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Telpoukhovskaia MA, Murdy TJ, Marola OJ, Charland K, MacLean M, Luquez T, Lish AM, Neuner S, Dunn A, Onos KD, Wiley J, Archer D, Huentelman MJ, Arnold M, Menon V, Goate A, Van Eldik LJ, Territo PR, Howell GR, Carter GW, O'Connell KMS, Kaczorowski CC. New directions for Alzheimer's disease research from the Jackson Laboratory Center for Alzheimer's and Dementia Research 2022 workshop. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2024; 10:e12458. [PMID: 38469553 PMCID: PMC10925728 DOI: 10.1002/trc2.12458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION In September 2022, The Jackson Laboratory Center for Alzheimer's and Dementia Research (JAX CADR) hosted a workshop with leading researchers in the Alzheimer's disease and related dementias (ADRD) field. METHODS During the workshop, the participants brainstormed new directions to overcome current barriers to providing patients with effective ADRD therapeutics. The participants outlined specific areas of focus. Following the workshop, each group used standard literature search methods to provide background for each topic. RESULTS The team of invited experts identified four key areas that can be collectively addressed to make a significant impact in the field: (1) Prioritize the diversification of disease targets, (2) enhance factors promoting resilience, (3) de-risk clinical pipeline, and (4) centralize data management. DISCUSSION In this report, we review these four objectives and propose innovations to expedite ADRD therapeutic pipelines.
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Affiliation(s)
| | - Thomas J. Murdy
- The Jackson Laboratory for Mammalian GeneticsBar HarborMaineUSA
| | | | - Kevin Charland
- The Jackson Laboratory for Mammalian GeneticsBar HarborMaineUSA
| | - Michael MacLean
- The Jackson Laboratory for Mammalian GeneticsBar HarborMaineUSA
| | - Tain Luquez
- Center for Translational and Computational NeuroimmunologyDepartment of NeurologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Alexandra M. Lish
- Ann Romney Center for Neurologic DiseasesDepartment of NeurologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Sarah Neuner
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Amy Dunn
- The Jackson Laboratory for Mammalian GeneticsBar HarborMaineUSA
| | - Kristen D. Onos
- The Jackson Laboratory for Mammalian GeneticsBar HarborMaineUSA
| | | | - Derek Archer
- Vanderbilt Memory and Alzheimer's CenterVanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of NeurologyVanderbilt University Medical CenterNashvilleTennesseeUSA
- Vanderbilt Genetics InstituteVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Matthew J. Huentelman
- Neurogenomics DivisionTranslational Genomics Research Institute (TGen)PhoenixArizonaUSA
| | - Matthias Arnold
- Institute of Computational BiologyHelmholtz Zentrum München, German Research Center for Environmental HealthNeuherbergGermany
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNorth CarolinaUSA
| | - Vilas Menon
- Center for Translational and Computational NeuroimmunologyDepartment of NeurologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Alison Goate
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | | | - Paul R. Territo
- Department of MedicineDivision of Clinical PharmacologyIndiana University School of MedicineIndianapolisIndianaUSA
- Stark Neuroscience Research InstituteIndiana University School of MedicineIndianapolisIndianaUSA
| | - Gareth R. Howell
- The Jackson Laboratory for Mammalian GeneticsBar HarborMaineUSA
- Graduate School of Biomedical Science and EngineeringUniversity of MaineOronoMaineUSA
- Neuroscience Program, Graduate School of Biomedical ScienceTufts University School of MedicineBostonMassachusettsUSA
- Genetics Program, Graduate School of Biomedical ScienceTufts University School of MedicineBostonMassachusettsUSA
| | - Gregory W. Carter
- The Jackson Laboratory for Mammalian GeneticsBar HarborMaineUSA
- Graduate School of Biomedical Science and EngineeringUniversity of MaineOronoMaineUSA
- Neuroscience Program, Graduate School of Biomedical ScienceTufts University School of MedicineBostonMassachusettsUSA
- Genetics Program, Graduate School of Biomedical ScienceTufts University School of MedicineBostonMassachusettsUSA
| | - Kristen M. S. O'Connell
- The Jackson Laboratory for Mammalian GeneticsBar HarborMaineUSA
- Graduate School of Biomedical Science and EngineeringUniversity of MaineOronoMaineUSA
- Neuroscience Program, Graduate School of Biomedical ScienceTufts University School of MedicineBostonMassachusettsUSA
- Genetics Program, Graduate School of Biomedical ScienceTufts University School of MedicineBostonMassachusettsUSA
| | - Catherine C. Kaczorowski
- The Jackson Laboratory for Mammalian GeneticsBar HarborMaineUSA
- Department of NeurologyUniversity of MichiganAnn ArborMichiganUSA
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Grasset L, Planche V, Bouteloup V, Azouani C, Dubois B, Blanc F, Paquet C, David R, Belin C, Jonveaux T, Julian A, Pariente J, Mangin JF, Chêne G, Dufouil C. Physical activity, biomarkers of brain pathologies and dementia risk: Results from the Memento clinical cohort. Alzheimers Dement 2023; 19:5700-5718. [PMID: 37422285 DOI: 10.1002/alz.13360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION This study aims to examine whether physical activity moderates the association between biomarkers of brain pathologies and dementia risk. METHODS From the Memento cohort, we analyzed 1044 patients with mild cognitive impairment, aged 60 and older. Self-reported physical activity was assessed using the International Physical Activity Questionnaire. Biomarkers of brain pathologies comprised medial temporal lobe atrophy (MTA), white matter lesions, and plasma amyloid beta (Aβ)42/40 and phosphorylated tau181. Association between physical activity and risk of developing dementia over 5 years of follow-up, and interactions with biomarkers of brain pathologies were tested. RESULTS Physical activity moderated the association between MTA and plasma Aβ42/40 level and increased dementia risk. Compared to participants with low physical activity, associations of both MTA and plasma Aβ42/40 on dementia risk were attenuated in participants with high physical activity. DISCUSSION Although reverse causality cannot be excluded, this work suggests that physical activity may contribute to cognitive reserve. HIGHLIGHTS Physical activity is an interesting modifiable target for dementia prevention. Physical activity may moderate the impact of brain pathology on dementia risk. Medial temporal lobe atrophy and plasma amyloid beta 42/40 ratio were associated with increased dementia risk especially in those with low level of physical activity.
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Affiliation(s)
- Leslie Grasset
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, CIC1401-EC, Bordeaux, France
| | - Vincent Planche
- University of Bordeaux, CNRS UMR 5293, Institut des Maladies Neurodégénératives, Centre Mémoire de Ressources et de Recherches, Pôle de Neurosciences Cliniques, CHU de Bordeaux, Bordeaux, France
| | - Vincent Bouteloup
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, CIC1401-EC, Bordeaux, France
- Pole de sante publique Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Chabha Azouani
- CATI multicentre imaging platform, US52-UAR2031, CEA, ICM, SU, CNRS, INSERM, APHP, Gif-sur-Yvette, France
| | - Bruno Dubois
- IM2A AP-HP INSERM UMR-S975 Groupe Hospitalier Pitié-Salpêtrière Institut de la Mémoire et de la Maladie d'Alzheimer Institut du Cerveau et de la Moelle épinière Sorbonne Université Paris, Paris, France
| | - Frédéric Blanc
- ICube laboratory, Pôle de Gériatrie, Université de Strasbourg, CNRS, UMR 7357, Fédération de Médecine Translationnelle de Strasbourg, Centre Mémoire de Ressources et de Recherches, Strasbourg, France
| | - Claire Paquet
- Université de Paris Cité, Centre de Neurologie Cognitive GHU APHP Nord Hôpital Lariboisière, INSERMU1144, Paris, France
| | - Renaud David
- Department of Old Age Psychiatry, Nice University Hospital, Nice, France
| | - Catherine Belin
- Service de Neurologie Hôpital Saint-Louis AP-HP, Paris, France
| | - Thérèse Jonveaux
- Centre Mémoire de Ressources et de Recherche de Lorraine, Service de Neurologie CHRU Nancy, Laboratoire Lorrain de Psychologie et de Neurosciences de la dynamique des comportements 2LPN EA 7489 Université de Lorraine, Nancy, France
| | - Adrien Julian
- Service de Neurologie CHU La Milétrie Centre Mémoire de Ressources et de Recherche, Poitiers, France
- Centre d'Investigation Clinique CIC1402, Poitiers, France
| | - Jérémie Pariente
- Department of Neurology, Toulouse University Hospital, Toulouse, France
- Toulouse NeuroImaging Center, Universite de Toulouse, Inserm, UPS, Toulouse, France
| | - Jean-François Mangin
- CATI multicentre imaging platform, US52-UAR2031, CEA, ICM, SU, CNRS, INSERM, APHP, Gif-sur-Yvette, France
- Université Paris-Saclay, CEA, CNRS, Neurospin, UMR 9027, Gif-sur-Yvette, France
| | - Geneviève Chêne
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, CIC1401-EC, Bordeaux, France
- Pole de sante publique Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Carole Dufouil
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, CIC1401-EC, Bordeaux, France
- Pole de sante publique Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
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Phongpreecha T, Godrich D, Berson E, Espinosa C, Kim Y, Cholerton B, Chang AL, Mataraso S, Bukhari SA, Perna A, Yakabi K, Montine KS, Poston KL, Mormino E, White L, Beecham G, Aghaeepour N, Montine TJ. Quantitative estimate of cognitive resilience and its medical and genetic associations. Alzheimers Res Ther 2023; 15:192. [PMID: 37926851 PMCID: PMC10626669 DOI: 10.1186/s13195-023-01329-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND We have proposed that cognitive resilience (CR) counteracts brain damage from Alzheimer's disease (AD) or AD-related dementias such that older individuals who harbor neurodegenerative disease burden sufficient to cause dementia remain cognitively normal. However, CR traditionally is considered a binary trait, capturing only the most extreme examples, and is often inconsistently defined. METHODS This study addressed existing discrepancies and shortcomings of the current CR definition by proposing a framework for defining CR as a continuous variable for each neuropsychological test. The linear equations clarified CR's relationship to closely related terms, including cognitive function, reserve, compensation, and damage. Primarily, resilience is defined as a function of cognitive performance and damage from neuropathologic damage. As such, the study utilized data from 844 individuals (age = 79 ± 12, 44% female) in the National Alzheimer's Coordinating Center cohort that met our inclusion criteria of comprehensive lesion rankings for 17 neuropathologic features and complete neuropsychological test results. Machine learning models and GWAS then were used to identify medical and genetic factors that are associated with CR. RESULTS CR varied across five cognitive assessments and was greater in female participants, associated with longer survival, and weakly associated with educational attainment or APOE ε4 allele. In contrast, damage was strongly associated with APOE ε4 allele (P value < 0.0001). Major predictors of CR were cardiovascular health and social interactions, as well as the absence of behavioral symptoms. CONCLUSIONS Our framework explicitly decoupled the effects of CR from neuropathologic damage. Characterizations and genetic association study of these two components suggest that the underlying CR mechanism has minimal overlap with the disease mechanism. Moreover, the identified medical features associated with CR suggest modifiable features to counteract clinical expression of damage and maintain cognitive function in older individuals.
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Affiliation(s)
- Thanaphong Phongpreecha
- Department of Pathology, Stanford University, Stanford, CA, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, 300 Pasteur Dr Rm L216, Stanford, CA, 94305, USA
| | - Dana Godrich
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, Miami, FL, USA
| | - Eloise Berson
- Department of Pathology, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, 300 Pasteur Dr Rm L216, Stanford, CA, 94305, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Camilo Espinosa
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, 300 Pasteur Dr Rm L216, Stanford, CA, 94305, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Yeasul Kim
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, 300 Pasteur Dr Rm L216, Stanford, CA, 94305, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | | | - Alan L Chang
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, 300 Pasteur Dr Rm L216, Stanford, CA, 94305, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Samson Mataraso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, 300 Pasteur Dr Rm L216, Stanford, CA, 94305, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Syed A Bukhari
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Amalia Perna
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Koya Yakabi
- Department of Pathology, Stanford University, Stanford, CA, USA
| | | | - Kathleen L Poston
- Department of Neurology Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Elizabeth Mormino
- Department of Neurology Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Lon White
- Pacific Health Research and Education Institute, Honolulu, HI, USA
| | - Gary Beecham
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, Miami, FL, USA
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, 300 Pasteur Dr Rm L216, Stanford, CA, 94305, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Thomas J Montine
- Department of Pathology, Stanford University, Stanford, CA, USA.
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Hurst C, Pugh DA, Abreha MH, Duong DM, Dammer EB, Bennett DA, Herskowitz JH, Seyfried NT. Integrated Proteomics to Understand the Role of Neuritin (NRN1) as a Mediator of Cognitive Resilience to Alzheimer's Disease. Mol Cell Proteomics 2023; 22:100542. [PMID: 37024090 PMCID: PMC10233303 DOI: 10.1016/j.mcpro.2023.100542] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/16/2023] [Accepted: 03/28/2023] [Indexed: 04/08/2023] Open
Abstract
The molecular mechanisms and pathways enabling certain individuals to remain cognitively normal despite high levels of Alzheimer's disease (AD) pathology remain incompletely understood. These cognitively normal people with AD pathology are described as preclinical or asymptomatic AD (AsymAD) and appear to exhibit cognitive resilience to the clinical manifestations of AD dementia. Here we present a comprehensive network-based approach from cases clinically and pathologically defined as asymptomatic AD to map resilience-associated pathways and extend mechanistic validation. Multiplex tandem mass tag MS (TMT-MS) proteomic data (n = 7787 proteins) was generated on brain tissue from Brodmann area 6 and Brodmann area 37 (n = 109 cases, n = 218 total samples) and evaluated by consensus weighted gene correlation network analysis. Notably, neuritin (NRN1), a neurotrophic factor previously linked to cognitive resilience, was identified as a hub protein in a module associated with synaptic biology. To validate the function of NRN1 with regard to the neurobiology of AD, we conducted microscopy and physiology experiments in a cellular model of AD. NRN1 provided dendritic spine resilience against amyloid-β (Aβ) and blocked Aβ-induced neuronal hyperexcitability in cultured neurons. To better understand the molecular mechanisms of resilience to Aβ provided by NRN1, we assessed how exogenous NRN1 alters the proteome by TMT-MS (n = 8238 proteins) of cultured neurons and integrated the results with the AD brain network. This revealed overlapping synapse-related biology that linked NRN1-induced changes in cultured neurons with human pathways associated with cognitive resilience. Collectively, this highlights the utility of integrating the proteome from the human brain and model systems to advance our understanding of resilience-promoting mechanisms and prioritize therapeutic targets that mediate resilience to AD.
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Affiliation(s)
- Cheyenne Hurst
- Department of Biochemistry, Emory School of Medicine, Emory Goizueta Alzheimer's Disease Research Center, Atlanta, Georgia, USA
| | - Derian A Pugh
- Department of Neurology, Center for Neurodegeneration and Experimental Therapeutics, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Measho H Abreha
- Department of Biochemistry, Emory School of Medicine, Emory Goizueta Alzheimer's Disease Research Center, Atlanta, Georgia, USA
| | - Duc M Duong
- Department of Biochemistry, Emory School of Medicine, Emory Goizueta Alzheimer's Disease Research Center, Atlanta, Georgia, USA
| | - Eric B Dammer
- Department of Biochemistry, Emory School of Medicine, Emory Goizueta Alzheimer's Disease Research Center, Atlanta, Georgia, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Jeremy H Herskowitz
- Department of Neurology, Center for Neurodegeneration and Experimental Therapeutics, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.
| | - Nicholas T Seyfried
- Department of Biochemistry, Emory School of Medicine, Emory Goizueta Alzheimer's Disease Research Center, Atlanta, Georgia, USA.
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Tornero-Costa R, Martinez-Millana A, Azzopardi-Muscat N, Lazeri L, Traver V, Novillo-Ortiz D. Methodological and Quality Flaws in the Use of Artificial Intelligence in Mental Health Research: Systematic Review. JMIR Ment Health 2023; 10:e42045. [PMID: 36729567 PMCID: PMC9936371 DOI: 10.2196/42045] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/02/2022] [Accepted: 11/20/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Artificial intelligence (AI) is giving rise to a revolution in medicine and health care. Mental health conditions are highly prevalent in many countries, and the COVID-19 pandemic has increased the risk of further erosion of the mental well-being in the population. Therefore, it is relevant to assess the current status of the application of AI toward mental health research to inform about trends, gaps, opportunities, and challenges. OBJECTIVE This study aims to perform a systematic overview of AI applications in mental health in terms of methodologies, data, outcomes, performance, and quality. METHODS A systematic search in PubMed, Scopus, IEEE Xplore, and Cochrane databases was conducted to collect records of use cases of AI for mental health disorder studies from January 2016 to November 2021. Records were screened for eligibility if they were a practical implementation of AI in clinical trials involving mental health conditions. Records of AI study cases were evaluated and categorized by the International Classification of Diseases 11th Revision (ICD-11). Data related to trial settings, collection methodology, features, outcomes, and model development and evaluation were extracted following the CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) guideline. Further, evaluation of risk of bias is provided. RESULTS A total of 429 nonduplicated records were retrieved from the databases and 129 were included for a full assessment-18 of which were manually added. The distribution of AI applications in mental health was found unbalanced between ICD-11 mental health categories. Predominant categories were Depressive disorders (n=70) and Schizophrenia or other primary psychotic disorders (n=26). Most interventions were based on randomized controlled trials (n=62), followed by prospective cohorts (n=24) among observational studies. AI was typically applied to evaluate quality of treatments (n=44) or stratify patients into subgroups and clusters (n=31). Models usually applied a combination of questionnaires and scales to assess symptom severity using electronic health records (n=49) as well as medical images (n=33). Quality assessment revealed important flaws in the process of AI application and data preprocessing pipelines. One-third of the studies (n=56) did not report any preprocessing or data preparation. One-fifth of the models were developed by comparing several methods (n=35) without assessing their suitability in advance and a small proportion reported external validation (n=21). Only 1 paper reported a second assessment of a previous AI model. Risk of bias and transparent reporting yielded low scores due to a poor reporting of the strategy for adjusting hyperparameters, coefficients, and the explainability of the models. International collaboration was anecdotal (n=17) and data and developed models mostly remained private (n=126). CONCLUSIONS These significant shortcomings, alongside the lack of information to ensure reproducibility and transparency, are indicative of the challenges that AI in mental health needs to face before contributing to a solid base for knowledge generation and for being a support tool in mental health management.
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Affiliation(s)
- Roberto Tornero-Costa
- Instituto Universitario de Investigación de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas, Universitat Politècnica de València, Valencia, Spain
| | - Antonio Martinez-Millana
- Instituto Universitario de Investigación de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas, Universitat Politècnica de València, Valencia, Spain
| | - Natasha Azzopardi-Muscat
- Division of Country Health Policies and Systems, World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Ledia Lazeri
- Division of Country Health Policies and Systems, World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Vicente Traver
- Instituto Universitario de Investigación de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas, Universitat Politècnica de València, Valencia, Spain
| | - David Novillo-Ortiz
- Division of Country Health Policies and Systems, World Health Organization, Regional Office for Europe, Copenhagen, Denmark
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Neuner SM, Telpoukhovskaia M, Menon V, O'Connell KMS, Hohman TJ, Kaczorowski CC. Translational approaches to understanding resilience to Alzheimer's disease. Trends Neurosci 2022; 45:369-383. [PMID: 35307206 PMCID: PMC9035083 DOI: 10.1016/j.tins.2022.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/07/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
Individuals who maintain cognitive function despite high levels of Alzheimer's disease (AD)-associated pathology are said to be 'resilient' to AD. Identifying mechanisms underlying resilience represents an exciting therapeutic opportunity. Human studies have identified a number of molecular and genetic factors associated with resilience, but the complexity of these cohorts prohibits a complete understanding of which factors are causal or simply correlated with resilience. Genetically and phenotypically diverse mouse models of AD provide new and translationally relevant opportunities to identify and prioritize new resilience mechanisms for further cross-species investigation. This review will discuss insights into resilience gained from both human and animal studies and highlight future approaches that may help translate these insights into therapeutics designed to prevent or delay AD-related dementia.
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Affiliation(s)
- Sarah M Neuner
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | | | - Vilas Menon
- Center for Translational and Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Kristen M S O'Connell
- The Jackson Laboratory, Bar Harbor, ME 04609, USA; Tufts University, School of Medicine, Graduate School of Biomedical Sciences, Boston, MA 02111, USA; The University of Maine, Graduate School of Biomedical Science and Engineering, Orono, ME 04469, USA
| | - Timothy J Hohman
- Vanderbilt Memory and Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA; Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Catherine C Kaczorowski
- The Jackson Laboratory, Bar Harbor, ME 04609, USA; Tufts University, School of Medicine, Graduate School of Biomedical Sciences, Boston, MA 02111, USA; The University of Maine, Graduate School of Biomedical Science and Engineering, Orono, ME 04469, USA.
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Silva PCD, de Oliveira LLV, Teixeira RLP, Brito MLDA, Filippe ARTM. Executive Functions in Alzheimer’s Disease: A Systematic Review. J Alzheimers Dis Rep 2022. [DOI: 10.3233/adr-210059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: In Alzheimer’s disease, in addition to memory, attention has been given to cognitive testing due to its interface and connection with memory. Objective: The aim of this study is to take a global view of executive functions and place the concept within the theoretical framework of Alzheimer’s disease dementia, verifying their role in the cognitive functioning of the human mind, as well as how they are compromised in this pathology. Methods: An initial search was carried out in databases such as PubMed, ScienceDirect, and Web of Science. The guiding question presented at the end of the introduction was elaborated from the PICO/PIO/PEO strategy. The selected articles, therefore, answered the guiding question, were made available in full, and published in the period from 2000 to 2020. Studies without specific methodology and which correlated with other diseases or other types of dementia were excluded. To meet the objective, an integrative literature review was adopted. Results: The results indicate that, although the tests to verify the performance of cognitive functions have their limitations, they bring some evidence that they have been compromised, especially when analyzed periodically during the development of dementia. Conclusion: It is concluded that there is an interference of executive functions in function of Alzheimer’s and that memory and attention are the most evident in this type of dementia.
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Affiliation(s)
| | | | | | - Max Leandro de Araújo Brito
- Faculdade de Engenharia, Letras e Ciências Sociais do Seridó da Universidade Federal do Rio Grande do Norte, State of Rio Grande do Norte, Brazil
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Modifiable lifestyle factors and cognitive reserve: A systematic review of current evidence. Ageing Res Rev 2022; 74:101551. [PMID: 34952208 PMCID: PMC8794051 DOI: 10.1016/j.arr.2021.101551] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/12/2021] [Accepted: 12/17/2021] [Indexed: 02/03/2023]
Abstract
This systematic review aims to summarize cognitive reserve (CR) evaluation approaches and to examine the role of seven selected modifiable lifestyle factors (diet, smoking, alcohol consumption, physical activity, cognitive leisure activity, sleep, and meditation) in mitigating the impacts of age- or disease-related brain changes on cognition. Eighteen population-based English empirical studies were included. We summarize the study designs and identify three CR models that were broadly used in these studies, including a residual model assessing lifestyle factors in relation to unexplained variance in cognition after accounting for brain markers, a moderation model testing whether lifestyle factors moderate the relationship between brain status and cognition, and a controlling model examining the associations between lifestyle factors and cognition when controlling for brain measures. We also present the findings for the impact of each lifestyle factor. No studies examined diet, sleep, or meditation, and only two studies focused on smoking and alcohol consumption each. Overall, the studies suggest lifestyle activity factors (physical and cognitive leisure activities) may contribute to CR and attenuate the damaging impact of brain changes on cognition. Standardized measurements of lifestyle factors and CR are needed, and mechanisms underlying CR need to be further addressed as well.
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The Road to Personalized Medicine in Alzheimer’s Disease: The Use of Artificial Intelligence. Biomedicines 2022; 10:biomedicines10020315. [PMID: 35203524 PMCID: PMC8869403 DOI: 10.3390/biomedicines10020315] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 02/05/2023] Open
Abstract
Dementia remains an extremely prevalent syndrome among older people and represents a major cause of disability and dependency. Alzheimer’s disease (AD) accounts for the majority of dementia cases and stands as the most common neurodegenerative disease. Since age is the major risk factor for AD, the increase in lifespan not only represents a rise in the prevalence but also adds complexity to the diagnosis. Moreover, the lack of disease-modifying therapies highlights another constraint. A shift from a curative to a preventive approach is imminent and we are moving towards the application of personalized medicine where we can shape the best clinical intervention for an individual patient at a given point. This new step in medicine requires the most recent tools and analysis of enormous amounts of data where the application of artificial intelligence (AI) plays a critical role on the depiction of disease–patient dynamics, crucial in reaching early/optimal diagnosis, monitoring and intervention. Predictive models and algorithms are the key elements in this innovative field. In this review, we present an overview of relevant topics regarding the application of AI in AD, detailing the algorithms and their applications in the fields of drug discovery, and biomarkers.
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Abstract
With the expected rise in Alzheimer's disease and related dementias (ADRD) in the coming decades due to the aging population and a lack of effective disease-modifying treatments, there is a need for preventive strategies that may tap into resilience parameters. A wide array of resilience strategies has been proposed including genetics, socioeconomic status, lifestyle modifications, behavioral changes, and management of comorbid disease. These different strategies can be broadly classified as distinguishing between modifiable and non-modifiable risk factors, some of which can be quantified so that their clinical intervention can be effectively accomplished. A clear shift in research focus from dementia risk to addressing disease resistance and resilience is emerging that has provided new potential therapeutic targets. Here we review and summarize the latest investigations of resilience mechanisms and methods of quantifying resilience for clinical research. These approaches include identifying genetic variants that may help identify novel pathways (e.g., lipid metabolism, cellular trafficking, synaptic function, inflammation) for therapeutic treatments and biomarkers for use in a precision medicine-like regimen. In addition, innovative structural and molecular neuroimaging analyses may assist in detecting and quantifying pathological changes well before the onset of clinical symptoms setting up the possibility of primary and secondary prevention trials. Lastly, we summarize recent studies demonstrating the study of resilience in caregivers of persons living with dementia may have direct and indirect impact on the quality of care and patient outcomes.
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Affiliation(s)
- Mahesh S. Joshi
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Boca Raton, FL, USA
| | - James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Boca Raton, FL, USA
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Watts A, Chalise P, Hu J, Hui D, Pa J, Andrews SJ, Michaelis EK, Swerdlow RH. A Mitochondrial DNA Haplogroup Defines Patterns of Five-Year Cognitive Change. J Alzheimers Dis 2022; 89:913-922. [PMID: 35964186 PMCID: PMC10015634 DOI: 10.3233/jad-220298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mitochondrial DNA (mtDNA) may play a role in Alzheimer's disease (AD) and cognitive decline. A particular haplogroup of mtDNA, haplogroup J, has been observed more commonly in patients with AD than in cognitively normal controls. OBJECTIVE We used two mtDNA haplogroups, H and J, to predict change in cognitive performance over five years. We hypothesized that haplogroup J carriers would show less cognitive resilience. METHODS We analyzed data from 140 cognitively normal older adults who participated in the University of Kansas Alzheimer's Disease Research Center clinical cohort between 2011 and 2020. We used factor analysis to create three composite scores (verbal memory, attention, and executive function) from 11 individual cognitive tests. We performed latent growth curve modeling to describe trajectories of cognitive performance and change adjusting for age, sex, years of education, and APOE ɛ4 allele carrier status. We compared haplogroup H, the most common group, to haplogroup J, the potential risk group. RESULTS Haplogroup J carriers had significantly lower baseline performance and slower rates of improvement on tests of verbal memory compared to haplogroup H carriers. We did not observe differences in executive function or attention. CONCLUSION Our results reinforce the role of mtDNA in changes to cognitive function in a domain associated with risk for dementia, verbal memory, but not with other cognitive domains. Future research should investigate the distinct mechanisms by which mtDNA might affect performance on verbal memory as compared to other cognitive domains across haplogroups.
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Affiliation(s)
- Amber Watts
- University of Kansas Alzheimer’s Disease Research Center
- Department of Psychology, University of Kansas
| | - Prabhakar Chalise
- University of Kansas Alzheimer’s Disease Research Center
- Department of Biostatistics and Data Science, University of Kansas Medical Center
| | - Jinxiang Hu
- University of Kansas Alzheimer’s Disease Research Center
- Department of Biostatistics and Data Science, University of Kansas Medical Center
| | - Dongwei Hui
- University of Kansas Alzheimer’s Disease Research Center
- Department of Pharmacology and Toxicology, University of Kansas
| | - Judy Pa
- Department of Neurosciences, University of California San Diego
| | - Shea J Andrews
- Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai
| | - Elias K Michaelis
- University of Kansas Alzheimer’s Disease Research Center
- Department of Pharmacology and Toxicology, University of Kansas
| | - Russell H Swerdlow
- University of Kansas Alzheimer’s Disease Research Center
- Department of Neurology, University of Kansas Medical Center
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center
- Department of Biochemistry and Molecular Biology, University of Kansas Medical Center
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Sapkota S, McFall GP, Masellis M, Dixon RA, Black SE. Differential Cognitive Decline in Alzheimer's Disease Is Predicted by Changes in Ventricular Size but Moderated by Apolipoprotein E and Pulse Pressure. J Alzheimers Dis 2021; 85:545-560. [PMID: 34864669 DOI: 10.3233/jad-215068] [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: 12/14/2022]
Abstract
BACKGROUND Differential cognitive trajectories in Alzheimer's disease (AD) may be predicted by biomarkers from multiple domains. OBJECTIVE In a longitudinal sample of AD and AD-related dementias patients (n = 312), we tested whether 1) change in brain morphometry (ventricular enlargement) predicts differential cognitive trajectories, 2) further risk is contributed by genetic (Apolipoprotein E [APOE] ɛ4+) and vascular (pulse pressure [PP]) factors separately, and 3) the genetic + vascular risk moderates this pattern. METHODS We applied a dynamic computational approach (parallel process models) to test both concurrent and change-related associations between predictor (ventricular size) and cognition (executive function [EF]/attention). We then tested these associations as stratified by APOE (ɛ4-/ɛ4+), PP (low/high), and APOE+ PP (low/intermediate/high) risk. RESULTS First, concurrently, higher ventricular size predicted lower EF/attention performance and, longitudinally, increasing ventricular size predicted steeper EF/attention decline. Second, concurrently, higher ventricular size predicted lower EF/attention performance selectively in APOEɛ4+ carriers, and longitudinally, increasing ventricular size predicted steeper EF/attention decline selectively in the low PP group. Third, ventricular size and EF/attention associations were absent in the high APOE+ PP risk group both concurrently and longitudinally. CONCLUSION As AD progresses, a threshold effect may be present in which ventricular enlargement in the context of exacerbated APOE+ PP risk does not produce further cognitive decline.
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Affiliation(s)
- Shraddha Sapkota
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - G Peggy McFall
- Department of Psychology (Science), University of Alberta, Edmonton, AB, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Mario Masellis
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
| | - Roger A Dixon
- Department of Psychology (Science), University of Alberta, Edmonton, AB, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
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Bennett DA. Reducing Your Risk of Alzheimer's Dementia: Building a Better Brain as We Age. Arch Clin Neuropsychol 2021; 36:1257-1265. [PMID: 34651647 PMCID: PMC8517621 DOI: 10.1093/arclin/acab052] [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] [Accepted: 06/16/2021] [Indexed: 11/14/2022] Open
Abstract
Alzheimer' dementia is a large and growing public health problem. Of utmost importance for limiting the impact of the disease on society is the prevention of dementia, that is, delay onset either by years whereby death ensues prior to dementia onset. The Religious Orders Study and the Rush Memory and Aging Project are two harmonized cohort studies of aging and dementia that include organ donation at death. Ongoing since 1994 and 1997, respectively, we published on the association of numerous experiential, psychological, and medical risk factors for dementia, many of which are potentially modifiable. Here, selected findings are reviewed based on a presentation at the 2020 National Academy of Neuropsychology given virtually in Chicago in October of 2020.
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Affiliation(s)
- David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA,Corresponding author at: Rush Alzheimer’s Disease Center; 1750 W. Harrison Street, Suite 1000; Chicago, IL 60612, USA. E-mail address:
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Huang W, Bartosch AM, Xiao H, Maji S, Youth EHH, Flowers X, Leskinen S, Tomljanovic Z, Iodice G, Boyett D, Spinazzi E, Menon V, McGovern RA, McKhann GM, Teich AF. An immune response characterizes early Alzheimer's disease pathology and subjective cognitive impairment in hydrocephalus biopsies. Nat Commun 2021; 12:5659. [PMID: 34580300 PMCID: PMC8476497 DOI: 10.1038/s41467-021-25902-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 09/06/2021] [Indexed: 11/21/2022] Open
Abstract
Early Alzheimer's disease (AD) pathology can be found in cortical biopsies taken during shunt placement for Normal Pressure Hydrocephalus. This represents an opportunity to study early AD pathology in living patients. Here we report RNA-seq data on 106 cortical biopsies from this patient population. A restricted set of genes correlate with AD pathology in these biopsies, and co-expression network analysis demonstrates an evolution from microglial homeostasis to a disease-associated microglial phenotype in conjunction with increasing AD pathologic burden, along with a subset of additional astrocytic and neuronal genes that accompany these changes. Further analysis demonstrates that these correlations are driven by patients that report mild cognitive symptoms, despite similar levels of biopsy β-amyloid and tau pathology in comparison to patients who report no cognitive symptoms. Taken together, these findings highlight a restricted set of microglial and non-microglial genes that correlate with early AD pathology in the setting of subjective cognitive decline.
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Affiliation(s)
- Wenrui Huang
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Anne Marie Bartosch
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Harrison Xiao
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Suvrajit Maji
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Elliot H H Youth
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Xena Flowers
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Sandra Leskinen
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
- Department of Neurology, Columbia University, New York, NY, USA
| | - Zeljko Tomljanovic
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Gail Iodice
- Department of Neurosurgery, Columbia University, New York, NY, USA
| | - Deborah Boyett
- Department of Neurosurgery, Columbia University, New York, NY, USA
| | | | - Vilas Menon
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
- Department of Neurology, Columbia University, New York, NY, USA
| | - Robert A McGovern
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Guy M McKhann
- Department of Neurosurgery, Columbia University, New York, NY, USA
| | - Andrew F Teich
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA.
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA.
- Department of Neurology, Columbia University, New York, NY, USA.
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Galvin JE, Kleiman MJ, Chrisphonte S, Cohen I, Disla S, Galvin CB, Greenfield KK, Moore C, Rawn S, Riccio ML, Rosenfeld A, Simon J, Walker M, Tolea MI. The Resilience Index: A Quantifiable Measure of Brain Health and Risk of Cognitive Impairment and Dementia. J Alzheimers Dis 2021; 84:1729-1746. [PMID: 34744081 PMCID: PMC10731582 DOI: 10.3233/jad-215077] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND There is increasing interest in lifestyle modification and integrative medicine approaches to treat and/or prevent mild cognitive impairment (MCI) and Alzheimer's disease and related dementias (ADRD). OBJECTIVE To address the need for a quantifiable measure of brain health, we created the Resilience Index (RI). METHODS This cross-sectional study analyzed 241 participants undergoing a comprehensive evaluation including the Clinical Dementia Rating and neuropsychological testing. Six lifestyle factors including physical activity, cognitive activity, social engagements, dietary patterns, mindfulness, and cognitive reserve were combined to derive the RI (possible range of scores: 1-378). Psychometric properties were determined. RESULTS The participants (39 controls, 75 MCI, 127 ADRD) had a mean age of 74.6±9.5 years and a mean education of 15.8±2.6 years. The mean RI score was 138.2±35.6. The RI provided estimates of resilience across participant characteristics, cognitive staging, and ADRD etiologies. The RI showed moderate-to-strong correlations with clinical and cognitive measures and very good discrimination (AUC: 0.836; 95% CI: 0.774-0.897) between individuals with and without cognitive impairment (diagnostic odds ratio = 8.9). Individuals with high RI scores (> 143) had better cognitive, functional, and behavioral ratings than individuals with low RI scores. Within group analyses supported that controls, MCI, and mild ADRD cases with high RI had better cognitive, functional, and global outcomes than those with low RI. CONCLUSION The RI is a brief, easy to administer, score and interpret assessment of brain health that incorporates six modifiable protective factors. Results from the RI could provide clinicians and researchers with a guide to develop personalized prevention plans to support brain health.
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Affiliation(s)
- James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael J. Kleiman
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephanie Chrisphonte
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Iris Cohen
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shanell Disla
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Conor B. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Keri K. Greenfield
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Claudia Moore
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Susan Rawn
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mary Lou Riccio
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Amie Rosenfeld
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Judith Simon
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marcia Walker
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Magdalena I. Tolea
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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