- Department of Radiology, Mayo Clinic, Rochester, Minnesota.,Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Nirubol Tosakulwong
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, Minnesota.,Department of Information Technology, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey L Gunter
- Department of Radiology, Mayo Clinic, Rochester, Minnesota.,Department of Information Technology, Mayo Clinic, Rochester, Minnesota
| | - Robert I Reid
- Department of Information Technology, Mayo Clinic, Rochester, Minnesota
| | - Liliana Gazzuola Rocca
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Timothy G Lesnick
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Carin Y Smith
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Kent R Bailey
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Rosebud O Roberts
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | | | - Virginia M Miller
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota.,Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Walter A Rocca
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Crook JE, Gunter JL, Ball CT, Jones DT, Graff-Radford J, Knopman DS, Boeve BF, Petersen RC, Jack CR, Graff-Radford NR. Linear vs volume measures of ventricle size: Relation to present and future gait and cognition. Neurology 2019; 94:e549-e556. [PMID: 31748251 DOI: 10.1212/wnl.0000000000008673] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 07/31/2019] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To compare the clinical utility of volume-based ratios with the standard linear ratio of Evans index (EI) by examining their associations with gait, cognition, and other patient and imaging variables. METHODS From MRI scans of 1,774 participants in the Mayo Clinic Study of Aging, we calculated 3 ventricle size measures: Evan index (frontal horn width divided by widest width of skull inner table), total ventricular volume, and frontal horn volume as ratios of total intracranial volume. Gait was measured by a timed 25-foot walk and cognition by a composite of psychometric tests. We also evaluated variables associated with the measures of ventricular size. Further, we evaluated gait and cognition associations with MRI of extraventricular findings seen in normal-pressure hydrocephalus: disproportionate enlargement of subarachnoid space (DESH) and focal sulcal dilations (FSD). RESULTS Ventricular volume measures had stronger association with gait and cognition measures than EI. In decreasing order of strength of association with ventricle size were DESH, FSD, white matter hyperintensity volume ratio, age, male sex, cortical thickness, and education. Modest evidence was observed that FSD was associated with future decline in gait and cognition. CONCLUSION Ventricular volume measures are clinically more useful than EI in indicating current and future gait and cognition. Multiple factors are associated with ventricle volume size, including FSD and DESH, suggesting that changes in CSF dynamics may go beyond simple ventriculomegaly.
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Affiliation(s)
- Julia E Crook
- From the Departments of Health Sciences Research (J.E.C., C.T.B.) and Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL; and Departments of Radiology (J.L.G., C.R.J.) and Neurology (D.T.J., J.G.-R., D.S.K., B.F.B., R.C.P.), Mayo Clinic, Rochester, MN
| | - Jeffrey L Gunter
- From the Departments of Health Sciences Research (J.E.C., C.T.B.) and Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL; and Departments of Radiology (J.L.G., C.R.J.) and Neurology (D.T.J., J.G.-R., D.S.K., B.F.B., R.C.P.), Mayo Clinic, Rochester, MN
| | - Colleen T Ball
- From the Departments of Health Sciences Research (J.E.C., C.T.B.) and Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL; and Departments of Radiology (J.L.G., C.R.J.) and Neurology (D.T.J., J.G.-R., D.S.K., B.F.B., R.C.P.), Mayo Clinic, Rochester, MN
| | - David T Jones
- From the Departments of Health Sciences Research (J.E.C., C.T.B.) and Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL; and Departments of Radiology (J.L.G., C.R.J.) and Neurology (D.T.J., J.G.-R., D.S.K., B.F.B., R.C.P.), Mayo Clinic, Rochester, MN
| | - Jonathan Graff-Radford
- From the Departments of Health Sciences Research (J.E.C., C.T.B.) and Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL; and Departments of Radiology (J.L.G., C.R.J.) and Neurology (D.T.J., J.G.-R., D.S.K., B.F.B., R.C.P.), Mayo Clinic, Rochester, MN
| | - David S Knopman
- From the Departments of Health Sciences Research (J.E.C., C.T.B.) and Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL; and Departments of Radiology (J.L.G., C.R.J.) and Neurology (D.T.J., J.G.-R., D.S.K., B.F.B., R.C.P.), Mayo Clinic, Rochester, MN
| | - Bradley F Boeve
- From the Departments of Health Sciences Research (J.E.C., C.T.B.) and Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL; and Departments of Radiology (J.L.G., C.R.J.) and Neurology (D.T.J., J.G.-R., D.S.K., B.F.B., R.C.P.), Mayo Clinic, Rochester, MN
| | - Ronald C Petersen
- From the Departments of Health Sciences Research (J.E.C., C.T.B.) and Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL; and Departments of Radiology (J.L.G., C.R.J.) and Neurology (D.T.J., J.G.-R., D.S.K., B.F.B., R.C.P.), Mayo Clinic, Rochester, MN
| | - Clifford R Jack
- From the Departments of Health Sciences Research (J.E.C., C.T.B.) and Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL; and Departments of Radiology (J.L.G., C.R.J.) and Neurology (D.T.J., J.G.-R., D.S.K., B.F.B., R.C.P.), Mayo Clinic, Rochester, MN
| | - Neill R Graff-Radford
- From the Departments of Health Sciences Research (J.E.C., C.T.B.) and Neurology (N.R.G.-R.), Mayo Clinic, Jacksonville, FL; and Departments of Radiology (J.L.G., C.R.J.) and Neurology (D.T.J., J.G.-R., D.S.K., B.F.B., R.C.P.), Mayo Clinic, Rochester, MN.
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Johansen MC, Shah AM, Lirette ST, Griswold M, Mosley TH, Solomon SD, Gottesman RF. Associations of Echocardiography Markers and Vascular Brain Lesions: The ARIC Study. J Am Heart Assoc 2019; 7:e008992. [PMID: 30526268 PMCID: PMC6405621 DOI: 10.1161/jaha.118.008992] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Associations between subtle changes in cardiac and cerebral structure and function are not well understood, with some studies suggesting that subclinical cardiac changes may be associated with markers of vascular brain insult. Methods and Results Data from the ARIC (Atherosclerosis Risk in Communities) Study (5th ARIC visit; 2011‐2013; N=1974) were used to explore relationships between abnormalities of cardiac structure/function and subclinical brain disease and to test specific associations between those cardiac and vascular brain changes that share a common mechanism. In adjusted models white matter hyperintensities were 0.66 cm3 greater (95% confidence interval [CI] 0.08‐1.25) for every 1‐mm increase in left ventricular LV wall thickness and 0.64 cm3 greater (95% CI 0.19‐1.08) for every 10 g/m2 increase in LV mass index, both markers of LV structure. Odds of brain infarction also increased with greater LV wall thickness (odds ratio 1.11, 95% CI 1.01‐1.23 per 1 mm) and larger LV mass (odds ratio 1.08, 95% CI 1.00‐1.17 per 10 g/m2). Higher ejection fraction (per 5%), a marker of systolic function, was significantly associated with decreased odds of overall infarct (odds ratio 0.85, 95% CI0.77‐0.95), but not with cortical infarction (odds ratio 0.92, 95% CI0.78‐1.08). Conclusions Among elderly participants in a large cohort study, subclinical markers of LV structure and LV systolic dysfunction were associated with increased odds of brain infarction and more white matter hyperintensities, independent of other vascular risk factors. This suggests end‐organ dysfunction occurs in the heart and brain in parallel, with further studies needed to determine causality.
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Mielke MM, Syrjanen JA, Bui HH, Petersen RC, Knopman DS, Jack CR, Graff-Radford J, Vemuri P. Elevated Plasma Ceramides Are Associated With Higher White Matter Hyperintensity Volume-Brief Report. Arterioscler Thromb Vasc Biol 2019; 39:2431-2436. [PMID: 31510790 PMCID: PMC6812619 DOI: 10.1161/atvbaha.119.313099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/03/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Sphingolipids, including S1P (sphingosine-1-phosphate) and ceramides, have been associated with vascular tone, blood pressure regulation, cardiovascular outcomes, and mortality. However, the relationship between plasma sphingolipids and cerebrovascular disease has not been examined. We aimed to assess the cross-sectional association between plasma sphingolipids and white matter hyperintensity (WMH) volume, which is a marker of cerebrovascular disease. Approach and Results: We included 588 participants (302 men and 286 women), aged 60 to 93, enrolled in the population-based Mayo Clinic Study of Aging who had MRI and plasma sphingolipids at the same study visit. Fasting plasma was obtained, and ceramides and S1P were assayed using liquid chromatography-electrospray ionization tandem mass spectrometry. Fluid-attenuated inversion recovery was used to measure WMH volume, defined as percent total intracranial volume. We used linear regression to cross-sectionally examine the relationships between plasma sphingolipids and WMH; both were log-transformed. In multivariable analyses adjusting for age, sex, and hypertension, higher levels of ceramide C16:0 (b [95% CI]=0.24 [0.02-0.45]) and the ceramide ratios C16:0_24:0 (b [95% CI]=0.30 [0.12-0.48]) and C24:1_24:0 (b [95% CI]=0.24 [0.07-0.41]) were associated with a higher WMH volume. A higher ceramide score was also associated with higher WMH volume (b [95% CI]=0.03 (0.01-0.04]). We did not observe any association between S1P and WMH volume. CONCLUSIONS Higher plasma ceramide C16:0 and 2 specific ceramide ratios (C16:0_24:0 and C24:1_24:0) are associated with greater WMH volumes, independent of hypertension, suggesting their utility for measurement of cerebrovascular disease.
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Affiliation(s)
- Michelle M Mielke
- From the Departments of Health Sciences Research (M.M.M., J.A.S., R.C.P.), Mayo Clinic Rochester, MN
- Neurology (M.M.M., R.C.P., D.S.K., J.G.-R.), Mayo Clinic Rochester, MN
| | - Jeremy A Syrjanen
- From the Departments of Health Sciences Research (M.M.M., J.A.S., R.C.P.), Mayo Clinic Rochester, MN
| | - Hai H Bui
- Eli Lilly and Company, Indianapolis, IN (H.H.B.)
| | - Ronald C Petersen
- From the Departments of Health Sciences Research (M.M.M., J.A.S., R.C.P.), Mayo Clinic Rochester, MN
- Neurology (M.M.M., R.C.P., D.S.K., J.G.-R.), Mayo Clinic Rochester, MN
| | - David S Knopman
- Neurology (M.M.M., R.C.P., D.S.K., J.G.-R.), Mayo Clinic Rochester, MN
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Power MC, Su D, Wu A, Reid RI, Jack CR, Knopman DS, Coresh J, Huang J, Kantarci K, Sharrett AR, Gottesman RG, Griswold ME, Mosley TH. Association of white matter microstructural integrity with cognition and dementia. Neurobiol Aging 2019; 83:63-72. [PMID: 31585368 PMCID: PMC6914220 DOI: 10.1016/j.neurobiolaging.2019.08.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/07/2019] [Accepted: 08/21/2019] [Indexed: 10/26/2022]
Abstract
Late-life measures of white matter (WM) microstructural integrity may predict cognitive status, cognitive decline, and incident mild cognitive impairment (MCI) or dementia. We considered participants of the Atherosclerosis Risk in Communities study who underwent cognitive assessment and neuroimaging in 2011-2013 and were followed through 2016-2017 (n = 1775 for analyses of prevalent MCI and dementia, baseline cognitive performance, and longitudinal cognitive change and n = 889 for analyses of incident MCI, dementia, or death). Cross-sectionally, both overall WM fractional anisotropy and overall WM mean diffusivity were strongly associated with baseline cognitive performance and risk of prevalent MCI or dementia. Longitudinally, greater overall WM mean diffusivity was associated with accelerated cognitive decline, as well as incident MCI, incident dementia, and mortality, but WM fractional anisotropy was not robustly associated with cognitive change or incident cognitive impairment. Both cross-sectional and longitudinal associations were attenuated after additionally adjusting for likely downstream pathologic changes. Increased WM mean diffusivity may provide an early indication of dementia pathogenesis.
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Affiliation(s)
- Melinda C Power
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
| | - Dan Su
- Department of Data Science, JD Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Aozhou Wu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert I Reid
- Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Joe Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Juebin Huang
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca G Gottesman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Mike E Griswold
- Department of Data Science, JD Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Thomas H Mosley
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS, USA; Department of Geriatrics, University of Mississippi Medical Center, Jackson, MS, USA
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Miller VM, Naftolin F, Asthana S, Black DM, Brinton EA, Budoff MJ, Cedars MI, Dowling NM, Gleason CE, Hodis HN, Jayachandran M, Kantarci K, Lobo RA, Manson JE, Pal L, Santoro NF, Taylor HS, Harman SM. The Kronos Early Estrogen Prevention Study (KEEPS): what have we learned? Menopause 2019; 26:1071-1084. [PMID: 31453973 PMCID: PMC6738629 DOI: 10.1097/gme.0000000000001326] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The Kronos Early Estrogen Prevention Study (KEEPS) was designed to address gaps in understanding the effects of timely menopausal hormone treatments (HT) on cardiovascular health and other effects of menopause after the premature termination of the Women's Health Initiative. METHOD The KEEPS was a randomized, double-blinded, placebo-controlled trial to test the hypothesis that initiation of HT (oral conjugated equine estrogens [o-CEE] or transdermal 17β-estradiol [t-E2]) in healthy, recently postmenopausal women (n = 727) would slow the progression of atherosclerosis as measured by changes in carotid artery intima-media thickness (CIMT). RESULTS After 4 years, neither HT affected the rate of increase in CIMT. There was a trend for reduced accumulation of coronary artery calcium with o-CEE. There were no severe adverse effects, including venous thrombosis. Several ancillary studies demonstrated a positive effect on mood with o-CEE, and reduced hot flashes, improved sleep, and maintenance of bone mineral density with both treatments. Sexual function improved with t-E2. There were no significant effects of either treatment on cognition, breast pain, or skin wrinkling. Variants of genes associated with estrogen metabolism influenced the age of menopause and variability in effects of the HT on CIMT. Platelet activation associated with the development of white matter hyperintensities in the brain. CONCLUSIONS KEEPS and its ancillary studies have supported the value and safety of the use of HT in recently postmenopausal women and provide a perspective for future research to optimize HT and health of postmenopausal women. The KEEPS continuation study continues to pursue these issues.
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Affiliation(s)
- Virginia M. Miller
- Departments of Surgery and Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Fredrick Naftolin
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY
| | - Sanjay Asthana
- Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, University of Wisconsin School of Medicine and Public Health and the Geriatric Research, Madison, WI
| | - Dennis M. Black
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA
| | | | - Matthew J. Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles, Torrance, CA
| | - Marcelle I. Cedars
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
| | - N. Maritza Dowling
- Departments of Acute and Chronic Care, Epidemiology and Biostatistics, George Washington University School of Nursing and Milken Institute School of Public Health, Washington, DC
| | - Carey E. Gleason
- Division of Geriatrics, Department of Medicine, University of Wisconsin School of Medicine and Public Health and the William S. Middleton Memorial VA, Geriatric Research, Education and Clinical Center, Madison, WI
| | - Howard N. Hodis
- Atherosclerosis Research Unit, University of Southern California, Los Angeles, CA
| | - Muthuvel Jayachandran
- Department of Physiology and Biomedical Engineering, Division of Nephrology and Hypertension, Division of Hematology Research, Mayo Clinic, Rochester, MN
| | | | - Rogerio A. Lobo
- Department of Obstetrics and Gynecology, Columbia University, New York, NY
| | - JoAnn E. Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Lubna Pal
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Nanette F. Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO
| | - Hugh S. Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
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Sintini I, Martin PR, Graff-Radford J, Senjem ML, Schwarz CG, Machulda MM, Spychalla AJ, Drubach DA, Knopman DS, Petersen RC, Lowe VJ, Jack CR, Josephs KA, Whitwell JL. Longitudinal tau-PET uptake and atrophy in atypical Alzheimer's disease. Neuroimage Clin 2019; 23:101823. [PMID: 31004914 PMCID: PMC6475765 DOI: 10.1016/j.nicl.2019.101823] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/28/2019] [Accepted: 04/09/2019] [Indexed: 01/16/2023]
Abstract
The aims of this study were: to examine regional rates of change in tau-PET uptake and grey matter volume in atypical Alzheimer's disease (AD); to investigate the role of age in such changes; to describe multimodal regional relationships between tau accumulation and atrophy. Thirty atypical AD patients underwent baseline and one-year follow-up MRI, [18F]AV-1451 PET and PiB PET. Region- and voxel-level rates of tau accumulation and grey matter atrophy relative to cognitively unimpaired individuals, and the influence of age on such rates, were assessed. Univariate and multivariate analyses were performed between baseline measurements and rates of change, between baseline tau and atrophy, and between the two rates of change. Regional patterns of change in tau and volume differed, with highest rates of tau accumulation in frontal lobe and highest rates of atrophy in temporoparietal regions. Age had a negative effect on disease progression, predominantly on tau, with younger patients having a more rapid accumulation. Baseline tau uptake and regions of tau accumulation were disconnected, with high baseline tau uptake across the cortex correlated with high rates of tau accumulation in frontal and sensorimotor regions. In contrast, baseline volume and atrophy were locally related in the occipitoparietal regions. Higher tau uptake at baseline was locally related to higher rates of atrophy in frontal and occipital lobes. Tau accumulation rates positively correlated with rates of atrophy. In summary, our study showed that tau accumulation and atrophy presented different regional patterns in atypical AD, with tau spreading into the frontal lobes while atrophy remains in temporoparietal and occipital cortex, suggesting a temporal disconnect between protein deposition and neurodegeneration.
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Affiliation(s)
- Irene Sintini
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
| | - Peter R Martin
- Department of Health Science Research (Biostatistics), Mayo Clinic, Rochester, MN, USA
| | | | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | | | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Li D, Misialek JR, Jack CR, Mielke MM, Knopman D, Gottesman R, Mosley T, Alonso A. Plasma Metabolites Associated with Brain MRI Measures of Neurodegeneration in Older Adults in the Atherosclerosis Risk in Communities⁻Neurocognitive Study (ARIC-NCS). Int J Mol Sci 2019; 20:ijms20071744. [PMID: 30970556 PMCID: PMC6479561 DOI: 10.3390/ijms20071744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 03/28/2019] [Accepted: 04/01/2019] [Indexed: 12/30/2022] Open
Abstract
Background: Plasma metabolites are associated with cognitive and physical function in the elderly. Because cerebral small vessel disease (SVD) and neurodegeneration are common causes of cognitive and physical function decline, the primary objective of this study was to investigate the associations of six plasma metabolites (two plasma phosphatidylcholines [PCs]: PC aa C36:5 and PC aa 36:6 and four sphingomyelins [SMs]: SM C26:0, SM [OH] C22:1, SM [OH] C22:2, SM [OH] C24:1) with magnetic resonance imaging (MRI) features of cerebral SVD and neurodegeneration in older adults. Methods: This study included 238 older adults in the Atherosclerosis Risk in Communities study at the fifth exam. Multiple linear regression was used to assess the association of each metabolite (log-transformed) in separate models with MRI measures except lacunar infarcts, for which binary logistic regression was used. Results: Higher concentrations of plasma PC aa C36:5 had adverse associations with MRI features of cerebral SVD (odds ratio of 1.69 [95% confidence interval: 1.01, 2.83] with lacunar infarct, and beta of 0.16 log [cm3] [0.02, 0.30] with log [White Matter Hyperintensities (WMH) volume]) while higher concentrations of 3 plasma SM (OH)s were associated with higher total brain volume (beta of 12.0 cm3 [5.5, 18.6], 11.8 cm3 [5.0, 18.6], and 7.3 cm3 [1.2, 13.5] for SM [OH] C22:1, SM [OH] C22:2, and SM [OH] C24:1, respectively). Conclusions: This study identified associations between certain plasma metabolites and brain MRI measures of SVD and neurodegeneration in older adults, particularly higher SM (OH) concentrations with higher total brain volume.
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Affiliation(s)
- Danni Li
- Department of Lab Medicine and Pathology, University of Minnesota, 420 Delaware Street SE, MMC 609, Minneapolis, MN 55455, USA.
| | - Jeffrey R Misialek
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
| | - Michelle M Mielke
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN 55906, USA.
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
| | - David Knopman
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
| | - Tom Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA.
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Zeydan B, Schwarz CG, Lowe VJ, Reid RI, Przybelski SA, Lesnick TG, Kremers WK, Senjem ML, Gunter JL, Min H, Vemuri P, Knopman DS, Petersen RC, Jack CR, Kantarci OH, Kantarci K. Investigation of white matter PiB uptake as a marker of white matter integrity. Ann Clin Transl Neurol 2019; 6:678-688. [PMID: 31019992 PMCID: PMC6469255 DOI: 10.1002/acn3.741] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/14/2019] [Accepted: 02/03/2019] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To investigate the associations of Pittsburgh compound-B (PiB) uptake in white matter hyperintensities (WMH) and normal appearing white matter (NAWM) with white matter (WM) integrity measured with DTI and cognitive function in cognitively unimpaired older adults. METHODS Cognitively unimpaired older adults from the population-based Mayo Clinic Study of Aging (n = 537, age 65-95) who underwent both PiB PET and DTI were included. The associations of WM PiB standard uptake value ratio (SUVr) with fractional anisotropy (FA) and mean diffusivity (MD) in the WMH and NAWM were tested after adjusting for age. The associations of PiB SUVr with cognitive function z-scores were tested after adjusting for age and global cortical PiB SUVr. RESULTS The WMH PiB SUVr was lower than NAWM PiB SUVr (P < 0.001). In the WMH, lower PiB SUVr correlated with lower FA (r = 0.21, P < 0.001), and higher MD (r = -0.31, P < 0.001). In the NAWM, lower PiB SUVr only correlated with higher MD (r = -0.10, P = 0.02). Both in the WMH and NAWM, lower PiB SUVr was associated with lower memory, language, and global cognitive function z-scores after adjusting for age and global cortical PiB SUVr. INTERPRETATION Reduced PiB uptake in the WMH is associated with a loss of WM integrity and cognitive function after accounting for the global cortical PiB uptake, suggesting that WM PiB uptake may be an early biomarker of WM integrity that precedes cognitive impairment in older adults. When using WM as a reference region in cross-sectional analysis of PiB SUVr, individual variability in WMH volume as well as age should be considered.
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Affiliation(s)
- Burcu Zeydan
- Department of RadiologyMayo ClinicRochesterMinnesota
- Department of NeurologyMayo ClinicRochesterMinnesota
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesota
| | | | - Val J. Lowe
- Department of RadiologyMayo ClinicRochesterMinnesota
| | - Robert I. Reid
- Department of Information TechnologyMayo ClinicRochesterMinnesota
| | | | | | | | - Matthew L. Senjem
- Department of RadiologyMayo ClinicRochesterMinnesota
- Department of Information TechnologyMayo ClinicRochesterMinnesota
| | - Jeffrey L. Gunter
- Department of RadiologyMayo ClinicRochesterMinnesota
- Department of Information TechnologyMayo ClinicRochesterMinnesota
| | - Hoon‐Ki Min
- Department of RadiologyMayo ClinicRochesterMinnesota
| | | | | | | | | | - Orhun H. Kantarci
- Department of NeurologyMayo ClinicRochesterMinnesota
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesota
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Shao IY, Power MC, Mosley T, Jack C, Gottesman RF, Chen LY, Norby FL, Soliman EZ, Alonso A. Association of Atrial Fibrillation With White Matter Disease. Stroke 2019; 50:989-991. [PMID: 30879437 PMCID: PMC6433530 DOI: 10.1161/strokeaha.118.023386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/30/2019] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Evidence suggests that atrial fibrillation (AF) is associated with increased risk of cognitive decline and dementia, even in the absence of stroke. White matter disease (WMD) is a potential mechanism linking AF to cognitive impairment. In this study, we explored the association between prevalent AF and WMD. Methods- We performed a cross-sectional analysis of participants attending the ARIC-NCS (Atherosclerosis Risk in Communities-Neurocognitive Study) in 2011 to 2013 who underwent brain magnetic resonance imaging. AF was ascertained from study visit electrocardiograms or prior hospitalization codes. Extent of WMD was defined by measures of white matter (WM) microstructural integrity and WM hyperintensity volume. Multivariable linear regression models were used to assess the association between AF and WMD. Results- Among 1899 participants (mean age, 76 years; 28% black; 60% women), 133 (7%) had prevalent AF. After multivariable adjustment, differences between participants with and without AF were -0.001 (95% CI, -0.006 to 0.004) for global WM fractional anisotropy, 0.031×10-4 mm2/s (95% CI, -0.075 to 0.137) for global WM mean diffusivity, and 0.08 mm3 (95% CI, -0.14 to 0.30) for WM hyperintensity volume. Conclusions- The results suggest that there is no association between prevalent AF and WMD.
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Affiliation(s)
- Iris Yuefan Shao
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Melinda C. Power
- Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington, DC
| | - Thomas Mosley
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS
| | | | | | - Lin Y. Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Faye L. Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Elsayed Z. Soliman
- Department of Epidemiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Frey BM, Petersen M, Mayer C, Schulz M, Cheng B, Thomalla G. Characterization of White Matter Hyperintensities in Large-Scale MRI-Studies. Front Neurol 2019; 10:238. [PMID: 30972001 PMCID: PMC6443932 DOI: 10.3389/fneur.2019.00238] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/22/2019] [Indexed: 01/18/2023] Open
Abstract
Background: White matter hyperintensities of presumed vascular origin (WMH) are a common finding in elderly people and a growing social malady in the aging western societies. As a manifestation of cerebral small vessel disease, WMH are considered to be a vascular contributor to various sequelae such as cognitive decline, dementia, depression, stroke as well as gait and balance problems. While pathophysiology and therapeutical options remain unclear, large-scale studies have improved the understanding of WMH, particularly by quantitative assessment of WMH. In this review, we aimed to provide an overview of the characteristics, research subjects and segmentation techniques of these studies. Methods: We performed a systematic review according to the PRISMA statement. One thousand one hundred and ninety-six potentially relevant articles were identified via PubMed search. Six further articles classified as relevant were added manually. After applying a catalog of exclusion criteria, remaining articles were read full-text and the following information was extracted into a standardized form: year of publication, sample size, mean age of subjects in the study, the cohort included, and segmentation details like the definition of WMH, the segmentation method, reference to methods papers as well as validation measurements. Results: Our search resulted in the inclusion and full-text review of 137 articles. One hundred and thirty-four of them belonged to 37 prospective cohort studies. Median sample size was 1,030 with no increase over the covered years. Eighty studies investigated in the association of WMH and risk factors. Most of them focussed on arterial hypertension, diabetes mellitus type II and Apo E genotype and inflammatory markers. Sixty-three studies analyzed the association of WMH and secondary conditions like cognitive decline, mood disorder and brain atrophy. Studies applied various methods based on manual (3), semi-automated (57), and automated segmentation techniques (75). Only 18% of the articles referred to an explicit definition of WMH. Discussion: The review yielded a large number of studies engaged in WMH research. A remarkable variety of segmentation techniques was applied, and only a minority referred to a clear definition of WMH. Most addressed topics were risk factors and secondary clinical conditions. In conclusion, WMH research is a vivid field with a need for further standardization regarding definitions and used methods.
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Affiliation(s)
- Benedikt M Frey
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carola Mayer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Schulz
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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50
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Whitwell JL, Martin P, Graff-Radford J, Machulda MM, Senjem ML, Schwarz CG, Weigand SD, Spychalla AJ, Drubach DA, Jack CR, Lowe VJ, Josephs KA. The role of age on tau PET uptake and gray matter atrophy in atypical Alzheimer's disease. Alzheimers Dement 2019; 15:675-685. [PMID: 30853465 DOI: 10.1016/j.jalz.2018.12.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/02/2018] [Accepted: 12/29/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Little is known about the role of age on neurodegeneration and protein deposition in atypical variants of Alzheimer's disease (AD). METHODS Regional tau and β-amyloid positron emission tomography standard uptake value ratios and gray matter volumes were calculated in a cohort of 42 participants with atypical AD. The relationship between regional metrics and age was modeled using a Bayesian hierarchical linear model. RESULTS Age was strongly associated with tau uptake across all cortical regions, particularly parietal, with greater uptake in younger participants. Younger age was associated with smaller parietal and lateral temporal volumes. Regional β-amyloid differed little by age. Age showed a stronger association with tau than volume and β-amyloid in all cortical regions. Age was not associated with cognitive performance. DISCUSSION Age is an important determinant of severity of cortical tau uptake in atypical AD, with young participants more likely to show widespread and severe cortical tau uptake.
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Affiliation(s)
| | - Peter Martin
- Department of Health Science Research, Mayo Clinic, Rochester MN, USA
| | | | - Mary M Machulda
- Department of Psychology and Psychiatry, Mayo Clinic, Rochester MN, USA
| | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester MN, USA; Department of Information Technology, Mayo Clinic, Rochester MN, USA
| | | | - Stephen D Weigand
- Department of Health Science Research, Mayo Clinic, Rochester MN, USA
| | | | | | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester MN, USA
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