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Guido G, Bonato A, Bonomi S, Franceschini S, Morris JC. Handedness in Alzheimer Disease: A Systematic Review. Alzheimer Dis Assoc Disord 2024; 38:298-304. [PMID: 39177174 DOI: 10.1097/wad.0000000000000640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/09/2024] [Indexed: 08/24/2024]
Abstract
Handedness has been a topic of scientific interest for many years. However, false and misleading ideas have dominated this field with a still limited amount of research into the association with clinical disorders like Alzheimer disease (AD). In accordance with PRISMA guidelines, PubMed, Embase, and Cochrane Library were searched for studies regarding the association of handedness and AD. Twelve articles were included. Case-control studies show that left-handedness is not a risk factor for late-onset AD (LOAD). However, nonright handedness was found to be more prevalent in patients with early-onset AD (EOAD). Moreover, handedness does not seem to affect neuropsychological performance. We also show that collapsing versus separating mixed and left-handedness may yield different results. Future research on the relation between handedness and AD may provide new insight into disease pathogenesis, improve rehabilitation, and help identify patients who will progress, aiding the design of prevention trials.
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Affiliation(s)
- Giorgio Guido
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania
| | - Alberto Bonato
- Department of Medicine, University of Padua, Padova, Italy
| | - Samuele Bonomi
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Simone Franceschini
- Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy
| | - John C Morris
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
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Nerattini M, Jett S, Andy C, Carlton C, Zarate C, Boneu C, Battista M, Pahlajani S, Loeb-Zeitlin S, Havryulik Y, Williams S, Christos P, Fink M, Brinton RD, Mosconi L. Systematic review and meta-analysis of the effects of menopause hormone therapy on risk of Alzheimer's disease and dementia. Front Aging Neurosci 2023; 15:1260427. [PMID: 37937120 PMCID: PMC10625913 DOI: 10.3389/fnagi.2023.1260427] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/25/2023] [Indexed: 11/09/2023] Open
Abstract
Introduction Despite a large preclinical literature demonstrating neuroprotective effects of estrogen, use of menopausal hormone therapy (HT) for Alzheimer's disease (AD) risk reduction has been controversial. Herein, we conducted a systematic review and meta-analysis of HT effects on AD and dementia risk. Methods Our systematic search yielded 6 RCT reports (21,065 treated and 20,997 placebo participants) and 45 observational reports (768,866 patient cases and 5.5 million controls). We used fixed and random effect meta-analysis to derive pooled relative risk (RR) and 95% confidence intervals (C.I.) from these studies. Results Randomized controlled trials conducted in postmenopausal women ages 65 and older show an increased risk of dementia with HT use compared with placebo [RR = 1.38, 95% C.I. 1.16-1.64, p < 0.001], driven by estrogen-plus-progestogen therapy (EPT) [RR = 1.64, 95% C.I. 1.20-2.25, p = 0.002] and no significant effects of estrogen-only therapy (ET) [RR = 1.19, 95% C.I. 0.92-1.54, p = 0.18]. Conversely, observational studies indicate a reduced risk of AD [RR = 0.78, 95% C.I. 0.64-0.95, p = 0.013] and all-cause dementia [RR = .81, 95% C.I. 0.70-0.94, p = 0.007] with HT use, with protective effects noted with ET [RR = 0.86, 95% C.I. 0.77-0.95, p = 0.002] but not with EPT [RR = 0.910, 95% C.I. 0.775-1.069, p = 0.251]. Stratified analysis of pooled estimates indicates a 32% reduced risk of dementia with midlife ET [RR = 0.685, 95% C.I. 0.513-0.915, p = 0.010] and non-significant reductions with midlife EPT [RR = 0.775, 95% C.I. 0.474-1.266, p = 0.309]. Late-life HT use was associated with increased risk, albeit not significant [EPT: RR = 1.323, 95% C.I. 0.979-1.789, p = 0.069; ET: RR = 1.066, 95% C.I. 0.996-1.140, p = 0.066]. Discussion These findings support renewed research interest in evaluating midlife estrogen therapy for AD risk reduction.
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Affiliation(s)
- Matilde Nerattini
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
- Department of Experimental and Clinical Biomedical Sciences, Nuclear Medicine Unit, University of Florence, Florence, Italy
| | - Steven Jett
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Caroline Andy
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Caroline Carlton
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Camila Zarate
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Camila Boneu
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Michael Battista
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Silky Pahlajani
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Susan Loeb-Zeitlin
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, United States
| | - Yelena Havryulik
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, United States
| | - Schantel Williams
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Paul Christos
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Matthew Fink
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Roberta Diaz Brinton
- Department of Neurology and Pharmacology, University of Arizona, Tucson, AZ, United States
| | - Lisa Mosconi
- Department of Neurology, Weill Cornell Medicine, New York, NY, United States
- Department of Experimental and Clinical Biomedical Sciences, Nuclear Medicine Unit, University of Florence, Florence, Italy
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
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Luo J, Beam CR, Gatz M. Is Stress an Overlooked Risk Factor for Dementia? A Systematic Review from a Lifespan Developmental Perspective. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:936-949. [PMID: 35622193 DOI: 10.1007/s11121-022-01385-1] [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] [Accepted: 05/16/2022] [Indexed: 11/26/2022]
Abstract
Stress exposure and stress reactivity may be potent factors associated with increased risk of dementia. The 2017 Lancet Commission on Dementia and its 2020 update reviewed modifiable risk factors associated with dementia, but stress was not addressed directly. The present study provides a focused review of the association between stress and dementia across the lifespan, with measures of stress including stress exposure, psychological stress, posttraumatic stress disorder (PTSD), and biological markers of stress. Published research articles were identified in the American Psychological Association PsycINFO database (1887-2021), Web of Science database, and Google Scholar. A total of 53 samples from 40 studies published from 1985 to 2020 met inclusion criteria. Results suggest that stressful life events that occur earlier in the lifespan, such as loss of a parent, psychological stress experienced in midlife, and extreme stress responses, i.e., PTSD, correlate with higher risk of dementia. Although results generally are mixed, a consistent theme is that stress experienced earlier in the lifespan and chronic stress portend the greatest risk of dementia. Reducing stress exposure and improving stress management when stress exposure cannot be changed are thus relevant strategies in dementia risk reduction.
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Affiliation(s)
- Jing Luo
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Chicago, IL, 60611, USA.
| | - Christopher R Beam
- Department of Psychology, University of Southern California, Los Angeles, CA, 90089-1061, USA
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, 90089-0191, USA
| | - Margaret Gatz
- Department of Psychology, University of Southern California, Los Angeles, CA, 90089-1061, USA
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, 90089-3332, USA
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4
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Wiegersma AM, Boots A, Langendam MW, Limpens J, Shenkin SD, Korosi A, Roseboom TJ, de Rooij SR. Do prenatal factors shape the risk for dementia?: A systematic review of the epidemiological evidence for the prenatal origins of dementia. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02471-7. [PMID: 37029828 DOI: 10.1007/s00127-023-02471-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 03/30/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE Prenatal factors such as maternal stress, infection and nutrition affect fetal brain development and may also influence later risk for dementia. The purpose of this systematic review was to provide an overview of all studies which investigated the association between prenatal factors and later risk for dementia. METHODS We systematically searched MEDLINE and Embase for original human studies reporting on associations between prenatal factors and dementia from inception to 23 November 2022. Prenatal factors could be any factor assessed during pregnancy, at birth or postnatally, provided they were indicative of a prenatal exposure. Risk of bias was assessed using the Newcastle Ottawa Scale. We followed PRISMA guidelines for reporting. RESULTS A total of 68 studies met eligibility criteria (including millions of individuals), assessing maternal age (N = 30), paternal age (N = 22), birth order (N = 15), season of birth (N = 16), place of birth (N = 13), prenatal influenza pandemic (N = 1) or Chinese famine exposure (N = 1), birth characteristics (N = 3) and prenatal hormone exposure (N = 4). We observed consistent results for birth in a generally less optimal environment (e.g. high infant mortality area) being associated with higher dementia risk. Lower and higher birth weight and prenatal famine exposure were associated with higher dementia risk. The studies on season of birth, digit ratio, prenatal influenza pandemic exposure, parental age and birth order showed inconsistent results and were hampered by relatively high risk of bias. CONCLUSION Our findings suggest that some prenatal factors, especially those related to a suboptimal prenatal environment, are associated with an increased dementia risk. As these associations may be confounded by factors such as parental socioeconomic status, more research is needed to examine the potential causal role of the prenatal environment in dementia.
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Affiliation(s)
- Aline Marileen Wiegersma
- Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Aging & Later Life, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
| | - Amber Boots
- Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging & Later Life, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Miranda W Langendam
- Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Methodology, Amsterdam, The Netherlands
| | - Jacqueline Limpens
- Medical Library, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Susan D Shenkin
- Geriatric Medicine, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Aniko Korosi
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Tessa J Roseboom
- Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging & Later Life, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Susanne R de Rooij
- Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging & Later Life, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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Brenowitz WD, Yaffe K. Observational studies in Alzheimer disease: bridging preclinical studies and clinical trials. Nat Rev Neurol 2022; 18:747-757. [PMID: 36316487 PMCID: PMC9894623 DOI: 10.1038/s41582-022-00733-7] [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] [Accepted: 09/28/2022] [Indexed: 11/29/2022]
Abstract
Recent high-profile failures of Alzheimer disease treatments at the clinical trial stage have led to renewed efforts to identify and test novel interventions for Alzheimer disease and related dementias (ADRD). In this Perspective, we highlight the importance of including well-designed observational studies as part of these efforts. Observational research is an important cornerstone for gathering evidence on risk factors and causes of ADRD; this evidence can then be combined with data from preclinical studies and randomized controlled trials to inform the development of effective interventions. Observational study designs can be particularly beneficial for hypothesis generation, posing questions that are unethical or impractical for a trial setting, studying life-course associations, research in populations typically not included in trials, and public health surveillance. Here, we discuss each of these situations in the specific context of ADRD research. We also highlight novel approaches to enhance causal inference and provide a timely discussion on how observational epidemiological studies help provide a bridge between preclinical studies and successful interventions for ADRD.
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Affiliation(s)
- Willa D Brenowitz
- Departments of Psychiatry and Behavioral Sciences, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Kristine Yaffe
- Departments of Psychiatry and Behavioral Sciences, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
- San Francisco VA Medical Center, San Francisco, CA, USA.
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Longitudinal Study of the Association between General Anesthesia and Increased Risk of Developing Dementia. J Pers Med 2021; 11:jpm11111215. [PMID: 34834567 PMCID: PMC8624274 DOI: 10.3390/jpm11111215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/24/2021] [Accepted: 11/13/2021] [Indexed: 12/12/2022] Open
Abstract
The association between exposure to general anesthesia (GA) and the risk of dementia is still undetermined. To investigate a possible link to the development of dementia in older people who have undergone GA, we analyzed nationwide representative cohort sample data from the Korean National Health Insurance Service. The study cohort comprised patients over 55 years of age who had undergone GA between January 2003 and December 2004 and consisted of 3100 patients who had undergone GA and 12,400 comparison subjects who had not received anesthesia. After the nine-year follow-up period, we found the overall incidence of dementia was higher in the patients who had undergone GA than in the comparison group (10.5 vs. 8.8 per 1000 person-years), with the risk being greater for women (adjusted HR of 1.44; 95% CI, 1.19–1.75) and those with comorbidities (adjusted HR of 1.39; 95% CI, 1.18–1.64). Patients who underwent GA showed higher risks for Alzheimer’s disease and vascular dementia (adjusted HR of 1.52; 95% CI, 1.27–1.82 and 1.64; 95% CI, 1.15–2.33, respectively). This longitudinal study using a sample cohort based on a nationwide population sample demonstrated a significant positive association between GA and dementia, including Alzheimer’s disease and vascular dementia.
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7
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Relationship between Surgery under General Anesthesia and the Development of Dementia: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3234013. [PMID: 32337238 PMCID: PMC7165327 DOI: 10.1155/2020/3234013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/02/2020] [Accepted: 03/18/2020] [Indexed: 12/22/2022]
Abstract
Objective To investigate the association between exposure to general anesthesia and the development of Alzheimer's disease (AD) and dementia by reviewing and integrating the evidence from epidemiological studies published to date. Methods We searched MEDLINE, EMBASE, and Google Scholar to identify all relevant articles up to April 2018 reporting the risk of AD/dementia following exposure to general anesthesia and finally updated in February 2020. We included patients older than 60 or 65 years who had not been diagnosed with dementia or AD before the study period. The overall pooled effect size (ES) was evaluated with a random-effect model. Subgroup analyses were conducted and possibility of publication bias was assessed. Results A total of 23 studies with 412253 patients were included in our analysis. A statistically significant positive association between exposure to general anesthesia and the occurrence of AD was detected in the overall analysis (pooled ES = 1.11, 95%confidence interval = 1.07–1.15), but with substantial heterogeneity (pχ2 < 0.001, I2 = 79.4). Although the overall analysis revealed a significant association, the results of the subgroup analyses were inconsistent, and the possibility of publication bias was detected. Conclusion s. This meta-analysis demonstrated a significant positive association between general anesthesia and AD. However, considering other results, our meta-analysis must be interpreted with caution. Particularly, it should be considered that it was nearly impossible to discriminate the influence of general anesthesia from the effect of surgery itself on the development of AD. Further, large-scale studies devised to reduce the risk of bias are needed to elucidate the evidence of association between general anesthesia and AD. Trial registration. PROSPERO International prospective register of systematic reviews CRD42017073790.
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Albayram O, MacIver B, Mathai J, Verstegen A, Baxley S, Qiu C, Bell C, Caldarone BJ, Zhou XZ, Lu KP, Zeidel M. Traumatic Brain Injury-related voiding dysfunction in mice is caused by damage to rostral pathways, altering inputs to the reflex pathways. Sci Rep 2019; 9:8646. [PMID: 31201348 PMCID: PMC6570649 DOI: 10.1038/s41598-019-45234-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/04/2019] [Indexed: 12/14/2022] Open
Abstract
Brain degeneration, including that caused by traumatic brain injury (TBI) often leads to severe bladder dysfunction, including incontinence and lower urinary tract symptoms; with the causes remaining unknown. Male C57BL/6J mice underwent repetitive moderate brain injury (rmdTBI) or sham injury, then mice received either cis P-tau monoclonal antibody (cis mAb), which prevents brain degeneration in TBI mice, or control (IgG). Void spot assays revealed age-dependent incontinence in IgG controls 8 months after injury, while cis mAb treated or sham mice showed no dysfunction. No obvious bladder pathology occurred in any group. Urodynamic cystometry in conscious mice revealed overactive bladder, reduced maximal voiding pressures and incontinence in IgG control, but not sham or cis mAb treated mice. Hyperphosphorylated tau deposition and neural tangle-like pathology occurred in cortical and hippocampal regions only of IgG control mice accompanied with post-traumatic neuroinflammation and was not seen in midbrain and hindbrain regions associated with bladder filling and voiding reflex arcs. In this model of brain degeneration bladder dysfunction results from rostral, and not hindbrain damage, indicating that rostral brain inputs are required for normal bladder functioning. Detailed analysis of the functioning of neural circuits controlling bladder function in TBI should lead to insights into how brain degeneration leads to bladder dysfunction, as well as novel strategies to treat these disorders.
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Affiliation(s)
- Onder Albayram
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA. .,Hematology and Oncology Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA. .,Division of Translational Therapeutics, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA. .,Cancer Research Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.
| | - Bryce MacIver
- Division of Nephrology, Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.
| | - John Mathai
- Division of Nephrology, Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Anne Verstegen
- Division of Nephrology, Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Sean Baxley
- Hematology and Oncology Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.,Division of Translational Therapeutics, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.,Cancer Research Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Chenxi Qiu
- Hematology and Oncology Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.,Division of Translational Therapeutics, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.,Cancer Research Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.,Broad Institute of Harvard University and Massachusetts Institute of Technology, Cambridge, MA, 02142, USA
| | - Carter Bell
- Hematology and Oncology Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.,Division of Translational Therapeutics, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.,Cancer Research Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Barbara J Caldarone
- NeuroBehavior Laboratory, Harvard NeuroDiscovery Center, Harvard Medical School, Boston, MA, 02115, USA
| | - Xiao Zhen Zhou
- Hematology and Oncology Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.,Division of Translational Therapeutics, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.,Cancer Research Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.,Broad Institute of Harvard University and Massachusetts Institute of Technology, Cambridge, MA, 02142, USA
| | - Kun Ping Lu
- Hematology and Oncology Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.,Division of Translational Therapeutics, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.,Cancer Research Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.,Broad Institute of Harvard University and Massachusetts Institute of Technology, Cambridge, MA, 02142, USA
| | - Mark Zeidel
- Division of Nephrology, Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
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Wadhawan A, Stiller JW, Potocki E, Okusaga O, Dagdag A, Lowry CA, Benros ME, Postolache TT. Traumatic Brain Injury and Suicidal Behavior: A Review. J Alzheimers Dis 2019; 68:1339-1370. [DOI: 10.3233/jad-181055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Abhishek Wadhawan
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Saint Elizabeths Hospital, Psychiatry Residency Training Program, Washington, DC, USA
| | - John W. Stiller
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Saint Elizabeths Hospital, Neurology Consultation Service, Washington, DC, USA
- Maryland State Athletic Commission, Baltimore, MD, USA
| | - Eileen Potocki
- VA Maryland Healthcare System, Baltimore VA Medical Center, Baltimore, MD, USA
| | - Olaoluwa Okusaga
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Michael E DeBakey VA Medical Center, Houston, TX, USA
| | - Aline Dagdag
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Psychiatry, University of Maryland Medical Center, Baltimore, MD, USA
| | - Christopher A. Lowry
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO, USA
- Department of Physical Medicine and Rehabilitation and Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, USA
| | - Michael E. Benros
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Teodor T. Postolache
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, USA
- Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 5, VA Capitol Health Care Network, Baltimore, MD, USA
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10
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Hassan M, Abbas Q, Seo SY, Shahzadi S, Ashwal HA, Zaki N, Iqbal Z, Moustafa AA. Computational modeling and biomarker studies of pharmacological treatment of Alzheimer's disease (Review). Mol Med Rep 2018; 18:639-655. [PMID: 29845262 PMCID: PMC6059694 DOI: 10.3892/mmr.2018.9044] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/05/2017] [Indexed: 12/31/2022] Open
Abstract
Alzheimer's disease (AD) is a complex and multifactorial disease. In order to understand the genetic influence in the progression of AD, and to identify novel pharmaceutical agents and their associated targets, the present study discusses computational modeling and biomarker evaluation approaches. Based on mechanistic signaling pathway approaches, various computational models, including biochemical and morphological models, are discussed to explore the strategies that may be used to target AD treatment. Different biomarkers are interpreted on the basis of morphological and functional features of amyloid β plaques and unstable microtubule‑associated tau protein, which is involved in neurodegeneration. Furthermore, imaging and cerebrospinal fluids are also considered to be key methods in the identification of novel markers for AD. In conclusion, the present study reviews various biochemical and morphological computational models and biomarkers to interpret novel targets and agonists for the treatment of AD. This review also highlights several therapeutic targets and their associated signaling pathways in AD, which may have potential to be used in the development of novel pharmacological agents for the treatment of patients with AD. Computational modeling approaches may aid the quest for the development of AD treatments with enhanced therapeutic efficacy and reduced toxicity.
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Affiliation(s)
- Mubashir Hassan
- Department of Biology, College of Natural Sciences, Kongju National University, Gongju, Chungcheongnam 32588, Republic of Korea
- Institute of Molecular Science and Bioinformatics, Dyal Singh Trust Library, Lahore 54000, Pakistan
| | - Qamar Abbas
- Department of Physiology, University of Sindh, Jamshoro 76080, Pakistan
| | - Sung-Yum Seo
- Department of Biology, College of Natural Sciences, Kongju National University, Gongju, Chungcheongnam 32588, Republic of Korea
| | - Saba Shahzadi
- Institute of Molecular Science and Bioinformatics, Dyal Singh Trust Library, Lahore 54000, Pakistan
- Department of Bioinformatics, Virtual University Davis Road Campus, Lahore 54000, Pakistan
| | - Hany Al Ashwal
- College of Information Technology, United Arab Emirates University, Al-Ain 15551, United Arab Emirates
| | - Nazar Zaki
- College of Information Technology, United Arab Emirates University, Al-Ain 15551, United Arab Emirates
| | - Zeeshan Iqbal
- Institute of Molecular Science and Bioinformatics, Dyal Singh Trust Library, Lahore 54000, Pakistan
| | - Ahmed A. Moustafa
- School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW 2751, Australia
- MARCS Institute for Brain, Behavior and Development, Western Sydney University, Sydney, NSW 2751, Australia
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Becker LC, Boyer I, Bergfeld WF, Belsito DV, Hill RA, Klaassen CD, Liebler DC, Marks JG, Shank RC, Slaga TJ, Snyder PW, Andersen FA. Safety Assessment of Alumina and Aluminum Hydroxide as Used in Cosmetics. Int J Toxicol 2018; 35:16S-33S. [PMID: 27913785 DOI: 10.1177/1091581816677948] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This is a safety assessment of alumina and aluminum hydroxide as used in cosmetics. Alumina functions as an abrasive, absorbent, anticaking agent, bulking agent, and opacifying agent. Aluminum hydroxide functions as a buffering agent, corrosion inhibitor, and pH adjuster. The Food and Drug Administration (FDA) evaluated the safe use of alumina in several medical devices and aluminum hydroxide in over-the-counter drugs, which included a review of human and animal safety data. The Cosmetic Ingredient Review (CIR) Expert Panel considered the FDA evaluations as part of the basis for determining the safety of these ingredients as used in cosmetics. Alumina used in cosmetics is essentially the same as that used in medical devices. This safety assessment does not include metallic or elemental aluminum as a cosmetic ingredient. The CIR Expert Panel concluded that alumina and aluminum hydroxide are safe in the present practices of use and concentration described in this safety assessment.
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Affiliation(s)
- Lillian C Becker
- Cosmetic Ingredient Review Scientific Analyst/Writer, Washington, DC, USA
| | - Ivan Boyer
- Cosmetic Ingredient Review Toxicologist, Washington, DC, USA
| | - Wilma F Bergfeld
- Cosmetic Ingredient Review Expert Panel Member, Washington, DC, USA
| | - Donald V Belsito
- Cosmetic Ingredient Review Expert Panel Member, Washington, DC, USA
| | - Ronald A Hill
- Cosmetic Ingredient Review Expert Panel Member, Washington, DC, USA
| | | | - Daniel C Liebler
- Cosmetic Ingredient Review Expert Panel Member, Washington, DC, USA
| | - James G Marks
- Cosmetic Ingredient Review Expert Panel Member, Washington, DC, USA
| | - Ronald C Shank
- Cosmetic Ingredient Review Expert Panel Member, Washington, DC, USA
| | - Thomas J Slaga
- Cosmetic Ingredient Review Expert Panel Member, Washington, DC, USA
| | - Paul W Snyder
- Cosmetic Ingredient Review Expert Panel Member, Washington, DC, USA
| | - F Alan Andersen
- Former Director, Cosmetic Ingredient Review, Washington, DC, USA
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Choi GJ, Kang H, Baek CW, Jung YH, Kim JW, Woo YC. Relationship between general anesthesia and Alzheimer disease: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e9314. [PMID: 29390504 PMCID: PMC5758206 DOI: 10.1097/md.0000000000009314] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Alzheimer disease (AD) entails a long-term progressive decline in the cognitive ability to think and remember, and it has become a major concern for patients receiving surgery and anesthesia. However, studies investigating the relationship between general anesthesia and AD have yielded inconsistent results. Therefore, we plan to perform a systematic review and meta-analysis to determine the relationship between general anesthesia and AD, and to verify whether general anesthesia is an independent risk factor for AD. METHODS A systematic and comprehensive search will be performed using MEDLINE, EMBASE, and Google scholar from their inception to August 2017. Peer-reviewed cohort and case-control studies including nested case-control studies reporting the relationship between general anesthesia and AD will be eligible for inclusion. The quality of included studies will be assessed using the Newcastle-Ottawa scale. Heterogeneity of estimates across studies as well as publication bias will be assessed. This systematic review and meta-analysis will be performed according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines and reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. All statistical analyses will be conducted using the Stata SE version 15.0. RESULTS The results of this systematic review and meta-analysis will be published in a peer-reviewed journal. CONCLUSION Our study will provide the evidence for the relationship between general anesthesia and dementia. The review will benefit patients and anesthesiologists, surgeons, and policymakers. ETHICS AND DISSEMINATION Ethical approval and informed consent are not required, as the study will be a literature review and will not involve direct contact with patients or alterations to patient care. TRIAL REGISTRATION The protocol for this review has been registered in the PROSPERO network (registration number: CRD42017073790).
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Affiliation(s)
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine
| | | | | | - Jeong Wook Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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13
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General anesthesia exposure and risk of dementia: a meta-analysis of epidemiological studies. Oncotarget 2017; 8:59628-59637. [PMID: 28938666 PMCID: PMC5601762 DOI: 10.18632/oncotarget.19524] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/12/2017] [Indexed: 11/25/2022] Open
Abstract
The association between exposure to general anesthesia and dementia risk has been inconsistently reported across epidemiological studies. To better understand the association, we conducted a meta-analysis of epidemiological studies. PubMed and Embase were searched through April 2017. Random-effects models were used to pool association estimates. We further evaluated potential dose-response relationship. Based on literature search, seven prospective/cohort studies, 11 case-control studies, and a pooled analysis of six case-control studies were identified. Sixteen of these studies were with high quality. After pooling available risk estimates, overall no significant association between exposure to general anesthesia (yes versus no) and dementia risk was detected (odds ratio (OR) = 1.03, 95% confidence interval (CI) 0.90–1.19, p for heterogeneity < 0.001). The null association persisted in the majority of subgroup analyses, although a significant positive association was detected in studies collecting anesthesia exposure using records (OR = 1.22, 95% CI 1.01–1.47, p for heterogeneity < 0.001), a method that is less prone to bias compared with interview or questionnaire using proxy reporters. Based on the dose-response analysis of three studies, a significant nonlinear relationship between times of exposure to general anesthesia and increased risk of dementia was suggested (p < 0.0001). Overall, this meta-analysis suggests that overall the evidence from epidemiological studies supporting a link between general anesthesia exposure and an increased dementia risk is not very strong, while an association was suggested in the studies collecting anesthesia exposure using records and those providing anesthesia exposure frequency data. Further well-designed studies are warranted to better characterize the relationship of interest.
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14
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Weiner MW, Harvey D, Hayes J, Landau SM, Aisen PS, Petersen RC, Tosun D, Veitch DP, Jack CR, Decarli C, Saykin AJ, Grafman J, Neylan TC. Effects of traumatic brain injury and posttraumatic stress disorder on development of Alzheimer's disease in Vietnam Veterans using the Alzheimer's Disease Neuroimaging Initiative: Preliminary Report. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2017; 3:177-188. [PMID: 28758146 PMCID: PMC5526098 DOI: 10.1016/j.trci.2017.02.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) have previously been reported to be associated with increased risk of Alzheimer's disease (AD). We are using biomarkers to study Vietnam Veterans with/without mild cognitive impairment with a history of at least one TBI and/or ongoing PTSD to determine whether these contribute to the development of AD. METHODS Potential subjects identified by Veterans Administration records underwent an initial telephone screen. Consented subjects underwent clinical evaluation, lumbar puncture, structural MRI and amyloid PET scans. RESULTS We observed worse cognitive functioning in PTSD and TBI + PTSD groups, worse global cognitive functioning in the PTSD group, lower superior parietal volume in the TBI + PTSD group, and lower amyloid positivity in the PTSD group, but not the TBI group compared to controls without TBI/PTSD. Medial temporal lobe atrophy was not increased in the PTSD and/or TBI groups. DISCUSSION Preliminary results do not indicate that TBI or PTSD increase the risk for AD measured by amyloid PET. Additional recruitment, longitudinal follow-up, and tau PET scans will provide more information in the future.
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Affiliation(s)
- Michael W Weiner
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San, Francisco, CA, USA.,Department of Radiology, University of California, San Francisco, CA, USA.,Department of Medicine, University of California, San Francisco, CA, USA.,Department of Psychiatry, University of California, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, CA, USA
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Jacqueline Hayes
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San, Francisco, CA, USA
| | - Susan M Landau
- Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA
| | - Paul S Aisen
- Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA
| | | | - Duygu Tosun
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San, Francisco, CA, USA
| | - Dallas P Veitch
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San, Francisco, CA, USA
| | | | - Charles Decarli
- Imaging of Dementia and Aging (IDeA) Laboratory, Department of Neurology and Center for Neuroscience, University of California, Davis, CA, USA
| | - Andrew J Saykin
- Indiana Alzheimer Disease Center, Department of Radiology and Imaging Sciences, Indiana University, School of Medicine, Indianapolis, IN, USA.,Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jordan Grafman
- Psychiatry and Behavioral Sciences & Cognitive Neurology/Alzheimer's Disease Research Center, Feinberg School of Medicine and Department of Psychology, Northwestern University, Chicago, IL, USA
| | - Thomas C Neylan
- Department of Psychiatry, University of California, San Francisco, CA, USA
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15
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Johnson VE, Stewart W, Arena JD, Smith DH. Traumatic Brain Injury as a Trigger of Neurodegeneration. ADVANCES IN NEUROBIOLOGY 2017; 15:383-400. [PMID: 28674990 DOI: 10.1007/978-3-319-57193-5_15] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although millions of individuals suffer a traumatic brain injury (TBI) worldwide each year, it is only recently that TBI has been recognized as a major public health problem. Beyond the acute clinical manifestations, there is growing recognition that a single severe TBI (sTBI) or repeated mild TBIs (rTBI) can also induce insidious neurodegenerative processes, which may be associated with early dementia, in particular chronic traumatic encephalopathy (CTE). Identified at autopsy examination in individuals with histories of exposure to sTBI or rTBI, CTE is recognized as a complex pathology featuring both macroscopic and microscopic abnormalities. These include cavum septum pellucidum, brain atrophy and ventricular dilation, together with pathologies in tau, TDP-43, and amyloid-β. However, the establishment and characterization of CTE as a distinct disease entity is in its infancy. Moreover, the relative "dose" of TBI, such as the frequency and severity of injury, associated with risk of CTE remains unknown. As such, there is a clear and pressing need to improve the recognition and diagnosis of CTE and to identify mechanistic links between TBI and chronic neurodegeneration.
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Affiliation(s)
- Victoria E Johnson
- Department of Neurosurgery, Penn Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - William Stewart
- Department of Neurosurgery, Penn Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK.,University of Glasgow, Glasgow, G12 8QQ, UK
| | - John D Arena
- Department of Neurosurgery, Penn Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Douglas H Smith
- Department of Neurosurgery, Penn Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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16
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Georgakis MK, Kalogirou EI, Diamantaras AA, Daskalopoulou SS, Munro CA, Lyketsos CG, Skalkidou A, Petridou ET. Age at menopause and duration of reproductive period in association with dementia and cognitive function: A systematic review and meta-analysis. Psychoneuroendocrinology 2016; 73:224-243. [PMID: 27543884 DOI: 10.1016/j.psyneuen.2016.08.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 07/27/2016] [Accepted: 08/02/2016] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The preponderance of dementia among postmenopausal women compared with same-age men and the female sex hormones neuroprotective properties support a tentative role of their deficiency in the dementia pathogenesis. METHODS Pairs of independent reviewers screened 12,323 publications derived from a search strategy for MEDLINE to identify articles investigating the association of age at menopause/reproductive period with (i) dementia and (ii) cognitive function; a snowball of eligible articles and reviews was conducted and authors were contacted for additional information. Random-effect models were used for the meta-analysis. RESULTS Age at menopause (13 studies; 19,449 participants) and reproductive period (4 studies; 9916 participants) in the highest categories were not associated with odds of dementia (effect size [ES]: 0.97 [0.78-1.21]) and Alzheimer's disease (ES: 1.06 [0.71-1.58]). Significant heterogeneity was however noted in both analyses (I2: 63.3%, p=0.003 and I2: 72.6%, p=0.01, respectively). Subgroup analyses by outcome assessment, study design, level of adjustment and study quality did not materially change the findings. In 9/13 studies assessing cognitive function, advanced age at menopause/longer reproductive period was significantly associated with better cognitive performance/lower decline. Due to statistical differences, no meta-analysis was possible for cognitive function. CONCLUSIONS Existing evidence does not support an association between indices of prolonged exposure to female hormones and lower dementia risk. There are indications, however, for better cognitive performance and delayed cognitive decline, supporting a link between female hormone deficiency and cognitive aging. Current literature limitations, indicated by the heterogeneous study-set, point towards research priorities in this clinically relevant area.
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Affiliation(s)
- Marios K Georgakis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece.
| | - Eleni I Kalogirou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece.
| | - Andreas-Antonios Diamantaras
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece; Program Medical Neurosciences, Charité-Universitätsmedizin, Berlin, 10117, Germany.
| | - Stella S Daskalopoulou
- Division of Internal Medicine, Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, H3G 1A4, Canada.
| | - Cynthia A Munro
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA.
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA.
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, 751 85, Sweden.
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece.
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Dams-O'Connor K, Guetta G, Hahn-Ketter AE, Fedor A. Traumatic brain injury as a risk factor for Alzheimer's disease: current knowledge and future directions. Neurodegener Dis Manag 2016; 6:417-29. [PMID: 27599555 DOI: 10.2217/nmt-2016-0017] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
There is growing concern about the late effects of traumatic brain injury (TBI). This scoping review summarizes clinical research from the past 10 years that evaluates the relationship between TBI and Alzheimer's disease. This review identified five studies that found increased risk for dementia after TBI, two studies that found no increased risk and four studies that found a relationship only under certain conditions or in specified subsamples. Methodological differences across studies preclude direct comparison of results, and discrepant findings elucidate the complex course of post-TBI neurodegeneration. We discuss the factors that influence the strength and direction of the relationship between TBI and Alzheimer's disease, and the implications of this body of research for patient care and future research.
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Affiliation(s)
- Kristen Dams-O'Connor
- Brain Injury Research Center, Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Gabrielle Guetta
- Brain Injury Research Center, Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Amanda E Hahn-Ketter
- Brain Injury Research Center, Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Andrew Fedor
- Brain Injury Research Center, Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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18
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Virk SA, Eslick GD. Aluminum Levels in Brain, Serum, and Cerebrospinal Fluid are Higher in Alzheimer's Disease Cases than in Controls: A Series of Meta-Analyses. J Alzheimers Dis 2016; 47:629-38. [PMID: 26401698 DOI: 10.3233/jad-150193] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Aluminum is the most studied environmental agent linked with Alzheimer's disease (AD). However, it remains unclear whether levels are significantly elevated in AD sufferers. OBJECTIVE To systematically assess levels of aluminum in brain, serum, and cerebrospinal fluid (CSF) of AD cases and controls. METHODS Electronic searches of Medline, Embase, PubMed, and Cochrane Library were conducted up to June 2015. Studies reporting brain, serum, or CSF aluminum levels in individuals with AD and non-demented controls were included. Meta-analyses were performed using random-effects models and the pooled standardized mean difference (SMD) reported with 95% confidence intervals (CI). RESULTS Overall, 34 studies involving 1,208 participants and 613 AD cases met the criteria for inclusion. Aluminum was measured in brain tissue in 20 studies (n = 386), serum in 12 studies (n = 698), and CSF in 4 studies (n = 124). Compared to control subjects, AD sufferers had significantly higher levels of brain (SMD 0.88; 95% CI, 0.25-1.51), serum (SMD 0.28; 95% CI, 0.03-0.54), and CSF (SMD 0.48; 95% CI, 0.03-0.93) aluminum. Sensitivity analyses excluding studies without age-matched controls did not impact upon these results. CONCLUSIONS The findings of the present meta-analyses demonstrate that aluminum levels are significantly elevated in brain, serum, and CSF of patients with AD. These findings suggest that elevated aluminum levels, particularly in serum, may serve as an early marker of AD and/or play a role in the development of the disease. These results substantially clarify the existing evidence examining the link between chronic aluminum exposure and the development of AD.
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Brief Report: Meta-analysis of Antacid Use and Alzheimer's Disease: Implications for the Aluminum Hypothesis. Epidemiology 2016; 26:769-73. [PMID: 26098935 DOI: 10.1097/ede.0000000000000326] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Exposure to aluminum remains a controversial risk factor for Alzheimer's disease. Antacids are aluminum-rich medications that are widely used in substantial amounts, but their association with Alzheimer's disease has not been systematically quantified. METHODS We conducted electronic searches of PubMed, Embase, and Cochrane Library up to January 2015 for case-control and cohort studies published in any language. Summary risk estimates were derived using random-effects models. RESULTS Seven case-control studies (n = 5,468; 829 Alzheimer's disease cases) and two cohort studies (n = 842; 110 Alzheimer's disease cases) met the criteria for inclusion. Study quality was limited by imprecise characterization of the timing and duration of antacid use. Regular antacid use was not associated with Alzheimer's disease in either case-control (odds ratio = 1.0; 95% confidence interval = 0.8, 1.2) or cohort studies (relative risk = 0.8; 95% confidence interval = 0.4, 1.8). Sensitivity analysis including studies specifically examining aluminum-containing antacids did not reveal an association. CONCLUSIONS Although the findings of this meta-analysis do not support an association between aluminum intake and Alzheimer's disease, prospective studies with longer follow-up and more precise characterization of exposure are required to definitively exclude an etiologic role for aluminum.
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Potter H, Granic A, Caneus J. Role of Trisomy 21 Mosaicism in Sporadic and Familial Alzheimer's Disease. Curr Alzheimer Res 2016; 13:7-17. [PMID: 26651340 PMCID: PMC5570437 DOI: 10.2174/156720501301151207100616] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/13/2015] [Accepted: 08/30/2015] [Indexed: 02/07/2023]
Abstract
Trisomy 21 and the consequent extra copy of the amyloid precursor protein (APP) gene and increased beta-amyloid (Aβ) peptide production underlie the universal development of Alzheimer's disease (AD) pathology and high risk of AD dementia in people with Down syndrome (DS). Trisomy 21 and other forms of aneuploidy also arise among neurons and peripheral cells in both sporadic and familial AD and in mouse and cell models thereof, reinforcing the conclusion that AD and DS are two sides of the same coin. The demonstration that 90% of the neurodegeneration in AD can be attributed to the selective loss of aneuploid neurons generated over the course of the disease indicates that aneuploidy is an essential feature of the pathogenic pathway leading to the depletion of neuronal cell populations. Trisomy 21 mosaicism also occurs in neurons and other cells from patients with Niemann-Pick C1 disease and from patients with familial or sporadic frontotemporal lobar degeneration (FTLD), as well as in their corresponding mouse and cell models. Biochemical studies have shown that Aβ induces mitotic spindle defects, chromosome mis-segregation, and aneuploidy in cultured cells by inhibiting specific microtubule motors required for mitosis. These data indicate that neuronal trisomy 21 and other types of aneuploidy characterize and likely contribute to multiple neurodegenerative diseases and are a valid target for therapeutic intervention. For example, reducing extracellular calcium or treating cells with lithium chloride (LiCl) blocks the induction of trisomy 21 by Aβ. The latter finding is relevant in light of recent reports of a lowered risk of dementia in bipolar patients treated with LiCl and in the stabilization of cognition in AD patients treated with LiCl.
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Affiliation(s)
- Huntington Potter
- Department of Neurology and Linda Crnic Institute for Down Syndrome, 12700 E. 19th Ave room 4010, mail stop 8608, Aurora CO 80045, USA.
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Hu X, Xu G. Does Anesthesia Cause Postoperative Cognitive Decline? Med Princ Pract 2016; 25:497. [PMID: 27165147 PMCID: PMC5588434 DOI: 10.1159/000446541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/02/2016] [Indexed: 01/01/2023] Open
Affiliation(s)
| | - Guohai Xu
- *Guohai Xu, Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, Jiangxi 330006 (China), E-Mail
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Ohara T, Ninomiya T, Hata J, Ozawa M, Yoshida D, Mukai N, Nagata M, Iwaki T, Kitazono T, Kanba S, Kiyohara Y. Midlife and Late‐Life Smoking and Risk of Dementia in the Community: The Hisayama Study. J Am Geriatr Soc 2015; 63:2332-9. [DOI: 10.1111/jgs.13794] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tomoyuki Ohara
- Department of NeuropsychiatryGraduate School of Medical Sciences Kyushu University Fukuoka Japan
- Department of Environmental MedicineGraduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Toshiharu Ninomiya
- Department of Environmental MedicineGraduate School of Medical Sciences Kyushu University Fukuoka Japan
- Department of Center for Cohort StudiesGraduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Jun Hata
- Department of Environmental MedicineGraduate School of Medical Sciences Kyushu University Fukuoka Japan
- Department of Center for Cohort StudiesGraduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Mio Ozawa
- Department of Environmental MedicineGraduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Daigo Yoshida
- Department of Environmental MedicineGraduate School of Medical Sciences Kyushu University Fukuoka Japan
- Department of Center for Cohort StudiesGraduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Naoko Mukai
- Department of Environmental MedicineGraduate School of Medical Sciences Kyushu University Fukuoka Japan
- Department of Center for Cohort StudiesGraduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Masaharu Nagata
- Department of Environmental MedicineGraduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Toru Iwaki
- Department of NeuropathologyGraduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Shigenobu Kanba
- Department of NeuropsychiatryGraduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Yutaka Kiyohara
- Department of Environmental MedicineGraduate School of Medical Sciences Kyushu University Fukuoka Japan
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Khan A, Prince M, Brayne C, Prina AM. Lifetime Prevalence and Factors Associated with Head Injury among Older People in Low and Middle Income Countries: A 10/66 Study. PLoS One 2015; 10:e0132229. [PMID: 26146992 PMCID: PMC4493012 DOI: 10.1371/journal.pone.0132229] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 06/12/2015] [Indexed: 12/04/2022] Open
Abstract
Introduction Traumatic brain injury (TBI) is a growing public health problem around the world, yet there is little information on the prevalence of head injury in low and middle income countries (LMICs). We utilised data collected by the 10/66 research group to investigate the lifetime prevalence of head injury in defined sites in low and middle income countries, its risk factors and its relationship with disability. Methods We analysed data from one-phase cross-sectional surveys of all residents aged 65 years and older (n = 16430) distributed across twelve sites in eight low and middle income countries (China, Cuba, Dominican Republic, India, Venezuela, Mexico, Peru, and Puerto Rico). Self-reported cases of head injury with loss of consciousness were identified during the interview. A sensitivity analysis including data provided by informants of people with dementia was also used to estimate the impact of this information on the estimates. Prevalence ratios (PR) from Poisson regressions were used to identify associated risk factors. Results The standardised lifetime prevalence of TBI ranged from 0.3% in China to 14.6% in rural Mexico and Venezuela. Being male (PR: 1.6, 95% CI: 1.29–1.82), younger (PR: 0.95, 95% CI: 0.92–0.99), with lower education (PR 0.91, 95% CI: 0.86–0.96), and having fewer assets (PR 0.92, 95% CI: 0.88–0.96), was associated with a higher prevalence of TBI when pooling estimates across sites. Discussion Our analysis revealed that the prevalence of TBI in LMICs is similar to that of developed nations. Considering the growing impact of TBI on health resources in these countries, there is an urgent need for further research.
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Affiliation(s)
- A. Khan
- Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR, United Kingdom
| | - M. Prince
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, De Crespigny Park, London, SE5 8AF, United Kingdom
| | - C. Brayne
- Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR, United Kingdom
| | - A. M. Prina
- Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR, United Kingdom
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, De Crespigny Park, London, SE5 8AF, United Kingdom
- * E-mail:
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Portbury SD, Adlard PA. Traumatic Brain Injury, Chronic Traumatic Encephalopathy, and Alzheimer’s Disease: Common Pathologies Potentiated by Altered Zinc Homeostasis. J Alzheimers Dis 2015; 46:297-311. [DOI: 10.3233/jad-143048] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Vincent AS, Roebuck-Spencer TM, Cernich A. Cognitive changes and dementia risk after traumatic brain injury: implications for aging military personnel. Alzheimers Dement 2015; 10:S174-87. [PMID: 24924669 DOI: 10.1016/j.jalz.2014.04.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Traumatic brain injury (TBI) is recognized as an important risk factor for the long-term cognitive health of military personnel, particularly in light of growing evidence that TBI increases risk for Alzheimer's disease and other dementias. In this article, we review the neurocognitive and neuropathologic changes after TBI with particular focus on the potential risk for cognitive decline across the life span in military service members. Implications for monitoring and surveillance of cognition in the aging military population are discussed. Additional studies are needed to clarify the factors that increase risk for later life cognitive decline, define the mechanistic link between these factors and dementia, and provide empirically supported interventions to mitigate the impact of TBI on cognition across the life span.
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Affiliation(s)
- Andrea S Vincent
- Cognitive Science Research Center, Department of Psychology, University of Oklahoma, Norman, OK, USA.
| | - Tresa M Roebuck-Spencer
- Cognitive Science Research Center, Department of Psychology, University of Oklahoma, Norman, OK, USA
| | - Alison Cernich
- Mental Health Services, Department of Veterans Affairs, Defense Centers of Excellence for Psychological Health & Traumatic Brain Injury, Washington, DC, USA
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Wei CJ, Cheng Y, Zhang Y, Sun F, Zhang WS, Zhang MY. Risk factors for dementia in highly educated elderly people in Tianjin, China. Clin Neurol Neurosurg 2014; 122:4-8. [PMID: 24908208 DOI: 10.1016/j.clineuro.2014.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 03/18/2014] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Low education level has been thought an important and specific risk factor for dementia. Therefore, we surveyed dementia in a highly educated population in Tianjin, China. METHODS In total, 1324 old people (aged 55 years and over) in three cluster samples from university communities in Tianjin responded to our survey. Data from psychological tests and dementia questionnaires were analyzed. RESULTS The prevalence of all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VD) was 4.98%, 2.11%, and 2.27%, respectively. A history of stroke (OR=6.036), lack of fruit (OR=5.489), early parental death (OR=3.102), household financial management (OR=2.638), a history of cardiovascular disease (OR=2.434), a history of hypertension (OR=2.042), physical exercise (OR=2.556), were significantly associated with dementia in a single-factor analysis. Four independent variables were entered in a regression equation: early parental death (OR=6.417), lack of fruit in the diet (OR=3.919), personal stroke history (OR=3.901), and lack of physical exercise (OR=2.220). CONCLUSION The prevalence of dementia was lower in highly educated elderly people in universities in Tianjin than in the general population. Risk factors for dementia included disease history, living habits, and early parental death, so corresponding interventions are required.
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Affiliation(s)
- Chong-Juan Wei
- Department of Geriatrics, Tianjin Geriatrics Institute, General Hospital of Tianjin Medical University, Tianjin 300052, China.
| | - Yan Cheng
- Department of Neurology, Tianjin Neurological Institute, General Hospital of Tianjin Medical University, Tianjin 300052, China
| | - Yun Zhang
- Department of Geriatrics, Tianjin Geriatrics Institute, General Hospital of Tianjin Medical University, Tianjin 300052, China
| | - Feng Sun
- Department of Geriatrics, Tianjin Geriatrics Institute, General Hospital of Tianjin Medical University, Tianjin 300052, China
| | - Wei-san Zhang
- Department of Geriatrics, Tianjin Geriatrics Institute, General Hospital of Tianjin Medical University, Tianjin 300052, China
| | - Ming-yi Zhang
- Department of Geriatrics, Tianjin Geriatrics Institute, General Hospital of Tianjin Medical University, Tianjin 300052, China
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Jones GRN. The Alzheimer pandemic: is paracetamol to blame? INFLAMMATION & ALLERGY DRUG TARGETS 2014; 13:2-14. [PMID: 24350947 PMCID: PMC3921468 DOI: 10.2174/1871528112666131219163405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 11/26/2013] [Accepted: 11/27/2013] [Indexed: 01/06/2023]
Abstract
HISTORICAL BACKGROUND The clinical recognition of a form of dementia closely resembling Alzheimer's disease dates from around 1800. The role of analgesics derived from coal-tar in the spread of the pandemic is traced in terms of the introduction of phenacetin (PN) in 1887; its nephrotoxicity; the observation of lesions characteristic of the disease by Fischer and Alzheimer; the discovery of paracetamol (PA) as the major metabolite of PN; the linking of kidney injury and dementia with high PN usage; and the failure of PN replacement by PA to halt and reverse the exponential, inexorable rise in the incidence of Alzheimer-type dementia. Fischer observed his first case before Alzheimer; it is proposed to rename the syndrome Fischer-Alzheimer disease (F-AD). Disease development: PA-metabolising enzymes are localised in the synaptic areas of the frontal cortex and hippocampus, where F-AD lesions arise. The initiating chemical lesions in liver poisoning comprise covalent binding of a highly reactive product of PA metabolism to proteins; similar events are believed to occur in brain, where alterations in the antigenic profiles of cerebral proteins activate the microglia. β-Amyloid forms, and, like PA itself, induces nitric oxide synthase. Peroxynitrite modifies cerebral proteins by nitrating tyrosine residues, further challenging the microglia and exacerbating the amyloid cascade. Spontaneous reinnervation, N-acetyl cysteine administration and tyrosine supplementation may attenuate the early stages of F-AD development. CONCLUSION F-AD is primarily a man-made condition with PA as its principal risk factor.
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Dosunmu R, Wu J, Basha MR, Zawia NH. Environmental and dietary risk factors in Alzheimer’s disease. Expert Rev Neurother 2014; 7:887-900. [PMID: 17610395 DOI: 10.1586/14737175.7.7.887] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disease that affects millions in the aging population worldwide and will affect millions more in the next 20 years. Over 90% of all cases are sporadic, with genetics playing a minor role in the etiology of AD. Therefore, it is crucial to investigate the environment and diet as primary risk factors in AD pathology. This review considers epidemiologic case control studies, and in vitro and in vivo research to investigate the potential of environmental exposure to metals, air pollution and pesticides as well as diet as risk factors for AD. In some cases, the role of genetic mutations and environmental risk is discussed. The evidence examined in this review provides a brief overview of the current literature on selected, significant risk factors in promoting amyloid-beta accumulation and aggregation, thus contributing to neurodegeneration.
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Affiliation(s)
- Remi Dosunmu
- University of Rhode Island, Department of Biomedical & Pharmaceutical Sciences, Kingston, RI 02881, USA.
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Bokenberger K, Pedersen NL, Gatz M, Dahl AK. The type A behavior pattern and cardiovascular disease as predictors of dementia. Health Psychol 2013; 33:1593-601. [PMID: 24364377 DOI: 10.1037/hea0000028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Research has suggested that greater psychophysiological reactivity to stress increases risk of dementia and that those with the Type A behavior pattern (TABP) are predisposed to elevated stress reactivity and cardiovascular disease (CVD), but no study has evaluated the associations among TABP, CVD, and dementia, prospectively. Hence, the present study aimed to investigate dementia risk in relation to TABP and CVD. METHODS A population-based cohort of 1,069 persons with a baseline mean age of 64.81 years from the Swedish Twin Registry was followed consecutively for up to 23 years. Based on self-reported items, TABP was measured using 6 scales: Ambition, Stress, Hard-driving, Neuroticism, Cynicism, and Paranoia. CVD was self-reported and dementia was diagnosed adhering to Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) or Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. RESULTS TABP was generally not associated with dementia risk. However, significant interaction effects of stress, paranoia, and cynicism with CVD on dementia risk were observed. That is, for those with CVD, high scores on stress, paranoia, and cynicism were associated with increased risk of dementia (hazard ratio [HR] = 1.43, 95% confidence interval [CI] = 0.95-2.15; HR = 1.39, 95% CI = 0.83-2.33; HR = 1.25, 95% CI = 0.76-2.06, respectively), whereas for those who did not have CVD, high scores on these measures appeared to be protective (HR = 0.76, 95% CI = 0.50-1.14; HR = 0.55, 95% CI = 0.34-0.89; HR = 0.50, 95% CI = 0.29-0.84, respectively). CONCLUSION Some features of TABP confer an increased risk for dementia in those with CVD, whereas those without CVD are protected. When evaluating the risk of dementia, CVD and personality traits should be taken into consideration.
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Affiliation(s)
| | | | - Margaret Gatz
- Department of Medical Epidemiology and Biostatistics
| | - Anna K Dahl
- Department of Medical Epidemiology and Biostatistics
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Seitz DP, Reimer CL, Siddiqui N. A review of epidemiological evidence for general anesthesia as a risk factor for Alzheimer's disease. Prog Neuropsychopharmacol Biol Psychiatry 2013; 47:122-7. [PMID: 22771690 DOI: 10.1016/j.pnpbp.2012.06.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 06/22/2012] [Accepted: 06/28/2012] [Indexed: 10/28/2022]
Abstract
Exposure to surgery and general anesthesia (GA) has been hypothesized to be a potential risk factor for the development of Alzheimer's disease (AD). Some basic science research studies have demonstrated AD pathology in animals following exposure to inhalational anesthetics. However, controversy exists as to whether GA is associated with an elevated risk of developing AD in human populations. While randomized controlled clinical trials would provide the strongest evidence for a causal relationship between exposure to surgery under GA and the subsequent development of AD, to date there have not been any trials to address this important question. Therefore, a potential relationship between GA and AD must currently be examined using observational methods. A recent meta-analysis of case-control studies (N = 15) did not find that AD was associated with prior exposure to GA (OR = 1.05, 95% CI: 0.93-1.19, p = 0.4). A limited number of retrospective cohort studies have likewise not provided definitive information supporting an association. Therefore, at the present time there is limited information to support the hypothesis of AD developing as a consequence of GA, although there are few high quality studies in this area. Given the high prevalence and impact of AD, and the relatively frequent exposure of large populations to surgical procedures, the association between AD and GA requires further study.
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Affiliation(s)
- Dallas P Seitz
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.
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Increased risk of dementia in people with previous exposure to general anesthesia: a nationwide population-based case-control study. Alzheimers Dement 2013; 10:196-204. [PMID: 23896612 DOI: 10.1016/j.jalz.2013.05.1766] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/01/2013] [Accepted: 05/04/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dementia, which leads to disability, is one of the important diseases occurring among older populations. However, the exact mechanism of the disease remains unknown. The potential risk factor of general anesthesia (GA) in the development of dementia is a controversial topic. Therefore, this study aimed to evaluate the association between previous exposure to different GA types and the incidence of dementia. METHODS Using the claims data of 1 million insured residents covered by Taiwan's universal health insurance from 2005 to 2009, 5345 newly diagnosed dementia patients older than 50 years were eligible for the study group. The control group, which consisted of 21,380 individuals without dementia, was matched for age, gender, and index date. GA was categorized into three subtypes: endotracheal tube intubation general anesthesia (ETGA), intravenous injection general anesthesia (IVGA) or intramuscular injection general anesthesia (IMGA), and heavy sedation. The multiple logistic regression model was used for analyses. RESULTS Individuals exposed to surgery under ETGA (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.25-1.44) and those exposed to surgery under IVGA or IMGA (OR, 1.28; 95% CI, 1.14-1.43) were at significantly higher risk of dementia in a dose-response relationship (P < .0001), whereas surgery under heavy sedation was not associated with increased risk of dementia (OR, 1.04; 95% CI, 0.68-1.59). The dementia risk for subjects with diabetes mellitus who received surgery under ETGA (OR, 1.59; 95% CI, 1.42-1.78), hypertension (OR, 1.98; 95% CI, 1.78-2.21), atherosclerosis (OR, 1.35; 95% CI, 1.22-1.50), or after having experienced a stroke (OR, 3.52; 95% CI, 3.13-3.97), but no interaction was found between surgery under ETGA and depression for the risk of dementia. CONCLUSIONS A history of previous exposure to surgery under GA might be associated with an increased risk of dementia, particularly in subjects who have undergone repeated exposure to GA. In addition, subjects who had received surgery under ETGA with comorbidities such as stroke, hypertension, diabetes mellitus, and atherosclerosis could have a potential relationship with dementia risk.
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Sprung J, Jankowski CJ, Roberts RO, Weingarten TN, Aguilar AL, Runkle KJ, Tucker AK, McLaren KC, Schroeder DR, Hanson AC, Knopman DS, Gurrieri C, Warner DO. Anesthesia and incident dementia: a population-based, nested, case-control study. Mayo Clin Proc 2013; 88:552-61. [PMID: 23642337 PMCID: PMC3784020 DOI: 10.1016/j.mayocp.2013.01.024] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 01/11/2013] [Accepted: 01/29/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To test the hypothesis that exposure to procedures requiring general anesthesia during adulthood is not significantly associated with incident dementia using a retrospective, population-based, nested, case-control study design. PARTICIPANTS AND METHODS Using the Rochester Epidemiology Project and the Mayo Clinic Alzheimer's Disease Patient Registry, residents of Olmsted County, Minnesota, diagnosed as having dementia between January 1, 1985, and December 31, 1994, were identified. For each incident case, a sex- and age-matched control was randomly selected from the general pool of Olmsted County residents who were dementia free in the index year of dementia diagnosis. Medical records were reviewed to determine exposures to procedures requiring anesthesia after age 45 years and before the index year. Data were analyzed using logistic regression. RESULTS We analyzed 877 cases of dementia, each with a corresponding control. Of the dementia cases, 615 (70%) underwent 1681 procedures requiring general anesthesia; of the controls, 636 (73%) underwent 1638 procedures. When assessed as a dichotomous variable, anesthetic exposure was not significantly associated with dementia (odds ratio, 0.89; 95% CI, 0.73-1.10; P=.27). In addition, no significant association was found when exposure was quantified as number of procedures (odds ratios, 0.87, 0.86, and 1.0 for 1, 2-3, and ≥4 exposures, respectively, compared with none; P=.51). CONCLUSION This study found no significant association between exposure to procedures requiring general anesthesia after age 45 years and incident dementia.
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Affiliation(s)
- Juraj Sprung
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
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Kokjohn TA, Maarouf CL, Daugs ID, Hunter JM, Whiteside CM, Malek-Ahmadi M, Rodriguez E, Kalback W, Jacobson SA, Sabbagh MN, Beach TG, Roher AE. Neurochemical profile of dementia pugilistica. J Neurotrauma 2013; 30:981-97. [PMID: 23268705 PMCID: PMC3684215 DOI: 10.1089/neu.2012.2699] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Dementia pugilistica (DP), a suite of neuropathological and cognitive function declines after chronic traumatic brain injury (TBI), is present in approximately 20% of retired boxers. Epidemiological studies indicate TBI is a risk factor for neurodegenerative disorders including Alzheimer disease (AD) and Parkinson disease (PD). Some biochemical alterations observed in AD and PD may be recapitulated in DP and other TBI persons. In this report, we investigate long-term biochemical changes in the brains of former boxers with neuropathologically confirmed DP. Our experiments revealed biochemical and cellular alterations in DP that are complementary to and extend information already provided by histological methods. ELISA and one-dimensional and two dimensional Western blot techniques revealed differential expression of select molecules between three patients with DP and three age-matched non-demented control (NDC) persons without a history of TBI. Structural changes such as disturbances in the expression and processing of glial fibrillary acidic protein, tau, and α-synuclein were evident. The levels of the Aβ-degrading enzyme neprilysin were reduced in the patients with DP. Amyloid-β levels were elevated in the DP participant with the concomitant diagnosis of AD. In addition, the levels of brain-derived neurotrophic factor and the axonal transport proteins kinesin and dynein were substantially decreased in DP relative to NDC participants. Traumatic brain injury is a risk factor for dementia development, and our findings are consistent with permanent structural and functional damage in the cerebral cortex and white matter of boxers. Understanding the precise threshold of damage needed for the induction of pathology in DP and TBI is vital.
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Affiliation(s)
- Tyler A. Kokjohn
- The Longtine Center for Neurodegenerative Biochemistry, Banner Sun Health Research Institute, Sun City, Arizona
- Department of Microbiology, Midwestern University School of Medicine, Glendale, Arizona
| | - Chera L. Maarouf
- The Longtine Center for Neurodegenerative Biochemistry, Banner Sun Health Research Institute, Sun City, Arizona
| | - Ian D. Daugs
- The Longtine Center for Neurodegenerative Biochemistry, Banner Sun Health Research Institute, Sun City, Arizona
| | - Jesse M. Hunter
- The Longtine Center for Neurodegenerative Biochemistry, Banner Sun Health Research Institute, Sun City, Arizona
| | - Charisse M. Whiteside
- The Longtine Center for Neurodegenerative Biochemistry, Banner Sun Health Research Institute, Sun City, Arizona
| | - Michael Malek-Ahmadi
- Cleo Roberts Center for Clinical Research, Banner Sun Health Research Institute, Sun City, Arizona
| | - Emma Rodriguez
- The Longtine Center for Neurodegenerative Biochemistry, Banner Sun Health Research Institute, Sun City, Arizona
- National Institute of Cardiology, Mexico City, Mexico
| | - Walter Kalback
- The Longtine Center for Neurodegenerative Biochemistry, Banner Sun Health Research Institute, Sun City, Arizona
| | - Sandra A. Jacobson
- Cleo Roberts Center for Clinical Research, Banner Sun Health Research Institute, Sun City, Arizona
| | - Marwan N. Sabbagh
- Cleo Roberts Center for Clinical Research, Banner Sun Health Research Institute, Sun City, Arizona
| | - Thomas G. Beach
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona
| | - Alex E. Roher
- The Longtine Center for Neurodegenerative Biochemistry, Banner Sun Health Research Institute, Sun City, Arizona
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Abstract
OBJECTIVE The critical window hypothesis of hormone therapy (HT) and cognitive function states that the effects of HT depend on timing of initiation with respect to age, the menopausal transition, or both, and that optimal effects are evident with early initiation. This article reviews clinical studies that bear on this hypothesis. METHODS Recognizing that the typical pattern of HT use is early HT initiation, this review describes findings from observational studies of ever use of HT and observational studies that looked specifically at the timing of HT on Alzheimer's disease (AD) and cognitive test performance. Randomized trials of HT and verbal memory are discussed, and neuroimaging studies bearing on the hypothesis are reviewed. RESULTS Observational data suggest that HT generally reduces the risk of AD. Three of three observational studies that specifically examined the timing of initiation in relation to AD risk each provide support for the window, whereas three of five observational studies of HT timing and cognitive test performance do. Randomized clinical trials of estrogen therapy in younger women find support for the hypothesis. Conjugated equine estrogens/medroxyprogesterone acetate increases risks regardless of timing. Little is known about the cognitive effects of other combination HT formulations. CONCLUSIONS A definitive trial to test the critical window hypothesis is not feasible. Evidence drawn from other sources provides initial support for the hypothesis. Although these findings are relevant to women who use HT to treat vasomotor symptoms, HT is currently not indicated for the treatment of cognitive complaints or for dementia prevention.
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Affiliation(s)
- Pauline M Maki
- Department of Psychiatry , University of Illinois at Chicago, Chicago, IL 60612, USA.
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Smith DH, Johnson VE, Stewart W. Chronic neuropathologies of single and repetitive TBI: substrates of dementia? Nat Rev Neurol 2013; 9:211-21. [PMID: 23458973 DOI: 10.1038/nrneurol.2013.29] [Citation(s) in RCA: 517] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Traumatic brain injury (TBI) has long been recognized to be a risk factor for dementia. This association has, however, only recently gained widespread attention through the increased awareness of 'chronic traumatic encephalopathy' (CTE) in athletes exposed to repetitive head injury. Originally termed 'dementia pugilistica' and linked to a career in boxing, descriptions of the neuropathological features of CTE include brain atrophy, cavum septum pellucidum, and amyloid-β, tau and TDP-43 pathologies, many of which might contribute to clinical syndromes of cognitive impairment. Similar chronic pathologies are also commonly found years after just a single moderate to severe TBI. However, little consensus currently exists on specific features of these post-TBI syndromes that might permit their confident clinical and/or pathological diagnosis. Moreover, the mechanisms contributing to neurodegeneration following TBI largely remain unknown. Here, we review the current literature and controversies in the study of chronic neuropathological changes after TBI.
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Affiliation(s)
- Douglas H Smith
- Penn Center for Brain Injury and Repair and Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, 105 Hayden Hall, 3320 Smith Walk, Philadelphia, PA 19104, USA
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Schmidt C, Karch A, Korth C, Zerr I. On the issue of transmissibility of Alzheimer disease: a critical review. Prion 2012; 6:447-52. [PMID: 23052009 DOI: 10.4161/pri.22502] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Results from recent experiments with rodents imply that Alzheimer disease might be inducible by seeding Aβ peptides into recipient animals. In respect to this new experimental data, public health aspects as well as epidemiological data have to be reevaluated. In this article, the available experimental and epidemiological data are reviewed.
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Affiliation(s)
- Christian Schmidt
- Clinical Dementia Center, Department of Neurology, Georg-August University, Goettingen, Germany.
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Abstract
OBJECTIVE The purpose of this study was to review the relationship between education and dementia. METHODS A systematic literature review was conducted of all published studies examining the relationship between education and dementia listed in the PubMed and PsycINFO databases from January 1985 to July 2010. The inclusion criteria were a measure of education and a dementia diagnosis by a standardized diagnostic procedure. Alzheimer disease and Total Dementia were the outcomes. RESULTS A total of 88 study populations from 71 studies met inclusion criteria. Overall, 51 studies (58%) reported significant effects of lower education on risk for dementia, whereas 37 studies (42%) reported no significant relationship. A relationship between education and risk for dementia was more consistent in developed regions compared with developing regions. Age, sex, race/ethnicity, and geographical region moderated the relationship. CONCLUSIONS Lower education was associated with a greater risk for dementia in many but not all studies. The level of education associated with risk for dementia varied by study population and more years of education did not uniformly attenuate the risk for dementia. It seemed that a more consistent relationship with dementia occurred when years of education reflected cognitive capacity, suggesting that the effect of education on risk for dementia may be best evaluated within the context of a lifespan developmental model.
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Giunta B, Obregon D, Velisetty R, Sanberg PR, Borlongan CV, Tan J. The immunology of traumatic brain injury: a prime target for Alzheimer's disease prevention. J Neuroinflammation 2012; 9:185. [PMID: 22849382 PMCID: PMC3458981 DOI: 10.1186/1742-2094-9-185] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 07/09/2012] [Indexed: 01/03/2023] Open
Abstract
A global health problem, traumatic brain injury (TBI) is especially prevalent in the current era of ongoing world military conflicts. Its pathological hallmark is one or more primary injury foci, followed by a spread to initially normal brain areas via cascades of inflammatory cytokines and chemokines resulting in an amplification of the original tissue injury by microglia and other central nervous system immune cells. In some cases this may predispose individuals to later development of Alzheimer’s disease (AD). The inflammatory-based progression of TBI has been shown to be active in humans for up to 17 years post TBI. Unfortunately, all neuroprotective drug trials have failed, and specific treatments remain less than efficacious. These poor results might be explained by too much of a scientific focus on neurons without addressing the functions of microglia in the brain, which are at the center of proinflammatory cytokine generation. To address this issue, we provide a survey of the TBI-related brain immunological mechanisms that may promote progression to AD. We discuss these immune and microglia-based inflammatory mechanisms involved in the progression of post-trauma brain damage to AD. Flavonoid-based strategies to oppose the antigen-presenting cell-like inflammatory phenotype of microglia will also be reviewed. The goal is to provide a rationale for investigations of inflammatory response following TBI which may represent a pathological link to AD. In the end, a better understanding of neuroinflammation could open therapeutic avenues for abrogation of secondary cell death and behavioral symptoms that may mediate the progression of TBI to later AD.
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Affiliation(s)
- Brian Giunta
- James A. Haley Veterans' Administration Hospital, 13000 Bruce B. Downs Blvd., Tampa, FL 33612, USA.
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Willhite CC, Ball GL, McLellan CJ. Total allowable concentrations of monomeric inorganic aluminum and hydrated aluminum silicates in drinking water. Crit Rev Toxicol 2012; 42:358-442. [DOI: 10.3109/10408444.2012.674101] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Seitz DP, Shah PS, Herrmann N, Beyene J, Siddiqui N. Exposure to general anesthesia and risk of Alzheimer's disease: a systematic review and meta-analysis. BMC Geriatr 2011; 11:83. [PMID: 22168260 PMCID: PMC3258207 DOI: 10.1186/1471-2318-11-83] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 12/14/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD) is common among older adults and leads to significant disability. Volatile anesthetic gases administered during general anesthesia (GA) have been hypothesized to be a risk factor for the development of AD. The objective of this study is to systematically review the association between exposure to GA and risk of AD. METHODS We searched electronic databases including MEDLINE, Embase, and Google scholar for observational studies examining the association between exposure to GA and risk of AD. We examined study quality using a modified version of the Newcastle-Ottawa risk of bias assessment for observational studies. We used standard meta-analytic techniques to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). Subgroup and sensitivity analyses were undertaken to evaluate the robustness of the findings. RESULTS A total of 15 case-control studies were included in the review. No cohort studies were identified that met inclusion criteria. There was variation in the methodological quality of included studies. There was no significant association between any exposure to GA and risk of AD (pooled OR: 1.05; 95% CI: 0.93 - 1.19, Z = 0.80, p = 0.43). There was also no significant association between GA and risk of AD in several subgroup and sensitivity analyses. CONCLUSIONS A history of exposure to GA is not associated with an increased risk of AD although there are few high-quality studies in this area. Prospective cohort studies with long-term follow-up or randomized controlled trials are required to further understand the association between GA and AD.
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Affiliation(s)
- Dallas P Seitz
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.
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Traumatic brain injury and amyloid-β pathology: a link to Alzheimer's disease? Nat Rev Neurosci 2011; 11:361-70. [PMID: 20216546 DOI: 10.1038/nrn2808] [Citation(s) in RCA: 419] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Traumatic brain injury (TBI) has devastating acute effects and in many cases seems to initiate long-term neurodegeneration. Indeed, an epidemiological association between TBI and the development of Alzheimer's disease (AD) later in life has been demonstrated, and it has been shown that amyloid-β (Aβ) plaques — one of the hallmarks of AD — may be found in patients within hours following TBI. Here, we explore the mechanistic underpinnings of the link between TBI and AD, focusing on the hypothesis that rapid Aβ plaque formation may result from the accumulation of amyloid precursor protein in damaged axons and a disturbed balance between Aβ genesis and catabolism following TBI.
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Wirdefeldt K, Adami HO, Cole P, Trichopoulos D, Mandel J. Epidemiology and etiology of Parkinson's disease: a review of the evidence. Eur J Epidemiol 2011; 26 Suppl 1:S1-58. [PMID: 21626386 DOI: 10.1007/s10654-011-9581-6] [Citation(s) in RCA: 724] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 04/05/2011] [Indexed: 12/14/2022]
Abstract
The etiology of Parkinson's disease (PD) is not well understood but likely to involve both genetic and environmental factors. Incidence and prevalence estimates vary to a large extent-at least partly due to methodological differences between studies-but are consistently higher in men than in women. Several genes that cause familial as well as sporadic PD have been identified and familial aggregation studies support a genetic component. Despite a vast literature on lifestyle and environmental possible risk or protection factors, consistent findings are few. There is compelling evidence for protective effects of smoking and coffee, but the biologic mechanisms for these possibly causal relations are poorly understood. Uric acid also seems to be associated with lower PD risk. Evidence that one or several pesticides increase PD risk is suggestive but further research is needed to identify specific compounds that may play a causal role. Evidence is limited on the role of metals, other chemicals and magnetic fields. Important methodological limitations include crude classification of exposure, low frequency and intensity of exposure, inadequate sample size, potential for confounding, retrospective study designs and lack of consistent diagnostic criteria for PD. Studies that assessed possible shared etiological components between PD and other diseases show that REM sleep behavior disorder and mental illness increase PD risk and that PD patients have lower cancer risk, but methodological concerns exist. Future epidemiologic studies of PD should be large, include detailed quantifications of exposure, and collect information on environmental exposures as well as genetic polymorphisms.
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Affiliation(s)
- Karin Wirdefeldt
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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Mosconi L, Tsui W, Murray J, McHugh P, Li Y, Williams S, Pirraglia E, Glodzik L, De Santi S, Vallabhajosula S, de Leon MJ. Maternal age affects brain metabolism in adult children of mothers affected by Alzheimer's disease. Neurobiol Aging 2011; 33:624.e1-9. [PMID: 21514691 DOI: 10.1016/j.neurobiolaging.2011.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 02/22/2011] [Accepted: 03/05/2011] [Indexed: 10/18/2022]
Abstract
Cognitively normal (NL) individuals with a maternal history of late-onset Alzheimer's disease (MH) show reduced brain glucose metabolism on FDG-PET as compared to those with a paternal history (PH) and those with negative family history (NH) of Alzheimer's disease (AD). This FDG-PET study investigates whether metabolic deficits in NL MH are associated with advancing maternal age at birth. Ninety-six NL individuals with FDG-PET were examined, including 36 MH, 24 PH, and 36 NH. Regional-to-whole brain gray matter standardized FDG uptake value ratios were examined for associations with parental age across groups using automated regions-of-interest and statistical parametric mapping. Groups were comparable for clinical and neuropsychological measures. Brain metabolism in AD-vulnerable regions was lower in MH compared to NH and PH, and negatively correlated with maternal age at birth only in MH. There were no associations between paternal age and metabolism in any group. Evidence for a maternally inherited, maternal age-related mechanism provides further insight on risk factors and genetic transmission in late-onset AD.
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Affiliation(s)
- Lisa Mosconi
- New York University School of Medicine, New York, NY 10016, USA.
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Abstract
We reviewed 143 papers that described the relationship between moderate drinking of alcohol and some aspect of cognition. Two types of papers were found: (1) those that provided ratios of risk between drinkers and nondrinkers (74 papers in total) and (2) those that, although they did not provide such ratios, allowed cognition in drinkers to be rated as "better," "no different," or "worse" than cognition in nondrinkers (69 papers in total). The history of research on moderate drinking and cognition can be divided into two eras: 1977-1997 and 1998-present. Phase I (1977-1997) was the era of neuropsychological evaluation involving mostly young to middle-aged (18-50 years old) subjects. Although initial studies indicated moderate drinking impaired cognition, many later studies failed to confirm this, instead finding no difference in cognition between drinkers and nondrinkers. Phase II (1998-present) was and is the era of mental status exam evaluation involving mostly older (≥55 years old) subjects. These studies overwhelmingly found that moderate drinking either reduced or had no effect on the risk of dementia or cognitive impairment. When all the ratios of risk from all the studies in phase II providing such ratios are entered into a comprehensive meta-analysis, the average ratio of risk for cognitive risk (dementia or cognitive impairment/decline) associated with moderate "social" (not alcoholic) drinking of alcohol is 0.77, with nondrinkers as the reference group. The benefit of moderate drinking applied to all forms of dementia (dementia unspecified, Alzheimer's disease, and vascular dementia) and to cognitive impairment (low test scores), but no significant benefit against cognitive decline (rate of decline in test scores) was found. Both light and moderate drinking provided a similar benefit, but heavy drinking was associated with nonsignificantly higher cognitive risk for dementia and cognitive impairment. Although the meta-analysis also indicated that wine was better than beer or spirits, this was based on a relatively small number of studies because most studies did not distinguish among these different types of alcohol. Furthermore, a number of the studies that did make the distinction reported no difference among the effects of these different types of alcohol. Therefore, at present this question remains unanswered. Analysis also showed that the presence of the apolipoprotein E epsilon 4 allele eliminated the benefit of moderate drinking. However, this was based on a relatively small number of studies and several other studies have found a beneficial effect of the epsilon e4 allele. Further studies are necessary to settle this question. The benefit of moderate alcohol for cognition was seen in both men and women, although the amount and pattern of drinking is very different between the two sexes. Lastly, the finding of unaffected or significantly reduced cognitive risk in light to moderate drinkers was seen in 14/19 countries for which country-specific ratio data were available, with three of the five remaining countries showing nonsignificant reductions as well. Overall, light to moderate drinking does not appear to impair cognition in younger subjects and actually seems to reduce the risk of dementia and cognitive decline in older subjects.
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Affiliation(s)
- Edward J Neafsey
- Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
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Cataldo JK, Prochaska JJ, Glantz SA. Cigarette smoking is a risk factor for Alzheimer's Disease: an analysis controlling for tobacco industry affiliation. J Alzheimers Dis 2010; 19:465-80. [PMID: 20110594 DOI: 10.3233/jad-2010-1240] [Citation(s) in RCA: 204] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To examine the relationship between smoking and Alzheimer's disease (AD) after controlling for study design, quality, secular trend, and tobacco industry affiliation of the authors, electronic databases were searched; 43 individual studies met the inclusion criteria. For evidence of tobacco industry affiliation, http://legacy.library.ucsf.edu was searched. One fourth (11/43) of individual studies had tobacco-affiliated authors. Using random effects meta-analysis, 18 case control studies without tobacco industry affiliation yielded a non-significant pooled odds ratio of 0.91 (95% CI, 0.75-1.10), while 8 case control studies with tobacco industry affiliation yielded a significant pooled odds ratio of 0.86 (95% CI, 0.75-0.98) suggesting that smoking protects against AD. In contrast, 14 cohort studies without tobacco-industry affiliation yielded a significantly increased relative risk of AD of 1.45 (95% CI, 1.16-1.80) associated with smoking and the three cohort studies with tobacco industry affiliation yielded a non-significant pooled relative risk of 0.60 (95% CI 0.27-1.32). A multiple regression analysis showed that case-control studies tended to yield lower average risk estimates than cohort studies (by -0.27 +/- 0.15, P=0.075), lower risk estimates for studies done by authors affiliated with the tobacco industry (by -0.37 +/- 0.13, P=0.008), no effect of the quality of the journal in which the study was published (measured by impact factor, P=0.828), and increasing secular trend in risk estimates (0.031/year +/- 0.013, P=0.02). The average risk of AD for cohort studies without tobacco industry affiliation of average quality published in 2007 was estimated to be 1.72 +/- 0.19 (P< 0.0005). The available data indicate that smoking is a significant risk factor for AD.
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Affiliation(s)
- Janine K Cataldo
- Department of Physiological Nursing, Gerontology, University of California, San Francisco, San Francisco, CA 94143-0610, USA.
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Abstract
OBJECTIVE To determine the relations between traumatic brain injury (TBI) and several neurologic outcomes 6 months or more after TBI. PARTICIPANTS Not applicable. DESIGN Systematic review of the published, peer-reviewed literature. PRIMARY MEASURES Not applicable. RESULTS We identified 75 studies that examined the relations between TBI and neurologic outcomes. Unprovoked seizures are causally related to penetrating TBI as well as to moderate and severe TBI. There was only limited evidence of an association between seizures and mild TBI. Dementia of the Alzheimer's type (DAT) was associated with moderate and severe TBI, but not with mild TBI unless there was loss of consciousness (LOC); the evidence for the latter was limited. Parkinsonism was associated with moderate and severe TBI, but there was only modest evidence of a link with mild TBI without LOC. Dementia pugilistica was associated with professional boxing. There was insufficient evidence to support an association between TBI and both multiple sclerosis and amyotrophic lateral sclerosis. TBI appeared to produce a host of postconcussive symptoms (eg, memory problems, dizziness, and irritability). Moderate and severe TBI were associated with endocrine problems such as hypopituitarism and growth hormone deficiency and possibly with diabetes insipidus. There was only limited evidence of an association between mild TBI and the development of ocular/visual motor deterioration. CONCLUSION TBI is strongly associated with several neurologic disorders 6 months or more after injury. Clinicians caring for TBI patients should monitor them closely for the development of these disorders. While some of these disorders can be treated after they arise (eg, seizures), a greater public health benefit would be achieved by preventing them before they develop. Research efforts to develop therapies aimed at secondary prevention are currently underway.
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Gwilliam MN, Hoggard N, Capener D, Singh P, Marzo A, Verma PK, Wilkinson ID. MR derived volumetric flow rate waveforms at locations within the common carotid, internal carotid, and basilar arteries. J Cereb Blood Flow Metab 2009; 29:1975-82. [PMID: 19756018 DOI: 10.1038/jcbfm.2009.176] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The volumetric flow rate (VFR) waveform over the cardiac cycle in the cerebral vasculature is a significant factor in many studies, which involve cerebrovascular function. Perhaps contrary to expectation, the literature in this area is sparse and the characteristics of blood flow waveforms are ill defined. A better understanding of the variation of blood flow rate and pulsatility may aid our knowledge of risk factors involved in diseases and conditions, such as stroke, arteriovenous malformation, or aneurysm rupture. This study sought to characterise the blood flow waveform over the cardiac cycle at levels within the carotid artery and basilar artery (BA) in a normal cohort. The study cohort consisted of 22 subjects (recruitment age: 20 to 40 years) with no history of vascular disease (median age=26 years, interquartile range=25 to 32 years). Two-dimensional quantitative phase-contrast magnetic resonance imaging was performed on each subject at nine anatomic locations within the carotid artery and BA. Significant differences in pulsatility were present within the carotid tree. Archetypal VFR waveforms were established for this group at the nine locations. A normal individual's VFR waveform at a location within the carotid tree can be estimated by taking the group's archetypal waveform for that location, and scaling by the individual's average flow rate.
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Affiliation(s)
- Matthew N Gwilliam
- Medical Physics and Clinical Engineering, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Fillit H, Nash DT, Rundek T, Zuckerman A. Cardiovascular risk factors and dementia. ACTA ACUST UNITED AC 2008; 6:100-18. [DOI: 10.1016/j.amjopharm.2008.06.004] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2008] [Indexed: 12/19/2022]
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