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Ramezani Kashal F, Nouredini G, Hezaveh ZS, Fakhrzadeh H, Moodi M, Khorashadizadeh M, Khodabakhshi H, Arzaghi SM, Ebrahimpour M, Payab M, Ejtahed HS, Sharifi F. The Association between cognitive impairment and anthropometric indices among the elderly: birjand longitudinal aging study. J Diabetes Metab Disord 2024; 23:1173-1182. [PMID: 38932884 PMCID: PMC11196492 DOI: 10.1007/s40200-024-01404-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/11/2024] [Indexed: 06/28/2024]
Abstract
Background The population of older adults has been consistently on the rise. We aimed to assess the possible relationship between cognitive decline and anthropometric indices in older adults, using data from the Birjand longitudinal aging study (BLAS). Methods In this cross-sectional research, the association between cognitive impairment as determined by two tests (Six Item Cognitive Impairment Test (6-CIT)) and (Mini-Mental State Examination (MMSE)) and anthropometric indices including waist circumference (WC), body mass index (BMI), waist to height ratio (WHtR), waist to hip ratio (WHR), body roundness index (BRI), and a body shape index (ABSI) were assessed among 1353 elderly ≥ 60 years old, participating in the BLAS cohort study (September 2018 to April 2019). Ordinal and binary logistic regression were used for analysis. Results According to the MMSE test, 58.3% of participants had cognitive impairment, while this frequency was 64.2% based on the 6-CIT test. A significant reverse association was observed between cognitive decline according to the 6-CIT test and BMI, WHR, and WC (P < 0.05). Cognitive impairment, according to MMSE, was inversely associated with WC and directly associated with WHtR and ABSI in the crude model, which disappeared after adjustment for confounders. BRI was not significantly related to any of the cognitive tests. According to BMI and WC, overweight and obesity could reduce the risk of cognitive impairment. Conclusions Overall, the result of this study showed that the risk of cognitive decline decreased among the elderly as BMI, WC, and WHR increased. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-024-01404-8.
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Affiliation(s)
- Fatemeh Ramezani Kashal
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Golnoush Nouredini
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Sajadi Hezaveh
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Hossein Fakhrzadeh
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Moodi
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
- School of Health, Birjand University of Medical Sciences, Birjand, Iran
| | - Masoumeh Khorashadizadeh
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Huriye Khodabakhshi
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Seyed Masoud Arzaghi
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Ebrahimpour
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Moloud Payab
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hanieh-Sadat Ejtahed
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Sharifi
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Kim H, Jung JH, Han K, Jeon HJ. Weight change in people with depression and the risk of dementia: a nationwide cohort study. Psychol Med 2024; 54:1284-1293. [PMID: 38179671 DOI: 10.1017/s0033291723003124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Depression is a risk factor for dementia and weight change can appear as a symptom of depression. However, the association between weight change after the diagnosis of depression and the risk of dementia is poorly established. This study aimed to investigate the association between weight change before and after a diagnosis of depression with the subsequent risk of dementia. METHODS The National Health Insurance Sharing Service database was used. 1 308 730 patients aged ⩾40 years diagnosed with depression were identified to be eligible. Weight changes after their depression diagnosis were categorized and subsequent incidence of dementia was followed up. RESULTS During an average follow-up period of 5.2 years (s.d., 2.0 years), 69 373 subjects were newly diagnosed with all-cause dementia (56 351 were Alzheimer's disease and 6877 were vascular dementia). Regarding all outcomes, compared to those with a minimal weight change (-5 to 5%), all groups with weight gain or loss showed increased risks of dementia after adjusting potential risk factors for dementia, in all analysis models with a dose-response relationship, showing a U-shaped association. CONCLUSIONS Weight change as a symptom of depression could be a predictor for the future development of dementia.
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Affiliation(s)
- Hyewon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin Hyung Jung
- Department of Biostatistics, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Hong Jin Jeon
- Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
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Park Y, Kim SH, Ryu J, Yoon HJ. Association of midlife body-weight variability and cycles with earlier dementia onset: a nationwide cohort study. Alzheimers Res Ther 2024; 16:91. [PMID: 38664832 PMCID: PMC11044324 DOI: 10.1186/s13195-024-01460-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Given the rising awareness of health-related lifestyle modifications, the impact of changes in body weight (BW) on cognitive function and dementia generates significant concern. This study aimed to investigate the association between BW changes and dementia in a middle-aged Korean population. METHODS A retrospective, population-based longitudinal study was conducted utilizing data from the National Health Insurance Service (NHIS) database. Participants aged 40 years or older in 2011 who underwent at least five health checkups between 2002 and 2011 were followed-up for dementia until 2020. A total of 3,635,988 dementia-free Korean aged < 65 at baseline were examined. We analyzed the association between BW variability independent of the mean (VIM) with BW cycle, defined as either an upward or a downward direction of BW, and the risk of incident dementia. RESULTS The results showed an increased risk of dementia in the highest quartile of VIM quartile (hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.47-1.58) compared to the lowest quartile of VIM. Additionally, the results showed an even higher increased risk of dementia in the highest BW cycle (≥ 2 cycles of 10% BW = HR 2.00, 95% CI 1.74-1.29). Notably, the combined concept of VIM with BW cycle showed an even higher dementia risk (highest quartile of VIM with ≥ 2 cycles of 10% BW = HR 2.37, 95% CI 2.05-2.74) compared to the baseline group (lowest quartile of VIM with < 3% BW cycle). CONCLUSIONS The present study highlights the importance of considering BW changes with BW variability along with the BW cycle to assess dementia risk in detail, providing valuable insights for preventive strategies.
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Affiliation(s)
- Yujin Park
- Healthcare Data Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Su Hwan Kim
- Department of Information Statistics, Gyeongsang National University, 501, Jinju-daero, Jinju-si, Gyeongsangnam-do, 52828, Republic of Korea
| | - Jiwon Ryu
- Hospital Medicine Center, Seoul National University Bundang Hospital, 83, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
| | - Hyung-Jin Yoon
- Department of Human Systems Medicine, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Medical Big Data Research Center, Seoul National University Medical Research Center, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Li Q, Zhan J, Feng Y, Liao Z, Li X. The Association of Body Mass Index with Cognition and Alzheimer's Disease Biomarkers in the Elderly with Different Cognitive Status: A Study from the Alzheimer's Disease Neuroimaging Initiative Database. J Alzheimers Dis Rep 2024; 8:9-24. [PMID: 38229832 PMCID: PMC10789287 DOI: 10.3233/adr-230163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/04/2023] [Indexed: 01/18/2024] Open
Abstract
Background The association of body mass index (BMI) with cognition and Alzheimer's disease (AD) biomarkers of the elderly remains inconclusive. Objective To investigate the relationship between BMI and cognition as well as AD biomarkers in the elderly with different cognitive status. Methods Participants with cognitively normal (CN) were included as the CN group. Participants with mild cognitive impairment and mild dementia were included as the cognitive impairment (CI) group. The relationship between BMI and AD biomarkers (cerebrospinal fluid Aβ42 and p-tau181, hippocampal volume [HV]), global cognition (Mini-Mental State Examination [MMSE]), memory, and executive function were explored. Results In the CI group, BMI was associated with MMSE (β= 0.03, p = 0.009), Aβ42 (β= 0.006, p = 0.029), p-tau181/Aβ42 ratio (β= -0.001, p = 0.011), and HV (β= 0.05, p < 0.001). However in the CN group, BMI exhibited associations with p-tau181 (β= 0.012, p = 0.014) and memory composite score (β= -0.04, p = 0.038), but not with p-tau181/Aβ42 ratio and HV. Moreover, mediation analysis showed that in the CI group, the positive effect of BMI on HV and MMSE score was partially mediated by diastolic blood pressure. Conclusion The association of BMI with cognition and AD biomarkers varies across different cognitive status. In particular, a lower BMI was associated with worse cognition, higher Aβ burden, and lower HV in individuals with CI. Clinical practice should strengthen the monitoring and management of BMI in patients with AD.
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Affiliation(s)
- Qin Li
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiehong Zhan
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuxue Feng
- Department of Neurology, The Fifth People’s Hospital of Chongqing, Chongqing, China
| | - Zixuan Liao
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaofeng Li
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Neurology, The Fifth People’s Hospital of Chongqing, Chongqing, China
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Morrow CB, Leoutsakos J, Yan H, Onyike C, Kamath V. Weight Change and Neuropsychiatric Symptoms in Alzheimer's Disease and Frontotemporal Dementia: Associations with Cognitive Decline. J Alzheimers Dis Rep 2023; 7:767-774. [PMID: 37662607 PMCID: PMC10473120 DOI: 10.3233/adr-230034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/29/2023] [Indexed: 09/05/2023] Open
Abstract
Weight changes, neuropsychiatric symptoms (NPS), and cognitive decline often coincide in Alzheimer's disease (AD) and frontotemporal dementia (FTD); however, the direction of their relationship remains unclear. This study aims to clarify the connection between weight changes, NPS, and cognition in AD and FTD. We found that cognitive decline was associated with decreased body mass index (BMI) in AD, while BMI gain was associated with increased conversion to FTD. Elevated NPS were associated with decreased BMI in AD and increased BMI in FTD. Identifying early changes in NPS and BMI may facilitate the detection of cognitive decline, providing an opportunity for early intervention.
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Affiliation(s)
- Christopher B. Morrow
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jeannie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Haijuan Yan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Chiadi Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Vidyulata Kamath
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Yang E, Wang J, Woodie LN, Greene MW, Kaddoumi A. Oleocanthal Ameliorates Metabolic and Behavioral Phenotypes in a Mouse Model of Alzheimer's Disease. Molecules 2023; 28:5592. [PMID: 37513464 PMCID: PMC10385639 DOI: 10.3390/molecules28145592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/15/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
Aging is a major risk factor for Alzheimer's disease (AD). AD mouse models are frequently used to assess pathology, behavior, and memory in AD research. While the pathological characteristics of AD are well established, our understanding of the changes in the metabolic phenotypes with age and pathology is limited. In this work, we used the Promethion cage systems® to monitor changes in physiological metabolic and behavioral parameters with age and pathology in wild-type and 5xFAD mouse models. Then, we assessed whether these parameters could be altered by treatment with oleocanthal, a phenolic compound with neuroprotective properties. Findings demonstrated metabolic parameters such as body weight, food and water intake, energy expenditure, dehydration, and respiratory exchange rate, and the behavioral parameters of sleep patterns and anxiety-like behavior are altered by age and pathology. However, the effect of pathology on these parameters was significantly greater than normal aging, which could be linked to amyloid-β deposition and blood-brain barrier (BBB) disruption. In addition, and for the first time, our findings suggest an inverse correlation between sleep hours and BBB breakdown. Treatment with oleocanthal improved the assessed parameters and reduced anxiety-like behavior symptoms and sleep disturbances. In conclusion, aging and AD are associated with metabolism and behavior changes, with the changes being greater with the latter, which were rectified by oleocanthal. In addition, our findings suggest that monitoring changes in metabolic and behavioral phenotypes could provide a valuable tool to assess disease severity and treatment efficacy in AD mouse models.
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Affiliation(s)
- Euitaek Yang
- Department of Drug Discovery and Development, Harrison College of Pharmacy, Auburn University, 720 S Donahue Dr., Auburn, AL 36849, USA
| | - Junwei Wang
- Department of Drug Discovery and Development, Harrison College of Pharmacy, Auburn University, 720 S Donahue Dr., Auburn, AL 36849, USA
| | - Lauren N Woodie
- Department of Nutrition, College of Human Sciences, Auburn University, Auburn, AL 36849, USA
| | - Michael W Greene
- Department of Nutrition, College of Human Sciences, Auburn University, Auburn, AL 36849, USA
| | - Amal Kaddoumi
- Department of Drug Discovery and Development, Harrison College of Pharmacy, Auburn University, 720 S Donahue Dr., Auburn, AL 36849, USA
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Simo-Tabue N, Boucaud-Maitre D, Letchimy L, Guilhem-Decleon J, Helene-Pelage J, Duval GT, Tabue-Teguo M. Correlates of Undernutrition in Older People in Guadeloupe (French West Indies): Results from the KASADS Study. Nutrients 2023; 15:2950. [PMID: 37447276 DOI: 10.3390/nu15132950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/17/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Objectives: This study aimed to determine the risk factors for undernutrition in community-dwelling older adults in Guadeloupe (Caribbean islands). Methods: We used data from the KArukera Study of Aging-Drugs Storage (KASADS), an observational cross-sectional study of community-dwelling older people living in Guadeloupe. The Mini Nutritional Assessment (MNA) was used to assess the risk of undernutrition. An MNA-short form (SF) score ≤11 defined the risk of undernutrition. Depression was assessed using the Center for Epidemiologic Studies Depression (CES-D) scale, cognitive function was assessed using the Mini Mental State Examination (MMSE), frailty was assessed using the Study of Osteoporotic Fractures index (SOF), and dependency was assessed using Lawton's instrumental activities of daily living (IADL) scale. Bivariate and multivariate analyses were used to determine the correlates of undernutrition. Results: The study sample comprised 115 patients aged 65 years or older; 67.8% were women, and the mean age was 76 ± 7.8 years. The prevalence of undernutrition was 21.7% (95% CI = 15.2-30.1%). In our bivariate analysis, the risk of undernutrition was associated with MMSE score, IADL score, frailty, and CES-D score. We found no significant relation between nutrition risk and other variables, such as marital status, pain, or polypharmacy. In the multivariate analysis, the factors associated with the risk of undernutrition were MMSE score (Odd-Ratio (OR): 0.74 (0.58-0.97)) and CES-D score (OR: 1.13 (1.02-1.27)). Conclusions: Cognitive decline and the risk of depression were independently associated with the risk of undernutrition in community-dwelling older people in Guadeloupe. Although we cannot imply causality in this relation, the detection of these three key geriatric syndromes in community-dwelling elders is essential to prevent adverse health outcomes. Further studies are warranted to confirm these findings.
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Affiliation(s)
- Nadine Simo-Tabue
- Pôle Gériatrie-Gérontologie, CHU de Martinique, 97261 Fort-de-France, France
| | | | - Laurys Letchimy
- Pôle Gériatrie-Gérontologie, CHU de Martinique, 97261 Fort-de-France, France
| | - Jeff Guilhem-Decleon
- Department of Geriatric Medicine, Angers University, CHU de Guadeloupe, 97110 Pointe-à-Pitre, France
| | - Jeannie Helene-Pelage
- Department of Geriatric Medicine, Angers University, CHU de Guadeloupe, 97110 Pointe-à-Pitre, France
| | - Guillaume T Duval
- Department of Geriatric, FWI University, CHU d'Angers, 49100 Angers, France
- Equipe EpiCliV, Université des Antilles, 34095 Montpellier, France
| | - Maturin Tabue-Teguo
- Pôle Gériatrie-Gérontologie, CHU de Martinique, 97261 Fort-de-France, France
- Equipe EpiCliV, Université des Antilles, 34095 Montpellier, France
- Equipe ACTIVE, INSERM 1219, Université de Bordeaux, 33600 Pessac, France
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Balietti M, Casoli T, Giorgetti B, Colangeli R, Nicoletti C, Solazzi M, Pugliese A, Conti F. Generation and Characterization of the First Murine Model of Alzheimer's Disease with Mutated AβPP Inserted in a BALB/c Background (C.B6/J-APPswe). J Alzheimers Dis 2023:JAD230195. [PMID: 37182890 DOI: 10.3233/jad-230195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Numerous mouse models of Alzheimer's disease (AD) are available, but all suffer from certain limitations, thus prompting further attempts. To date, no one model exists with amyloidopathy in a BALB/c strain. OBJECTIVE To generate and characterize the C.B6/J-APPswe mouse, a model of AD with a mutated human gene for the amyloid-β protein precursor (AβPP) inserted in a BALB/c background. METHODS We analyzed five groups at different ages (3, 6, 9, 12, and 16-18 months) of C.B6/J-APPswe and wild-type mice (50% males and 50% females) for the main hallmarks of AD by western blotting, amyloid-β (Aβ) ELISA, immunocytochemistry, electrophysiology, and behavioral tests. RESULTS The C.B6/J-APPswe mouse displays early AβPP and Aβ production, late amyloid plaques formation, high level of tau phosphorylation, synaptic deficits (reduced density and functional impairment due to a reduced post-synaptic responsiveness), neurodegeneration caused by apoptosis and necroptosis/necrosis, microgliosis, astrocytic abnormalities, and sex-related differences in explorative behavior, anxiety-like behavior, and spatial long-term and working memories. Social housing is feasible despite the intra-cage aggressiveness of male animals. CONCLUSION C.B6/J-APPswe mice develop most of the distinctive features of AD and is a suitable model for the study of brain atrophy mechanisms and of the differences between males and females in the onset of cognitive/non-cognitive deficits.
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Affiliation(s)
- Marta Balietti
- Center for Neurobiology of Aging, IRCCS INRCA, Ancona, Italy
| | - Tiziana Casoli
- Center for Neurobiology of Aging, IRCCS INRCA, Ancona, Italy
| | | | - Roberto Colangeli
- Section of Neuroscience and Cell Biology, Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Cristina Nicoletti
- Section of Neuroscience and Cell Biology, Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Moreno Solazzi
- Center for Neurobiology of Aging, IRCCS INRCA, Ancona, Italy
| | - Arianna Pugliese
- Section of Neuroscience and Cell Biology, Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Fiorenzo Conti
- Center for Neurobiology of Aging, IRCCS INRCA, Ancona, Italy
- Section of Neuroscience and Cell Biology, Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
- Fondazione di Medicina Molecolare e Terapia Cellulare, Università Politecnica delle Marche, Ancona, Italy
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Gan J, Shi Z, Zuo C, Zhao X, Liu S, Chen Y, Zhang N, Cai L, Cui R, Ai L, Guan YH, Ji Y. Analysis of positron emission tomography hypometabolic patterns and neuropsychiatric symptoms in patients with dementia syndromes. CNS Neurosci Ther 2023. [PMID: 36924296 DOI: 10.1111/cns.14169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
AIMS To estimate the proportions of specific hypometabolic patterns and their association with neuropsychiatric symptoms (NPS) in patients with cognitive impairment (CI). METHODS This multicenter study with 1037 consecutive patients was conducted from December 2012 to December 2019. 18 F-FDG PET and clinical/demographic information, NPS assessments were recorded and analyzed to explore the associations between hypometabolic patterns and clinical features by correlation analysis and multivariable logistic regression models. RESULTS Patients with clinical Alzheimer's disease (AD, 81.6%, 605/741) and dementia with Lewy bodies (67.9%, 19/28) mostly had AD-pattern hypometabolism, and 76/137 (55.5%) of patients with frontotemporal lobar degeneration showed frontal and anterior temporal pattern (FT-P) hypometabolism. Besides corticobasal degeneration, patients with behavioral variant frontotemporal dementia (36/58), semantic dementia (7/10), progressive non-fluent aphasia (6/9), frontotemporal lobar degeneration and amyotrophic lateral sclerosis (3/5), and progressive supranuclear palsy (21/37) also mostly showed FT-P hypometabolism. The proportion of FT-P hypometabolism was associated with the presence of hallucinations (R = 0.171, p = 0.04), anxiety (R = 0.182, p = 0.03), and appetite and eating abnormalities (R = 0.200, p = 0.01) in AD. CONCLUSION Specific hypometabolic patterns in FDG-PET are associated with NPS and beneficial for the early identification and management of NPS in patients with CI.
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Affiliation(s)
- Jinghuan Gan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhihong Shi
- Department of Neurology, Tianjin Dementia Institute, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Tianjin, China
| | - Chuantao Zuo
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaobin Zhao
- Department of Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuai Liu
- Department of Neurology, Tianjin Dementia Institute, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Tianjin, China
| | - Yongjie Chen
- Department of Epidemiology and Statistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Nan Zhang
- Department of Neurology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Li Cai
- Department of PET-CT Diagnostics, Tianjin Medical University General Hospital, Tianjin, China
| | - Ruixue Cui
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Ai
- Department of Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Hui Guan
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Yong Ji
- Department of Neurology, Tianjin Dementia Institute, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Tianjin, China
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Weise CM, Chen K, Chen Y, Devadas V, Su Y, Reiman EM. Differential impact of body mass index and leptin on baseline and longitudinal positron emission tomography measurements of the cerebral metabolic rate for glucose in amnestic mild cognitive impairment. Front Aging Neurosci 2022; 14:1031189. [PMID: 36570534 PMCID: PMC9782536 DOI: 10.3389/fnagi.2022.1031189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/19/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Several studies have suggested that greater adiposity in older adults is associated with a lower risk of Alzheimer's disease (AD) related cognitive decline, some investigators have postulated that this association may be due to the protective effects of the adipose tissue-derived hormone leptin. In this study we sought to demonstrate that higher body mass indices (BMIs) are associated with greater baseline FDG PET measurements of the regional cerebral metabolic rate for glucose (rCMRgl), a marker of local neuronal activity, slower rCMRgl declines in research participants with amnestic mild cognitive impairment (aMCI). We then sought to clarify the extent to which those relationships are attributable to cerebrospinal fluid (CSF) or plasma leptin concentrations. Materials and methods We used baseline PET images from 716 73 ± 8 years-old aMCI participants from the AD Neuroimaging Initiative (ADNI) of whom 453 had follow up images (≥6 months; mean follow up time 3.3 years). For the leptin analyses, we used baseline CSF samples from 81 of the participants and plasma samples from 212 of the participants. Results As predicted, higher baseline BMI was associated with greater baseline CMRgl measurements and slower declines within brain regions preferentially affected by AD. In contrast and independently of BMI, CSF, and plasma leptin concentrations were mainly related to less baseline CMRgl within mesocorticolimbic brain regions implicated in energy homeostasis. Discussion While higher BMIs are associated with greater baseline CMRgl and slower declines in persons with aMCI, these associations appear not to be primarily attributable to leptin concentrations.
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Affiliation(s)
- Christopher M. Weise
- Department of Neurology, Marti-Luther-University of Halle-Wittenberg, Halle, Germany,Department of Neurology, University of Leipzig, Leipzig, Germany,*Correspondence: Christopher M. Weise,
| | - Kewei Chen
- Banner Alzheimer’s Institute, Phoenix, AZ, United States,School of Mathematics and Statistics, Arizona State University, Tempe, AZ, United States,Department of Neurology, College of Medicine, University of Arizona, Phoenix, AZ, United States,Arizona Alzheimer’s Consortium, Phoenix, AZ, United States
| | - Yinghua Chen
- Banner Alzheimer’s Institute, Phoenix, AZ, United States
| | - Vivek Devadas
- Banner Alzheimer’s Institute, Phoenix, AZ, United States
| | - Yi Su
- Banner Alzheimer’s Institute, Phoenix, AZ, United States,Department of Neurology, College of Medicine, University of Arizona, Phoenix, AZ, United States,Arizona Alzheimer’s Consortium, Phoenix, AZ, United States,School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ, United States
| | - Eric M. Reiman
- Banner Alzheimer’s Institute, Phoenix, AZ, United States,Arizona Alzheimer’s Consortium, Phoenix, AZ, United States,Department of Psychiatry, College of Medicine, University of Arizona, Phoenix, AZ, United States,Neurogenomics Division, Translational Genomics Research Institute, Phoenix, AZ, United States,Arizona State University-Banner Health Neurodegenerative Disease Research Center, Arizona State University, Tempe, AZ, United States
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11
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Kang SH, Kim JH, Chang Y, Cheon BK, Choe YS, Jang H, Kim HJ, Koh SB, Na DL, Kim K, Seo SW. Independent effect of body mass index variation on amyloid-β positivity. Front Aging Neurosci 2022; 14:924550. [PMID: 35936766 PMCID: PMC9354132 DOI: 10.3389/fnagi.2022.924550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives The relationship of body mass index (BMI) changes and variability with amyloid-β (Aβ) deposition remained unclear, although there were growing evidence that BMI is associated with the risk of developing cognitive impairment or AD dementia. To determine whether BMI changes and BMI variability affected Aβ positivity, we investigated the association of BMI changes and BMI variability with Aβ positivity, as assessed by PET in a non-demented population. Methods We retrospectively recruited 1,035 non-demented participants ≥50 years of age who underwent Aβ PET and had at least three BMI measurements in the memory clinic at Samsung Medical Center. To investigate the association between BMI change and variability with Aβ deposition, we performed multivariable logistic regression. Further distinctive underlying features of BMI subgroups were examined by employing a cluster analysis model. Results Decreased (odds ratio [OR] = 1.68, 95% confidence interval [CI] 1.16–2.42) or increased BMI (OR = 1.60, 95% CI 1.11–2.32) was associated with a greater risk of Aβ positivity after controlling for age, sex, APOE e4 genotype, years of education, hypertension, diabetes, baseline BMI, and BMI variability. A greater BMI variability (OR = 1.73, 95% CI 1.07–2.80) was associated with a greater risk of Aβ positivity after controlling for age, sex, APOE e4 genotype, years of education, hypertension, diabetes, baseline BMI, and BMI change. We also identified BMI subgroups showing a greater risk of Aβ positivity. Conclusion Our findings suggest that participants with BMI change, especially those with greater BMI variability, are more vulnerable to Aβ deposition regardless of baseline BMI. Furthermore, our results may contribute to the design of strategies to prevent Aβ deposition with respect to weight control.
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Affiliation(s)
- Sung Hoon Kang
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
- Neuroscience Center, Samsung Medical Center, Seoul, South Korea
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jong Hyuk Kim
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Bo Kyoung Cheon
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
- Neuroscience Center, Samsung Medical Center, Seoul, South Korea
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Yeong Sim Choe
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
- Neuroscience Center, Samsung Medical Center, Seoul, South Korea
- Department of Health Sciences & Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
- Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
- Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Duk L. Na
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
- Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Kyunga Kim
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
- Department of Data Convergence and Future Medicine, School of Medicine, Sungkyunkwan University, Seoul, South Korea
- *Correspondence: Kyunga Kim,
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
- Neuroscience Center, Samsung Medical Center, Seoul, South Korea
- Department of Health Sciences & Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Samsung Alzheimer Research Center, Center for Clinical Epidemiology Medical Center, Seoul, South Korea
- Department of Intelligent Precision Healthcare Convergence, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Sang Won Seo,
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12
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Kishino Y, Sugimoto T, Kimura A, Kuroda Y, Uchida K, Matsumoto N, Saji N, Niida S, Sakurai T. Longitudinal association between nutritional status and behavioral and psychological symptoms of dementia in older women with mild cognitive impairment and early-stage Alzheimer’s disease. Clin Nutr 2022; 41:1906-1912. [DOI: 10.1016/j.clnu.2022.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022]
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13
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Castillo-García IM, López-Álvarez J, Osorio R, Olazarán J, Ramos García MI, Agüera-Ortiz L. Clinical Trajectories of Neuropsychiatric Symptoms in Mild-Moderate to Advanced Dementia. J Alzheimers Dis 2022; 86:861-875. [PMID: 35147532 DOI: 10.3233/jad-215133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is high prevalence of neuropsychiatric symptoms (NPS) among dementia patients. NPS are correlated with dementia progression, functional decline, early institutionalization, and death. There is scarce evidence on the progression of NPS in the latest stages of dementia. OBJECTIVE To describe the prevalence of NPS in mild-moderate to severe dementia and to reveal the progression of each NPS over time. METHODS We studied 317 patients (77.3% female, average age: 81.5 years) with a DSM-IV-TR diagnosis of dementia. This is a cross-sectional, and a prospective longitudinal study with 78-month follow-up. We assessed cognitive status (Mini-Mental State Examination and Severe Mini-Mental State Examination), dementia severity (Global Deterioration Scale and Clinical Dementia Rating), and psychopathological measures (Neuropsychiatric Inventory, APADEM-Nursing Home, Apathy Inventory, Cornell Scale for Depression in Dementia, and Cohen-Mansfield Agitation Inventory). RESULTS Overall prevalence of NPS was 94.6%, being apathy the most prevalent (66.7%) and the one whose severity increased the most with progression of dementia. Agitation/aggression, irritability, and sleeping and eating disorders also increased over time. Delusions and depressive symptoms decreased in severity with disease progression. In severe dementia, female displayed more severe depressive symptoms and eating disorders, while male displayed more agitation/aggression and sleep disturbances. CONCLUSION NPS in dementia follow a heterogeneous course. Apathy is the most prevalent NPS and the one that worsens most significantly over time. The course of some NPS differs between sexes. Further research is required to understand the evolution of NPS at advanced stages of dementia.
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Affiliation(s)
- Isabel M Castillo-García
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 deOctubre, Madrid, Spain
| | - Jorge López-Álvarez
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 deOctubre, Madrid, Spain.,Alzheimer's Centre Reina Sofia-CIEN Foundation, Madrid, Spain
| | - Ricardo Osorio
- Alzheimer's Centre Reina Sofia-CIEN Foundation, Madrid, Spain.,Department of Psychiatry NYU Grossman School of Medicine, New York, NY, USA
| | - Javier Olazarán
- Alzheimer's Centre Reina Sofia-CIEN Foundation, Madrid, Spain.,Servicio de Neurología, HGU Gregorio Marañón, Madrid, Spain
| | - Maria I Ramos García
- Alzheimer's Centre Reina Sofia-CIEN Foundation, Madrid, Spain.,Instituto de Psiquiatría y Salud Mental, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISC), Madrid, Spain
| | - Luis Agüera-Ortiz
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 deOctubre, Madrid, Spain.,Alzheimer's Centre Reina Sofia-CIEN Foundation, Madrid, Spain.,Centro deInvestigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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14
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Xiong C, Luo J, Agboola F, Grant E, Morris JC. A family of estimators to diagnostic accuracy when candidate tests are subject to detection limits-Application to diagnosing early stage Alzheimer disease. Stat Methods Med Res 2022; 31:882-898. [PMID: 35044258 DOI: 10.1177/09622802211072511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In disease diagnosis, individuals are usually assumed to be one of the two basic types, healthy or diseased, as typically based on an established gold standard. Candidate markers for diagnosing a disease often are much cheaper and less invasive than the gold standard but must be evaluated against the gold standard for their sensitivity and specificity to accurately diagnose the disease. When candidate diagnostic markers are fully measured, receiver operating characteristic curves have been the standard approaches for assessing diagnostic accuracy. However, full measurements of diagnostic markers may not be available above or below certain limits due to various practical and technical limitations. For example, in the diagnosis of Alzheimer disease using cerebrospinal fluid biomarkers, the Roche Elecsys® immunoassays have a measuring range for multiple cerebrospinal fluid molecular concentrations. Many cognitive tests used in diagnosing dementia due to Alzheimer disease are also subject to detection limits, often referred to as the floor and ceiling effects in the neuropsychological literature. We propose a new statistical methodology for estimating the diagnostic accuracy when a diagnostic marker is subject to detection limits by dividing the entire study sample into two sub-samples by a threshold of the diagnostic marker. We then propose a family of estimators to the area under the receiver operating characteristic curve by combining a conditional nonparametric estimator and another conditional semi-parametric estimator derived from Cox's proportional hazards model. We derive the variance to the proposed estimators, and further, assess the performance of the proposed estimators as a function of possible thresholds through an extensive simulation study, and recommend the optimum thresholds. Finally, we apply the proposed methodology to assess the ability of several cerebrospinal fluid biomarkers and cognitive tests in diagnosing early stage Alzheimer disease dementia.
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Affiliation(s)
- Chengjie Xiong
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA.,Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Jingqin Luo
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA.,Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,Siteman Cancer Center Biostatistics Core, Washington University School of Medicine, St. Louis, MO, USA
| | - Folasade Agboola
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA.,Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Elizabeth Grant
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA.,Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - John C Morris
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.,Departments of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
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15
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Soysal P, Tan SG, Rogowska M, Jawad S, Smith L, Veronese N, Tsiptsios D, Tsamakis K, Stewart R, Mueller C. Weight loss in Alzheimer's disease, vascular dementia and dementia with Lewy bodies: Impact on mortality and hospitalization by dementia subtype. Int J Geriatr Psychiatry 2021; 37. [PMID: 34807996 DOI: 10.1002/gps.5659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/17/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Loss of weight is associated with cognitive decline as well as several adverse outcomes in dementia. The aim of this study was to assess whether weight loss is associated with mortality and hospitalization in dementia subtypes. METHODS A cohort of 11,607 patients with dementia in Alzheimer's disease (AD), vascular dementia (VD), or dementia with Lewy bodies (DLB) was assembled from a large dementia care health records database in Southeast London. A natural language processing algorithm was developed to established whether loss of weight was recorded around the time of dementia diagnosis. Cox proportional hazard models were applied to examine the associations of reported weight loss with mortality and emergency hospitalization. RESULTS Weight loss around the time of dementia was recorded in 25.5% of the whole sample and was most common in patients with DLB. A weight loss-related increased risk for mortality was detected after adjustment for confounders (Hazard ratio (HR):1.07; 95% confidence interval (CI):1.02-1.15) and in patients with AD (HR: 1.11; 95% CI: 1.04-1.20), but not in DLB and VD. Weight loss was associated with a significantly increased emergency hospitalization risk (HR: 1.14; 95% CI: 1.08-1.20) and in all three subtypes. CONCLUSIONS While there were associations with increased hospitalization risk for all three subtype diagnoses, weight loss was only associated with increased mortality in AD. Weight loss should be considered as an accompanying symptom in dementia and interventions should be considered to ameliorate risk of adverse outcomes.
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Affiliation(s)
- Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Semen Gokce Tan
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Sana Jawad
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Lee Smith
- Cambridge Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Dimitrios Tsiptsios
- Neurophysiology Department, Sunderland Royal Hospital, South Tyneside & Sunderland NHS Foundation Trust, Sunderland, UK
| | - Konstantinos Tsamakis
- Second Department of Psychiatry, University General Hospital 'ATTIKON', School of Medicine, Athens, Greece
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robert Stewart
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christoph Mueller
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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16
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Nutritional status assessment in Alzheimer disease and its influence on disease progression. NEUROLOGÍA (ENGLISH EDITION) 2021; 37:735-747. [PMID: 34657824 DOI: 10.1016/j.nrleng.2019.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 11/04/2019] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Nutritional deficiencies are frequent in Alzheimer disease (AD), even in early stages. Nutritional impairment (NI) may be associated with faster disease progression. The objective of this study was to describe the frequency of NI and the associated risk factors at the time of diagnosis and to analyse its influence on subsequent progression. METHODS We performed a prospective, multicentre, observational study of patients recently diagnosed with prodromal AD (pAD) or dementia due to AD (ADd). Two clinical assessments were conducted over a period of 18 months. The Mini Nutritional Assessment test (MNA; score range, 0-30; cut-off point for NI, < 24) was used to estimate nutritional status. Progression was defined as an increase of ≥ 3 points on the Clinical Dementia Rating-sum of boxes test. RESULTS The sample included 50 patients with pAD (mean [standard deviation] age, 76.1 [5.3] years; 68% women), and 127 with ADd (80 [5.9] years; 72.4% women). A total of 141 (79.7%) completed both evaluations. The prevalence of NI was 28.2% (24% for pAD, 29.9% for ADd; P = .43), with the majority (92%) at risk of malnutrition. NI was associated with female sex (odds ratio [OR]: 4.2; 95% confidence interval [CI]: 1.7-10.5; P < .001) and greater behavioural involvement (OR: 5.8; 95% CI: 2.6-12.7; P < .001). A larger proportion of patients with progression was observed among those with NI than among those with normal nutritional status (50% vs 28.7%, P < .05; ADd: 53.6% vs 31.8%, P < .05; pAD: 41.7% vs 22.9%, P = .21). Greater cognitive impairment (OR: 2.1; 95% CI: 1.03-4.4; P < .05) and NI (OR: 2.4; 95% CI: 1.1-5.1; P < .05) were independent risk factors for disease progression. CONCLUSIONS NI is highly prevalent in patients with AD. Assessing nutritional status at the time of diagnosis may enable identification of patients at greater risk of disease progression.
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17
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Moody JN, Valerio KE, Hasselbach AN, Prieto S, Logue MW, Hayes SM, Hayes JP. Body Mass Index and Polygenic Risk for Alzheimer's Disease Predict Conversion to Alzheimer's Disease. J Gerontol A Biol Sci Med Sci 2021; 76:1415-1422. [PMID: 33880516 PMCID: PMC8277084 DOI: 10.1093/gerona/glab117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Indexed: 12/25/2022] Open
Abstract
Body mass index (BMI) is a risk factor for Alzheimer's disease (AD) although the relationship is complex. Obesity in midlife is associated with increased risk for AD, whereas evidence supports both higher and lower BMI increasing risk for AD in late life. This study examined the influence of individual differences in genetic risk for AD to further clarify the relationship between late-life BMI and conversion to AD. Participants included 52 individuals diagnosed as having mild cognitive impairment (MCI) at baseline who converted to AD within 24 months and 52 matched MCI participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort. BMI was measured at baseline. Genetic risk for AD was assessed via genome-wide polygenic risk scores. Conditional logistic regression models were run to determine if BMI and polygenic risk predicted conversion to AD. Results showed an interaction between BMI and genetic risk, such that individuals with lower BMI and higher polygenic risk were more likely to convert to AD relative to individuals with higher BMI. These results remained significant after adjusting for cerebrospinal fluid biomarkers of AD. Exploratory sex-stratified analyses revealed this relationship only remained significant in males. These results show that higher genetic risk in the context of lower BMI predicts conversion to AD in the next 24 months, particularly among males. These findings suggest that genetic risk for AD in the context of lower BMI may serve as a prodromal risk factor for future conversion to AD.
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Affiliation(s)
- Jena N Moody
- Department of Psychology, The Ohio State University, Columbus, USA
| | - Kate E Valerio
- Department of Psychology, The Ohio State University, Columbus, USA
| | | | - Sarah Prieto
- Department of Psychology, The Ohio State University, Columbus, USA
| | - Mark W Logue
- National Center for PTSD, VA Boston Healthcare System, Massachusetts, USA
- Psychiatry and Biomedical Genetics, Boston University School of Medicine, Massachusetts, USA
| | - Scott M Hayes
- Department of Psychology, The Ohio State University, Columbus, USA
- Chronic Brain Injury Initiative, The Ohio State University, Columbus, USA
| | - Jasmeet P Hayes
- Department of Psychology, The Ohio State University, Columbus, USA
- Chronic Brain Injury Initiative, The Ohio State University, Columbus, USA
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18
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Integrative Functional Genomic Analysis of Molecular Signatures and Mechanistic Pathways in the Cell Cycle Underlying Alzheimer's Disease. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:5552623. [PMID: 34336099 PMCID: PMC8290224 DOI: 10.1155/2021/5552623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/25/2021] [Indexed: 11/18/2022]
Abstract
Objective Alzheimer's disease (AD) is associated with cell cycle reentry of mature neurons that subsequently undergo degeneration. This study is aimed to identify key regulators of the cell cycle and their underlying pathways for developing optimal treatment of AD. Methods RNA sequencing data were profiled to screen for differentially expressed genes in the cell cycle. Correlation of created modules with AD phenotype was computed by weight gene correlation network analysis (WGCNA). Signature genes for trophic factor receptors were determined using Pearson correlation coefficient (PCC) analysis. Results Among the 13,679 background genes, 775 cell cycle genes and 77 trophic factor receptors were differentially expressed in AD versus nondementia controls. Four coexpression modules were constructed by WGCNA, among which the turquoise module had the strongest correlation with AD. According to PCC analysis, 10 signature trophic receptors most strongly interacting with cell cycle genes were filtered and subsequently displayed in the global regulatory network. Further cross-talking pathways of signature receptors, such as glutamatergic synapse, long-term potentiation, PI3K-Akt, and MAPK signaling pathways, were identified. Conclusions Our findings highlighted the mechanistic pathways of signature trophic receptors in cell cycle perturbation underlying AD pathogenesis, thereby providing new molecular targets for therapeutic intervention in AD.
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19
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Chen Y, Dang M, Zhang Z. Brain mechanisms underlying neuropsychiatric symptoms in Alzheimer's disease: a systematic review of symptom-general and -specific lesion patterns. Mol Neurodegener 2021; 16:38. [PMID: 34099005 PMCID: PMC8186099 DOI: 10.1186/s13024-021-00456-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/11/2021] [Indexed: 12/16/2022] Open
Abstract
Neuropsychiatric symptoms (NPSs) are common in patients with Alzheimer's disease (AD) and are associated with accelerated cognitive impairment and earlier deaths. This review aims to explore the neural pathogenesis of NPSs in AD and its association with the progression of AD. We first provide a literature overview on the onset times of NPSs. Different NPSs occur in different disease stages of AD, but most symptoms appear in the preclinical AD or mild cognitive impairment stage and develop progressively. Next, we describe symptom-general and -specific patterns of brain lesions. Generally, the anterior cingulate cortex is a commonly damaged region across all symptoms, and the prefrontal cortex, especially the orbitofrontal cortex, is also a critical region associated with most NPSs. In contrast, the anterior cingulate-subcortical circuit is specifically related to apathy in AD, the frontal-limbic circuit is related to depression, and the amygdala circuit is related to anxiety. Finally, we elucidate the associations between the NPSs and AD by combining the onset time with the neural basis of NPSs.
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Affiliation(s)
- Yaojing Chen
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875 China
- BABRI Centre, Beijing Normal University, Beijing, 100875 China
| | - Mingxi Dang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875 China
- BABRI Centre, Beijing Normal University, Beijing, 100875 China
| | - Zhanjun Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875 China
- BABRI Centre, Beijing Normal University, Beijing, 100875 China
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20
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Downregulation of ATP6V1A Involved in Alzheimer's Disease via Synaptic Vesicle Cycle, Phagosome, and Oxidative Phosphorylation. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:5555634. [PMID: 33981384 PMCID: PMC8087993 DOI: 10.1155/2021/5555634] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/02/2021] [Accepted: 03/24/2021] [Indexed: 12/12/2022]
Abstract
Objective The objective of this study was to investigate the potential molecular mechanisms of ATPase H+ transporting V1 subunit A (ATP6V1A) underlying Alzheimer's disease (AD). Methods Microarray expression data of human temporal cortex samples from the GSE118553 dataset were profiled to screen for differentially expressed genes (DEGs) between AD/control and ATP6V1A-low/high groups. Correlations of coexpression modules with AD and ATP6V1A were assessed by weight gene correlation network analysis (WGCNA). DEGs strongly interacting with ATP6V1A were extracted to construct global regulatory network. Further cross-talking pathways of ATP6V1A were identified by functional enrichment analysis. Diagnostic performance of ATP6V1A in AD prediction was evaluated using area under the curve (AUC) analysis. Results The mean expression of ATP6V1A was significantly downregulated in AD compared with nondementia controls. A total of 1,364 DEGs were overlapped from AD/control and ATP6V1A-low/high groups. Based on these DEGs, four coexpression modules were predicted by WGCNA. The blue, brown, and turquoise modules were significantly correlated with AD and low ATP6V1A, whose DEGs were enriched in phagosome, oxidative phosphorylation, synaptic vesicle cycle, focal adhesion, and gamma-aminobutyric acidergic (GABAergic) synapse. Global regulatory network was constructed to identify the cross-talking pathways of ATP6V1A, such as synaptic vesicle cycle, phagosome, and oxidative phosphorylation. According to the AUC value of 74.2%, low ATP6V1A expression accurately predicted the occurrence of AD. Conclusions Our findings highlighted the pleiotropic roles of low ATP6V1A in AD pathogenesis, possibly mediated by synaptic vesicle cycle, phagosome, and oxidative phosphorylation.
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21
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Valotassiou V, Sifakis N, Tzavara C, Lykou E, Tsinia N, Kamtsadeli V, Sali D, Angelidis G, Psimadas D, Tsougos I, Papageorgiou SG, Georgoulias P, Papatriantafyllou J. Eating Disorders in Frontotemporal Dementia and Alzheimer's Disease: Evaluation of Brain Perfusion Correlates Using 99mTc-HMPAO SPECT with Brodmann Areas Analysis. J Alzheimers Dis 2021; 80:1657-1667. [PMID: 33720894 DOI: 10.3233/jad-201434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Eating disorders (ED) in dementia represent a significant impairment affecting patients' and caregivers' lives. In frontotemporal dementia (FTD), ED include overeating, sweet food preference, stereotypical eating, and hyperorality, while in Alzheimer's disease (AD), anorexia and appetite loss are the most common ED. OBJECTIVE The aim of our study was to highlight Brodmann areas (BAs) implicated specifically in the appearance of ED in FTD and AD. METHODS We studied 141 patients, 75 with FTD and 66 with AD. We used the NeuroGamTM software on the reconstructed single photon emission computed tomography-SPECT data for the automated comparison of BAs perfusion on the left (L) and right (R) hemisphere with perfusion in corresponding BAs of a normal database. RESULTS The FTD group included 27 men and 48 women, age (mean±SD) 65.8±8.5 years, duration of disease 3.4±3.3 years, Mini-Mental State Examination (MMSE) 17.9±8.6, ED score on Neuropsychiatric Inventory (NPI) 4.7±8.5. ED in FTD were correlated with hypoperfusion in right anterior and dorsolateral prefrontal cortices (BAs 10R, 46R), left orbitofrontal cortex (BA 12L), orbital part of the right inferior frontal gyrus (BA 47R), and left parahippocampal gyrus (BA 36L). The AD group included 21 men and 45 women, age (mean±SD) 70.2±8.0 years, duration of disease 3.3±2.4 years, MMSE 20.2±6, ED-NPI score 2.7±3.9. ED in AD were correlated with hypoperfusion in left inferior temporal cortex (BA 20L). CONCLUSION SPECT imaging with automated mapping of brain cortex could contribute to the understanding of the neural networks involved in the manifestation of ED in dementia.
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Affiliation(s)
- Varvara Valotassiou
- Nuclear Medicine Department, University Hospital of Larissa, Thessaly, Greece
| | - Nikolaos Sifakis
- Nuclear Medicine Department, "Alexandra" General Hospital, Athens, Greece
| | - Chara Tzavara
- Nuclear Medicine Department, University Hospital of Larissa, Thessaly, Greece
| | - Evi Lykou
- 3rd Age Day Care Center, IASIS, Athens, Greece
| | - Niki Tsinia
- 1st University Psychiatric Department, Aeginition Hospital, Athens, Greece
| | | | - Dimitra Sali
- Neurology Department, Evrokliniki, Athens, Greece
| | - George Angelidis
- Nuclear Medicine Department, University Hospital of Larissa, Thessaly, Greece
| | - Dimitrios Psimadas
- Nuclear Medicine Department, University Hospital of Larissa, Thessaly, Greece
| | - Ioannis Tsougos
- Medical Physics Department, Medical School, University of Thessaly, Greece
| | | | | | - John Papatriantafyllou
- 3rd Age Day Care Center, IASIS, Athens, Greece.,Memory Disorders Clinic, Medical Center, Athens, Greece
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22
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Body mass index trajectories and the risk for Alzheimer's disease among older adults. Sci Rep 2021; 11:3087. [PMID: 33542352 PMCID: PMC7862316 DOI: 10.1038/s41598-021-82593-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/21/2021] [Indexed: 12/14/2022] Open
Abstract
The effect of body mass index (BMI) changes and variability on the risk for Alzheimer’s disease (AD) remains unclear. We analyzed 45,076 participants, whose BMI were measured on phase 1 (2002–2003), phase 2 (2004–2005), and phase 3 (2006–2007), of the Korean National Health Insurance Service-Health Screening Cohort. We evaluated the effect of 2- and 4-year BMI changes and BMI variability on the risk of AD using Cox regression models. In men, association between 2-year BMI changes, BMI variability, and the risk of AD was not significant. Risk of AD was higher in men whose BMI had decreased 10.1–15.0% over 4 years. In women, aHRs and 95% CIs for AD were 1.14 (1.02–1.29), 1.44 (1.17–1.79), and 1.51 (1.09–2.09) when 2-year BMI loss was 5.1–10.0%, 10.1–15.0%, and > 15.0%. The HRs for AD in women significantly increased when 4-year BMI loss was > 5.0%. The aHR and 95% CI for AD was 1.31 (1.17–1.46) in the 4th quartile of average successive variability (ASV) compared with the 1st quartile of ASV in women. BMI loss over 2- and 4-year period was associated with increased risk for AD, and risk increased in women with higher BMI variability. Appropriate body weight management is recommended to prevent AD.
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23
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Fostinelli S, De Amicis R, Leone A, Giustizieri V, Binetti G, Bertoli S, Battezzati A, Cappa SF. Eating Behavior in Aging and Dementia: The Need for a Comprehensive Assessment. Front Nutr 2020; 7:604488. [PMID: 33392240 PMCID: PMC7772186 DOI: 10.3389/fnut.2020.604488] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/23/2020] [Indexed: 01/01/2023] Open
Abstract
Eating behavior can change during aging due to physiological, psychological, and social changes. Modifications can occur at different levels: (1) in food choice, (2) in eating habits, and (3) in dietary intake. A good dietary behavior, like the Mediterranean dietary pattern, can be a protective factor for some aging related pathologies, such as dementia, while a worse eating behavior can lead to pathological conditions such as malnutrition. Changes in eating behavior can also be linked to the onset of dementia: for some types of dementia, such as frontotemporal dementia, dietary changes are one of the key clinical diagnostic feature, for others, like Alzheimer's disease, weight loss is a clinical reported feature. For these reasons, it is important to be able to assess eating behavior in a proper way, considering that there are normal age-related changes. An adequate assessment of dietary behavior can help to plan preventive intervention strategies for heathy aging or can help to identify abnormal behaviors that underline aging related-diseases. In this review, we have analyzed normal age-related and dementia-related changes and the tools that can be used to assess eating behavior. Thus, we make recommendations to screening and monitoring eating behavior in aging and dementia, and to adopt these tools in clinical practice.
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Affiliation(s)
- Silvia Fostinelli
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Ramona De Amicis
- Department of Food, Environmental and Nutritional Sciences, International Center for the Assessment of Nutritional Status, University of Milan, Milan, Italy
| | - Alessandro Leone
- Department of Food, Environmental and Nutritional Sciences, International Center for the Assessment of Nutritional Status, University of Milan, Milan, Italy
| | - Valentina Giustizieri
- Department of Food, Environmental and Nutritional Sciences, International Center for the Assessment of Nutritional Status, University of Milan, Milan, Italy
| | - Giuliano Binetti
- Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Simona Bertoli
- Department of Food, Environmental and Nutritional Sciences, International Center for the Assessment of Nutritional Status, University of Milan, Milan, Italy.,Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Obesity Unit and Laboratory of Nutrition and Obesity Research, Milan, Italy
| | - Alberto Battezzati
- Department of Food, Environmental and Nutritional Sciences, International Center for the Assessment of Nutritional Status, University of Milan, Milan, Italy
| | - Stefano F Cappa
- University School for Advanced Studies, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
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24
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Verhaar BJ, de Leeuw FA, Doorduijn AS, Fieldhouse JL, van de Rest O, Teunissen CE, van Berckel BN, Barkhof F, Visser M, de van der Schueren MA, Scheltens P, Kester MI, Muller M, van der Flier WM. Nutritional status and structural brain changes in Alzheimer's disease: The NUDAD project. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12063. [PMID: 32793798 PMCID: PMC7418890 DOI: 10.1002/dad2.12063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Weight loss is associated with higher mortality and progression of cognitive decline, but its associations with magnetic resonance imaging (MRI) changes related to Alzheimer's disease (AD) are unknown. METHODS We included 412 patients from the NUDAD project, comprising 129 with AD dementia, 107 with mild cognitive impairment (MCI), and 176 controls. Associations between nutritional status and MRI measures were analyzed using linear regression, adjusted for age, sex, education, cognitive functioning, and cardiovascular risk factors. RESULTS Lower body mass index (BMI), fat mass (FM), and fat free mass index were associated with higher medial temporal atrophy (MTA) scores. Lower BMI, FM, and waist circumference were associated with more microbleeds. Stratification by diagnosis showed that the observed associations with microbleeds were only significant in MCI. DISCUSSION Lower indicators of nutritional status were associated with more MTA and microbleeds, with largest effect sizes in MCI.
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Affiliation(s)
- Barbara J.H. Verhaar
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Internal Medicine, Amsterdam Cardiovascular SciencesVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Francisca A. de Leeuw
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Clinical Chemistry, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Astrid S. Doorduijn
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Nutrition and Dietetics, Amsterdam Public Health Research InstituteVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Jay L.P. Fieldhouse
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Ondine van de Rest
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenthe Netherlands
| | - Charlotte E. Teunissen
- Department of Clinical Chemistry, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Bart N.M. van Berckel
- Department of Radiology and Nuclear MedicineVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Frederik Barkhof
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Radiology and Nuclear MedicineVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- UCL Institutes of Neurology and Healthcare EngineeringLondonUnited Kingdom
| | - Marjolein Visser
- Department of Health Sciences, Faculty of ScienceVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Marian A.E. de van der Schueren
- Department of Nutrition and Dietetics, Amsterdam Public Health Research InstituteVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Nutrition and HealthHAN University of Applied SciencesNijmegenthe Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Maartje I. Kester
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Majon Muller
- Department of Internal Medicine, Amsterdam Cardiovascular SciencesVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
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25
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Relationship between malnutrition and different fall risk assessment tools in a geriatric in-patient unit. Aging Clin Exp Res 2020; 32:1279-1287. [PMID: 31482296 DOI: 10.1007/s40520-019-01309-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 08/06/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Despite decades of research evaluating different predictive strategies to identify persons at risk for falls, nutritional issues have received little attention. Malnutrition leads to weight loss associated with muscle weakness and consequently increases the risk of falls. AIMS The current study assessed the association between nutritional state and fall risk scores in a geriatric in-patient unit in Ain Shams University Hospital, Cairo, Egypt. METHODS A cross-sectional study was conducted to assess the nutritional state of 190 older inpatients using a short form of the Mini-Nutritional Assessment (MNA-SF), and the risk of falls was assessed using the Morse Fall Scale (MFS), Johns Hopkins fall risk assessment tool (JH-FRAT), Schmid Fall Risk Assessment Tool (Schmid-FRAT), Hendrich II Fall Risk Model (HII-FRM) and Functional Assessment Instrument (FAI). The generalised linear models (GLM) and odds ratio (OR) were calculated to test the nutritional status as a risk factor for falls. RESULTS Malnutrition was significantly associated with high fall risk as assessed by MFS and HII-FRM (OR = 2.833, 95% CI 1.358-5.913, P = 0.006; OR = 3.477, 95% CI 1.822-6.636, P < 0.001), with the highest OR for JH-FRAT (OR = 5.455, 95% CI 1.548-19.214, P = 0.008). After adjusting for age, the adjusted Charlson Comorbidity Index (ACCI), number of fall risk-increasing drugs (FRIDs), risk of malnutrition or malnourished were significantly associated with high fall risk as assessed by MFS (OR = 2.761, 95% CI 1.306-5.836, P = 0.008), JH-FRAT (OR = 4.938, 95% CI 1.368-17.828, P = 0.015), and HII-FRM (OR = 3.486, 95% CI 1.783-6.815, P < 0.001). CONCLUSIONS This study demonstrated a significant association between malnutrition and fall risk assessment scores, especially JH-FRAT, in hospitalised older patients.
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26
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Qu Y, Hu HY, Ou YN, Shen XN, Xu W, Wang ZT, Dong Q, Tan L, Yu JT. Association of body mass index with risk of cognitive impairment and dementia: A systematic review and meta-analysis of prospective studies. Neurosci Biobehav Rev 2020; 115:189-198. [PMID: 32479774 DOI: 10.1016/j.neubiorev.2020.05.012] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/24/2020] [Accepted: 05/23/2020] [Indexed: 01/10/2023]
Abstract
Controversies persist about the associations of body mass index (BMI) with risk of cognitive impairment and dementia. This study aimed to evaluate these associations from various aspects, in which Embase, PubMed and Cochrane databases were searched to identify prospective studies up to May 2019. Random-effects meta-analyses and dose-response meta-analysis were conducted, involving twenty-nine of 20,083 identified literatures. Meta-analysis showed that midlife underweight, obesity and late-life underweight conferred 1.39-, 1.31- and 1.64-fold excess risk for cognitive impairment and dementia, while late-life overweight and obesity conferred 21% and 25% reduced risk. In dose-response meta-analysis, all cause dementia (ACD), Alzheimer's disease (AD) and vascular dementia (VaD) risk in midlife was significantly elevated when BMI surpassed 29, 30 and 32 kg/m2. AD risk in late-life was decreased when BMI was under 27 kg/m2, while this protection for VaD was absent when BMI surpassed 39 kg/m2. Higher BMI produced opposite exerted opposite effects on dementia in mid- and late-age population. Firstly reported, a dose-response relationship further supports the guideline from the standpoint of dementia prevention.
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Affiliation(s)
- Yi Qu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - He-Ying Hu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ya-Nan Ou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xue-Ning Shen
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Xu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Zuo-Teng Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Qiang Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
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27
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Lee SH, Byun MS, Lee JH, Yi D, Sohn BK, Lee JY, Kim YK, Shin SA, Sohn CH, Lee DY. Sex-Specific Association of Lifetime Body Mass Index with Alzheimer's Disease Neuroimaging Biomarkers. J Alzheimers Dis 2020; 75:767-777. [PMID: 32333586 PMCID: PMC7369081 DOI: 10.3233/jad-191216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Although recent studies indicate that the relationship between body mass index (BMI) and Alzheimer’s disease (AD) may differ by both sex and age of BMI measurement, little information is available on sex- or age-specific associations between BMI and AD neuropathologies. Objective: To examined whether sex-specific BMIs measured at different life-stages (in early adulthood, midlife, and late life) were associated with cerebral amyloid-β (Aβ) deposition and AD-signature region cortical thickness (AD-CT) in cognitively normal (CN) older adults. Methods: A total of 212 CN subjects aged 60–90 years (females 108, males 104), who participated in the Korean Brain Aging Study for Early Diagnosis and Prediction of Alzheimer’s Disease (KBASE), an ongoing prospective cohort study, were included. All participants underwent comprehensive clinical and neuropsychological assessments, [11C] Pittsburgh Compound B positron emission tomography, and brain magnetic resonance imaging. BMIs at different life stages were calculated. Multiple regression analyses were performed separately for either sex. Results: In males, lower early adulthood or midlife BMI was associated with greater cerebral Aβ deposition, but late life BMI was not. Lower midlife BMI was associated with reduced AD-CT, but the BMI in early adulthood and late life was not. In females, no significant association was observed between any lifetime BMI and Aβ deposition or AD-CT. Conclusion: Our results support a male-specific association between BMI prior to late life, and in vivo AD pathologies. Avoiding underweight status early in life may be important to prevent AD dementia in males, but not females.
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Affiliation(s)
- Seung Hoon Lee
- Department of Neuropsychiatry, Bucheon Geriatric Medical Center, Republic of Korea
| | - Min Soo Byun
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jun Ho Lee
- Department of Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Dahyun Yi
- Institute of Human Behavioral Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Bo Kyung Sohn
- Department of Neuropsychiatry, Inje University Sanggye Paik Hospital , Seoul, Republic of Korea
| | - Jun-Young Lee
- Department of Neuropsychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Seong A Shin
- Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Young Lee
- Institute of Human Behavioral Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
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28
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Paul SS. Strategies for home nutritional support in dementia care and its relevance in low-middle-income countries. J Family Med Prim Care 2020; 9:43-48. [PMID: 32110563 PMCID: PMC7014876 DOI: 10.4103/jfmpc.jfmpc_850_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/04/2019] [Accepted: 12/12/2019] [Indexed: 11/30/2022] Open
Abstract
Older people suffering from dementia are prone to develop malnutrition. Ensuring adequate nutrition among such patients has always been a challenge for the carers due to the pathological and chronic nature of the disease. In this article, the author tries to analyze the use of five different strategies in providing adequate nutrition for such patients in their own homes by the carers using a narrative literature review method. The strategies include nutrition screening and assessment, training and education program for the caregiver, mealtime environment and routine modification, provision of nutritional supplements, and role of artificial nutrition and hydration (ANH). An attempt was made to critically engage the readers while exploring the feasibility and challenges involved in implementing such strategies in resource-poor settings like low-middle-income countries. The article concludes that the first four strategies should be used in tandem to prevent the risk of malnutrition. It does not recommend ANH and concludes that it does not bring in any added benefit and may worsen the quality of life.
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Affiliation(s)
- Sherin S Paul
- Department of Community Medicine, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
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29
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Obesity Is Less Frequently Associated with Cognitive Impairment in Elderly Individuals: A Cross-Sectional Study in Yogyakarta, Indonesia. Nutrients 2020; 12:nu12020367. [PMID: 32019161 PMCID: PMC7071195 DOI: 10.3390/nu12020367] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 12/16/2022] Open
Abstract
Obesity is one of the factors associated with cognitive impairment. However, obesity may differently affect cognitive function in different age groups, and scarce data are available from low- and middle-income countries. This cross-sectional study aimed to identify the association between obesity and cognitive impairment among 143 elderly individuals in Yogyakarta. We recorded the sociodemographic factors and some comorbidities, also measured the body mass index as a parameter of obesity, cognitive function using Montreal Cognitive Assessment—Indonesia, mood condition and depression status using geriatric depression scale-short form, as well as the daily life function using Activity of Daily Living and Instrumental Activity of Daily Living. After adjustment for the sociodemographic and comorbidities, we found that subjects with older age were more likely to have cognitive impairment (odds ratio [OR] 3.544, 95%CI: 1.36–9.22, p < 0.01) and compared with elderly individuals with normal weight, obese elderly individuals were 40% less likely to have cognitive impairment (OR 0.604, 95%CI: 0.39–0.95, p < 0.05). This study suggests that obesity in elderly individuals is less frequently associated with cognitive impairment. These findings support the reverse causation mechanism related to body mass index (BMI) and cognitive impairment in low/middle-income countries.
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30
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Izquierdo Delgado E, Gutiérrez Ríos R, Andrés Calvo M, Repiso Gento I, Castrillo Sanz A, Rodríguez Herrero R, Rodríguez Sanz MF, Tola-Arribas MA. Nutritional status assessment in Alzheimer disease and its influence on disease progression. Neurologia 2020; 37:S0213-4853(19)30148-3. [PMID: 31980283 DOI: 10.1016/j.nrl.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/20/2019] [Accepted: 11/04/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Nutritional deficiencies are frequent in Alzheimer disease (AD), even in early stages. Nutritional impairment (NI) may be associated with faster disease progression. The objective of this study was to describe the frequency of NI and the associated risk factors at the time of diagnosis and to analyse its influence on subsequent progression. METHODS We performed a prospective, multicentre, observational study of patients recently diagnosed with prodromal AD (pAD) or dementia due to AD (ADd). Two clinical assessments were conducted over a period of 18months. The Mini Nutritional Assessment test (MNA; score range, 0-30; cut-off point for NI, <24) was used to estimate nutritional status. Progression was defined as an increase of ≥3points on the Clinical Dementia Rating-sum of boxes test. RESULTS The sample included 50 patients with pAD (mean [standard deviation] age, 76.1 [5.3] years; 68% women), and 127 with ADd (80 [5.9] years; 72.4% women). A total of 141 (79.7%) completed both evaluations. The prevalence of NI was 28.2% (24% for pAD, 29.9% for ADd; P=.43), with the majority (92%) at risk of malnutrition. NI was associated with female sex (odds ratio [OR]: 4.2; 95% confidence interval [CI]: 1.7-10.5; P<.001) and greater behavioural involvement (OR: 5.8; 95%CI: 2.6-12.7; P<.001). A larger proportion of patients with progression was observed among those with NI than among those with normal nutritional status (50% vs 28.7%, P<.05; ADd: 53.6% vs 31.8%, P<.05; pAD: 41.7% vs 22.9%, P=.21). Greater cognitive impairment (OR: 2.1; 95%CI: 1.03-4.4; P<.05) and NI (OR: 2.4; 95%CI: 1.1-5.1; P<.05) were independent risk factors for disease progression. CONCLUSIONS NI is highly prevalent in patients with AD. Assessing nutritional status at the time of diagnosis may enable identification of patients at greater risk of disease progression.
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Affiliation(s)
- E Izquierdo Delgado
- Servicio de Medicina Interna, Hospital Universitario Río Hortega, Valladolid, España
| | - R Gutiérrez Ríos
- Sección de Neurología, Complejo Asistencial de Segovia, Segovia, España
| | - M Andrés Calvo
- Servicio de Medicina Interna, Hospital Universitario Río Hortega, Valladolid, España
| | - I Repiso Gento
- Medicina de Familia, Área Sanitaria Valladolid Oeste, Valladolid, España
| | - A Castrillo Sanz
- Sección de Neurología, Complejo Asistencial de Segovia, Segovia, España
| | | | | | - M A Tola-Arribas
- Sección de Neurología, Hospital Universitario Río Hortega, Valladolid, España.
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Roh E, Hwang SY, Kim JA, Lee YB, Hong SH, Kim NH, Seo JA, Kim SG, Kim NH, Choi KM, Baik SH, Yoo HJ. Body Weight Variability Increases Dementia Risk Among Older Adults: A Nationwide Population-Based Cohort Study. Front Endocrinol (Lausanne) 2020; 11:291. [PMID: 32528407 PMCID: PMC7247844 DOI: 10.3389/fendo.2020.00291] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/17/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Recent growing evidences suggest that body weight (Bwt) variability, a repeated loss and regain of weight within a specific period, causes metabolic disturbances and can be a marker for poor homeostasis. Although there have been many studies about the association between Bwt variability and various health status, its association with the incidence of dementia among elderly people has not been examined. Methods: We performed a retrospective elderly cohort study from 19,987 participants with mean age 73 years old in the Korean National Health Insurance Service. We examined the risk of incident dementia, including Alzheimer's dementia and vascular dementia, according to the quartile of Bwt variability, represented as coefficient of variation (Bwt-CV), SD (Bwt-SD), and variability independent of the mean (Bwt-VIM). Results: In fully adjusted model, the group with the highest Bwt variability (Bwt-VIM Q4) showed an increased risk of all-cause dementia (hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.206-1.603) and Alzheimer's dementia (HR 1.46, CI 1.240-1.724) compared to the lowest quartile (Bwt-VIM Q1). We also found that subjects with the highest Bwt variability (Q4) and underweight BMI had a significantly increased risk of developing dementia (HR 1.994, 95% CI 1.302-3.054), while subjects with low Bwt variability (Q1 and Q2) and obese BMI had decreased risk of dementia (HR 0.664, 95% CI 0.505-0.872 and HR 0.648, 95% CI 0.493-0.852, respectively) compared to reference group (lowest Bwt variability (Q1) with normal baseline BMI). The effect of Bwt variability on the incidence of dementia was more prominent in subjects <75 years old and abnormal BMI groups (P for interaction < 0.05). Conclusion: The present study revealed that high Bwt variability was associated with an increased risk of dementia in the elderly.
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Affiliation(s)
- Eun Roh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Soon Young Hwang
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Jung A. Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - So-hyeon Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Ji A. Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
- *Correspondence: Hye Jin Yoo
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Hayes JP, Moody JN, Roca JG, Hayes SM. Body mass index is associated with smaller medial temporal lobe volume in those at risk for Alzheimer's disease. Neuroimage Clin 2019; 25:102156. [PMID: 31927127 PMCID: PMC6953956 DOI: 10.1016/j.nicl.2019.102156] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/26/2019] [Accepted: 12/26/2019] [Indexed: 11/29/2022]
Abstract
Body mass index (BMI) has a complex relationship with Alzheimer's disease (AD); in midlife, high BMI is associated with increased risk for AD, whereas the relationship in late-life is still unclear. To clarify the relationship between late-life BMI and risk for AD, this study examined the extent to which genetic predisposition for AD moderates BMI and AD-related biomarker associations. Participants included 126 cognitively normal older adults at baseline from the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort. Genetic risk for AD was assessed via polygenic hazard score. AD-related biomarkers assessed were medial temporal lobe volume and cerebrospinal fluid (CSF) biomarkers. Hierarchical linear regressions were implemented to examine the effects of BMI and polygenic hazard score on AD-related biomarkers. Results showed that BMI moderated the relationship between genetic risk for AD and medial temporal lobe volume, such that individuals with high BMI and high genetic risk for AD showed lower volume in the entorhinal cortex and hippocampus. In sex-stratified analyses, these results remained significant only in females. Finally, BMI and genetic risk for AD were independently associated with CSF biomarkers of AD. These results provide evidence that high BMI is associated with lower volume in AD-vulnerable brain regions in individuals at genetic risk for AD, particularly females. The genetic pathways of AD may be exacerbated by high BMI. Environmental and genetic risk factors rarely occur in isolation, which underscores the importance of looking at their synergistic effects, as they provide insight into early risk factors for AD that prevention methods could target.
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Affiliation(s)
- Jasmeet P Hayes
- Department of Psychology, The Ohio State University, 225 Psychology Building, 1835 Neil Avenue, Columbus, OH 43210 United States; Chronic Brain Injury Initiative, The Ohio State University, 203 Bricker Hall, 190 North Oval Mall, Columbus, OH 43210 United States.
| | - Jena N Moody
- Department of Psychology, The Ohio State University, 225 Psychology Building, 1835 Neil Avenue, Columbus, OH 43210 United States.
| | - Juan Guzmán Roca
- Department of Psychology, The Ohio State University, 225 Psychology Building, 1835 Neil Avenue, Columbus, OH 43210 United States.
| | - Scott M Hayes
- Department of Psychology, The Ohio State University, 225 Psychology Building, 1835 Neil Avenue, Columbus, OH 43210 United States; Chronic Brain Injury Initiative, The Ohio State University, 203 Bricker Hall, 190 North Oval Mall, Columbus, OH 43210 United States.
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Sun X, Nie B, Zhao S, Chen Q, Li P, Zhang T, Pan T, Feng T, Wang L, Yin X, Zhang W, Zhao S, Shan B, Liu H, Liang S, Ai L, Wang G. Tau PET Distributional Pattern in AD Patients with Visuospatial Dysfunction. Curr Alzheimer Res 2019; 16:1055-1062. [PMID: 31724513 DOI: 10.2174/1567205016666191113152434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/25/2019] [Accepted: 10/21/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Visuospatial dysfunction is one predominant symptom in many atypical Alzheimer's disease (AD) patients, however, until now its neural correlates still remain unclear. For the accumulation of intracellular hyperphosphorylated tau proteins is a major pathogenic factor in neurodegeneration of AD, the distributional pattern of tau could highlight the affected brain regions associated with specific cognitive deficits. OBJECTIVE We investigated the brain regions particularly affected by tau accumulation in patients with visuospatial dysfunction to explore its neural correlates. METHODS Using 18F-AV-1451 tau positron emission tomography (PET), voxel-wise two-sample t-tests were performed between AD patients with obvious visuospatial dysfunction (VS-AD) and cognitively normal subjects, AD patients with little-to-no visuospatial dysfunction (non VS-AD) and cognitively normal subjects, respectively. RESULTS Results showed increased tau accumulations mainly located in occipitoparietal cortex, posterior cingulate cortex, precuneus, inferior and medial temporal cortex in VS-AD patients, while increased tau accumulations mainly occurred in the inferior and medial temporal cortex in non VS-AD patients. CONCLUSION These findings suggested that occipitoparietal cortex, posterior cingulate cortex and precuneus, which were particularly affected by increased tau accumulation in VS-AD patients, may associate with visuospatial dysfunction of AD.
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Affiliation(s)
- Xi Sun
- College of Physical Science and Technology, Zhengzhou University, Zhengzhou 450001, China.,Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, China
| | - Binbin Nie
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, China.,School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing 100049, China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Shujun Zhao
- College of Physical Science and Technology, Zhengzhou University, Zhengzhou 450001, China
| | - Qian Chen
- Department of Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China
| | - Panlong Li
- College of Physical Science and Technology, Zhengzhou University, Zhengzhou 450001, China.,Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, China
| | - Tianhao Zhang
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, China.,School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Tingting Pan
- College of Physical Science and Technology, Zhengzhou University, Zhengzhou 450001, China.,Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, China
| | - Ting Feng
- College of Physical Science and Technology, Zhengzhou University, Zhengzhou 450001, China.,Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, China
| | - Luying Wang
- College of Physical Science and Technology, Zhengzhou University, Zhengzhou 450001, China.,Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, China
| | - Xiaolong Yin
- College of Physical Science and Technology, Zhengzhou University, Zhengzhou 450001, China.,Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, China
| | - Wei Zhang
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, China.,School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Shilun Zhao
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, China.,School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Baoci Shan
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, China.,School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing 100049, China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Hua Liu
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, China.,School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Shengxiang Liang
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China.,Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Lin Ai
- Department of Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China
| | - Guihong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China
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34
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Kim SE, Lee JS, Woo S, Kim S, Kim HJ, Park S, Lee BI, Park J, Kim Y, Jang H, Kim SJ, Cho SH, Lee B, Lockhart SN, Na DL, Seo SW. Sex-specific relationship of cardiometabolic syndrome with lower cortical thickness. Neurology 2019; 93:e1045-e1057. [PMID: 31444241 DOI: 10.1212/wnl.0000000000008084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 04/10/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate whether cardiometabolic factors were associated with age-related differences in cortical thickness in relation to sex. METHODS In this cross-sectional study, we enrolled 1,322 cognitively normal elderly (≥65 years old) individuals (774 [58.5%] men, 548 [41.5%] women). We measured cortical thickness using a surface-based analysis. We analyzed the associations of cardiometabolic risk factors with cortical thickness using multivariate linear regression models after adjusting for possible confounders and interactions with age. RESULT Among women, hypertension (β = -1.119 to -0.024, p < 0.05) and diabetes mellitus (β = -0.920, p = 0.03) were independently associated with lower mean cortical thickness. In addition, there was an interaction effect between obesity (body mass index [BMI] ≥27.5 kg/m2) and age on cortical thickness in women (β = -0.324 to -0.010, p < 0.05), suggesting that age-related differences in cortical thickness were more prominent in obese women compared to women with normal weight. Moreover, low education level (<6 years) was correlated with lower mean cortical thickness (β = -0.053 to -0.046, p < 0.05). Conversely, among men, only being underweight (BMI ≤18.5 kg/m2, β = -2.656 to -0.073, p < 0.05) was associated with lower cortical thickness. CONCLUSIONS Our findings suggest that cortical thickness is more vulnerable to cardiometabolic risk factors in women than in men. Therefore, sex-specific prevention strategies may be needed to protect against accelerated brain aging.
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Affiliation(s)
- Si Eun Kim
- From the Departments of Neurology (S.E.K., H.J.K., S.P., H.J., S.J.K., S.H.C., D.L.N., S.W.S.), Clinical Research Design and Evaluation (S.W.S.), and Health Sciences and Technology (D.L.N.), SAIHST, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; Department of Neurology (S.E.K., B.I.L., J.P.), Inje University College of Medicine, Haeundae Paik Hospital, Busan; Department of Neurology (J.S.L.), Kyung Hee University Hospital; Statistics and Data Center (S.W., S.K.), Center for Clinical Epidemiology (S.W.S.), and Samsung Alzheimer Research Center, Neuroscience Center (H.J.K., S.P., H.J., D.L.N., S.W.S.), Samsung Medical Center, Seoul; Department of Neurology (Y.K.), Kangwon National University College of Medicine, Chuncheon-si, Gangwon-do; Department of Neurology (S.J.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital; Department of Neurology (S.H.C.), Chonnam National University Hospital, Gwangju; Department of Neurology (B.L.), Yuseong Geriatric Rehabilitation Hospital, Pohang, Korea; and Department of Internal Medicine (S.N.L.), Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jin San Lee
- From the Departments of Neurology (S.E.K., H.J.K., S.P., H.J., S.J.K., S.H.C., D.L.N., S.W.S.), Clinical Research Design and Evaluation (S.W.S.), and Health Sciences and Technology (D.L.N.), SAIHST, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; Department of Neurology (S.E.K., B.I.L., J.P.), Inje University College of Medicine, Haeundae Paik Hospital, Busan; Department of Neurology (J.S.L.), Kyung Hee University Hospital; Statistics and Data Center (S.W., S.K.), Center for Clinical Epidemiology (S.W.S.), and Samsung Alzheimer Research Center, Neuroscience Center (H.J.K., S.P., H.J., D.L.N., S.W.S.), Samsung Medical Center, Seoul; Department of Neurology (Y.K.), Kangwon National University College of Medicine, Chuncheon-si, Gangwon-do; Department of Neurology (S.J.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital; Department of Neurology (S.H.C.), Chonnam National University Hospital, Gwangju; Department of Neurology (B.L.), Yuseong Geriatric Rehabilitation Hospital, Pohang, Korea; and Department of Internal Medicine (S.N.L.), Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Sookyoung Woo
- From the Departments of Neurology (S.E.K., H.J.K., S.P., H.J., S.J.K., S.H.C., D.L.N., S.W.S.), Clinical Research Design and Evaluation (S.W.S.), and Health Sciences and Technology (D.L.N.), SAIHST, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; Department of Neurology (S.E.K., B.I.L., J.P.), Inje University College of Medicine, Haeundae Paik Hospital, Busan; Department of Neurology (J.S.L.), Kyung Hee University Hospital; Statistics and Data Center (S.W., S.K.), Center for Clinical Epidemiology (S.W.S.), and Samsung Alzheimer Research Center, Neuroscience Center (H.J.K., S.P., H.J., D.L.N., S.W.S.), Samsung Medical Center, Seoul; Department of Neurology (Y.K.), Kangwon National University College of Medicine, Chuncheon-si, Gangwon-do; Department of Neurology (S.J.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital; Department of Neurology (S.H.C.), Chonnam National University Hospital, Gwangju; Department of Neurology (B.L.), Yuseong Geriatric Rehabilitation Hospital, Pohang, Korea; and Department of Internal Medicine (S.N.L.), Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Seonwoo Kim
- From the Departments of Neurology (S.E.K., H.J.K., S.P., H.J., S.J.K., S.H.C., D.L.N., S.W.S.), Clinical Research Design and Evaluation (S.W.S.), and Health Sciences and Technology (D.L.N.), SAIHST, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; Department of Neurology (S.E.K., B.I.L., J.P.), Inje University College of Medicine, Haeundae Paik Hospital, Busan; Department of Neurology (J.S.L.), Kyung Hee University Hospital; Statistics and Data Center (S.W., S.K.), Center for Clinical Epidemiology (S.W.S.), and Samsung Alzheimer Research Center, Neuroscience Center (H.J.K., S.P., H.J., D.L.N., S.W.S.), Samsung Medical Center, Seoul; Department of Neurology (Y.K.), Kangwon National University College of Medicine, Chuncheon-si, Gangwon-do; Department of Neurology (S.J.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital; Department of Neurology (S.H.C.), Chonnam National University Hospital, Gwangju; Department of Neurology (B.L.), Yuseong Geriatric Rehabilitation Hospital, Pohang, Korea; and Department of Internal Medicine (S.N.L.), Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Hee Jin Kim
- From the Departments of Neurology (S.E.K., H.J.K., S.P., H.J., S.J.K., S.H.C., D.L.N., S.W.S.), Clinical Research Design and Evaluation (S.W.S.), and Health Sciences and Technology (D.L.N.), SAIHST, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; Department of Neurology (S.E.K., B.I.L., J.P.), Inje University College of Medicine, Haeundae Paik Hospital, Busan; Department of Neurology (J.S.L.), Kyung Hee University Hospital; Statistics and Data Center (S.W., S.K.), Center for Clinical Epidemiology (S.W.S.), and Samsung Alzheimer Research Center, Neuroscience Center (H.J.K., S.P., H.J., D.L.N., S.W.S.), Samsung Medical Center, Seoul; Department of Neurology (Y.K.), Kangwon National University College of Medicine, Chuncheon-si, Gangwon-do; Department of Neurology (S.J.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital; Department of Neurology (S.H.C.), Chonnam National University Hospital, Gwangju; Department of Neurology (B.L.), Yuseong Geriatric Rehabilitation Hospital, Pohang, Korea; and Department of Internal Medicine (S.N.L.), Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Seongbeom Park
- From the Departments of Neurology (S.E.K., H.J.K., S.P., H.J., S.J.K., S.H.C., D.L.N., S.W.S.), Clinical Research Design and Evaluation (S.W.S.), and Health Sciences and Technology (D.L.N.), SAIHST, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; Department of Neurology (S.E.K., B.I.L., J.P.), Inje University College of Medicine, Haeundae Paik Hospital, Busan; Department of Neurology (J.S.L.), Kyung Hee University Hospital; Statistics and Data Center (S.W., S.K.), Center for Clinical Epidemiology (S.W.S.), and Samsung Alzheimer Research Center, Neuroscience Center (H.J.K., S.P., H.J., D.L.N., S.W.S.), Samsung Medical Center, Seoul; Department of Neurology (Y.K.), Kangwon National University College of Medicine, Chuncheon-si, Gangwon-do; Department of Neurology (S.J.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital; Department of Neurology (S.H.C.), Chonnam National University Hospital, Gwangju; Department of Neurology (B.L.), Yuseong Geriatric Rehabilitation Hospital, Pohang, Korea; and Department of Internal Medicine (S.N.L.), Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Byung In Lee
- From the Departments of Neurology (S.E.K., H.J.K., S.P., H.J., S.J.K., S.H.C., D.L.N., S.W.S.), Clinical Research Design and Evaluation (S.W.S.), and Health Sciences and Technology (D.L.N.), SAIHST, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; Department of Neurology (S.E.K., B.I.L., J.P.), Inje University College of Medicine, Haeundae Paik Hospital, Busan; Department of Neurology (J.S.L.), Kyung Hee University Hospital; Statistics and Data Center (S.W., S.K.), Center for Clinical Epidemiology (S.W.S.), and Samsung Alzheimer Research Center, Neuroscience Center (H.J.K., S.P., H.J., D.L.N., S.W.S.), Samsung Medical Center, Seoul; Department of Neurology (Y.K.), Kangwon National University College of Medicine, Chuncheon-si, Gangwon-do; Department of Neurology (S.J.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital; Department of Neurology (S.H.C.), Chonnam National University Hospital, Gwangju; Department of Neurology (B.L.), Yuseong Geriatric Rehabilitation Hospital, Pohang, Korea; and Department of Internal Medicine (S.N.L.), Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jinse Park
- From the Departments of Neurology (S.E.K., H.J.K., S.P., H.J., S.J.K., S.H.C., D.L.N., S.W.S.), Clinical Research Design and Evaluation (S.W.S.), and Health Sciences and Technology (D.L.N.), SAIHST, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; Department of Neurology (S.E.K., B.I.L., J.P.), Inje University College of Medicine, Haeundae Paik Hospital, Busan; Department of Neurology (J.S.L.), Kyung Hee University Hospital; Statistics and Data Center (S.W., S.K.), Center for Clinical Epidemiology (S.W.S.), and Samsung Alzheimer Research Center, Neuroscience Center (H.J.K., S.P., H.J., D.L.N., S.W.S.), Samsung Medical Center, Seoul; Department of Neurology (Y.K.), Kangwon National University College of Medicine, Chuncheon-si, Gangwon-do; Department of Neurology (S.J.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital; Department of Neurology (S.H.C.), Chonnam National University Hospital, Gwangju; Department of Neurology (B.L.), Yuseong Geriatric Rehabilitation Hospital, Pohang, Korea; and Department of Internal Medicine (S.N.L.), Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Yeshin Kim
- From the Departments of Neurology (S.E.K., H.J.K., S.P., H.J., S.J.K., S.H.C., D.L.N., S.W.S.), Clinical Research Design and Evaluation (S.W.S.), and Health Sciences and Technology (D.L.N.), SAIHST, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; Department of Neurology (S.E.K., B.I.L., J.P.), Inje University College of Medicine, Haeundae Paik Hospital, Busan; Department of Neurology (J.S.L.), Kyung Hee University Hospital; Statistics and Data Center (S.W., S.K.), Center for Clinical Epidemiology (S.W.S.), and Samsung Alzheimer Research Center, Neuroscience Center (H.J.K., S.P., H.J., D.L.N., S.W.S.), Samsung Medical Center, Seoul; Department of Neurology (Y.K.), Kangwon National University College of Medicine, Chuncheon-si, Gangwon-do; Department of Neurology (S.J.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital; Department of Neurology (S.H.C.), Chonnam National University Hospital, Gwangju; Department of Neurology (B.L.), Yuseong Geriatric Rehabilitation Hospital, Pohang, Korea; and Department of Internal Medicine (S.N.L.), Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Hyemin Jang
- From the Departments of Neurology (S.E.K., H.J.K., S.P., H.J., S.J.K., S.H.C., D.L.N., S.W.S.), Clinical Research Design and Evaluation (S.W.S.), and Health Sciences and Technology (D.L.N.), SAIHST, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; Department of Neurology (S.E.K., B.I.L., J.P.), Inje University College of Medicine, Haeundae Paik Hospital, Busan; Department of Neurology (J.S.L.), Kyung Hee University Hospital; Statistics and Data Center (S.W., S.K.), Center for Clinical Epidemiology (S.W.S.), and Samsung Alzheimer Research Center, Neuroscience Center (H.J.K., S.P., H.J., D.L.N., S.W.S.), Samsung Medical Center, Seoul; Department of Neurology (Y.K.), Kangwon National University College of Medicine, Chuncheon-si, Gangwon-do; Department of Neurology (S.J.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital; Department of Neurology (S.H.C.), Chonnam National University Hospital, Gwangju; Department of Neurology (B.L.), Yuseong Geriatric Rehabilitation Hospital, Pohang, Korea; and Department of Internal Medicine (S.N.L.), Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Seung Joo Kim
- From the Departments of Neurology (S.E.K., H.J.K., S.P., H.J., S.J.K., S.H.C., D.L.N., S.W.S.), Clinical Research Design and Evaluation (S.W.S.), and Health Sciences and Technology (D.L.N.), SAIHST, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; Department of Neurology (S.E.K., B.I.L., J.P.), Inje University College of Medicine, Haeundae Paik Hospital, Busan; Department of Neurology (J.S.L.), Kyung Hee University Hospital; Statistics and Data Center (S.W., S.K.), Center for Clinical Epidemiology (S.W.S.), and Samsung Alzheimer Research Center, Neuroscience Center (H.J.K., S.P., H.J., D.L.N., S.W.S.), Samsung Medical Center, Seoul; Department of Neurology (Y.K.), Kangwon National University College of Medicine, Chuncheon-si, Gangwon-do; Department of Neurology (S.J.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital; Department of Neurology (S.H.C.), Chonnam National University Hospital, Gwangju; Department of Neurology (B.L.), Yuseong Geriatric Rehabilitation Hospital, Pohang, Korea; and Department of Internal Medicine (S.N.L.), Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Soo Hyun Cho
- From the Departments of Neurology (S.E.K., H.J.K., S.P., H.J., S.J.K., S.H.C., D.L.N., S.W.S.), Clinical Research Design and Evaluation (S.W.S.), and Health Sciences and Technology (D.L.N.), SAIHST, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; Department of Neurology (S.E.K., B.I.L., J.P.), Inje University College of Medicine, Haeundae Paik Hospital, Busan; Department of Neurology (J.S.L.), Kyung Hee University Hospital; Statistics and Data Center (S.W., S.K.), Center for Clinical Epidemiology (S.W.S.), and Samsung Alzheimer Research Center, Neuroscience Center (H.J.K., S.P., H.J., D.L.N., S.W.S.), Samsung Medical Center, Seoul; Department of Neurology (Y.K.), Kangwon National University College of Medicine, Chuncheon-si, Gangwon-do; Department of Neurology (S.J.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital; Department of Neurology (S.H.C.), Chonnam National University Hospital, Gwangju; Department of Neurology (B.L.), Yuseong Geriatric Rehabilitation Hospital, Pohang, Korea; and Department of Internal Medicine (S.N.L.), Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Byungju Lee
- From the Departments of Neurology (S.E.K., H.J.K., S.P., H.J., S.J.K., S.H.C., D.L.N., S.W.S.), Clinical Research Design and Evaluation (S.W.S.), and Health Sciences and Technology (D.L.N.), SAIHST, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; Department of Neurology (S.E.K., B.I.L., J.P.), Inje University College of Medicine, Haeundae Paik Hospital, Busan; Department of Neurology (J.S.L.), Kyung Hee University Hospital; Statistics and Data Center (S.W., S.K.), Center for Clinical Epidemiology (S.W.S.), and Samsung Alzheimer Research Center, Neuroscience Center (H.J.K., S.P., H.J., D.L.N., S.W.S.), Samsung Medical Center, Seoul; Department of Neurology (Y.K.), Kangwon National University College of Medicine, Chuncheon-si, Gangwon-do; Department of Neurology (S.J.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital; Department of Neurology (S.H.C.), Chonnam National University Hospital, Gwangju; Department of Neurology (B.L.), Yuseong Geriatric Rehabilitation Hospital, Pohang, Korea; and Department of Internal Medicine (S.N.L.), Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Samuel N Lockhart
- From the Departments of Neurology (S.E.K., H.J.K., S.P., H.J., S.J.K., S.H.C., D.L.N., S.W.S.), Clinical Research Design and Evaluation (S.W.S.), and Health Sciences and Technology (D.L.N.), SAIHST, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; Department of Neurology (S.E.K., B.I.L., J.P.), Inje University College of Medicine, Haeundae Paik Hospital, Busan; Department of Neurology (J.S.L.), Kyung Hee University Hospital; Statistics and Data Center (S.W., S.K.), Center for Clinical Epidemiology (S.W.S.), and Samsung Alzheimer Research Center, Neuroscience Center (H.J.K., S.P., H.J., D.L.N., S.W.S.), Samsung Medical Center, Seoul; Department of Neurology (Y.K.), Kangwon National University College of Medicine, Chuncheon-si, Gangwon-do; Department of Neurology (S.J.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital; Department of Neurology (S.H.C.), Chonnam National University Hospital, Gwangju; Department of Neurology (B.L.), Yuseong Geriatric Rehabilitation Hospital, Pohang, Korea; and Department of Internal Medicine (S.N.L.), Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Duk L Na
- From the Departments of Neurology (S.E.K., H.J.K., S.P., H.J., S.J.K., S.H.C., D.L.N., S.W.S.), Clinical Research Design and Evaluation (S.W.S.), and Health Sciences and Technology (D.L.N.), SAIHST, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; Department of Neurology (S.E.K., B.I.L., J.P.), Inje University College of Medicine, Haeundae Paik Hospital, Busan; Department of Neurology (J.S.L.), Kyung Hee University Hospital; Statistics and Data Center (S.W., S.K.), Center for Clinical Epidemiology (S.W.S.), and Samsung Alzheimer Research Center, Neuroscience Center (H.J.K., S.P., H.J., D.L.N., S.W.S.), Samsung Medical Center, Seoul; Department of Neurology (Y.K.), Kangwon National University College of Medicine, Chuncheon-si, Gangwon-do; Department of Neurology (S.J.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital; Department of Neurology (S.H.C.), Chonnam National University Hospital, Gwangju; Department of Neurology (B.L.), Yuseong Geriatric Rehabilitation Hospital, Pohang, Korea; and Department of Internal Medicine (S.N.L.), Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Sang Won Seo
- From the Departments of Neurology (S.E.K., H.J.K., S.P., H.J., S.J.K., S.H.C., D.L.N., S.W.S.), Clinical Research Design and Evaluation (S.W.S.), and Health Sciences and Technology (D.L.N.), SAIHST, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; Department of Neurology (S.E.K., B.I.L., J.P.), Inje University College of Medicine, Haeundae Paik Hospital, Busan; Department of Neurology (J.S.L.), Kyung Hee University Hospital; Statistics and Data Center (S.W., S.K.), Center for Clinical Epidemiology (S.W.S.), and Samsung Alzheimer Research Center, Neuroscience Center (H.J.K., S.P., H.J., D.L.N., S.W.S.), Samsung Medical Center, Seoul; Department of Neurology (Y.K.), Kangwon National University College of Medicine, Chuncheon-si, Gangwon-do; Department of Neurology (S.J.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital; Department of Neurology (S.H.C.), Chonnam National University Hospital, Gwangju; Department of Neurology (B.L.), Yuseong Geriatric Rehabilitation Hospital, Pohang, Korea; and Department of Internal Medicine (S.N.L.), Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
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Kimura A, Sugimoto T, Kitamori K, Saji N, Niida S, Toba K, Sakurai T. Malnutrition is Associated with Behavioral and Psychiatric Symptoms of Dementia in Older Women with Mild Cognitive Impairment and Early-Stage Alzheimer's Disease. Nutrients 2019; 11:E1951. [PMID: 31434232 PMCID: PMC6723872 DOI: 10.3390/nu11081951] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/06/2019] [Accepted: 08/16/2019] [Indexed: 01/15/2023] Open
Abstract
We examined the nutritional status and its association with behavioral psychiatric symptoms of dementia (BPSD) among 741 memory clinic patients (normal cognition (NC), 152; mild cognitive impairment (MCI), 271; early-stage Alzheimer disease (AD), 318). Nutritional status and BPSD were assessed using the Mini Nutritional Assessment Short-Form (MNA-SF) and the Dementia Behavior Disturbance Scale (DBD), respectively. Compared to subjects with NC, more subjects with MCI and early-stage AD were at risk of malnutrition (MNA-SF, 8-11: NC, 34.2%; MCI, 47.5%; early-stage AD, 53.8%) and were malnourished (MNA-SF, 0-7: NC, 4.6%; MCI, 5.9%; early-stage AD, 8.2%). Among patients with MCI or early-stage AD, those at risk of/with malnutrition showed higher DBD scores than those well-nourished (12.7 ± 9.0 vs. 9.5 ± 7.3; p < 0.001). Moreover, analysis of covariance adjusting for confounders showed that nutritional status was significantly associated with specific BPSD, including "verbal aggressiveness/emotional disinhibition" (F = 5.87, p = 0.016) and "apathy/memory impairment" (F = 15.38, p < 0.001), which were revealed by factor analysis of DBD. Our results suggest that malnutrition is common among older adults with mild cognitive decline, and possibility that nutritional problems are associated with individual BPSD.
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Affiliation(s)
- Ai Kimura
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
- Medical Genome Center, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
- Department of Cognitive and Behavioral Science, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Taiki Sugimoto
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
- Medical Genome Center, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 657-8501, Japan
| | - Kazuya Kitamori
- Department of Food and Nutritional Environment, College of Human Life and Environment, Kinjo Gakuin University, Nagoya 463-0021, Japan
| | - Naoki Saji
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
| | - Shumpei Niida
- Medical Genome Center, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
| | - Kenji Toba
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan.
- Department of Cognitive and Behavioral Science, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan.
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Doucet GE, Rasgon N, McEwen BS, Micali N, Frangou S. Elevated Body Mass Index is Associated with Increased Integration and Reduced Cohesion of Sensory-Driven and Internally Guided Resting-State Functional Brain Networks. Cereb Cortex 2019; 28:988-997. [PMID: 28119342 DOI: 10.1093/cercor/bhx008] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Indexed: 12/11/2022] Open
Abstract
Elevated body mass index (BMI) is associated with increased multi-morbidity and mortality. The investigation of the relationship between BMI and brain organization has the potential to provide new insights relevant to clinical and policy strategies for weight control. Here, we quantified the association between increasing BMI and the functional organization of resting-state brain networks in a sample of 496 healthy individuals that were studied as part of the Human Connectome Project. We demonstrated that higher BMI was associated with changes in the functional connectivity of the default-mode network (DMN), central executive network (CEN), sensorimotor network (SMN), visual network (VN), and their constituent modules. In siblings discordant for obesity, we showed that person-specific factors contributing to obesity are linked to reduced cohesiveness of the sensory networks (SMN and VN). We conclude that higher BMI is associated with widespread alterations in brain networks that balance sensory-driven (SMN, VN) and internally guided (DMN, CEN) states which may augment sensory-driven behavior leading to overeating and subsequent weight gain. Our results provide a neurobiological context for understanding the association between BMI and brain functional organization while accounting for familial and person-specific influences.
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Affiliation(s)
- Gaelle E Doucet
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, USA
| | - Natalie Rasgon
- Center for Neuroscience in Women's Health, Stanford University, Palo Alto, CA 91304, USA
| | - Bruce S McEwen
- Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY 10065, USA
| | - Nadia Micali
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, USA
| | - Sophia Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, USA
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Thirunavu V, McCullough A, Su Y, Flores S, Dincer A, Morris JC, Cruchaga C, Benzinger TL, Gordon BA. Higher Body Mass Index Is Associated with Lower Cortical Amyloid-β Burden in Cognitively Normal Individuals in Late-Life. J Alzheimers Dis 2019; 69:817-827. [PMID: 31156169 PMCID: PMC7047466 DOI: 10.3233/jad-190154] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Both low and high body mass index (BMI) have been associated with an increased risk of dementia, including that caused by Alzheimer's disease (AD). Specifically, high middle-age BMI or a low late-age BMI has been considered a predictor for the development of AD dementia. Less studied is the relationship between BMI and AD pathology. OBJECTIVE We explored the association between BMI and cortical amyloid-β (Aβ) burden in cognitively normal participants that were either in mid-life (45-60 years) or late-life (>60). METHODS We analyzed cross-sectional baseline data from the Knight Alzheimer Disease Research Center (ADRC) at Washington University. Aβ pathology was measured in 373 individuals with Aβ PET imaging and was quantified using Centiloid units. We split the cohort into mid- and late-life groups for analyses (n = 96 and n = 277, respectively). We ran general linear regression models to predict Aβ levels from BMI while controlling for age, sex, years of education, and APOE4 status. Analyses were also conducted to test the interaction between BMI and APOE4 genotype and between BMI and sex. RESULTS Higher BMI was associated with lower cortical Aβ burden in late-life (β= -0.81, p = 0.0066), but no relationship was found in mid-life (β= 0.04, p > 0.5). The BMI×APOE4+ and BMI×male interaction terms were not significant in the mid-life (β= 0.28, p = 0.41; β= 0.64, p = 0.13) or the late-life (β= 0.17, p > 0.5; β= 0.50, p = 0.43) groups. CONCLUSION Higher late-life BMI is associated with lower cortical Aβ burden in cognitively normal individuals.
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Affiliation(s)
| | - Austin McCullough
- Department of Radiology, Washington University in St. Louis, MO, USA
| | - Yi Su
- Banner Alzheimer’s Institute, Phoenix, AZ, USA
| | - Shaney Flores
- Department of Radiology, Washington University in St. Louis, MO, USA
| | - Aylin Dincer
- Department of Radiology, Washington University in St. Louis, MO, USA
| | - John C. Morris
- Knight Alzheimer Disease Research Center, Washington University in St. Louis, MO, USA
- Department of Neurology, Washington University in St. Louis, MO, USA
| | - Carlos Cruchaga
- Knight Alzheimer Disease Research Center, Washington University in St. Louis, MO, USA
- Department of Psychiatry, Washington University in St. Louis, MO, USA
| | - Tammie L.S. Benzinger
- Department of Radiology, Washington University in St. Louis, MO, USA
- Knight Alzheimer Disease Research Center, Washington University in St. Louis, MO, USA
| | - Brian A. Gordon
- Department of Radiology, Washington University in St. Louis, MO, USA
- Knight Alzheimer Disease Research Center, Washington University in St. Louis, MO, USA
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Herke M, Fink A, Langer G, Wustmann T, Watzke S, Hanff A, Burckhardt M. Environmental and behavioural modifications for improving food and fluid intake in people with dementia. Cochrane Database Syst Rev 2018; 7:CD011542. [PMID: 30021248 PMCID: PMC6513567 DOI: 10.1002/14651858.cd011542.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Weight loss, malnutrition and dehydration are common problems for people with dementia. Environmental modifications such as, change of routine, context or ambience at mealtimes, or behavioural modifications, such as education or training of people with dementia or caregivers, may be considered to try to improve food and fluid intake and nutritional status of people with dementia. OBJECTIVES Primary: To assess the effects of environmental or behavioural modifications on food and fluid intake and nutritional status in people with dementia. Secondary: To assess the effects of environmental or behavioural modifications in connection with nutrition on mealtime behaviour, cognitive and functional outcomes and quality of life, in specific settings (i.e. home care, residential care and nursing home care) for different stages of dementia. To assess the adverse consequences or effects of the included interventions. SEARCH METHODS We searched the Specialized Register of Cochrane Dementia and Cognitive Improvement (ALOIS), MEDLINE, Eembase, PsycINFO, CINAHL, ClinicalTrials.gov and the World Health Organization (WHO) portal/ICTRP on 17 January 2018. We scanned reference lists of other reviews and of included articles. SELECTION CRITERIA We included randomised controlled trials (RCTs) investigating interventions designed to modify the mealtime environment of people with dementia, to modify the mealtime behaviour of people with dementia or their caregivers, or both, with the intention of improving food and fluid intake. We included people with any common dementia subtype. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed the risk of bias of included trials. We assessed the quality of evidence for each outcome using the GRADE approach. MAIN RESULTS We included nine studies, investigating 1502 people. Three studies explicitly investigated participants with Alzheimer's disease; six did not specify the type of dementia. Five studies provided clear measures to identify the severity of dementia at baseline, and overall very mild to severe stages were covered. The interventions and outcome measures were diverse. The overall quality of evidence was mainly low to very low.One study implemented environmental as well as behavioural modifications by providing additional food items between meals and personal encouragement to consume them. The control group received no intervention. Differences between groups were very small and the quality of the evidence from this study was very low, so we are very uncertain of any effect of this intervention.The remaining eight studies implemented behavioural modifications.Three studies provided nutritional education and nutrition promotion programmes. Control groups did not receive these programmes. After 12 months, the intervention group showed slightly higher protein intake per day (mean difference (MD) 0.11 g/kg, 95% confidence interval (CI) -0.01 to 0.23; n = 78, 1 study; low-quality evidence), but there was no clear evidence of a difference in nutritional status assessed with body mass index (BMI) (MD -0.26 kg/m² favouring control, 95% CI -0.70 to 0.19; n = 734, 2 studies; moderate-quality evidence), body weight (MD -1.60 kg favouring control, 95% CI -3.47 to 0.27; n = 656, 1 study; moderate-quality evidence), or score on Mini Nutritional Assessment (MNA) (MD -0.10 favouring control, 95% CI -0.67 to 0.47; n = 656, 1 study; low-quality evidence). After six months, the intervention group in one study had slightly lower BMI (MD -1.79 kg/m² favouring control, 95% CI -1.28 to -2.30; n = 52, 1 study; moderate-quality evidence) and body weight (MD -8.11 kg favouring control, 95% CI -2.06 to -12.56; n = 52, 1 study; moderate-quality evidence). This type of intervention may have a small positive effect on food intake, but little or no effect, or a negative effect, on nutritional status.Two studies compared self-feeding skills training programmes. In one study, the control group received no training and in the other study the control group received a different self-feeding skills training programme. For both comparisons the quality of the evidence was very low and we are very uncertain whether these interventions have any effect.One study investigated general training of nurses to impart knowledge on how to feed people with dementia and improve attitudes towards people with dementia. Again, the quality of the evidence was very low so that we cannot be certain of any effect.Two studies investigated vocal or tactile positive feedback provided by caregivers while feeding participants. After three weeks, the intervention group showed an increase in calories consumed per meal (MD 200 kcal, 95% CI 119.81 to 280.19; n = 42, 1 study; low-quality evidence) and protein consumed per meal (MD 15g, 95% CI 7.74 to 22.26; n = 42, 1 study; low-quality evidence). This intervention may increase the intake of food and liquids slightly; nutritional status was not assessed. AUTHORS' CONCLUSIONS Due to the quantity and quality of the evidence currently available, we cannot identify any specific environmental or behavioural modifications for improving food and fluid intake in people with dementia.
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Affiliation(s)
- Max Herke
- Martin Luther University Halle‐WittenbergInstitute for Medical SociologyMagdeburger Str. 8Halle (Saale)Germany06112
| | - Astrid Fink
- Martin Luther University Halle‐WittenbergInstitute for Medical SociologyMagdeburger Str. 8Halle (Saale)Germany06112
| | - Gero Langer
- Martin Luther University Halle‐WittenbergInstitute of Health and Nursing SciencesMagdeburger Strasse 8Halle (Saale)Germany06112
| | - Tobias Wustmann
- Martin Luther University Halle‐WittenbergDepartment of Psychiatry, Psychotherapy and PsychosomaticsJulius Kühn Strasse 7Halle (Saale)Germany06112
| | - Stefan Watzke
- Martin Luther University Halle‐WittenbergDepartment of Psychiatry, Psychotherapy and PsychosomaticsJulius Kühn Strasse 7Halle (Saale)Germany06112
| | | | - Marion Burckhardt
- Martin Luther University Halle‐WittenbergInstitute of Health and Nursing SciencesMagdeburger Strasse 8Halle (Saale)Germany06112
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Rocaspana-García M, Blanco-Blanco J, Arias-Pastor A, Gea-Sánchez M, Piñol-Ripoll G. Study of community-living Alzheimer's patients' adherence to the Mediterranean diet and risks of malnutrition at different disease stages. PeerJ 2018; 6:e5150. [PMID: 30002978 PMCID: PMC6037138 DOI: 10.7717/peerj.5150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/12/2018] [Indexed: 01/09/2023] Open
Abstract
Background Alzheimer’s disease (AD) is a neurodegenerative disease that is characterized by deficits in episodic memory. It is the most common form of dementia and affects 50–70% of patients with cognitive impairments over the age of 65. Elderly people are particularly susceptible to malnutrition and that risk is even higher in patients with AD. This study assessed the nutritional status of patients with AD at different stages of AD and explored how that status correlated with cognitive, functional and behavioural variables and caregiver overburden. The characteristics of the diet and the degree of adherence to the Mediterranean diet were also analysed. Methods This was a cross-sectional study that was representative of the general population and it was carried out in the Unit of Cognitive Disorders, Lleida, Spain. The participants were 111 subjects with AD who were aged 65 and over and still living at home. The subjects’ nutritional status was assessed using the Mini Nutritional Assessment (MNA) and Controlling Nutritional Status system. The monthly food intake was estimated using the short Food Frequency Questionnaire and adherence to the Mediterranean diet was evaluated using the Mediterranean Diet Score. The Mini Mental State Examination (MMSE), Global Deterioration Scale, Neuropsychiatric Inventory (NPI) and Zarit Burden Interview (ZBI) were also used. Results We found that 68% of the subjects presented with a risk of malnutrition and 19% were malnourished according to the MNA scale. Patients ate a higher quantity of meat and dairy products than recommended and fewer products from the remaining healthier food groups. Of the 111 subjects, 73% showed low adherence to the Mediterranean diet and 27% showed moderate adherence. There was a partial correlation between nutritional status and the MMSE when the data were adjusted for age and sex (r = 0, 318; p = 0.001) and inverse correlations were found for functional status (r = − 0.283; p = 0.004) and the NPI (r = − 0.409; p = 0.000) and ZBI scales (r = − 0.433; p = 0.000) when they were adjusted using the same variables. The ZBI scale (OR 1.08, 95% CI [1.01–1.15]) showed an increase in the risk of malnutrition in the multivariate analysis. Discussion Alterations in nutritional status were more common during the advanced stages of AD and were also associated with behavioural changes and caregiver overburden. Low adherence to traditional healthy diets in Mediterranean countries and food intake profiles should be considered when managing patients with AD. Other countries can use the results to examine diets in people with AD that are high in meat and dairy and low in healthy food groups like fruit and vegetables.
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Affiliation(s)
| | - Joan Blanco-Blanco
- GESEC Research Group, Faculty of Nursing and Physiotherapy, University of Lleida, Health Care Research Group (GRECS), Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
| | - Alfonso Arias-Pastor
- Unit of Cognitive Disorders, Santa Maria University Hospital, Clinical Neuroscience Research, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
| | - Montserrat Gea-Sánchez
- GESEC Research Group, Faculty of Nursing and Physiotherapy, University of Lleida, Health Care Research Group (GRECS), Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
| | - Gerard Piñol-Ripoll
- Unit of Cognitive Disorders, Santa Maria University Hospital, Clinical Neuroscience Research, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
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Suma S, Watanabe Y, Hirano H, Kimura A, Edahiro A, Awata S, Yamashita Y, Matsushita K, Arai H, Sakurai T. Factors affecting the appetites of persons with Alzheimer's disease and mild cognitive impairment. Geriatr Gerontol Int 2018; 18:1236-1243. [PMID: 29808955 DOI: 10.1111/ggi.13455] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/04/2018] [Accepted: 04/25/2018] [Indexed: 11/30/2022]
Abstract
AIM Appetite loss has been associated with Alzheimer's disease (AD) and mild cognitive impairment (MCI). Among older people, decreased appetite can result in poor nutrition and subsequent loss of independent living. We examined the factors related to appetite loss in persons with AD and MCI to provide evidence for countermeasures to prevent appetite loss and progression of cognitive impairment. METHODS We included 1238 older adults undergoing outpatient treatment at the Center for Comprehensive Care and Research on Memory Disorders (Medical Center for Dementia) at the National Center for Geriatrics and Gerontology in Obu, Japan. The Council on Nutrition Appetite Questionnaire, an appetite questionnaire for older people, was used to evaluate appetite. Appetite loss in persons diagnosed with AD or MCI was divided into two groups according to the Council on Nutrition Appetite Questionnaire scores, and logistic regression analysis was carried out to identify independent factors associated with appetite loss. The following variables were used to evaluate for covariates: general information, functional evaluation and medications. RESULTS The AD and MCI groups contained 853 and 385 individuals, respectively. In both groups, depression and difficulty in maintaining attention while eating were significantly associated with poor appetite. Among persons with AD, lower vitality, more comorbidities, non-use of antidementia drugs and use of psychotropic drugs were also significantly associated with poor appetite. CONCLUSIONS The present study recognized possible factors individually associated with appetite loss among persons with AD or MCI. Future studies are required to examine supportive strategies to treat poor appetite in these populations. Geriatr Gerontol Int 2018; 18: 1236-1243.
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Affiliation(s)
- Shino Suma
- Section of Preventive and Public Health Dentistry, Division of Oral Health Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan.,Department of Oral Diseases Research, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yutaka Watanabe
- Department of Oral Diseases Research, National Center for Geriatrics and Gerontology, Obu, Japan.,Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | | | - Ai Kimura
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ayako Edahiro
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Shuichi Awata
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yoshihisa Yamashita
- Section of Preventive and Public Health Dentistry, Division of Oral Health Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Kenji Matsushita
- Department of Oral Diseases Research, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
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Sugimoto T, Nakamura A, Kato T, Iwata K, Saji N, Arahata Y, Hattori H, Bundo M, Ito K, Niida S, Sakurai T. Decreased Glucose Metabolism in Medial Prefrontal Areas is Associated with Nutritional Status in Patients with Prodromal and Early Alzheimer's Disease. J Alzheimers Dis 2018; 60:225-233. [PMID: 28826182 DOI: 10.3233/jad-170257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Weight loss is frequently observed in patients with Alzheimer's disease (AD); however, the underlying mechanisms are not well understood. OBJECTS To clarify the associations between nutritional status and AD-related brain changes using Pittsburgh Compound-B (PiB)-PET, fluorodeoxyglucose (FDG)-PET, and structural MRI. METHODS The subjects were 34 amyloid-β (Aβ)-positive individuals with mild cognitive impairment or early AD (prodromal/early AD), and 55 Aβ-negative cognitively normal (CN) subjects who attended the Multimodal Neuroimaging for AD Diagnosis (MULNIAD) study. Nutritional status of the subjects was assessed by body mass index and waist to height ratio (waist circumference/height). The associations between nutritional status and brain changes were examined by multiple regression analysis using statistical parametric mapping. RESULTS In the prodromal/early AD group, nutritional status was significantly positively correlated with regional cerebral glucose metabolism (rCGM) in the medial prefrontal cortices, while different topographical associations were seen in the CN group, suggesting these changes were AD-specific. Aβ deposition and gray matter volume were not significantly associated with nutritional status. Sub-analysis in the prodromal/early AD group demonstrated that fat mass index, but not fat-free mass index, was positively correlated with rCGM in the medial prefrontal areas. CONCLUSION This present study provides preliminary results suggesting that hypometabolism in the medial prefrontal areas is specifically associated with AD-related weight loss, and decrease in fat mass may have a key role.
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Affiliation(s)
- Taiki Sugimoto
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.,Medical Genome Center, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Community Health Sciences, Kobe University, Graduate School of Health Sciences, Kobe, Japan
| | - Akinori Nakamura
- Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takashi Kato
- Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kaori Iwata
- Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Naoki Saji
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yutaka Arahata
- Department of Neurology, National Centerfor Geriatrics and Gerontology, Obu, Japan
| | - Hideyuki Hattori
- Department of Psychiatry, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Masahiko Bundo
- Department of Neurosurgery, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kengo Ito
- Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Radiology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shumpei Niida
- Medical Genome Center, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
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Bloch K, Gil-Ad I, Vanichkin A, Hornfeld SH, Koroukhov N, Taler M, Vardi P, Weizman A. Intracerebroventricular Streptozotocin Induces Obesity and Dementia in Lewis Rats. J Alzheimers Dis 2018; 60:121-136. [PMID: 28800326 DOI: 10.3233/jad-161289] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Animal models of dementia associated with metabolic abnormalities play an important role in understanding the bidirectional relationships between these pathologies. Rodent strains develop cognitive dysfunctions without alteration of peripheral metabolism following intracerebroventricular administration of streptozotocin (icv-STZ). OBJECTIVE We aimed to estimate the effect of icv-STZ on cognitive functions and peripheral metabolism in Lewis rats, which are rarely used for the induction of cognitive abnormalities. METHODS Inbred adult Lewis rats were treated with single icv-STZ (3 mg/kg). Cognitive functions were assessed using Morris water maze (MWM) test and locomotion by the Open Field test. Metabolic alterations were studied using histological and biochemical analysis of brain and peripheral tissues. RESULTS The icv-STZ induced rapid weight decline during the first two weeks. Thereafter, the rats showed an accelerated weight gain. Three months after the icv-STZ treatment, the rats were severely obese and revealed fatty liver, pancreatic islet hypertrophy, significantly elevated levels of blood insulin, leptin, and adiponectin, but intact peripheral glucose homeostasis. The icv-STZ rats expressed amyloid-β deposits in blood vessels of leptomeningeal area, microgliosis, astrogliosis, and spongiosis in fimbria-fornix area of hippocampus. Locomotor activities of icv-STZ treated and sham-operated rats were similar. In the MWM test, the icv-STZ treated rats demonstrated severely impaired spatial learning during both acquisition and reversal phases. CONCLUSIONS Icv-STZ treated Lewis rats develop severe dementia associated with obesity and peripheral metabolic abnormalities. This animal model may be useful for exploring the pathophysiological relationship between obesity and dementia and provides a new tool for development of effective therapy.
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Affiliation(s)
- Konstantin Bloch
- Laboratory of Diabetes and Obesity Research, Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Irit Gil-Ad
- Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Alexey Vanichkin
- Laboratory of Transplantation, Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Shay Henry Hornfeld
- Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Nickolay Koroukhov
- Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Michal Taler
- Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Pnina Vardi
- Laboratory of Diabetes and Obesity Research, Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Abraham Weizman
- Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel.,Research Unit, Geha Mental Health Center, Petah Tikva, Israel
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Hsu DC, Mormino EC, Schultz AP, Amariglio RE, Donovan NJ, Rentz DM, Johnson KA, Sperling RA, Marshall GA. Lower Late-Life Body-Mass Index is Associated with Higher Cortical Amyloid Burden in Clinically Normal Elderly. J Alzheimers Dis 2018; 53:1097-105. [PMID: 27340843 DOI: 10.3233/jad-150987] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Lower body-mass index (BMI) in late life has been associated with an increased risk of dementia, and weight loss has been associated with more rapid decline in Alzheimer's disease (AD) dementia. OBJECTIVE To explore the association between BMI and cortical amyloid burden in clinically normal (CN) elderly at risk for AD dementia. METHODS Cross-sectional analyses were completed using baseline data from the Harvard Aging Brain Study, consisting of 280 community-dwelling CN older adults aged 62-90. Assessments included medical histories and physical exam, Pittsburgh compound B (PiB) positron emission tomography (PET) amyloid imaging, and apolipoprotein E ɛ4 (APOE4) genotyping. For the primary analysis, a general linear regression model was used to evaluate the association of BMI with PiB retention. Covariates included age, sex, years of education, and APOE4 carrier status. Secondary analyses were performed for BMI subdivisions (normal, overweight, obese), APOE4 carriers, and BMI×APOE4 interaction. RESULTS In the primary analysis, greater PiB retention was associated with lower BMI (β = -0.14, p = 0.02). In the secondary analyses, APOE4 carrier status (β= -0.27, p = 0.02) and normal BMI (β= -0.25, p = 0.01), as opposed to overweight or obese BMI, were associated with greater PiB retention. The BMI×APOE4 interaction was also significant (β= -0.14, p = 0.04). CONCLUSIONS This finding offers new insight into the role of BMI at the preclinical stage of AD, wherein lower BMI late in life is associated with greater cortical amyloid burden. Future studies are needed to elucidate the mechanism behind this association, especially in those with lower BMI who are APOE4 carriers.
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Affiliation(s)
- David C Hsu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Mercy Medical Group, Sacramento, CA, USA
| | - Elizabeth C Mormino
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aaron P Schultz
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rebecca E Amariglio
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nancy J Donovan
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dorene M Rentz
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Keith A Johnson
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Reisa A Sperling
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gad A Marshall
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Joo SH, Yun SH, Kang DW, Hahn CT, Lim HK, Lee CU. Body Mass Index in Mild Cognitive Impairment According to Age, Sex, Cognitive Intervention, and Hypertension and Risk of Progression to Alzheimer's Disease. Front Psychiatry 2018; 9:142. [PMID: 29719518 PMCID: PMC5913709 DOI: 10.3389/fpsyt.2018.00142] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 04/03/2018] [Indexed: 12/20/2022] Open
Abstract
Introduction: Mild cognitive impairment (MCI) is a prodromal stage of dementia. The association of body mass index (BMI) and progression to Alzheimer's disease (AD) in MCI subjects according to age, sex, and cognitive intervention remains unknown. We investigated the relationship between BMI and the risk of progression to AD in subjects with MCI, as well as the effect of BMI on progression to AD depending on age, sex, cognitive intervention, and chronic diseases. Methods: Three hundred and eighty-eight MCI subjects were followed for 36.3 ± 18.4 months, prospectively. They underwent neuropsychological testing more than twice during the follow-up period. The MCI subjects were categorized into underweight, normal weight, overweight, and obese subgroups. The associations between baseline BMI and progression to AD over the follow-up period were estimated using Cox proportional hazard regression models. Data were analyzed after stratification by age, sex, cognitive intervention, and chronic diseases. Results: After adjustment for the covariates, the underweight MCI group had a higher risk of progression to AD [hazard ratio (HR): 2.38, 95% confidence interval (CI): 1.17-4.82] relative to the normal weight group. After stratifying by age, sex, cognitive intervention, and chronic diseases, this effect remained significant among females (HR: 3.15, 95% CI: 1.40-7.10), the older elderly ≥75 years old (HR: 3.52, 95% CI: 1.42-8.72), the non-intervention group (HR: 3.06, 95%CI: 1.18-7.91), and the hypertensive group (HR: 4.71, 95% CI: 1.17-18.99). Conclusion: These data indicate that underweight could be a useful marker for identifying individuals at increased risk for AD in MCI subjects. This association is even stronger in females, older elderly subjects, the non-cognitive intervention group, and the hypertensive group.
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Affiliation(s)
- Soo Hyun Joo
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Se Hee Yun
- Seocho Center for Dementia, Seoul, South Korea
| | - Dong Woo Kang
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chang Tae Hahn
- Department of Psychiatry, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyun Kook Lim
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chang Uk Lee
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Mathys J, Gholamrezaee M, Henry H, von Gunten A, Popp J. Decreasing body mass index is associated with cerebrospinal fluid markers of Alzheimer's pathology in MCI and mild dementia. Exp Gerontol 2017; 100:45-53. [PMID: 29054536 DOI: 10.1016/j.exger.2017.10.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/19/2017] [Accepted: 10/16/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Several studies have identified an association between body mass index (BMI) and the incidence and severity of Alzheimer's disease (AD) but this relationship is not fully understood. OBJECTIVE The primary objective of this study was to assess the possible association between BMI and cerebrospinal fluid (CSF) biomarkers of AD pathology in subjects with normal cognition and cognitive impairment. The secondary objective was to test whether BMI may contribute to improve the accuracy of a clinical model to predict AD pathology in memory clinic patients with cognitive impairment. METHOD One hundred and seven elderly subjects with cognitive impairment (91 memory clinic patients with mild cognitive impairment [MCI] and 16 with dementia of AD type) and 55 cognitively healthy volunteers were included in this study. All subjects received a comprehensive clinical and neuropsychological evaluation and a lumbar puncture for CSF biomarker analysis. Multiple linear regressions and receiver operating characteristic (ROC) analyses were carried out to assess the association between BMI and the CSF biomarkers of AD pathology. RESULTS BMI was positively correlated with the CSF levels of Aβ42 and negatively with tau and P-tau181 in participants with cognitive impairment. The associations were independent of age, sex, educational level, type and severity of cognitive impairment, cerebrovascular risk factors and the presence of the APOEε4 allele. Furthermore, BMI significantly improved the sensitivity and specificity of a multi-factorial model to predict the presence of an AD CSF biomarker profile. CONCLUSION Lower BMI is associated with cerebral AD pathology rather than with cognitive impairment in elderly subjects with MCI and mild dementia. Along with other clinical factors, decreasing BMI may help the clinician to identify patients with cognitive impairment due to AD.
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Affiliation(s)
- Jules Mathys
- Old Age Psychiatry, Department of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - Mehdi Gholamrezaee
- Departement of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - Hugues Henry
- Departement of Laboratory Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Old Age Psychiatry, Department of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - Julius Popp
- Old Age Psychiatry, Department of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland; Geriatric Psychiatry, Geneva University Hospitals and University of Geneva, Switzerland.
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Cova I, Clerici F, Maggiore L, Pomati S, Cucumo V, Ghiretti R, Galimberti D, Scarpini E, Mariani C, Caracciolo B. Body Mass Index Predicts Progression of Mild Cognitive Impairment to Dementia. Dement Geriatr Cogn Disord 2017; 41:172-80. [PMID: 27028129 DOI: 10.1159/000444216] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/21/2016] [Indexed: 11/19/2022] Open
Abstract
AIMS To examine the relationship between body mass index (BMI) and progression to dementia and Alzheimer's disease (AD) in mild cognitive impairment (MCI). MATERIALS AND METHODS Two hundred and twenty-eight MCI subjects (mean age 74.04 ± 6.94 years; 57% female) from a memory clinic were followed for 2.40 ± 1.58 years. Baseline height and weight were used to calculate the BMI. The main outcome was progression to dementia (DSM-IV criteria) and AD (NINCDS-ADRDA criteria). Cox proportional hazard models were used to assess the longitudinal association of BMI with dementia and AD, adjusting for a comprehensive set of covariates, including vascular risk factors/diseases and neuroimaging profiles. RESULTS Out of 228 subjects with MCI, 117 (51.3%) progressed to dementia. Eighty-nine (76%) of the incident dementia cases had AD. In both unadjusted and multi-adjusted models, a higher BMI was associated with a reduced risk of dementia (multi-adjusted HR 0.9; 95% CI 0.8-0.9) and AD (multi-adjusted HR 0.9; 95% CI 0.8-0.9). Being underweight increased the risk of all types of dementia (multi-adjusted HR 2.5; 95% CI 1.2-5.1) but was not specifically associated with AD (multi-adjusted HR 2.2; 95% CI 0.9-5.3). CONCLUSIONS BMI predicted progression of MCI to dementia and AD. In particular, a higher BMI was associated with a lower risk of dementia and AD, and underweight was associated with a higher risk of dementia. BMI assessment may improve the prognostic accuracy of MCI in clinical practice.
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Affiliation(s)
- Ilaria Cova
- Center for Research and Treatment on Cognitive Dysfunctions, Institute of Clinical Neurology, Department of Clinical Sciences, x2018;Luigi Sacco' Hospital, University of Milan, Milan, Italy
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47
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Alosco ML, Duskin J, Besser LM, Martin B, Chaisson CE, Gunstad J, Kowall NW, McKee AC, Stern RA, Tripodis Y. Modeling the Relationships Among Late-Life Body Mass Index, Cerebrovascular Disease, and Alzheimer's Disease Neuropathology in an Autopsy Sample of 1,421 Subjects from the National Alzheimer's Coordinating Center Data Set. J Alzheimers Dis 2017; 57:953-968. [PMID: 28304301 DOI: 10.3233/jad-161205] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The relationship between late-life body mass index (BMI) and Alzheimer's disease (AD) is poorly understood due to the lack of research in samples with autopsy-confirmed AD neuropathology (ADNP). The role of cerebrovascular disease (CVD) in the interplay between late-life BMI and ADNP is unclear. We conducted a retrospective longitudinal investigation and used joint modeling of linear mixed effects to investigate causal relationships among repeated antemortem BMI measurements, CVD (quantified neuropathologically), and ADNP in an autopsy sample of subjects across the AD clinical continuum. The sample included 1,421 subjects from the National Alzheimer's Coordinating Center's Uniform Data Set and Neuropathology Data Set with diagnoses of normal cognition (NC; n = 234), mild cognitive impairment (MCI; n = 201), or AD dementia (n = 986). ADNP was defined as moderate to frequent neuritic plaques and Braak stageIII-VI. Ischemic Injury Scale (IIS) operationalized CVD. Joint modeling examined relationships among BMI, IIS, and ADNP in the overall sample and stratified by initial visit Clinical Dementia Rating score. Subject-specific random intercept for BMI was the predictor for ADNP due to minimal BMI change (p = 0.3028). Analyses controlling for demographic variables and APOE ɛ4 showed lower late-life BMI predicted increased odds of ADNP in the overall sample (p < 0.001), and in subjects with CDR of 0 (p = 0.0021) and 0.5 (p = 0.0012), but not ≥1.0 (p = 0.2012). Although higher IIS predicted greater odds of ADNP (p < 0.0001), BMI did not predict IIS (p = 0.2814). The current findings confirm lower late-life BMI confers increased odds for ADNP. Lower late-life BMI may be a preclinical indicator of underlying ADNP.
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Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Jonathan Duskin
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA
| | - Lilah M Besser
- National Alzheimer's Coordinating Center, University of Washington, Seattle, WA, USA
| | - Brett Martin
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA.,Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | - Christine E Chaisson
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA.,Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Neil W Kowall
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA.,Neurology Service, VA Boston Healthcare System, Boston, MA, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA.,VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston, MA, USA.,Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA.,Departments of Neurosurgery and Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Yorghos Tripodis
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
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48
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LeBlanc ES, Rizzo JH, Pedula KL, Yaffe K, Ensrud KE, Cauley J, Cawthon PM, Cummings S, Hillier TA. Weight Trajectory over 20 Years and Likelihood of Mild Cognitive Impairment or Dementia Among Older Women. J Am Geriatr Soc 2017; 65:511-519. [PMID: 27991654 PMCID: PMC5685172 DOI: 10.1111/jgs.14552] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The association between weight change and cognition is controversial. We examined the association between 20-year weight change and cognitive function in late life. DESIGN Cohort study. SETTING Study of Osteoporotic Fractures (SOF). PARTICIPANTS One thousand two hundred eighty-nine older, community-dwelling women (mean baseline age 68 (65-81) and 88 (82-102) at cognitive testing). MEASUREMENTS Study of Osteoporotic Fractures participants had body weight measured repeatedly over 20 years (mean 8 weights). Adjudicated cognitive status was classified as normal (n = 775) or mild cognitive impairment (MCI)/dementia (n = 514) at Year 20. Logistic models were used to evaluate whether absolute weight change, rate of weight loss per year, presence of abrupt, unrecovered weight loss, and weight variability were associated with MCI or dementia. RESULTS Women with greater rate of weight loss over 20 years had increased chance of developing MCI or dementia. In age/education/clinic-adjusted "base" models, each 0.5 kg/yr decrease resulted in 30% increased odds of MCI/dementia (OR = 1.30 [95% CI: 1.14, 1.49]). After adjustment for age, education, clinic, depression, and walking speed, there was 17% (OR = 1.17 [95% CI: 1.02, 1.35]) increased odds of MCI/dementia for each 0.5 kg/yr decrease in weight. In base models, variability in weight was significant. Each 1% average deviation from each woman's predicted weight curve was associated with 11% increased odds of MCI/dementia (OR = 1.11 [95% CI: 1.04, 1.18]). The estimate was attenuated after full adjustment (OR = 1.06 [95% CI: 0.99, 1.14]). The presence of an abrupt weight decline was not associated with MCI/dementia. CONCLUSIONS Rate of weight loss over 20 years was associated with development of MCI or dementia in women surviving past 80 years, suggesting that nutritional status, social-environmental factors, and/or adipose tissue function and structure may affect cognitive function with aging.
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Affiliation(s)
- Erin S. LeBlanc
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Joanne H. Rizzo
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Kathryn L. Pedula
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Kristine Yaffe
- Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California San Francisco School of Medicine and San Francisco VA Medical Center, San Francisco, CA, USA
| | - Kristine E. Ensrud
- Department of Medicine, University of Minnesota; University of Epidemiology & Community Health, University of Minnesota; Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN University of Minnesota, USA
| | - Jane Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peggy M. Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Steven Cummings
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Teresa A. Hillier
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
- Center for Health Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
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49
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Pivi GAK, Vieira NMDA, da Ponte JB, de Moraes DSC, Bertolucci PHF. Nutritional management for Alzheimer’s disease in all stages: mild, moderate, and severe. ACTA ACUST UNITED AC 2017. [DOI: 10.1186/s41110-016-0025-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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50
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Ahmed RM, Landin-Romero R, Collet TH, van der Klaauw AA, Devenney E, Henning E, Kiernan MC, Piguet O, Farooqi IS, Hodges JR. Energy expenditure in frontotemporal dementia: a behavioural and imaging study. Brain 2017; 140:171-183. [PMID: 27789521 PMCID: PMC5379863 DOI: 10.1093/brain/aww263] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/22/2016] [Accepted: 09/04/2016] [Indexed: 02/02/2023] Open
Abstract
SEE FINGER DOI101093/AWW312 FOR A SCIENTIFIC COMMENTARY ON THIS ARTICLE: Abnormal eating behaviour and metabolic parameters including insulin resistance, dyslipidaemia and body mass index are increasingly recognized as important components of neurodegenerative disease and may contribute to survival. It has previously been established that behavioural variant frontotemporal dementia is associated with abnormal eating behaviour characterized by increased sweet preference. In this study, it was hypothesized that behavioural variant frontotemporal dementia might also be associated with altered energy expenditure. A cohort of 19 patients with behavioural variant frontotemporal dementia, 13 with Alzheimer's disease and 16 (age- and sex-matched) healthy control subjects were studied using Actiheart devices (CamNtech) to assess resting and stressed heart rate. Actiheart devices were fitted for 7 days to measure sleeping heart rate, activity levels, and resting, active and total energy expenditure. Using high resolution structural magnetic resonance imaging the neural correlates of increased resting heart rate were investigated including cortical thickness and region of interest analyses. In behavioural variant frontotemporal dementia, resting (P = 0.001), stressed (P = 0.037) and sleeping heart rate (P = 0.038) were increased compared to control subjects, and resting heart rate (P = 0.020) compared to Alzheimer disease patients. Behavioural variant frontotemporal dementia was associated with decreased activity levels compared to controls (P = 0.002) and increased resting energy expenditure (P = 0.045) and total energy expenditure (P = 0.035). Increased resting heart rate correlated with behavioural (Cambridge Behavioural Inventory) and cognitive measures (Addenbrooke's Cognitive Examination). Increased resting heart rate in behavioural variant frontotemporal dementia correlated with atrophy involving the mesial temporal cortex, insula, and amygdala, regions previously suggested to be involved exclusively in social and emotion processing in frontotemporal dementia. These neural correlates overlap the network involved in eating behaviour in frontotemporal dementia, suggesting a complex interaction between eating behaviour, autonomic function and energy homeostasis. As such the present study suggests that increased heart rate and autonomic changes are prevalent in behavioural variant frontotemporal dementia, and are associated with changes in energy expenditure. An understanding of these changes and neural correlates may have potential relevance to disease progression and prognosis.
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Affiliation(s)
- Rebekah M Ahmed
- 1 Neuroscience Research Australia, Sydney, Australia,2 University of New South Wales, Sydney, Australia,3 ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, 2031 Australia,4 Brain and Mind Centre, Sydney Medical School, University of Sydney, Australia,Correspondence to: Dr Rebekah Ahmed, Brain and Mind Centre, University of Sydney 94 Mallett St Camperdown 2050, Australia E-mail:
| | - Ramon Landin-Romero
- 1 Neuroscience Research Australia, Sydney, Australia,2 University of New South Wales, Sydney, Australia,3 ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, 2031 Australia
| | - Tinh-Hai Collet
- 5 University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, UK
| | - Agatha A van der Klaauw
- 5 University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, UK
| | - Emma Devenney
- 1 Neuroscience Research Australia, Sydney, Australia,2 University of New South Wales, Sydney, Australia,3 ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, 2031 Australia,4 Brain and Mind Centre, Sydney Medical School, University of Sydney, Australia
| | - Elana Henning
- 5 University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, UK
| | - Matthew C Kiernan
- 4 Brain and Mind Centre, Sydney Medical School, University of Sydney, Australia
| | - Olivier Piguet
- 1 Neuroscience Research Australia, Sydney, Australia,2 University of New South Wales, Sydney, Australia,3 ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, 2031 Australia
| | - I Sadaf Farooqi
- 5 University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, UK
| | - John R Hodges
- 1 Neuroscience Research Australia, Sydney, Australia,2 University of New South Wales, Sydney, Australia,3 ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, 2031 Australia,Correspondence may also be addressed to: Professor John Hodges, e-mail:
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