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Choi J, Hall CB, Clouston SAP, Cleven KL, Mann FD, Luft BJ, Zammit AR. Cross-sectional association between posttraumatic stress and cognition is moderated by pulmonary functioning in world trade center responders. Am J Ind Med 2024. [PMID: 38943489 DOI: 10.1002/ajim.23631] [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: 11/07/2023] [Revised: 04/18/2024] [Accepted: 06/11/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) symptomatology and poorer pulmonary function are highly prevalent psychiatric and medical conditions. In the present study, we tested for the individual, additive, and modifying associations of PTSD symptomatology and pulmonary function with cognitive performance. METHODS In this cross-sectional study, a total of 1,401 World Trade Center (WTC) responders (mean age = 53, SD = 8 years, 92% males) participated in the study. Cogstate assessment measured cognitive performance. PTSD symptomatology was measured using the trauma-specific version of the posttraumatic stress disorder checklist (PCL-17) adapted for the WTC attacks. The 1-second forced expiratory volume and forced vital capacity (FEV1/FVC) ratio was used to measure pulmonary function. Linear regressions with cognitive performance as the outcome were conducted to assess individual, additive, and moderating associations of PTSD symptomatology and pulmonary function. RESULTS Higher PTSD symptomatology and poorer pulmonary function were negatively associated with cognitive performance. A 10% increase on the FEV1/FVC ratio moderated the association between PTSD symptomatology and cognition, whereby its association with cognition was stronger when PTSD symptomatology was higher (est. = 0.01, 95%CI = 0.004, 0.01, p < 0.001). When stratified by responder type, these associations persisted in trained (est. = 0.01, 95%CI = 0.01, 0.02, p < 0.001), but not in non-trained (est. = 0.004, 95% C.I. = -0.01, 0.02, p = 0.39) responders. CONCLUSIONS In the presence of higher PTSD, better pulmonary functioning is associated with better cognitive performance. Early intervention efforts to mitigate preventable cognitive decline in high-risk populations should be studied, especially since intervention in one modality may have an impact on others.
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Affiliation(s)
- Jaeun Choi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
- The Saul R Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sean A P Clouston
- Department of Family, Population and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Krystal L Cleven
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Frank D Mann
- Department of Family, Population and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Benjamin J Luft
- World Trade Center Program Clinical Center of Excellence, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Andrea R Zammit
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
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2
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Vanderlip CR, Stark CE. Digital cognitive assessments as low-burden markers for predicting future cognitive decline and tau accumulation across the Alzheimer's spectrum. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.23.595638. [PMID: 38826456 PMCID: PMC11142177 DOI: 10.1101/2024.05.23.595638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Digital cognitive assessments, particularly those that can be done at home, present as low burden biomarkers for participants and patients alike, but their effectiveness in diagnosis of Alzheimer's or predicting its trajectory is still unclear. Here, we assessed what utility or added value these digital cognitive assessments provide for identifying those at high risk for cognitive decline. We analyzed >500 ADNI participants who underwent a brief digital cognitive assessment and Aβ/tau PET scans, examining their ability to distinguish cognitive status and predict cognitive decline. Performance on the digital cognitive assessment were superior to both cortical Aβ and entorhinal tau in detecting mild cognitive impairment and future cognitive decline, with mnemonic discrimination deficits emerging as the most critical measure for predicting decline and future tau accumulation. Digital assessments are effective in identifying at-risk individuals, supporting their utility as low-burden tools for early Alzheimer's detection and monitoring.
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Affiliation(s)
- Casey R. Vanderlip
- Department of Neurobiology and Behavior, 1424 Biological Sciences III Irvine, University of California Irvine, Irvine, CA, 92697 USA
| | - Craig E.L. Stark
- Department of Neurobiology and Behavior, 1424 Biological Sciences III Irvine, University of California Irvine, Irvine, CA, 92697 USA
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3
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Ennis GE, Betthauser TJ, Koscik RL, Chin NA, Christian BT, Asthana S, Johnson SC, Bendlin BB. The relationship of insulin resistance and diabetes to tau PET SUVR in middle-aged to older adults. Alzheimers Res Ther 2023; 15:55. [PMID: 36932429 PMCID: PMC10022314 DOI: 10.1186/s13195-023-01180-2] [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: 12/14/2022] [Accepted: 01/31/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Insulin resistance (IR) and type 2 diabetes have been found to increase the risk for Alzheimer's clinical syndrome in epidemiologic studies but have not been associated with tau tangles in neuropathological research and have been inconsistently associated with cerebrospinal fluid P-tau181. IR and type 2 diabetes are well-recognized vascular risk factors. Some studies suggest that cardiovascular risk may act synergistically with cortical amyloid to increase tau measured using tau PET. Utilizing data from largely nondemented middle-aged and older adult cohorts enriched for AD risk, we investigated the association of IR and diabetes to tau PET and whether amyloid moderated those relationships. METHODS Participants were enrolled in either the Wisconsin Registry for Alzheimer's Prevention (WRAP) or Wisconsin Alzheimer's Disease Research Center (WI-ADRC) Clinical Core. Two partially overlapping samples were studied: a sample characterized using HOMA-IR (n=280 WRAP participants) and a sample characterized on diabetic status (n=285 WRAP and n=109 WI-ADRC). IR was measured using the homeostasis model assessment of insulin resistance (HOMA-IR). Tau PET employing the radioligand 18F-MK-6240 was used to detect AD-specific aggregated tau. Linear regression tested the relationship of IR and diabetic status to tau PET standardized uptake value ratio (SUVR) within the entorhinal cortex and whether relationships were moderated by amyloid assessed by amyloid PET distribution volume ratio (DVR) and amyloid PET positivity status. RESULTS Neither HOMA-IR nor diabetic status was significantly associated with tau PET SUVR. The relationship between IR and tau PET SUVR was not moderated by amyloid PET DVR or positivity status. The association between diabetic status and tau PET SUVR was not significantly moderated by amyloid PET DVR but was significantly moderated by amyloid PET positivity status. Among the amyloid PET-positive participants, the estimated marginal tau PET SUVR mean was higher in the diabetic (n=6) relative to the nondiabetic group (n=88). CONCLUSION Findings indicate that IR may not be related to tau in generally healthy middle-aged and older adults who are in the early stages of the AD clinicopathologic continuum but suggest the need for additional research to investigate whether a synergistic relationship between type 2 diabetes and amyloid is associated with increased tau levels.
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Affiliation(s)
- Gilda E Ennis
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.
| | - Tobey J Betthauser
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Rebecca Langhough Koscik
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Nathaniel A Chin
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Bradley T Christian
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Hospital Department of Veterans Affairs, Madison, WI, USA
| | - Sterling C Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Hospital Department of Veterans Affairs, Madison, WI, USA
| | - Barbara B Bendlin
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Hospital Department of Veterans Affairs, Madison, WI, USA
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4
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White JP, Schembri A, Prenn-Gologranc C, Ondrus M, Katina S, Novak P, Lim YY, Edgar C, Maruff P. Sensitivity of Individual and Composite Test Scores from the Cogstate Brief Battery to Mild Cognitive Impairment and Dementia Due to Alzheimer's Disease. J Alzheimers Dis 2023; 96:1781-1799. [PMID: 38007647 DOI: 10.3233/jad-230352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
BACKGROUND The Cogstate Brief Battery (CBB) is a computerized cognitive test battery used commonly to identify cognitive deficits related to Alzheimer's disease (AD). However, AD and normative samples used to understand the sensitivity of the CBB to AD in the clinic have been limited, as have the outcome measures studied. OBJECTIVE This study investigated the sensitivity of CBB outcomes, including potential composite scores, to cognitive impairment in mild cognitive impairment (MCI) and dementia due to AD, in carefully selected samples. METHODS Samples consisted of 4,871 cognitively unimpaired adults and 184 adults who met clinical criteria for MCI (Clinical Dementia Rating (CDR) = 0.5) or dementia (CDR > 0.5) due to AD and CBB naive. Speed and accuracy measures from each test were examined, and theoretically- and statistically-derived composites were created. Sensitivity and specificity of classification of cognitive impairment were compared between outcomes. RESULTS Individual CBB measures of learning and working memory showed high discriminability for AD-related cognitive impairment for CDR 0.5 (AUCs ∼ 0.79-0.88), and CDR > 0.5 (AUCs ∼ 0.89-0.96) groups. Discrimination ability for theoretically derived CBB composite measures was high, particularly for the Learning and Working Memory (LWM) composite (CDR 0.5 AUC = 0.90, CDR > 0.5 AUC = 0.97). As expected, statistically optimized linear composite measures showed strong discrimination abilities albeit similar to the LWM composite. CONCLUSIONS In older adults, the CBB is effective for discriminating cognitive impairment due to MCI or AD-dementia from unimpaired cognition with the LWM composite providing the strongest sensitivity.
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Affiliation(s)
| | | | | | | | - Stanislav Katina
- AXON Neuroscience CRM Services SE, Bratislava, Slovakia
- Institute of Mathematics and Statistics, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Petr Novak
- AXON Neuroscience CRM Services SE, Bratislava, Slovakia
| | - Yen Ying Lim
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Chris Edgar
- Cogstate Ltd, Melbourne, Victoria, Australia
| | - Paul Maruff
- Cogstate Ltd, Melbourne, Victoria, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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5
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García-Escobar G, Puig-Pijoan A, Puente-Periz V, Fernández-Lebrero A, María Manero R, Navalpotro-Gómez I, Suárez-Calvet M, Grau-Rivera O, Contador-Muñana J, Cascales-Lahoz D, Duran-Jordà X, Boltes N, Pont-Sunyer MC, Ortiz-Gil J, Carrillo-Molina S, López-Villegas MD, Abellán-Vidal MT, Martínez-Casamitjana MI, Hernández-Sánchez JJ, Padrós-Fluvià A, Peña-Casanova J, Sánchez-Benavides G. NEURONORMA Cognitive Battery Associations with Cerebrospinal Fluid Amyloid-β and Tau Levels in the Continuum of Alzheimer's Disease. J Alzheimers Dis 2023; 92:1303-1321. [PMID: 37038810 DOI: 10.3233/jad-220930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND Neuropsychological assessments are essential to define the cognitive profile and contribute to the diagnosis of Alzheimer's disease (AD). The progress in knowledge about the pathophysiological process of the disease has allowed conceptualizing AD through biomarkers as a biological continuum that encompasses different clinical stages. OBJECTIVE To explore the association between cerebrospinal fluid (CSF) biomarkers of AD and cognition using the NEURONORMA battery, in a sample of cognitively unimpaired (CU), mild cognitive impaired (MCI), and mild dementia of the Alzheimer type (DAT) subjects, and to characterize the cognitive profiles in MCI subjects classified by A/T/N system. METHODS 42 CU, 35 MCI, and 35 mild DAT were assessed using the NEURONORMA battery. Core AD biomarkers [amyloid-β42 (Aβ42) peptide, total tau (t-tau), and phosphorylated tau 181 (p-tau181)] proteins were measured in CSF. Correlation coefficients, multivariate regression, and effect sizes were calculated. We explored the age- and education-adjusted cognitive profiles by A/T/N variants within the MCI group. RESULTS Cognitive outcomes were directly associated with CSF Aβ42 and inversely with CSF tau measures. We found differences in both biomarkers and cognitive outcomes comparing all pairs except for CSF measures between cognitively impaired groups. The highest effect size was in memory tasks and biomarkers ratios. Lower performances were in memory and executive domains in MCI subjects with AD pathology (A+T+N±) compared to those with normal levels of AD biomarkers (A- T- N). CONCLUSION This study provides further evidence of the validity of Spanish NEURONORMA cognitive battery to characterize cognitive impairment in the AD pathological continuum.
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Affiliation(s)
- Greta García-Escobar
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Albert Puig-Pijoan
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Cognitive Impairment and Movement Disorders Unit, Neurology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Víctor Puente-Periz
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Cognitive Impairment and Movement Disorders Unit, Neurology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Aida Fernández-Lebrero
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Cognitive Impairment and Movement Disorders Unit, Neurology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
| | - Rosa María Manero
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Cognitive Impairment and Movement Disorders Unit, Neurology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Irene Navalpotro-Gómez
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Cognitive Impairment and Movement Disorders Unit, Neurology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
| | - Marc Suárez-Calvet
- Cognitive Impairment and Movement Disorders Unit, Neurology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Oriol Grau-Rivera
- Cognitive Impairment and Movement Disorders Unit, Neurology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - José Contador-Muñana
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Cognitive Impairment and Movement Disorders Unit, Neurology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
| | - Diego Cascales-Lahoz
- Cognitive Impairment and Movement Disorders Unit, Neurology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | | | - Núncia Boltes
- Neurology Department, Hospital General de Granollers, Granollers, Spain
| | | | - Jordi Ortiz-Gil
- Neurology Department, Hospital General de Granollers, Granollers, Spain
- Psychology Unit, Hospital General de Granollers, Granollers, Spain
- Maria Angustias Gimenez Research Foundation (FIDMAG), Sant Boi del Llobregat, Spain
| | - Sara Carrillo-Molina
- Neurology Department, Hospital General de Granollers, Granollers, Spain
- Psychology Unit, Hospital General de Granollers, Granollers, Spain
| | - María Dolores López-Villegas
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centre Emili Mira, Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Santa Coloma de Gramenet, Spain
| | - María Teresa Abellán-Vidal
- Centre Emili Mira, Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Santa Coloma de Gramenet, Spain
| | | | | | | | - Jordi Peña-Casanova
- Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Gonzalo Sánchez-Benavides
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
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6
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Kochan NA, Heffernan M, Valenzuela M, Sachdev PS, Lam BCP, Fiatarone Singh M, Anstey KJ, Chau T, Brodaty H. Reliability, Validity, and User-Experience of Remote Unsupervised Computerized Neuropsychological Assessments in Community-Living 55- to 75-Year-Olds. J Alzheimers Dis 2022; 90:1629-1645. [PMID: 36314208 DOI: 10.3233/jad-220665] [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: 12/24/2022]
Abstract
BACKGROUND Self-administered computerized neuropsychological assessments (CNAs) provide lower cost, more accessible alternatives to traditional in-person assessments but lack critical information on psychometrics and subjective experience of older adults in remote testing environments. OBJECTIVE We used an online brief battery of computerized tasks selected from the Cogstate Brief Battery (CBB) and Cambridge Brain Sciences (CBS) to 1) determine test-retest reliability in an unsupervised setting; 2) examine convergent validity with a comprehensive 'gold standard' paper-and-pencil neuropsychological test battery administered in-person; and 3) explore user-experience of remote computerized testing and individual tests. METHODS Fifty-two participants (mean age 65.8±5.7 years) completed CBB and CBS tests on their own computer, unsupervised from home, on three occasions, and visited a research center for an in-person paper-and-pencil assessment. They also completed a user-experience questionnaire. RESULTS Test-retest reliabilities varied for individual measures (ICCs = 0.20 to 0.83). Global cognition composites showed excellent reliability (ICCs > 0.8 over 1-month follow-up). A strong relationship between a combination of CNA measures and paper-and-pencil battery was found (canonical correlation R = 0.87, p = 0.04). Most tests were rated as enjoyable with easy-to-understand instructions. Ratings of general experience with online testing were mostly favorable; few had difficulty concentrating (17%) or using the computer for tasks (10%), although over one-third experienced performance anxiety (38%). CONCLUSION A combined brief online battery selected from two CNAs demonstrated robust psychometric standards for reliability (global composite), and convergent validity with a gold standard battery, and mostly good usability and acceptability in the remote testing environment.
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Affiliation(s)
- Nicole A Kochan
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, UNSW Medicine and Health, University of New South Wales, Sydney, Australia
| | - Megan Heffernan
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, UNSW Medicine and Health, University of New South Wales, Sydney, Australia
| | - Michael Valenzuela
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, UNSW Medicine and Health, University of New South Wales, Sydney, Australia.,Skin2Neuron Pty Ltd, Sydney, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, UNSW Medicine and Health, University of New South Wales, Sydney, Australia.,Neuropsychiatric Institute, The Prince of Wales Hospital, Sydney, Australia.,UNSW Ageing Futures Institute, University of New South Wales, Sydney, Australia
| | - Ben C P Lam
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, UNSW Medicine and Health, University of New South Wales, Sydney, Australia
| | - Maria Fiatarone Singh
- Sydney School of Health Sciences and Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Kaarin J Anstey
- School of Psychology, University of New South Wales, Sydney, Australia.,Neuroscience Research Australia, Sydney, Australia.,UNSW Ageing Futures Institute, University of New South Wales, Sydney, Australia
| | - Tiffany Chau
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, UNSW Medicine and Health, University of New South Wales, Sydney, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, UNSW Medicine and Health, University of New South Wales, Sydney, Australia.,UNSW Ageing Futures Institute, University of New South Wales, Sydney, Australia
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7
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Betthauser TJ, Bilgel M, Koscik RL, Jedynak BM, An Y, Kellett KA, Moghekar A, Jonaitis EM, Stone CK, Engelman CD, Asthana S, Christian BT, Wong DF, Albert M, Resnick SM, Johnson SC. Multi-method investigation of factors influencing amyloid onset and impairment in three cohorts. Brain 2022; 145:4065-4079. [PMID: 35856240 PMCID: PMC9679170 DOI: 10.1093/brain/awac213] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/24/2022] [Accepted: 05/20/2022] [Indexed: 01/25/2023] Open
Abstract
Alzheimer's disease biomarkers are becoming increasingly important for characterizing the longitudinal course of disease, predicting the timing of clinical and cognitive symptoms, and for recruitment and treatment monitoring in clinical trials. In this work, we develop and evaluate three methods for modelling the longitudinal course of amyloid accumulation in three cohorts using amyloid PET imaging. We then use these novel approaches to investigate factors that influence the timing of amyloid onset and the timing from amyloid onset to impairment onset in the Alzheimer's disease continuum. Data were acquired from the Alzheimer's Disease Neuroimaging Initiative (ADNI), the Baltimore Longitudinal Study of Aging (BLSA) and the Wisconsin Registry for Alzheimer's Prevention (WRAP). Amyloid PET was used to assess global amyloid burden. Three methods were evaluated for modelling amyloid accumulation using 10-fold cross-validation and holdout validation where applicable. Estimated amyloid onset age was compared across all three modelling methods and cohorts. Cox regression and accelerated failure time models were used to investigate whether sex, apolipoprotein E genotype and e4 carriage were associated with amyloid onset age in all cohorts. Cox regression was used to investigate whether apolipoprotein E (e4 carriage and e3e3, e3e4, e4e4 genotypes), sex or age of amyloid onset were associated with the time from amyloid onset to impairment onset (global clinical dementia rating ≥1) in a subset of 595 ADNI participants that were not impaired before amyloid onset. Model prediction and estimated amyloid onset age were similar across all three amyloid modelling methods. Sex and apolipoprotein E e4 carriage were not associated with PET-measured amyloid accumulation rates. Apolipoprotein E genotype and e4 carriage, but not sex, were associated with amyloid onset age such that e4 carriers became amyloid positive at an earlier age compared to non-carriers, and greater e4 dosage was associated with an earlier amyloid onset age. In the ADNI, e4 carriage, being female and a later amyloid onset age were all associated with a shorter time from amyloid onset to impairment onset. The risk of impairment onset due to age of amyloid onset was non-linear and accelerated for amyloid onset age >65. These findings demonstrate the feasibility of modelling longitudinal amyloid accumulation to enable individualized estimates of amyloid onset age from amyloid PET imaging. These estimates provide a more direct way to investigate the role of amyloid and other factors that influence the timing of clinical impairment in Alzheimer's disease.
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Affiliation(s)
- Tobey J Betthauser
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin
School of Medicine and Public Health, Madison,
WI, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine
and Public Health, Madison, WI, USA
| | - Murat Bilgel
- Laboratory of Behavioral Neuroscience, National Institute on Aging,
National Institutes of Health, Baltimore, MD,
USA
| | - Rebecca L Koscik
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin
School of Medicine and Public Health, Madison,
WI, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine
and Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine
and Public Health, Madison, WI, USA
| | - Bruno M Jedynak
- Department of Mathematics and Statistics, Portland State
University, Portland, OR, USA
| | - Yang An
- Laboratory of Behavioral Neuroscience, National Institute on Aging,
National Institutes of Health, Baltimore, MD,
USA
| | - Kristina A Kellett
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin
School of Medicine and Public Health, Madison,
WI, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine
and Public Health, Madison, WI, USA
| | - Abhay Moghekar
- Laboratory of Behavioral Neuroscience, National Institute on Aging,
National Institutes of Health, Baltimore, MD,
USA
| | - Erin M Jonaitis
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin
School of Medicine and Public Health, Madison,
WI, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine
and Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine
and Public Health, Madison, WI, USA
| | - Charles K Stone
- Department of Medicine, University of Wisconsin-Madison School of Medicine
and Public Health, Madison, WI, USA
| | - Corinne D Engelman
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin
School of Medicine and Public Health, Madison,
WI, USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine
and Public Health, Madison, WI, USA
- Department of Population Health Sciences, University of Wisconsin-Madison
School of Medicine and Public Health, Madison,
WI, USA
| | - Sanjay Asthana
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin
School of Medicine and Public Health, Madison,
WI, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine
and Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine
and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton
Veterans Hospital, Madison, WI, USA
| | - Bradley T Christian
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin
School of Medicine and Public Health, Madison,
WI, USA
- Waisman Laboratory for Brain Imaging and Behavior, University of
Wisconsin-Madison, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin-Madison School of
Medicine and Public Health, Madison, WI, USA
| | - Dean F Wong
- Department of Radiology, Mallinckrodt Institute of Radiology, Neurology,
Psychiatry and Neuroscience, Washington University School of Medicine,
St. Louis, MO, USA
| | - Marilyn Albert
- Department of Neurology, Division of Cognitive Neuroscience, Johns Hopkins
University School of Medicine, Baltimore, MD,
USA
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging,
National Institutes of Health, Baltimore, MD,
USA
| | - Sterling C Johnson
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin
School of Medicine and Public Health, Madison,
WI, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine
and Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine
and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton
Veterans Hospital, Madison, WI, USA
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8
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Saunders TS, Gadd DA, Spires‐Jones TL, King D, Ritchie C, Muniz‐Terrera G. Associations between cerebrospinal fluid markers and cognition in ageing and dementia: A systematic review. Eur J Neurosci 2022; 56:5650-5713. [PMID: 35338546 PMCID: PMC9790745 DOI: 10.1111/ejn.15656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/08/2022] [Accepted: 03/13/2022] [Indexed: 12/30/2022]
Abstract
A biomarker associated with cognition in neurodegenerative dementias would aid in the early detection of disease progression, complement clinical staging and act as a surrogate endpoint in clinical trials. The current systematic review evaluates the association between cerebrospinal fluid protein markers of synapse loss and neuronal injury and cognition. We performed a systematic search which revealed 67 studies reporting an association between cerebrospinal fluid markers of interest and neuropsychological performance. Despite the substantial heterogeneity between studies, we found some evidence for an association between neurofilament-light and worse cognition in Alzheimer's diseases, frontotemporal dementia and typical cognitive ageing. Moreover, there was an association between cerebrospinal fluid neurogranin and cognition in those with an Alzheimer's-like cerebrospinal fluid biomarker profile. Some evidence was found for cerebrospinal fluid neuronal pentraxin-2 as a correlate of cognition across dementia syndromes. Due to the substantial heterogeneity of the field, no firm conclusions can be drawn from this review. Future research should focus on improving standardization and reporting as well as establishing the importance of novel markers such as neuronal pentraxin-2 and whether such markers can predict longitudinal cognitive decline.
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Affiliation(s)
- Tyler S. Saunders
- UK Dementia Research InstituteThe University of EdinburghEdinburghUK,Center for Discovery Brain SciencesThe University of EdinburghEdinburghUK,Center for Clinical Brain SciencesThe University of EdinburghEdinburghUK,Center for Dementia PreventionThe University of EdinburghEdinburghUK
| | - Danni A. Gadd
- Center for Genomic and Experimental Medicine, Institute of Genetics and Molecular MedicineUniversity of EdinburghEdinburghUK
| | - Tara L. Spires‐Jones
- UK Dementia Research InstituteThe University of EdinburghEdinburghUK,Center for Discovery Brain SciencesThe University of EdinburghEdinburghUK
| | - Declan King
- UK Dementia Research InstituteThe University of EdinburghEdinburghUK,Center for Discovery Brain SciencesThe University of EdinburghEdinburghUK
| | - Craig Ritchie
- Center for Clinical Brain SciencesThe University of EdinburghEdinburghUK,Center for Dementia PreventionThe University of EdinburghEdinburghUK
| | - Graciela Muniz‐Terrera
- Center for Clinical Brain SciencesThe University of EdinburghEdinburghUK,Center for Dementia PreventionThe University of EdinburghEdinburghUK
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9
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Pettigrew C, Soldan A, Brichko R, Zhu Y, Wang MC, Kutten K, Bilgel M, Mori S, Miller MI, Albert M. Computerized paired associate learning performance and imaging biomarkers in older adults without dementia. Brain Imaging Behav 2022; 16:921-929. [PMID: 34686968 PMCID: PMC9012682 DOI: 10.1007/s11682-021-00583-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 01/21/2023]
Abstract
This cross-sectional study examined whether performance on the computerized Paired Associate Learning (PAL) task from the Cambridge Neuropsychological Test Automated Battery is associated with amyloid positivity as measured by Positron Emission Tomography, regional volume composites as measured by Magnetic Resonance Imaging, and cognitive impairment. Participants from the BIOCARD Study (N = 73, including 62 cognitively normal and 11 with mild cognitive impairment; M age = 70 years) completed the PAL task, a comprehensive clinical and neuropsychological assessment, and neuroimaging as part of their annual study visit. In linear regressions covarying age, sex, years of education and diagnosis, higher PAL error scores were associated with amyloid positivity but not with medial temporal or cortical volume composites. By comparison, standard neuropsychological measures of episodic memory and global cognition were unrelated to amyloid positivity, but better performance on the verbal episodic memory measures was associated with larger cortical volume composites. Participants with mild cognitive impairment demonstrated worse cognitive performance on all of the cognitive measures, including the PAL task. These findings suggest that this computerized visual paired associate learning task may be more sensitive to amyloid positivity than standard neuropsychological tests, and may therefore be a promising tool for detecting amyloid positivity in non-demented participants.
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Affiliation(s)
- Corinne Pettigrew
- Department of Neurology, Division of Cognitive Neuroscience, Johns Hopkins University School of Medicine, 1620 McElderry Street, Reed Hall West - 1, Baltimore, MD, 21205, USA.
| | - Anja Soldan
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Rostislav Brichko
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Yuxin Zhu
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21287, USA
| | - Mei-Cheng Wang
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21287, USA
| | - Kwame Kutten
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Murat Bilgel
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute On Aging, Baltimore, MD, 21224, USA
| | - Susumu Mori
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Michael I Miller
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Marilyn Albert
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
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10
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Clouston SAP, Kritikos M, Huang C, Kuan PF, Vaska P, Pellecchia AC, Santiago-Michels S, Carr MA, Gandy S, Sano M, Bromet EJ, Lucchini RG, Luft BJ. Reduced cerebellar cortical thickness in World Trade Center responders with cognitive impairment. Transl Psychiatry 2022; 12:107. [PMID: 35296637 PMCID: PMC8927406 DOI: 10.1038/s41398-022-01873-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 01/22/2023] Open
Abstract
Prior research has demonstrated high levels of cognitive and physical functional impairments in World Trade Center (WTC) responders. A follow-up neuroimaging study identified changes to white matter connectivity within the cerebellum in responders with cognitive impairment (CI). In the first study to examine cerebellar cortical thickness in WTC responders with CI, we fielded a structural magnetic resonance imaging protocol. WTC responders (N = 99) participated in a structural magnetic resonance imaging (MRI) study, of whom 48 had CI. Participants with CI did not differ demographically or by intracranial volume when compared to cognitively unimpaired participants. MRIs were processed using the CERES imaging pipeline; bilateral cortical thickness in 12 cerebellar lobules was reported. Analyses were completed comparing mean cerebellar cortical thickness across groups. Lobules were examined to determine the location and functional correlates of reduced cerebellar cortical thickness. Multivariable-adjusted analyses accounted for the false discovery rate. Mean cerebellar cortical thickness was reduced by 0.17 mm in responders with CI. Decrements in cerebellar cortical thickness were symmetric and located in the Cerebellar Crus (I and II), and in Lobules IV, VI, VIIb, VIIIa, VIIIb, and IX. Cerebellar cortical thickness was associated with episodic memory, response speed, and tandem balance. WTC responders with CI had evidence of reduced cerebellar cortical thickness that was present across lobules in a pattern unique to this cohort.
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Affiliation(s)
- Sean A. P. Clouston
- Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook, Stony Brook, NY USA ,Program in Public Health, Renaissance School of Medicine at Stony Brook, Stony Brook, NY USA
| | - Minos Kritikos
- Program in Public Health, Renaissance School of Medicine at Stony Brook, Stony Brook, NY USA
| | - Chuan Huang
- Department of Radiology, Renaissance School of Medicine at Stony Brook, Stony Brook, NY USA
| | - Pei-Fen Kuan
- grid.36425.360000 0001 2216 9681Department of Applied Mathematics, Stony Brook University, Stony Brook, NY USA
| | - Paul Vaska
- Department of Radiology, Renaissance School of Medicine at Stony Brook, Stony Brook, NY USA ,grid.36425.360000 0001 2216 9681Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY USA
| | - Alison C. Pellecchia
- Department of Medicine, Renaissance School of Medicine at Stony Brook, Stony Brook, NY USA
| | | | - Melissa A. Carr
- Department of Medicine, Renaissance School of Medicine at Stony Brook, Stony Brook, NY USA
| | - Sam Gandy
- grid.59734.3c0000 0001 0670 2351Center for Cognitive Health and NFL Neurological Care, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY USA ,grid.59734.3c0000 0001 0670 2351Mount Sinai Alzheimer’s Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Mary Sano
- grid.59734.3c0000 0001 0670 2351Mount Sinai Alzheimer’s Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Evelyn J. Bromet
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook, Stony Brook, NY USA
| | - Roberto G. Lucchini
- grid.65456.340000 0001 2110 1845Department of Environmental Health Sciences, Robert Stempel College of Public Health, Florida International University, Miami, FL USA
| | - Benjamin J. Luft
- Director of the World Trade Center Health and Wellness Program, Department of Medicine, Renaissance School of Medicine at Stony Brook, Stony Brook, NY USA
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11
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Rivera‐Rivera LA, Eisenmenger L, Cody KA, Reher T, Betthauser T, Cadman RV, Rowley HA, Carlsson CM, Chin NA, Johnson SC, Johnson KM. Cerebrovascular stiffness and flow dynamics in the presence of amyloid and tau biomarkers. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12253. [PMID: 35005194 PMCID: PMC8719432 DOI: 10.1002/dad2.12253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/30/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION This work investigated the relationship between cerebrovascular disease (CVD) markers and Alzheimer's disease (AD) biomarkers of amyloid beta deposition, and neurofibrillary tau tangles in subjects spanning the AD clinical spectrum. METHODS A total of 136 subjects participated in this study. Four groups were established based on AD biomarker positivity from positron emission tomography (amyloid [A] and tau [T]) and clinical diagnosis (cognitively normal [CN] and impaired [IM]). CVD markers were derived from structural and quantitative magnetic resonance imaging data. RESULTS Transcapillary pulse wave delay was significantly longer in controls compared to AT biomarker-confirmed groups (A+/T-/CN P < .001, A+/T+/CN P < .001, A+/T+/IM P = .003). Intracranial low-frequency oscillations were diminished in AT biomarker-confirmed groups both CN and impaired (A+/T-/CN P = .039, A+/T+/CN P = .007, A+/T+/IM P = .011). A significantly higher presence of microhemorrhages was measured in A+/T+/CN compared to controls (P = .006). DISCUSSION Cerebrovascular markers indicate increased vessel stiffness and reduced vasomotion in AT biomarker-positive subjects during preclinical AD.
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Affiliation(s)
- Leonardo A. Rivera‐Rivera
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of Medical PhysicsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Laura Eisenmenger
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Karly A. Cody
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Thomas Reher
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Tobey Betthauser
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Robert V. Cadman
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Howard A. Rowley
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Cynthia M. Carlsson
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Geriatric Research Education and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Nathaniel A. Chin
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Sterling C. Johnson
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Geriatric Research Education and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Kevin M. Johnson
- Department of Medical PhysicsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
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12
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Wong A, Robinson L, Soroush S, Suresh A, Yang D, Madu K, Harhay MN, Pourrezaei K. Assessment of cerebral oxygenation response to hemodialysis using near-infrared spectroscopy (NIRS): Challenges and solutions. JOURNAL OF INNOVATIVE OPTICAL HEALTH SCIENCES 2021; 14:2150016. [PMID: 35173820 PMCID: PMC8846418 DOI: 10.1142/s1793545821500164] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
To date, the clinical use of functional near-infrared spectroscopy (NIRS) to detect cerebral ischemia has been largely limited to surgical settings, where motion artifacts are minimal. In this study, we present novel techniques to address the challenges of using NIRS to monitor ambulatory patients with kidney disease during approximately eight hours of hemodialysis (HD) treatment. People with end-stage kidney disease who require HD are at higher risk for cognitive impairment and dementia than age-matched controls. Recent studies have suggested that HD-related declines in cerebral blood flow might explain some of the adverse outcomes of HD treatment. However, there are currently no established paradigms for monitoring cerebral perfusion in real-time during HD treatment. In this study, we used NIRS to assess cerebral hemodynamic responses among 95 prevalent HD patients during two consecutive HD treatments. We observed substantial signal attenuation in our predominantly Black patient cohort that required probe modifications. We also observed consistent motion artifacts that we addressed by developing a novel NIRS methodology, called the HD cerebral oxygen demand algorithm (HD-CODA), to identify episodes when cerebral oxygen demand might be outpacing supply during HD treatment. We then examined the association between a summary measure of time spent in cerebral deoxygenation, derived using the HD-CODA, and hemodynamic and treatment-related variables. We found that this summary measure was associated with intradialytic mean arterial pressure, heart rate, and volume removal. Future studies should use the HD-CODA to implement studies of real-time NIRS monitoring for incident dialysis patients, over longer time frames, and in other dialysis modalities.
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Affiliation(s)
- Ardy Wong
- Drexel University School of Bioengineering, Philadelphia, Pennsylvania
| | - Lucy Robinson
- Department of Epidemiology & Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Seena Soroush
- Drexel University College of Arts and Sciences, Philadelphia, Pennsylvania
| | - Aditi Suresh
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Dia Yang
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Kelechi Madu
- Drexel University School of Bioengineering, Philadelphia, Pennsylvania
| | - Meera N. Harhay
- Department of Epidemiology & Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
- Tower Health Transplant Institute, Tower Health System, West Reading, Pennsylvania
| | - Kambiz Pourrezaei
- Drexel University School of Bioengineering, Philadelphia, Pennsylvania
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13
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Ibarra R, Radanovic M, Pais MV, Talib LL, Forlenza OV. AD-Related CSF Biomarkers Across Distinct Levels of Cognitive Impairment: Correlations With Global Cognitive State. J Geriatr Psychiatry Neurol 2021; 34:659-667. [PMID: 32757819 DOI: 10.1177/0891988720944237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM Associations between cerebrospinal fluid (CSF) biomarkers of Alzheimer's disease (AD) with the severity of cognitive impairment are unclear. We examined the correlations between CSF biomarkers and cognitive performance in the AD continuum. METHODS We studied 143 elderly patients: cognitively unimpaired (n = 51), mild cognitive impairment (MCI) amnestic (n = 55) and nonamnestic (n = 20), and mild AD (n = 17) assessed with the Cambridge Cognitive Test (CAMCOG). We correlated total CAMCOG and its subdomains with CSF Aβ42, T-tau, p-tau levels, and Aβ42/p-tau. RESULTS In the total sample, T-tau and Aβ42/p-tau correlated with the total CAMCOG (P < .01); all biomarkers correlated with memory (P < .001); T-tau correlated with language (P < .01). CONCLUSION Memory and T-tau levels may be the most suitable parameters to reflect cognitive/CSF biomarker correlations. At present, such correlations are of little use in routine clinical practice.
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Affiliation(s)
- Romel Ibarra
- Laboratorio de Neurociencias (LIM-27), Faculdade de Medicina, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Brazil
| | - Marcia Radanovic
- Laboratorio de Neurociencias (LIM-27), Faculdade de Medicina, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Brazil
| | - Marcos V Pais
- Laboratorio de Neurociencias (LIM-27), Faculdade de Medicina, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Brazil
| | - Leda L Talib
- Laboratorio de Neurociencias (LIM-27), Faculdade de Medicina, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Brazil
| | - Orestes V Forlenza
- Laboratorio de Neurociencias (LIM-27), Faculdade de Medicina, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Brazil
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14
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Deri Y, Clouston SAP, DeLorenzo C, Gardus JD, Bartlett EA, Santiago-Michels S, Bangiyev L, Kreisl WC, Kotov R, Huang C, Slifstein M, Parsey RV, Luft BJ. Neuroinflammation in World Trade Center responders at midlife: A pilot study using [ 18F]-FEPPA PET imaging. Brain Behav Immun Health 2021; 16:100287. [PMID: 34589784 PMCID: PMC8474562 DOI: 10.1016/j.bbih.2021.100287] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/20/2021] [Indexed: 02/08/2023] Open
Abstract
Background Neuroinflammation has long been theorized to arise from exposures to fine particulate matter and to be modulated when individuals experience chronic stress, both of which are also though to cause cognitive decline in part as a result of neuroinflammation. Objectives Hypothesizing that neuroinflammation might be linked to experiences at the World Trade Center (WTC) events, this study explored associations between glial activation and neuropsychological measures including post-traumatic stress disorder (PTSD) symptom severity and WTC exposure duration. Methods Translocator protein 18-kDa (TSPO) is overexpressed by activated glial cells, predominantly microglia and astrocytes, making TSPO distribution a putative biomarker for neuroinflammation. Twenty WTC responders completed neuropsychological assessments and in vivo PET brain scan with [18F]-FEPPA. Generalized linear modeling was used to test associations between PTSD, and WTC exposure duratiioni as the predictor and both global and regional [18F]-FEPPA total distribution volumes as the outcomes. Result Responders were 56.0 ± 4.7 years-old, and 75% were police officers on 9/11/2001, and all had at least a high school education. Higher PTSD symptom severity was associated with global and regional elevations in [18F]-FEPPA binding predominantly in the hippocampus (d = 0.72, P = 0.001) and frontal cortex (d = 0.64, P = 0.004). Longer exposure duration to WTC sites was associated with higher [18F]-FEPPA binding in the parietal cortex. Conclusion Findings from this study of WTC responders at midlife suggest that glial activation is associated with PTSD symptoms, and WTC exposure duration. Future investigation is needed to understand the important role of neuroinflammation in highly exposed WTC responders. We examined the theory that glial activation is associated with 9/11 exposures. TSPO-Vt was examined using PET in 20 responders adjusting for TSPO genotype. Responders with PTSD had increased TSPO distribution volume in the hippocampus. Heavily exposed responders had increased TSPO distribution in the parietal cortex.
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Affiliation(s)
- Yael Deri
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Sean A P Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Christine DeLorenzo
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.,Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - John D Gardus
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Elizabeth A Bartlett
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Stephanie Santiago-Michels
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Lev Bangiyev
- Department of Radiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - William C Kreisl
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Roman Kotov
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Chuan Huang
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.,Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA.,Department of Radiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Mark Slifstein
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Ramin V Parsey
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.,Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Benjamin J Luft
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.,Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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15
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Pudumjee SB, Lundt ES, Albertson SM, Machulda MM, Kremers WK, Jack CR, Knopman DS, Petersen RC, Mielke MM, Stricker NH. A Comparison of Cross-Sectional and Longitudinal Methods of Defining Objective Subtle Cognitive Decline in Preclinical Alzheimer's Disease Based on Cogstate One Card Learning Accuracy Performance. J Alzheimers Dis 2021; 83:861-877. [PMID: 34366338 DOI: 10.3233/jad-210251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Longitudinal, but not cross-sectional, cognitive testing is one option proposed to define transitional cognitive decline for individuals on the Alzheimer's disease continuum. OBJECTIVE Compare diagnostic accuracy of cross-sectional subtle objective cognitive impairment (sOBJ) and longitudinal objective decline (ΔOBJ) over 30 months for identifying 1) cognitively unimpaired participants with preclinical Alzheimer's disease defined by elevated brain amyloid and tau (A+T+) and 2) incident mild cognitive impairment (MCI) based on Cogstate One Card Learning (OCL) accuracy performance. METHODS Mayo Clinic Study of Aging cognitively unimpaired participants aged 50 + with amyloid and tau PET scans (n = 311) comprised the biomarker-defined sample. A case-control sample of participants aged 65 + remaining cognitively unimpaired for at least 30 months included 64 who subsequently developed MCI (incident MCI cases) and 184 controls, risk-set matched by age, sex, education, and visit number. sOBJ was assessed by OCL z-scores. ΔOBJ was assessed using within subjects' standard deviation and annualized change from linear regression or linear mixed effects (LME) models. Concordance measures Area Under the ROC Curve (AUC) or C-statistic and odds ratios (OR) from conditional logistic regression models were derived. sOBJ and ΔOBJ were modeled jointly to compare methods. RESULTS sOBJ and ΔOBJ-LME methods differentiated A+T+ from A-T- (AUC = 0.64, 0.69) and controls from incident MCI (C-statistic = 0.59, 0.69) better than chance; other ΔOBJ methods did not. ΔOBJ-LME improved prediction of future MCI over baseline sOBJ (p = 0.003) but not over 30-month sOBJ (p = 0.09). CONCLUSION Longitudinal decline did not offer substantial benefit over cross-sectional assessment in detecting preclinical Alzheimer's disease or incident MCI.
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Affiliation(s)
- Shehroo B Pudumjee
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Emily S Lundt
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Sabrina M Albertson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Walter K Kremers
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ronald C Petersen
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Nikki H Stricker
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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16
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Edgar CJ, Siemers E, Maruff P, Petersen RC, Aisen PS, Weiner MW, Albala B. Pilot Evaluation of the Unsupervised, At-Home Cogstate Brief Battery in ADNI-2. J Alzheimers Dis 2021; 83:915-925. [PMID: 34366337 PMCID: PMC8543269 DOI: 10.3233/jad-210201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: There is a need for feasible, scalable assessments to detect cognitive impairment and decline. The Cogstate Brief Battery (CBB) is validated for Alzheimer’s disease (AD) and in unsupervised and bring your own device contexts. The CBB has shown usability for self-completion in the home but has not been employed in this way in a multisite clinical trial in AD. Objective: The objective of the pilot was to evaluate feasibility of at-home, self-completion of the CBB in the Alzheimer’s Disease Neuroimaging Initiative (ADNI) over 24 months. Methods: The CBB was included as a pilot for cognitively normal (CN) and mild cognitive impairment (MCI) participants in ADNI-2, invited to take the assessment in-clinic, then at at-home over a period of 24 months follow-up. Data were analyzed to explore acceptability/usability, concordance of in-clinic and at-home assessment, and validity. Results: Data were collected for 104 participants (46 CN, 51 MCI, and 7 AD) who consented to provide CBB data. Subsequent analyses were performed for the CN and MCI groups only. Test completion rates were 100%for both the first in-clinic supervised and first at-home unsupervised assessments, with few repeat performances required. However, available follow-up data declined sharply over time. Good concordance was seen between in-clinic and at-home assessments, with non-significant and small effect size differences (Cohen’s d between -0.04 and 0.28) and generally moderate correlations (r = 0.42 to 0.73). Known groups validity was also supported (11/16 comparisons with Cohen’s d≥0.3). Conclusion: These data demonstrate the feasibility of use for the CBB for unsupervised at-home, testing, including MCI groups. Optimal approaches to the application of assessments to support compliance over time remain to be determined.
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Affiliation(s)
| | | | | | | | - Paul S Aisen
- University of Southern California, San Diego, CA, USA
| | - Michael W Weiner
- Department of Radiology, Medicine, and Psychiatry, University of California San Francisco, San Francisco, CA, USA
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Ennis GE, Koscik RL, Ma Y, Jonaitis EM, Van Hulle CA, Betthauser TJ, Randall AM, Chin N, Engelman CD, Anderson R, Suridjan I, Kollmorgen G, Christian BT, Carlsson CM, Asthana S, Johnson SC, Zetterberg H, Blennow K, Bendlin BB. Insulin resistance is related to cognitive decline but not change in CSF biomarkers of Alzheimer's disease in non-demented adults. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12220. [PMID: 34337133 PMCID: PMC8319658 DOI: 10.1002/dad2.12220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/10/2021] [Accepted: 06/04/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION We investigated whether insulin resistance (IR) was associated with longitudinal age-related change in cognition and biomarkers of Alzheimer's disease (AD) pathology and neurodegeneration in middle-aged and older adults who were non-demented at baseline. METHODS IR was measured with homeostatic model assessment of insulin resistance (HOMA2-IR). Core AD-related cerebrospinal fluid (CSF) biomarkers and cognition were assessed, respectively, on n = 212 (1 to 5 visits) and n = 1299 (1 to 6 visits). Linear mixed models tested whether HOMA2-IR moderated age-related change in CSF biomarkers and cognition. Linear regressions tested whether HOMA2-IR x apolipoprotein E ε4 allele (APOE ε4) carrier status predicted amyloid beta [Aβ] chronicity (estimated duration of amyloid positron emission tomography [PET] positivity) (n = 253). RESULTS Higher HOMA2-IR was associated with greater cognitive decline but not with changes in CSF biomarkers. HOMA2-IR x APOE4 was not related to Aβ chronicity but was significantly associated with CSF phosphorylated tau (P-tau)181/Aβ42 level. DISCUSSION In non-demented adults IR may not be directly associated with age-related change in AD biomarkers. Additional research is needed to determine mechanisms linking IR to cognitive decline.
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Affiliation(s)
- Gilda E Ennis
- Wisconsin Alzheimer's Disease Research Center University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Rebecca L Koscik
- Wisconsin Alzheimer's Disease Research Center University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Wisconsin Alzheimer's Institute University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Yue Ma
- Wisconsin Alzheimer's Disease Research Center University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Erin M Jonaitis
- Wisconsin Alzheimer's Institute University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Carol A Van Hulle
- Wisconsin Alzheimer's Disease Research Center University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Tobey J Betthauser
- Wisconsin Alzheimer's Disease Research Center University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Division of Geriatrics and Gerontology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Allison M Randall
- Wisconsin Alzheimer's Disease Research Center University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Nathaniel Chin
- Wisconsin Alzheimer's Disease Research Center University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Division of Geriatrics and Gerontology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Corinne D Engelman
- Department of Population Health Sciences University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Rozalyn Anderson
- Division of Geriatrics and Gerontology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Geriatric Research Education and Clinical Center William S. Middleton Hospital Department of Veterans Affairs Madison Wisconsin USA
| | | | | | - Bradley T Christian
- Wisconsin Alzheimer's Disease Research Center University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Waisman Laboratory for Brain Imaging and Behavior University of Wisconsin-Madison Madison Wisconsin USA
- Department of Medical Physics University of Wisconsin-Madison Madison Wisconsin USA
| | - Cynthia M Carlsson
- Wisconsin Alzheimer's Disease Research Center University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Wisconsin Alzheimer's Institute University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Division of Geriatrics and Gerontology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Geriatric Research Education and Clinical Center William S. Middleton Hospital Department of Veterans Affairs Madison Wisconsin USA
| | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research Center University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Wisconsin Alzheimer's Institute University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Division of Geriatrics and Gerontology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Geriatric Research Education and Clinical Center William S. Middleton Hospital Department of Veterans Affairs Madison Wisconsin USA
| | - Sterling C Johnson
- Wisconsin Alzheimer's Disease Research Center University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Wisconsin Alzheimer's Institute University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Division of Geriatrics and Gerontology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Geriatric Research Education and Clinical Center William S. Middleton Hospital Department of Veterans Affairs Madison Wisconsin USA
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology The Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden
- UK Dementia Research Institute at UCL London UK
- Department of Neurodegenerative Disease UCL Institute of Neurology London UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology The Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden
| | - Barbara B Bendlin
- Wisconsin Alzheimer's Disease Research Center University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Wisconsin Alzheimer's Institute University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Division of Geriatrics and Gerontology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Geriatric Research Education and Clinical Center William S. Middleton Hospital Department of Veterans Affairs Madison Wisconsin USA
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Langhough Koscik R, Hermann BP, Allison S, Clark LR, Jonaitis EM, Mueller KD, Betthauser TJ, Christian BT, Du L, Okonkwo O, Birdsill A, Chin N, Gleason C, Johnson SC. Validity Evidence for the Research Category, "Cognitively Unimpaired - Declining," as a Risk Marker for Mild Cognitive Impairment and Alzheimer's Disease. Front Aging Neurosci 2021; 13:688478. [PMID: 34381351 PMCID: PMC8350058 DOI: 10.3389/fnagi.2021.688478] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/16/2021] [Indexed: 12/11/2022] Open
Abstract
While clinically significant cognitive impairment is the key feature of the symptomatic stages of the Alzheimer's disease (AD) continuum, subtle cognitive decline is now known to occur years before a clinical diagnosis of mild cognitive impairment (MCI) or dementia due to AD is made. The primary aim of this study was to examine criterion validity evidence for an operational definition of "cognitively unimpaired-declining" (CU-D) in the Wisconsin Registry for Alzheimer's Prevention (WRAP), a longitudinal cohort study following cognition and risk factors from mid-life and on. Cognitive status was determined for each visit using a consensus review process that incorporated internal norms and published norms; a multi-disciplinary panel reviewed cases first to determine whether MCI or dementia was present, and subsequently whether CU-D was present, The CU-D group differed from CU-stable (CU-S) and MCI on concurrent measures of cognition, demonstrating concurrent validity. Participants who changed from CU-S to CU-D at the next study visit demonstrated greater declines than those who stayed CU-S. In addition, those who were CU-D were more likely to progress to MCI or dementia than those who were CU-S (predictive validity). In a subsample with positron emission tomography (PET) imaging, the CU-D group also differed from the CU-S and MCI/Dementia groups on measures of amyloid and tau burden, indicating that biomarker evidence of AD was elevated in those showing sub-clinical (CU-D) decline. Together, the results corroborate other studies showing that cognitive decline begins long before a dementia diagnosis and indicate that operational criteria can detect subclinical decline that may signal AD or other dementia risk.
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Affiliation(s)
- Rebecca Langhough Koscik
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
| | - Bruce P Hermann
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
- Department of Neurology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Samantha Allison
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
- Madison VA GRECC, William S. Middleton Memorial Hospital, Madison, WI, United States
| | - Lindsay R Clark
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
- Madison VA GRECC, William S. Middleton Memorial Hospital, Madison, WI, United States
| | - Erin M Jonaitis
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
| | - Kimberly D Mueller
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
- Department of Communication Sciences and Disorders, University of Wisconsin, Madison, WI, United States
| | - Tobey J Betthauser
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
| | - Bradley T Christian
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
- Department of Medical Physics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Lianlian Du
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Ozioma Okonkwo
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
| | - Alex Birdsill
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
- Madison VA GRECC, William S. Middleton Memorial Hospital, Madison, WI, United States
| | - Nathaniel Chin
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
| | - Carey Gleason
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
- Madison VA GRECC, William S. Middleton Memorial Hospital, Madison, WI, United States
- Department of Geriatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Sterling C Johnson
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Wisconsin Alzheimer's Disease Research Center, Madison, WI, United States
- Madison VA GRECC, William S. Middleton Memorial Hospital, Madison, WI, United States
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Deri Y, Clouston SAP, DeLorenzo C, Gardus JD, Horton M, Tang C, Pellecchia AC, Santiago‐Michels S, Carr MA, Gandy S, Sano M, Bromet EJ, Lucchini RG, Luft BJ. Selective hippocampal subfield volume reductions in World Trade Center responders with cognitive impairment. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12165. [PMID: 33816755 PMCID: PMC8011041 DOI: 10.1002/dad2.12165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The objective of this study was to investigate associations between dementia in World Trade Center (WTC) responders and in vivo volumetric measures of hippocampal subfield volumes in WTC responders at midlife. METHODS A sample of 99 WTC responders was divided into dementia and unimpaired groups. Participants underwent structural T1-weighted magnetic resonance imaging. Volumetric measures included the overall hippocampus and eight subfields. Regression models examined volumetric measure of interest adjusting for confounders including intracranial volume. RESULTS Dementia was associated with smaller hippocampal volume and with reductions across hippocampal subfields. Smaller hippocampal subfield volumes were associated with longer cumulative time worked at the WTC. Domain-specific cognitive performance was associated with lower volumetric measures across hippocampal subregions. CONCLUSIONS This is the first study to investigate hippocampal subfield volumes in a sample of WTC responders at midlife. Selective hippocampal subfield volume reductions suggested abnormal cognition that were associated with WTC exposure duration.
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Affiliation(s)
- Yael Deri
- Department of MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Sean A. P. Clouston
- Program in Public Health and Department of Family, Population, and Preventive MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Christine DeLorenzo
- Department of PsychiatryRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
- Department of Biomedical EngineeringStony Brook UniversityStony BrookNew YorkUSA
| | - John D. Gardus
- Department of PsychiatryRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Megan Horton
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Cheuk Tang
- Biomedical Engineering and Imaging InstituteIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Alison C. Pellecchia
- Stony Brook World Trade Center Wellness ProgramRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Stephanie Santiago‐Michels
- Stony Brook World Trade Center Wellness ProgramRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Melissa A. Carr
- Stony Brook World Trade Center Wellness ProgramRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Sam Gandy
- Barbara and Maurice Deane Center for Wellness and Cognitive Health and the Mount Sinai Center for NFL Neurological Care, Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Mount Sinai Alzheimer's Disease Research CenterIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Mary Sano
- Mount Sinai Alzheimer's Disease Research CenterIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Evelyn J. Bromet
- Department of PsychiatryRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Roberto G. Lucchini
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Benjamin J. Luft
- Department of MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
- Stony Brook World Trade Center Wellness ProgramRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
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Papp KV, Rentz DM, Maruff P, Sun CK, Raman R, Donohue MC, Schembri A, Stark C, Yassa MA, Wessels AM, Yaari R, Holdridge KC, Aisen PS, Sperling RA. The Computerized Cognitive Composite (C3) in an Alzheimer's Disease Secondary Prevention Trial. J Prev Alzheimers Dis 2021; 8:59-67. [PMID: 33336226 PMCID: PMC7755110 DOI: 10.14283/jpad.2020.38] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND Computerized cognitive assessments may improve Alzheimer's disease (AD) secondary prevention trial efficiency and accuracy. However, they require validation against standard outcomes and relevant biomarkers. OBJECTIVE To assess the feasibility and validity of the tablet-based Computerized Cognitive Composite (C3). DESIGN Cross-sectional analysis of cognitive screening data from the A4 study (Anti-Amyloid in Asymptomatic AD). SETTING Multi-center international study. PARTICIPANTS Clinically normal (CN) older adults (65-85; n=4486). MEASUREMENTS Participants underwent florbetapir-Positron Emission Tomography for Aβ+/- classification. They completed the C3 and standard paper and pencil measures included in the Preclinical Alzheimer's Cognitive Composite (PACC). The C3 combines memory measures sensitive to change over time (Cogstate Brief Battery-One Card Learning) and measures shown to be declining early in AD including pattern separation (Behavioral Pattern Separation Test- Object- Lure Discrimination Index) and associative memory (Face Name Associative Memory Exam- Face-Name Matching). C3 acceptability and completion rates were assessed using qualitative and quantitative methods. C3 performance was explored in relation to Aβ+/- groups (n=1323/3163) and PACC. RESULTS C3 was feasible for CN older adults to complete. Rates of incomplete or invalid administrations were extremely low, even in the bottom quartile of cognitive performers (PACC). C3 was moderately correlated with PACC (r=0.39). Aβ+ performed worse on C3 compared with Aβ- [unadjusted Cohen's d=-0.22 (95%CI: -0.31,-0.13) p<0.001] and at a magnitude comparable to the PACC [d=-0.32 (95%CI: -0.41,-0.23) p<0.001]. Better C3 performance was observed in younger, more educated, and female participants. CONCLUSIONS These findings provide support for both the feasibility and validity of C3 and computerized cognitive outcomes more generally in AD secondary prevention trials.
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Affiliation(s)
- K V Papp
- Kathryn V. Papp, Center for Alzheimer Research and Treatment; 60 Fenwood Road; Boston, MA 02115, Telephone: 617-643-5322; Fax: 857-5461, Email Address:
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Thompson F, Cysique LA, Harriss LR, Taylor S, Savage G, Maruff P, Mcdermott R. Acceptability and Usability of Computerized Cognitive Assessment Among Australian Indigenous Residents of the Torres Strait Islands. Arch Clin Neuropsychol 2020; 35:1288-1302. [PMID: 32647858 DOI: 10.1093/arclin/acaa037] [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] [Received: 10/07/2019] [Revised: 04/23/2020] [Accepted: 05/29/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This cross-sectional study aimed to investigate the acceptability and usability of the Cogstate Brief Battery (CBB) in a community-based sample of Australian Indigenous people from the Torres Strait region, based on a user experience framework of human-computer interaction. METHODS Two-hundred community participants completed the four subtests of the CBB on an iPad platform, during a free adult health check on two islands in the region, between October and December 2016. Acceptability was defined as completing the learning trial of a task and usability as continuing a task through to completion, determined by examiner acumen and internal Cogstate completion and integrity criteria. These were combined into a single dichotomous completion measure for logistic regression analyses. Performance-measured as reaction times and accuracy of responses-was analyzed using linear regression analyses. RESULTS CBB completion ranged from 82.0% to 91.5% across the four tasks and the odds of completing decreased with age. After adjusting for age, iPad/tablet familiarity increased the odds of completion for all tasks while level of education and employment increased the odds for some tasks only. These variables accounted for 18.0%-23.8% of the variance in reaction times on speeded tasks. Age and education had the most effect, although semipartial correlations were modest. CONCLUSIONS When administered in a health-screening context, the acceptability and usability of the CBB were greatest in young- to middle-aged participants with some education and iPad/tablet experience. Older and more vulnerable participants may have benefited from additional time and practice on the CBB prior to administration.
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Affiliation(s)
- Fintan Thompson
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Lucette A Cysique
- Neurosciences Research Australia, Psychology Department, University of New South Wales, Sydney, New South Wales, Australia
| | - Linton R Harriss
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Sean Taylor
- Top End Health Service, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Greg Savage
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | | | - Robyn Mcdermott
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
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Mueller KD, Koscik RL, Du L, Bruno D, Jonaitis EM, Koscik AZ, Christian BT, Betthauser TJ, Chin NA, Hermann BP, Johnson SC. Proper names from story recall are associated with beta-amyloid in cognitively unimpaired adults at risk for Alzheimer's disease. Cortex 2020; 131:137-150. [PMID: 32861209 PMCID: PMC7530114 DOI: 10.1016/j.cortex.2020.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/11/2020] [Accepted: 07/21/2020] [Indexed: 12/29/2022]
Abstract
Due to advances in the early detection of Alzheimer's disease (AD) biomarkers including beta-amyloid (Aβ), neuropsychological measures that are sensitive to concurrent, subtle changes in cognition are critically needed. Story recall tasks have shown sensitivity to early memory declines in persons with mild cognitive impairment (MCI) and early stage dementia, as well as in persons with autosomal dominantly inherited AD up to 10 years prior to a dementia diagnosis. However, the evidence is inconclusive regarding relationships between evidence of Aβ and story recall measures. Because story recall tasks require the encoding and delayed retrieval of several lexical-semantic categories, such as proper names, verbs, and numerical expressions, and because lexical categories have been shown to be differentially impaired in persons with MCI, we focused on item-level analyses of lexical-semantic retrieval from a quintessential story recall task, Logical Memory from the Wechsler Memory Scale-Revised. Our objective was to investigate whether delayed recall of lexical categories (proper names, verbs and/or numerical expressions), as well as the traditional total score measure, was associated with "preclinical AD," or cognitively unimpaired adults with positive Aβ deposition on positron emission tomography (PET) neuroimaging using Pittsburgh Compound B (PiB). We developed an item-level scoring system, in which we parsed items into lexical categories and examined the immediate and delayed recall of these lexical categories from 217 cognitively unimpaired participants from the Wisconsin Registry for Alzheimer's Prevention (WRAP). We performed binary logistic regression models with story recall score as predictor and Aβ status (positive/negative) as the outcome. Using baseline Logical Memory data, proper names from delayed story recall were significantly associated with Aβ status, such that participants who recalled more proper names were less likely to be classified as PiB(+) (odds ratio = .58, p = .01). None of the other story recall variables, including total score, were associated with PiB status. Secondary analyses determined that immediate recall of proper names was not significantly associated with Aβ, suggesting a retrieval deficit rather than that of encoding. The present findings suggest that lexical semantic retrieval measures from existing story recall tasks may be sensitive to Aβ deposition, and may provide added utility to a widely-used, long-standing neuropsychological test for early detection of cognitive decline on the AD continuum.
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Affiliation(s)
- Kimberly D Mueller
- Department of Communication Sciences and Disorders, University of Wisconsin - Madison, Madison, WI, USA; Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Rebecca L Koscik
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Lianlian Du
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Davide Bruno
- School of Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, UK
| | - Erin M Jonaitis
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Audra Z Koscik
- Department of Communication Sciences and Disorders, University of Wisconsin - Madison, Madison, WI, USA; Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Bradley T Christian
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin - Madison, Madison, WI, USA; Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, USA
| | - Tobey J Betthauser
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, USA
| | - Nathaniel A Chin
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Bruce P Hermann
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Neurology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
| | - Sterling C Johnson
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Geriatric Research Education and Clinical Center, William S. Middleton Veterans Hospital, Madison, WI, USA
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Sznitman SR, Vulfsons S, Meiri D, Weinstein G. Medical cannabis and cognitive performance in middle to old adults treated for chronic pain. Drug Alcohol Rev 2020; 40:272-280. [PMID: 32964502 DOI: 10.1111/dar.13171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 08/04/2020] [Accepted: 08/25/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION AND AIMS Cannabis exposure is becoming more common in older age but little is known about how it is associated with brain health in this population. This study assesses the relationship between long-term medical cannabis (MC) use and cognitive function in a sample of middle-aged and old chronic pain patients. DESIGN AND METHODS A cross-sectional study was conducted among chronic pain patients aged 50+ years who had MC licenses (n = 63) and a comparison group who did not have MC licenses (n = 62). CogState computerised brief battery was used to assess cognitive performance of psychomotor reaction, attention, working memory and new learning. Regression models and Bayesian t-tests examined differences in cognitive performance in the two groups. Furthermore, the associations between MC use patterns (dosage, cannabinoid concentrations, length and frequency of use and hours since last use) with cognition were assessed among MC licensed patients. RESULTS Mean age was 63 ± 6 and 60 ± 5 years in the non-exposed and MC patients, respectively. Groups did not significantly differ in terms of cognitive performance measures. Furthermore, none of the MC use patterns were associated with cognitive performance. DISCUSSION AND CONCLUSIONS These results suggest that use of whole plant MC does not have a widespread impact on cognition in older chronic pain patients. Considering the increasing use of MC in older populations, this study could be a first step towards a better risk-benefit assessment of MC treatment in this population. Future studies are urgently needed to further clarify the implications of late-life cannabis use for brain health.
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Affiliation(s)
- Sharon R Sznitman
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Simon Vulfsons
- Institute for Pain Medicine, Rambam Health Care Campus, Haifa, Israel.,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - David Meiri
- Faculty of Biology, Technion-Israel Institute of Technology, Haifa, Israel
| | - Galit Weinstein
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Betthauser TJ, Koscik RL, Jonaitis EM, Allison SL, Cody KA, Erickson CM, Rowley HA, Stone CK, Mueller KD, Clark LR, Carlsson CM, Chin NA, Asthana S, Christian BT, Johnson SC. Amyloid and tau imaging biomarkers explain cognitive decline from late middle-age. Brain 2020; 143:320-335. [PMID: 31886494 PMCID: PMC6935717 DOI: 10.1093/brain/awz378] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/23/2019] [Accepted: 10/11/2019] [Indexed: 11/14/2022] Open
Abstract
This study investigated differences in retrospective cognitive trajectories between amyloid and tau PET biomarker stratified groups in initially cognitively unimpaired participants sampled from the Wisconsin Registry for Alzheimer's Prevention. One hundred and sixty-seven initially unimpaired individuals (baseline age 59 ± 6 years; 115 females) were stratified by elevated amyloid-β and tau status based on 11C-Pittsburgh compound B (PiB) and 18F-MK-6240 PET imaging. Mixed effects models were used to determine if longitudinal cognitive trajectories based on a composite of cognitive tests including memory and executive function differed between biomarker groups. Secondary analyses investigated group differences for a variety of cross-sectional health and cognitive tests, and associations between 18F-MK-6240, 11C-PiB, and age. A significant group × age interaction was observed with post hoc comparisons indicating that the group with both elevated amyloid and tau pathophysiology were declining approximately three times faster in retrospective cognition compared to those with just one or no elevated biomarkers. This result was robust against various thresholds and medial temporal lobe regions defining elevated tau. Participants were relatively healthy and mostly did not differ between biomarker groups in health factors at the beginning or end of study, or most cognitive measures at study entry. Analyses investigating association between age, MK-6240 and PiB indicated weak associations between age and 18F-MK-6240 in tangle-associated regions, which were negligible after adjusting for 11C-PiB. Strong associations, particularly in entorhinal cortex, hippocampus and amygdala, were observed between 18F-MK-6240 and global 11C-PiB in regions associated with Braak neurofibrillary tangle stages I-VI. These results suggest that the combination of pathological amyloid and tau is detrimental to cognitive decline in preclinical Alzheimer's disease during late middle-age. Within the Alzheimer's disease continuum, middle-age health factors likely do not greatly influence preclinical cognitive decline. Future studies in a larger preclinical sample are needed to determine if and to what extent individual contributions of amyloid and tau affect cognitive decline. 18F-MK-6240 shows promise as a sensitive biomarker for detecting neurofibrillary tangles in preclinical Alzheimer's disease.
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Affiliation(s)
- Tobey J Betthauser
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Rebecca L Koscik
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Erin M Jonaitis
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Samantha L Allison
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Geriatric Research Education and Clinical Center, William S. Middleton Veterans Hospital, Madison, WI, USA
| | - Karly A Cody
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Claire M Erickson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Howard A Rowley
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Charles K Stone
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Kimberly D Mueller
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA
| | - Lindsay R Clark
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Geriatric Research Education and Clinical Center, William S. Middleton Veterans Hospital, Madison, WI, USA
| | - Cynthia M Carlsson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Geriatric Research Education and Clinical Center, William S. Middleton Veterans Hospital, Madison, WI, USA
| | - Nathaniel A Chin
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Geriatric Research Education and Clinical Center, William S. Middleton Veterans Hospital, Madison, WI, USA
| | - Bradley T Christian
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison, Madison, WI, USA.,Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Sterling C Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Geriatric Research Education and Clinical Center, William S. Middleton Veterans Hospital, Madison, WI, USA
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Koscik RL, Betthauser TJ, Jonaitis EM, Allison SL, Clark LR, Hermann BP, Cody KA, Engle JW, Barnhart TE, Stone CK, Chin NA, Carlsson CM, Asthana S, Christian BT, Johnson SC. Amyloid duration is associated with preclinical cognitive decline and tau PET. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12007. [PMID: 32211502 PMCID: PMC7085284 DOI: 10.1002/dad2.12007] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/20/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION This study applies a novel algorithm to longitudinal amyloid positron emission tomography (PET) imaging to identify age-heterogeneous amyloid trajectory groups, estimate the age and duration (chronicity) of amyloid positivity, and investigate chronicity in relation to cognitive decline and tau burden. METHODS Cognitively unimpaired participants (n = 257) underwent one to four amyloid PET scans (Pittsburgh Compound B, PiB). Group-based trajectory modeling was applied to participants with longitudinal scans (n = 171) to identify and model amyloid trajectory groups, which were combined with Bayes theorem to estimate age and chronicity of amyloid positivity. Relationships between chronicity, cognition, clinical progression, and tau PET (MK-6240) were investigated using regression models. RESULTS Chronicity explained more heterogeneity in amyloid burden than age and binary amyloid status. Chronicity was associated with faster cognitive decline, increased risk of abnormal cognition, and higher entorhinal tau. DISCUSSION Amyloid chronicity provides unique information about cognitive decline and neurofibrillary tangle development and may be useful to investigate preclinical Alzheimer's disease.
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Affiliation(s)
- Rebecca L. Koscik
- Wisconsin Alzheimer's InstituteUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
- Department of MedicineUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
| | - Tobey J. Betthauser
- Department of MedicineUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
- Wisconsin Alzheimer's Disease Research CenterUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
| | - Erin M. Jonaitis
- Wisconsin Alzheimer's InstituteUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
- Department of MedicineUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
| | - Samantha L. Allison
- Department of MedicineUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
- Wisconsin Alzheimer's Disease Research CenterUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
- Geriatric Research Education and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWisconsin
| | - Lindsay R. Clark
- Department of MedicineUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
- Wisconsin Alzheimer's Disease Research CenterUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
- Geriatric Research Education and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWisconsin
| | - Bruce P. Hermann
- Wisconsin Alzheimer's InstituteUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
- Department of NeurologyUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
| | - Karly A. Cody
- Department of MedicineUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
- Wisconsin Alzheimer's Disease Research CenterUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
| | - Jonathan W. Engle
- Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWisconsin
| | - Todd E. Barnhart
- Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWisconsin
| | - Charles K. Stone
- Department of MedicineUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
| | - Nathaniel A. Chin
- Department of MedicineUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
- Wisconsin Alzheimer's Disease Research CenterUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
| | - Cynthia M. Carlsson
- Wisconsin Alzheimer's InstituteUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
- Department of MedicineUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
- Wisconsin Alzheimer's Disease Research CenterUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
- Geriatric Research Education and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWisconsin
| | - Sanjay Asthana
- Department of MedicineUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
- Wisconsin Alzheimer's Disease Research CenterUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
- Geriatric Research Education and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWisconsin
| | - Bradley T. Christian
- Wisconsin Alzheimer's Disease Research CenterUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
- Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWisconsin
- Waisman Laboratory for Brain Imaging and BehaviorUniversity of Wisconsin‐MadisonMadisonWisconsin
| | - Sterling C. Johnson
- Wisconsin Alzheimer's InstituteUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
- Department of MedicineUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
- Wisconsin Alzheimer's Disease Research CenterUniversity of WisconsinSchool of Medicine and Public HealthMadisonWisconsin
- Geriatric Research Education and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWisconsin
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Chehrehnegar N, Nejati V, Shati M, Esmaeili M, Rezvani Z, Haghi M, Foroughan M. Behavioral and cognitive markers of mild cognitive impairment: diagnostic value of saccadic eye movements and Simon task. Aging Clin Exp Res 2019; 31:1591-1600. [PMID: 30659514 DOI: 10.1007/s40520-019-01121-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/03/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mild Cognitive Impairment (MCI) has been considered as a prodromal stage of Alzheimer disease (AD). Subtle changes in specific aspects of executive function like inhibitory control have been found in MCI. AIMS We examined attentional and inhibitory control with the aim to distinguish between amnestic MCI patients and healthy controls. METHOD Using neuropsychological, behavioral, and oculomotor function experiments, we examined executive function in 59 normal control, 49, multiple domain amnestic MCI (a-MCI) subjects, and 21 early stage AD patients using eye tracking and Simon task as measures of attentional control, to determine which saccade and behavioral tasks were sensitive enough to identify a-MCI. Saccades were investigated in gap and overlap pro-saccade and anti-saccade tasks. RESULTS Scores on the Simon task were inversely correlated with general cognitive status and can distinguish a-MCI from controls with excellent specificity (AUC = 0.65 for reaction time and 0.59 for false responses). More importantly, our results showed that saccadic gains were affected in a-MCI and were the most sensitive measures to distinguish a-MCI from normal participants AST gap task AUC = 0.7, PST gap task AUC = 0.63, AST overlap task (AUC = 0.73). Moreover, these parameters were strongly correlated with neuropsychological measures. Using tests in parallel model, improved sensitivity up to 0.97. CONCLUSION The present results enable us to suggest eye tracking along with behavioral data as a possible sensitive tools to detect a-MCI in preclinical stage.
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Affiliation(s)
- Negin Chehrehnegar
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Occupational Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Nejati
- Department of Psychology and Educational Sciences, Shahid Behehsti University Tehran, Tehran, Iran
- Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | - Mohsen Shati
- Mental health, Research center, School of behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdieh Esmaeili
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Zahra Rezvani
- Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | - Marjan Haghi
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mahshid Foroughan
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
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27
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Clark LR, Koscik RL, Allison SL, Berman SE, Norton D, Carlsson CM, Betthauser TJ, Bendlin BB, Christian BT, Chin NA, Asthana S, Johnson SC. Hypertension and obesity moderate the relationship between β-amyloid and cognitive decline in midlife. Alzheimers Dement 2019; 15:418-428. [PMID: 30367828 PMCID: PMC6408972 DOI: 10.1016/j.jalz.2018.09.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/14/2018] [Accepted: 09/09/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND This study tested if central obesity, hypertension, or depressive symptoms moderated the relationship between β-amyloid (Aβ) and longitudinal cognitive performance in late middle-aged adults enriched for Alzheimer's disease (AD) risk. METHODS Participants (n = 207; ages = 40-70 years; 73% parental AD) in the Wisconsin Registry for Alzheimer's Prevention study completed 3+ neuropsychological evaluations and a [11C]PiB positron emission tomography scan or lumbar puncture. Linear mixed-effects regression models tested interactions of risk factor × Aβ × visit age on longitudinal Verbal Learning & Memory and Speed & Flexibility factor scores. RESULTS The relationship between Aβ and Verbal Learning & Memory decline was moderated by hypertension (χ2(1) = 3.85, P = .04) and obesity (χ2(1) = 6.12, P = .01); those with both elevated Aβ and the risk factor declined at faster rates than those with only elevated Aβ or elevated risk factors. CONCLUSION In this cohort, hypertension and obesity moderated the relationship between Aβ and cognitive decline.
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Affiliation(s)
- Lindsay R Clark
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
| | - Rebecca L Koscik
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Samantha L Allison
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sara E Berman
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Medical Scientist and Neuroscience Training Programs, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Derek Norton
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA
| | - Cynthia M Carlsson
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Tobey J Betthauser
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Waisman Center and Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Barbara B Bendlin
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Bradley T Christian
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Waisman Center and Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Nathaniel A Chin
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sanjay Asthana
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Sterling C Johnson
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
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28
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Jonaitis EM, Koscik RL, Clark LR, Ma Y, Betthauser TJ, Berman SE, Allison SL, Mueller KD, Hermann BP, Van Hulle CA, Christian BT, Bendlin BB, Blennow K, Zetterberg H, Carlsson CM, Asthana S, Johnson SC. Measuring longitudinal cognition: Individual tests versus composites. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2019; 11:74-84. [PMID: 31673596 PMCID: PMC6816509 DOI: 10.1016/j.dadm.2018.11.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Introduction Longitudinal cohort studies of cognitive aging must confront several sources of within-person variability in scores. In this article, we compare several neuropsychological measures in terms of longitudinal error variance and relationships with biomarker-assessed brain amyloidosis (Aβ). Methods Analyses used data from the Wisconsin Registry for Alzheimer's Prevention. We quantified within-person longitudinal variability and age-related trajectories for several global and domain-specific composites and their constituent scores. For a subset with cerebrospinal fluid or amyloid positron emission tomography measures, we examined how Aβ modified cognitive trajectories. Results Global and theoretically derived composites exhibited lower intraindividual variability and stronger age × Aβ interactions than did empirically derived composites or raw scores from single tests. For example, the theoretical executive function outperformed other executive function scores on both metrics. Discussion These results reinforce the need for careful selection of cognitive outcomes in study design, and support the emerging consensus favoring composites over single-test measures. Identifying early cognitive change requires tests with low error variance. In a middle-aged sample, composites were less noisy than single tests. Global and theory-driven composites outperformed data-driven composites.
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Affiliation(s)
- Erin M Jonaitis
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Rebecca L Koscik
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Lindsay R Clark
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison WI, USA.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Yue Ma
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Tobey J Betthauser
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Sara E Berman
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Samantha L Allison
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison WI, USA.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Kimberly D Mueller
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.,Department of Communication Sciences and Disorders, University of Wisconsin, Madison, WI, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Carol A Van Hulle
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Bradley T Christian
- Department of Medical Physics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.,Department of Psychiatry, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Barbara B Bendlin
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Cynthia M Carlsson
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison WI, USA.,Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Sanjay Asthana
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison WI, USA.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Sterling C Johnson
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison WI, USA.,Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
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Hackett K, Krikorian R, Giovannetti T, Melendez-Cabrero J, Rahman A, Caesar EE, Chen JL, Hristov H, Seifan A, Mosconi L, Isaacson RS. Utility of the NIH Toolbox for assessment of prodromal Alzheimer's disease and dementia. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2018; 10:764-772. [PMID: 30505926 PMCID: PMC6247399 DOI: 10.1016/j.dadm.2018.10.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction The NIH Toolbox Cognition Battery (NIHTB-CB) is a computer-based protocol not yet validated for clinical assessment. Methods We administered the NIHTB-CB and traditional neuropsychological tests to 247 Memory Disorders and Alzheimer's Prevention Clinic patients with subjective cognitive decline, mild cognitive impairment, mild dementia due to Alzheimer's disease, and normal cognition. Principal component analysis, partial correlations, and univariate general linear model tests were performed to assess construct validity. Discriminant function analyses compared classification accuracy. Results Principal component analysis identified three conceptually coherent factors: memory (MEMNIH), executive function (EFNIH), and crystallized intelligence (CINIH). These factors were strongly associated with corresponding traditional tests and differed across diagnostic groups as expected. Both NIHTB and traditional batteries yielded strong overall discriminative ability (>80%). Discussion The NIHTB-CB is a valid method to assess neurocognitive domains pertinent to aging and dementia and has utility for applications in a memory clinic setting.
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Affiliation(s)
- Katherine Hackett
- Department of Psychology, Temple University, Philadelphia, PA, USA
- Corresponding author. Tel.: +914-582-7581; Fax: +215-204-5539.
| | - Robert Krikorian
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | - Aneela Rahman
- Department of Neurology, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA
| | | | - Jaclyn L. Chen
- Stony Brook University School of Medicine, New York, NY, USA
| | - Hollie Hristov
- Department of Neurology, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA
| | | | - Lisa Mosconi
- Department of Neurology, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA
| | - Richard S. Isaacson
- Department of Neurology, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA
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Betthauser TJ, Cody KA, Zammit MD, Murali D, Converse AK, Barnhart TE, Stone CK, Rowley HA, Johnson SC, Christian BT. In Vivo Characterization and Quantification of Neurofibrillary Tau PET Radioligand 18F-MK-6240 in Humans from Alzheimer Disease Dementia to Young Controls. J Nucl Med 2018; 60:93-99. [PMID: 29777006 DOI: 10.2967/jnumed.118.209650] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/14/2018] [Indexed: 11/16/2022] Open
Abstract
Tau PET imaging has potential for elucidating changes in the deposition of neuropathological tau aggregates that are occurring during the progression of Alzheimer disease (AD). This work investigates in vivo kinetics, quantification strategies, and imaging characteristics of a novel tau PET radioligand 18F-MK-6240 in humans. Methods: Fifty-one individuals ranging from cognitively normal young controls to persons with dementia underwent T1-weighted MRI as well as 11C-PiB and 18F-MK-6240 PET imaging. PET data were coregistered to the MRI, and time-activity curves were extracted from regions of interest to assess 18F-MK-6240 kinetics. The pons and inferior cerebellum were investigated as potential reference regions. Reference tissue methods (Logan graphical analysis [LGA] and multilinear reference tissue method [MRTM2]) were investigated for quantification of 18F-MK-6240 distribution volume ratios (DVRs) in a subset of 19 participants. Stability of DVR methods was evaluated using truncated scan durations. SUV ratio (SUVR) estimates were compared with DVR estimates to determine the optimal timing window for SUVR analysis. Parametric SUVR images were used to identify regions of potential off-target binding and to compare binding patterns with neurofibrillary tau staging established in neuropathology literature. Results: SUVs in the pons and the inferior cerebellum indicated consistent clearance across all 51 subjects. LGA and MRTM2 DVR estimates were similar, with LGA slightly underestimating DVR compared with MRTM2. DVR estimates remained stable when truncating the scan duration to 60 min. SUVR determined 70-90 min after injection of 18F-MK-6240 indicated linearity near unity when compared with DVR estimates and minimized potential spill-in from uptake outside the brain. 18F-MK-6240 binding patterns in target regions were consistent with neuropathological neurofibrillary tau staging. Off-target binding regions included the ethmoid sinus, clivus, meninges, substantia nigra, but not the basal ganglia or choroid plexus. Conclusion: 18F-MK-6240 is a promising PET radioligand for in vivo imaging of neurofibrillary tau aggregates in AD with minimal off-target binding in the human brain.
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Affiliation(s)
- Tobey J Betthauser
- Department of Medical Physics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin .,Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Karly A Cody
- Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Matthew D Zammit
- Department of Medical Physics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.,Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Dhanabalan Murali
- Department of Medical Physics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Alexander K Converse
- Department of Medical Physics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.,Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Todd E Barnhart
- Department of Medical Physics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Charles K Stone
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Howard A Rowley
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Sterling C Johnson
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin; and.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Bradley T Christian
- Department of Medical Physics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.,Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
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Vogt NM, Kerby RL, Dill-McFarland KA, Harding SJ, Merluzzi AP, Johnson SC, Carlsson CM, Asthana S, Zetterberg H, Blennow K, Bendlin BB, Rey FE. Gut microbiome alterations in Alzheimer's disease. Sci Rep 2017; 7:13537. [PMID: 29051531 PMCID: PMC5648830 DOI: 10.1038/s41598-017-13601-y] [Citation(s) in RCA: 1129] [Impact Index Per Article: 161.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/27/2017] [Indexed: 12/22/2022] Open
Abstract
Alzheimer's disease (AD) is the most common form of dementia. However, the etiopathogenesis of this devastating disease is not fully understood. Recent studies in rodents suggest that alterations in the gut microbiome may contribute to amyloid deposition, yet the microbial communities associated with AD have not been characterized in humans. Towards this end, we characterized the bacterial taxonomic composition of fecal samples from participants with and without a diagnosis of dementia due to AD. Our analyses revealed that the gut microbiome of AD participants has decreased microbial diversity and is compositionally distinct from control age- and sex-matched individuals. We identified phylum- through genus-wide differences in bacterial abundance including decreased Firmicutes, increased Bacteroidetes, and decreased Bifidobacterium in the microbiome of AD participants. Furthermore, we observed correlations between levels of differentially abundant genera and cerebrospinal fluid (CSF) biomarkers of AD. These findings add AD to the growing list of diseases associated with gut microbial alterations, as well as suggest that gut bacterial communities may be a target for therapeutic intervention.
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Affiliation(s)
- Nicholas M Vogt
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue J5/1 Mezzanine, Madison, WI 53792, USA
| | - Robert L Kerby
- Department of Bacteriology, University of Wisconsin-Madison, 1550 Linden Drive, Madison, WI 53706, USA
| | - Kimberly A Dill-McFarland
- Department of Bacteriology, University of Wisconsin-Madison, 1550 Linden Drive, Madison, WI 53706, USA
| | - Sandra J Harding
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue J5/1 Mezzanine, Madison, WI 53792, USA
| | - Andrew P Merluzzi
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue J5/1 Mezzanine, Madison, WI 53792, USA
| | - Sterling C Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue J5/1 Mezzanine, Madison, WI 53792, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, WARF Building, 610 Walnut Street, 9th Floor, Suite 957, Madison, WI 53726, USA
| | - Cynthia M Carlsson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue J5/1 Mezzanine, Madison, WI 53792, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, WARF Building, 610 Walnut Street, 9th Floor, Suite 957, Madison, WI 53726, USA
| | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue J5/1 Mezzanine, Madison, WI 53792, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Molecular Neuroscience, University College London Institute of Neurology, Queen Square, London, United Kingdom
- UK Dementia Research Institute at University College London, London, United Kingdom
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Barbara B Bendlin
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue J5/1 Mezzanine, Madison, WI 53792, USA.
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, WARF Building, 610 Walnut Street, 9th Floor, Suite 957, Madison, WI 53726, USA.
| | - Federico E Rey
- Department of Bacteriology, University of Wisconsin-Madison, 1550 Linden Drive, Madison, WI 53706, USA.
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Boots EA, Schultz SA, Clark LR, Racine AM, Darst BF, Koscik RL, Carlsson CM, Gallagher CL, Hogan KJ, Bendlin BB, Asthana S, Sager MA, Hermann BP, Christian BT, Dubal DB, Engelman CD, Johnson SC, Okonkwo OC. BDNF Val66Met predicts cognitive decline in the Wisconsin Registry for Alzheimer's Prevention. Neurology 2017; 88:2098-2106. [PMID: 28468845 DOI: 10.1212/wnl.0000000000003980] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 03/13/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the influence of the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism on longitudinal cognitive trajectories in a large, cognitively healthy cohort enriched for Alzheimer disease (AD) risk and to understand whether β-amyloid (Aβ) burden plays a moderating role in this relationship. METHODS One thousand twenty-three adults (baseline age 54.94 ± 6.41 years) enrolled in the Wisconsin Registry for Alzheimer's Prevention underwent BDNF genotyping and cognitive assessment at up to 5 time points (average follow-up 6.92 ± 3.22 years). A subset (n = 140) underwent 11C-Pittsburgh compound B (PiB) scanning. Covariate-adjusted mixed-effects regression models were used to elucidate the effect of BDNF on cognitive trajectories in 4 cognitive domains, including verbal learning and memory, speed and flexibility, working memory, and immediate memory. Secondary mixed-effects regression models were conducted to examine whether Aβ burden, indexed by composite PiB load, modified any observed BDNF-related cognitive trajectories. RESULTS Compared to BDNF Val/Val homozygotes, Met carriers showed steeper decline in verbal learning and memory (p = 0.002) and speed and flexibility (p = 0.017). In addition, Aβ burden moderated the relationship between BDNF and verbal learning and memory such that Met carriers with greater Aβ burden showed even steeper cognitive decline (p = 0.033). CONCLUSIONS In a middle-aged cohort with AD risk, carriage of the BDNF Met allele was associated with steeper decline in episodic memory and executive function. This decline was exacerbated by greater Aβ burden. These results suggest that the BDNF Val66Met polymorphism may play an important role in cognitive decline and could be considered as a target for novel AD therapeutics.
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Affiliation(s)
- Elizabeth A Boots
- From the Geriatric Research Education and Clinical Center (E.A.B., S.A.S., L.R.C., C.M.C., C.L.G., B.B.B., S.A., S.C.J., O.C.C.), William S. Middleton Memorial Veterans Hospital; Wisconsin Alzheimer's Disease Research Center (E.A.B., S.A.S., L.R.C., A.M.R., C.M.C., C.L.G., B.B.B., S.A., M.A.S., B.P.H., B.T.C., S.C.J., O.C.O.), Wisconsin Alzheimer's Institute (L.R.C., R.L.K., C.M.C., K.J.H., B.B.B., S.A., M.A.S., B.P.H., C.D.E., S.C.J., O.C.O.), Department of Population Health Sciences (B.F.D., C.D.E.), Department of Neurology (C.L.G., B.P.H.), Department of Anesthesiology (K.J.H.), Department of Radiology (M.A.S.), and Department of Medical Physics (B.T.C.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.B.D.), University of California, San Francisco
| | - Stephanie A Schultz
- From the Geriatric Research Education and Clinical Center (E.A.B., S.A.S., L.R.C., C.M.C., C.L.G., B.B.B., S.A., S.C.J., O.C.C.), William S. Middleton Memorial Veterans Hospital; Wisconsin Alzheimer's Disease Research Center (E.A.B., S.A.S., L.R.C., A.M.R., C.M.C., C.L.G., B.B.B., S.A., M.A.S., B.P.H., B.T.C., S.C.J., O.C.O.), Wisconsin Alzheimer's Institute (L.R.C., R.L.K., C.M.C., K.J.H., B.B.B., S.A., M.A.S., B.P.H., C.D.E., S.C.J., O.C.O.), Department of Population Health Sciences (B.F.D., C.D.E.), Department of Neurology (C.L.G., B.P.H.), Department of Anesthesiology (K.J.H.), Department of Radiology (M.A.S.), and Department of Medical Physics (B.T.C.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.B.D.), University of California, San Francisco
| | - Lindsay R Clark
- From the Geriatric Research Education and Clinical Center (E.A.B., S.A.S., L.R.C., C.M.C., C.L.G., B.B.B., S.A., S.C.J., O.C.C.), William S. Middleton Memorial Veterans Hospital; Wisconsin Alzheimer's Disease Research Center (E.A.B., S.A.S., L.R.C., A.M.R., C.M.C., C.L.G., B.B.B., S.A., M.A.S., B.P.H., B.T.C., S.C.J., O.C.O.), Wisconsin Alzheimer's Institute (L.R.C., R.L.K., C.M.C., K.J.H., B.B.B., S.A., M.A.S., B.P.H., C.D.E., S.C.J., O.C.O.), Department of Population Health Sciences (B.F.D., C.D.E.), Department of Neurology (C.L.G., B.P.H.), Department of Anesthesiology (K.J.H.), Department of Radiology (M.A.S.), and Department of Medical Physics (B.T.C.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.B.D.), University of California, San Francisco
| | - Annie M Racine
- From the Geriatric Research Education and Clinical Center (E.A.B., S.A.S., L.R.C., C.M.C., C.L.G., B.B.B., S.A., S.C.J., O.C.C.), William S. Middleton Memorial Veterans Hospital; Wisconsin Alzheimer's Disease Research Center (E.A.B., S.A.S., L.R.C., A.M.R., C.M.C., C.L.G., B.B.B., S.A., M.A.S., B.P.H., B.T.C., S.C.J., O.C.O.), Wisconsin Alzheimer's Institute (L.R.C., R.L.K., C.M.C., K.J.H., B.B.B., S.A., M.A.S., B.P.H., C.D.E., S.C.J., O.C.O.), Department of Population Health Sciences (B.F.D., C.D.E.), Department of Neurology (C.L.G., B.P.H.), Department of Anesthesiology (K.J.H.), Department of Radiology (M.A.S.), and Department of Medical Physics (B.T.C.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.B.D.), University of California, San Francisco
| | - Burcu F Darst
- From the Geriatric Research Education and Clinical Center (E.A.B., S.A.S., L.R.C., C.M.C., C.L.G., B.B.B., S.A., S.C.J., O.C.C.), William S. Middleton Memorial Veterans Hospital; Wisconsin Alzheimer's Disease Research Center (E.A.B., S.A.S., L.R.C., A.M.R., C.M.C., C.L.G., B.B.B., S.A., M.A.S., B.P.H., B.T.C., S.C.J., O.C.O.), Wisconsin Alzheimer's Institute (L.R.C., R.L.K., C.M.C., K.J.H., B.B.B., S.A., M.A.S., B.P.H., C.D.E., S.C.J., O.C.O.), Department of Population Health Sciences (B.F.D., C.D.E.), Department of Neurology (C.L.G., B.P.H.), Department of Anesthesiology (K.J.H.), Department of Radiology (M.A.S.), and Department of Medical Physics (B.T.C.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.B.D.), University of California, San Francisco
| | - Rebecca L Koscik
- From the Geriatric Research Education and Clinical Center (E.A.B., S.A.S., L.R.C., C.M.C., C.L.G., B.B.B., S.A., S.C.J., O.C.C.), William S. Middleton Memorial Veterans Hospital; Wisconsin Alzheimer's Disease Research Center (E.A.B., S.A.S., L.R.C., A.M.R., C.M.C., C.L.G., B.B.B., S.A., M.A.S., B.P.H., B.T.C., S.C.J., O.C.O.), Wisconsin Alzheimer's Institute (L.R.C., R.L.K., C.M.C., K.J.H., B.B.B., S.A., M.A.S., B.P.H., C.D.E., S.C.J., O.C.O.), Department of Population Health Sciences (B.F.D., C.D.E.), Department of Neurology (C.L.G., B.P.H.), Department of Anesthesiology (K.J.H.), Department of Radiology (M.A.S.), and Department of Medical Physics (B.T.C.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.B.D.), University of California, San Francisco
| | - Cynthia M Carlsson
- From the Geriatric Research Education and Clinical Center (E.A.B., S.A.S., L.R.C., C.M.C., C.L.G., B.B.B., S.A., S.C.J., O.C.C.), William S. Middleton Memorial Veterans Hospital; Wisconsin Alzheimer's Disease Research Center (E.A.B., S.A.S., L.R.C., A.M.R., C.M.C., C.L.G., B.B.B., S.A., M.A.S., B.P.H., B.T.C., S.C.J., O.C.O.), Wisconsin Alzheimer's Institute (L.R.C., R.L.K., C.M.C., K.J.H., B.B.B., S.A., M.A.S., B.P.H., C.D.E., S.C.J., O.C.O.), Department of Population Health Sciences (B.F.D., C.D.E.), Department of Neurology (C.L.G., B.P.H.), Department of Anesthesiology (K.J.H.), Department of Radiology (M.A.S.), and Department of Medical Physics (B.T.C.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.B.D.), University of California, San Francisco
| | - Catherine L Gallagher
- From the Geriatric Research Education and Clinical Center (E.A.B., S.A.S., L.R.C., C.M.C., C.L.G., B.B.B., S.A., S.C.J., O.C.C.), William S. Middleton Memorial Veterans Hospital; Wisconsin Alzheimer's Disease Research Center (E.A.B., S.A.S., L.R.C., A.M.R., C.M.C., C.L.G., B.B.B., S.A., M.A.S., B.P.H., B.T.C., S.C.J., O.C.O.), Wisconsin Alzheimer's Institute (L.R.C., R.L.K., C.M.C., K.J.H., B.B.B., S.A., M.A.S., B.P.H., C.D.E., S.C.J., O.C.O.), Department of Population Health Sciences (B.F.D., C.D.E.), Department of Neurology (C.L.G., B.P.H.), Department of Anesthesiology (K.J.H.), Department of Radiology (M.A.S.), and Department of Medical Physics (B.T.C.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.B.D.), University of California, San Francisco
| | - Kirk J Hogan
- From the Geriatric Research Education and Clinical Center (E.A.B., S.A.S., L.R.C., C.M.C., C.L.G., B.B.B., S.A., S.C.J., O.C.C.), William S. Middleton Memorial Veterans Hospital; Wisconsin Alzheimer's Disease Research Center (E.A.B., S.A.S., L.R.C., A.M.R., C.M.C., C.L.G., B.B.B., S.A., M.A.S., B.P.H., B.T.C., S.C.J., O.C.O.), Wisconsin Alzheimer's Institute (L.R.C., R.L.K., C.M.C., K.J.H., B.B.B., S.A., M.A.S., B.P.H., C.D.E., S.C.J., O.C.O.), Department of Population Health Sciences (B.F.D., C.D.E.), Department of Neurology (C.L.G., B.P.H.), Department of Anesthesiology (K.J.H.), Department of Radiology (M.A.S.), and Department of Medical Physics (B.T.C.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.B.D.), University of California, San Francisco
| | - Barbara B Bendlin
- From the Geriatric Research Education and Clinical Center (E.A.B., S.A.S., L.R.C., C.M.C., C.L.G., B.B.B., S.A., S.C.J., O.C.C.), William S. Middleton Memorial Veterans Hospital; Wisconsin Alzheimer's Disease Research Center (E.A.B., S.A.S., L.R.C., A.M.R., C.M.C., C.L.G., B.B.B., S.A., M.A.S., B.P.H., B.T.C., S.C.J., O.C.O.), Wisconsin Alzheimer's Institute (L.R.C., R.L.K., C.M.C., K.J.H., B.B.B., S.A., M.A.S., B.P.H., C.D.E., S.C.J., O.C.O.), Department of Population Health Sciences (B.F.D., C.D.E.), Department of Neurology (C.L.G., B.P.H.), Department of Anesthesiology (K.J.H.), Department of Radiology (M.A.S.), and Department of Medical Physics (B.T.C.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.B.D.), University of California, San Francisco
| | - Sanjay Asthana
- From the Geriatric Research Education and Clinical Center (E.A.B., S.A.S., L.R.C., C.M.C., C.L.G., B.B.B., S.A., S.C.J., O.C.C.), William S. Middleton Memorial Veterans Hospital; Wisconsin Alzheimer's Disease Research Center (E.A.B., S.A.S., L.R.C., A.M.R., C.M.C., C.L.G., B.B.B., S.A., M.A.S., B.P.H., B.T.C., S.C.J., O.C.O.), Wisconsin Alzheimer's Institute (L.R.C., R.L.K., C.M.C., K.J.H., B.B.B., S.A., M.A.S., B.P.H., C.D.E., S.C.J., O.C.O.), Department of Population Health Sciences (B.F.D., C.D.E.), Department of Neurology (C.L.G., B.P.H.), Department of Anesthesiology (K.J.H.), Department of Radiology (M.A.S.), and Department of Medical Physics (B.T.C.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.B.D.), University of California, San Francisco
| | - Mark A Sager
- From the Geriatric Research Education and Clinical Center (E.A.B., S.A.S., L.R.C., C.M.C., C.L.G., B.B.B., S.A., S.C.J., O.C.C.), William S. Middleton Memorial Veterans Hospital; Wisconsin Alzheimer's Disease Research Center (E.A.B., S.A.S., L.R.C., A.M.R., C.M.C., C.L.G., B.B.B., S.A., M.A.S., B.P.H., B.T.C., S.C.J., O.C.O.), Wisconsin Alzheimer's Institute (L.R.C., R.L.K., C.M.C., K.J.H., B.B.B., S.A., M.A.S., B.P.H., C.D.E., S.C.J., O.C.O.), Department of Population Health Sciences (B.F.D., C.D.E.), Department of Neurology (C.L.G., B.P.H.), Department of Anesthesiology (K.J.H.), Department of Radiology (M.A.S.), and Department of Medical Physics (B.T.C.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.B.D.), University of California, San Francisco
| | - Bruce P Hermann
- From the Geriatric Research Education and Clinical Center (E.A.B., S.A.S., L.R.C., C.M.C., C.L.G., B.B.B., S.A., S.C.J., O.C.C.), William S. Middleton Memorial Veterans Hospital; Wisconsin Alzheimer's Disease Research Center (E.A.B., S.A.S., L.R.C., A.M.R., C.M.C., C.L.G., B.B.B., S.A., M.A.S., B.P.H., B.T.C., S.C.J., O.C.O.), Wisconsin Alzheimer's Institute (L.R.C., R.L.K., C.M.C., K.J.H., B.B.B., S.A., M.A.S., B.P.H., C.D.E., S.C.J., O.C.O.), Department of Population Health Sciences (B.F.D., C.D.E.), Department of Neurology (C.L.G., B.P.H.), Department of Anesthesiology (K.J.H.), Department of Radiology (M.A.S.), and Department of Medical Physics (B.T.C.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.B.D.), University of California, San Francisco
| | - Bradley T Christian
- From the Geriatric Research Education and Clinical Center (E.A.B., S.A.S., L.R.C., C.M.C., C.L.G., B.B.B., S.A., S.C.J., O.C.C.), William S. Middleton Memorial Veterans Hospital; Wisconsin Alzheimer's Disease Research Center (E.A.B., S.A.S., L.R.C., A.M.R., C.M.C., C.L.G., B.B.B., S.A., M.A.S., B.P.H., B.T.C., S.C.J., O.C.O.), Wisconsin Alzheimer's Institute (L.R.C., R.L.K., C.M.C., K.J.H., B.B.B., S.A., M.A.S., B.P.H., C.D.E., S.C.J., O.C.O.), Department of Population Health Sciences (B.F.D., C.D.E.), Department of Neurology (C.L.G., B.P.H.), Department of Anesthesiology (K.J.H.), Department of Radiology (M.A.S.), and Department of Medical Physics (B.T.C.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.B.D.), University of California, San Francisco
| | - Dena B Dubal
- From the Geriatric Research Education and Clinical Center (E.A.B., S.A.S., L.R.C., C.M.C., C.L.G., B.B.B., S.A., S.C.J., O.C.C.), William S. Middleton Memorial Veterans Hospital; Wisconsin Alzheimer's Disease Research Center (E.A.B., S.A.S., L.R.C., A.M.R., C.M.C., C.L.G., B.B.B., S.A., M.A.S., B.P.H., B.T.C., S.C.J., O.C.O.), Wisconsin Alzheimer's Institute (L.R.C., R.L.K., C.M.C., K.J.H., B.B.B., S.A., M.A.S., B.P.H., C.D.E., S.C.J., O.C.O.), Department of Population Health Sciences (B.F.D., C.D.E.), Department of Neurology (C.L.G., B.P.H.), Department of Anesthesiology (K.J.H.), Department of Radiology (M.A.S.), and Department of Medical Physics (B.T.C.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.B.D.), University of California, San Francisco
| | - Corinne D Engelman
- From the Geriatric Research Education and Clinical Center (E.A.B., S.A.S., L.R.C., C.M.C., C.L.G., B.B.B., S.A., S.C.J., O.C.C.), William S. Middleton Memorial Veterans Hospital; Wisconsin Alzheimer's Disease Research Center (E.A.B., S.A.S., L.R.C., A.M.R., C.M.C., C.L.G., B.B.B., S.A., M.A.S., B.P.H., B.T.C., S.C.J., O.C.O.), Wisconsin Alzheimer's Institute (L.R.C., R.L.K., C.M.C., K.J.H., B.B.B., S.A., M.A.S., B.P.H., C.D.E., S.C.J., O.C.O.), Department of Population Health Sciences (B.F.D., C.D.E.), Department of Neurology (C.L.G., B.P.H.), Department of Anesthesiology (K.J.H.), Department of Radiology (M.A.S.), and Department of Medical Physics (B.T.C.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.B.D.), University of California, San Francisco
| | - Sterling C Johnson
- From the Geriatric Research Education and Clinical Center (E.A.B., S.A.S., L.R.C., C.M.C., C.L.G., B.B.B., S.A., S.C.J., O.C.C.), William S. Middleton Memorial Veterans Hospital; Wisconsin Alzheimer's Disease Research Center (E.A.B., S.A.S., L.R.C., A.M.R., C.M.C., C.L.G., B.B.B., S.A., M.A.S., B.P.H., B.T.C., S.C.J., O.C.O.), Wisconsin Alzheimer's Institute (L.R.C., R.L.K., C.M.C., K.J.H., B.B.B., S.A., M.A.S., B.P.H., C.D.E., S.C.J., O.C.O.), Department of Population Health Sciences (B.F.D., C.D.E.), Department of Neurology (C.L.G., B.P.H.), Department of Anesthesiology (K.J.H.), Department of Radiology (M.A.S.), and Department of Medical Physics (B.T.C.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.B.D.), University of California, San Francisco
| | - Ozioma C Okonkwo
- From the Geriatric Research Education and Clinical Center (E.A.B., S.A.S., L.R.C., C.M.C., C.L.G., B.B.B., S.A., S.C.J., O.C.C.), William S. Middleton Memorial Veterans Hospital; Wisconsin Alzheimer's Disease Research Center (E.A.B., S.A.S., L.R.C., A.M.R., C.M.C., C.L.G., B.B.B., S.A., M.A.S., B.P.H., B.T.C., S.C.J., O.C.O.), Wisconsin Alzheimer's Institute (L.R.C., R.L.K., C.M.C., K.J.H., B.B.B., S.A., M.A.S., B.P.H., C.D.E., S.C.J., O.C.O.), Department of Population Health Sciences (B.F.D., C.D.E.), Department of Neurology (C.L.G., B.P.H.), Department of Anesthesiology (K.J.H.), Department of Radiology (M.A.S.), and Department of Medical Physics (B.T.C.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.B.D.), University of California, San Francisco.
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