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Sinclair LI, Lawton MA, Palmer JC, Ballard CG. Characterization of Depressive Symptoms in Dementia and Examination of Possible Risk Factors. J Alzheimers Dis Rep 2023; 7:213-225. [PMID: 36994115 PMCID: PMC10041449 DOI: 10.3233/adr-239000] [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] [Accepted: 01/12/2023] [Indexed: 03/06/2023] Open
Abstract
Background Depression in individuals with Alzheimer's disease (AD) is common, distressing, difficult to treat, and inadequately understood. It occurs more frequently in AD than in older adults without dementia. The reasons why some patients develop depression during AD and others do not remain obscure. Objective We aimed to characterize depression in AD and to identify risk factors. Methods We used data from three large dementia focused cohorts: ADNI (n = 665 with AD, 669 normal cognition), NACC (n = 698 with AD, 711 normal cognition), and BDR (n = 757 with AD). Depression ratings were available using the GDS and NPI and in addition for BDR the Cornell. A cut-off of≥8 was used for the GDS and the Cornell Scale for Depression in Dementia,≥6 for the NPI depression sub-scale, and≥2 for the NPI-Q depression sub-scale. We used logistic regression to examine potential risk factors and random effects meta-analysis and an interaction term to look for interactions between each risk factor and the presence of cognitive impairment. Results In individual studies there was no evidence of a difference in risk factors for depressive symptoms in AD. In the meta-analysis the only risk factor which increased the risk of depressive symptoms in AD was previous depression, but information on this was only available from one study (OR 7.78 95% CI 4.03-15.03). Conclusion Risk factors for depression in AD appear to differ to those for depression per se supporting suggestions of a different pathological process, although a past history of depression was the strongest individual risk factor.
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Affiliation(s)
- Lindsey I. Sinclair
- Dementia Research Group, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael A. Lawton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jennifer C. Palmer
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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Cacabelos R, Carril JC, Corzo L, Pego R, Cacabelos N, Alcaraz M, Muñiz A, Martínez-Iglesias O, Naidoo V. Pharmacogenetics of anxiety and depression in Alzheimer's disease. Pharmacogenomics 2023; 24:27-57. [PMID: 36628952 DOI: 10.2217/pgs-2022-0137] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Anxiety and depression coexist with cognitive impairment in Alzheimer's disease along with other concomitant disorders (>60%), which require multipurpose treatments. Polypharmaceutical regimens cause drug-drug interactions and adverse drug reactions, potentially avoidable in number and severity with the implementation of pharmacogenetic procedures. The accumulation of defective variants (>30 genes per patient in more than 50% of cases) in pharmagenes (pathogenic, mechanistic, metabolic, transporter, pleiotropic) influences the therapeutic response to antidementia, antidepressant and anxiolytic drugs in polyvalent regimens. APOE, CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP2E1, CYP3A4, CYP3A5, CYP4F2, COMT, MAOB, CHAT, GSTP1, NAT2, SLC30A8, SLCO1B1, ADRA2A, ADRB2, BCHE, GABRA1, HMGCR, HTR2C, IFNL3, NBEA, UGT1A1, ABCB1, ABCC2, ABCG2, SLC6A2, SLC6A3, SLC6A4, MTHFR and OPRM1 variants affect anxiety and depression in Alzheimer's disease.
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Affiliation(s)
- Ramón Cacabelos
- Department of Genomic Medicine, International Center of Neuroscience & Genomic Medicine, EuroEspes Biomedical Research Center, Bergondo, Corunna, 15165, Spain
| | - Juan C Carril
- Department of Genomics & Pharmacogenomics, International Center of Neuroscience & Genomic Medicine, EuroEspes Biomedical Research Center, Bergondo, Corunna, 15165, Spain
| | - Lola Corzo
- Department of Medical Biochemistry, International Center of Neuroscience & Genomic Medicine, EuroEspes Biomedical Research Center, Bergondo, Corunna, 15165, Spain
| | - Rocío Pego
- Department of Neuropsychology, International Center of Neuroscience & Genomic Medicine, EuroEspes Biomedical Research Center, Bergondo, Corunna, 15165, Spain
| | - Natalia Cacabelos
- Department of Medical Documentation, International Center of Neuroscience & Genomic Medicine, EuroEspes Biomedical Research Center, Bergondo, Corunna, 15165, Spain
| | - Margarita Alcaraz
- Department of Nursing, International Center of Neuroscience & Genomic Medicine, EuroEspes Biomedical Research Center, Bergondo, Corunna, 15165, Spain
| | - Adriana Muñiz
- Department of Nursing, International Center of Neuroscience & Genomic Medicine, EuroEspes Biomedical Research Center, Bergondo, Corunna, 15165, Spain
| | - Olaia Martínez-Iglesias
- Department of Medical Epigenetics, International Center of Neuroscience & Genomic Medicine, EuroEspes Biomedical Research Center, Bergondo, Corunna, 15165, Spain
| | - Vinogran Naidoo
- Department of Basic Neuroscience, International Center of Neuroscience & Genomic Medicine, EuroEspes Biomedical Research Center, Bergondo, Corunna, 15165, Spain
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3
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Cao QL, Sun Y, Hu H, Wang ZT, Tan L, Yu JT. Association of Cerebral Small Vessel Disease Burden with Neuropsychiatric Symptoms in Non-Demented Elderly: A Longitudinal Study. J Alzheimers Dis 2022; 89:583-592. [PMID: 35912738 DOI: 10.3233/jad-220128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The links between cerebral small vessel disease (CSVD) burden and neuropsychiatric symptoms (NPS) have not been fully studied. OBJECTIVE We aimed to explore the associations of the CSVD burden with Neuropsychiatric Inventory (NPI) total scores and its subsyndromes in the elderly without dementia. METHODS We investigated 630 non-demented participants from the Alzheimer's Disease Neuroimaging Initiative. All of them had NPI assessments and 3 Tesla MRI scans at baseline and 616 had longitudinal NPI assessments during the follow-up. Linear mixed-effects models were used to investigate the cross-sectional and longitudinal associations of CSVD burden with NPI total scores and its subsyndromes. RESULTS Higher CSVD burden longitudinally predicted more serious neuropsychiatric symptoms, including NPS (p = 0.0001), hyperactivity (p = 0.0007), affective symptoms (p = 0.0096), and apathy (p < 0.0001) in the total participants. Lacunar infarcts (LIs), white matter hyperactivities (WMHs), and cerebral microbleeds (CMBs) might play important roles in the occurrence of NPS, since they were longitudinally associated with specific neuropsychiatric subsyndromes. LIs contributed to hyperactivity (p = 0.0094), psychosis (p = 0.0392), affective symptoms (p = 0.0156), and apathy (p < 0.0001). WMHs were associated with hyperactivity (p = 0.0408) and apathy (p = 0.0343). However, CMBs were only related to apathy (p = 0.0148). CONCLUSION CSVD burden was associated with multiple neuropsychiatric symptoms, suggesting the importance of monitoring and controlling vascular risk factors. Different markers of CSVD were associated with specific subsyndromes of NPS, suggesting that different markers tended to occur in different encephalic regions.
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Affiliation(s)
- Qiao-Ling Cao
- Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Nanjing, China
| | - Yan Sun
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Hao Hu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Zuo-Teng Wang
- Department of Neurology, Qingdao Municipal Hospital, College of Medicine and Pharmaceutics, Ocean University of China, Qingdao, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Nanjing, China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
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Johnsen B, Strand BH, Martinaityte I, Mathiesen EB, Schirmer H. Improved Cognitive Function in the Tromsø Study in Norway From 2001 to 2016. Neurol Clin Pract 2022; 11:e856-e866. [PMID: 34992969 DOI: 10.1212/cpj.0000000000001115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/21/2021] [Indexed: 12/15/2022]
Abstract
Background and Objectives Physical capacity and cardiovascular risk profiles seem to be improving in the population. Cognition has been improving due to a birth cohort effect, but evidence is conflicting on whether this improvement remains in the latest decades and what is causing the changes in our population older than 60 years. We aimed to investigate birth cohort differences in cognition. Methods The study comprised 9,514 participants from the Tromsø Study, an ongoing longitudinal cohort study. Participants were aged 60-87 years, born between 1914 and 1956. They did 4 cognitive tests in 3 waves during 2001-2016. Linear regression was applied and adjusted for age, education, blood pressure, smoking, hypercholesterolemia, stroke, heart attack, depression, diabetes, physical activity, alcohol use, BMI, and height. Results Cognitive test scores were better in later-born birth cohorts for all age groups, and in both sexes, compared with earlier-born cohorts. Increased education, physical activity, alcohol intake, decreasing smoking prevalence, and increasing height were associated with one-third of this improvement across birth cohorts in women and one-half of the improvement in men. Discussion Cognitive results were better in more recent-born birth cohorts compared with earlier born, assessed at the same age. The improvement was present in all cognitive domains, suggesting an overall improvement in cognitive performance. The 80-year-olds assessed in 2015-2016 performed like 60-year-olds assessed in 2001. The improved scores were associated with increased education level, increase in modest drinking frequency, increased physical activity, and, for men, smoking cessation and increased height.
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Affiliation(s)
- Bente Johnsen
- Department of Clinical Medicine (BJ, IM, EBM, HS), UiT The Arctic University of Norway; Department of Medicine (BJ, IM), University Hospital of North Norway, Tromsø; Norwegian Institute of Public Health (BHS), Oslo; Department of Neurology (EBM), University Hospital of North Norway, Tromsø; Department of Cardiology (HS), Akershus University Hospital, Lørenskog; and Institute of Clinical Medicine (HS), University of Oslo, Norway
| | - Bjørn Heine Strand
- Department of Clinical Medicine (BJ, IM, EBM, HS), UiT The Arctic University of Norway; Department of Medicine (BJ, IM), University Hospital of North Norway, Tromsø; Norwegian Institute of Public Health (BHS), Oslo; Department of Neurology (EBM), University Hospital of North Norway, Tromsø; Department of Cardiology (HS), Akershus University Hospital, Lørenskog; and Institute of Clinical Medicine (HS), University of Oslo, Norway
| | - Ieva Martinaityte
- Department of Clinical Medicine (BJ, IM, EBM, HS), UiT The Arctic University of Norway; Department of Medicine (BJ, IM), University Hospital of North Norway, Tromsø; Norwegian Institute of Public Health (BHS), Oslo; Department of Neurology (EBM), University Hospital of North Norway, Tromsø; Department of Cardiology (HS), Akershus University Hospital, Lørenskog; and Institute of Clinical Medicine (HS), University of Oslo, Norway
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine (BJ, IM, EBM, HS), UiT The Arctic University of Norway; Department of Medicine (BJ, IM), University Hospital of North Norway, Tromsø; Norwegian Institute of Public Health (BHS), Oslo; Department of Neurology (EBM), University Hospital of North Norway, Tromsø; Department of Cardiology (HS), Akershus University Hospital, Lørenskog; and Institute of Clinical Medicine (HS), University of Oslo, Norway
| | - Henrik Schirmer
- Department of Clinical Medicine (BJ, IM, EBM, HS), UiT The Arctic University of Norway; Department of Medicine (BJ, IM), University Hospital of North Norway, Tromsø; Norwegian Institute of Public Health (BHS), Oslo; Department of Neurology (EBM), University Hospital of North Norway, Tromsø; Department of Cardiology (HS), Akershus University Hospital, Lørenskog; and Institute of Clinical Medicine (HS), University of Oslo, Norway
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5
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Soo SA, Ng KP, Wong F, Saffari SE, Yatawara C, Ismail Z, Kandiah N. The Association Between Diabetes Mellitus and Mild Behavioral Impairment Among Mild Cognitive Impairment: Findings from Singapore. J Alzheimers Dis 2021; 82:411-420. [PMID: 34024829 DOI: 10.3233/jad-210037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Mild behavioral impairment (MBI) describes persistent behavioral changes in later life as an at-risk state for dementia. While cardiovascular risk factors (CVRFs) are linked to dementia, it is uncertain how CVRFs are associated with MBI. OBJECTIVE To determine the prevalence of MBI and its association with CVRFs among cognitively normal (CN) and mild cognitive impairment (MCI) individuals in Singapore. METHODS 172 individuals (79 CN and 93 MCI) completed the MBI-checklist (MBI-C). The prevalence of MBI and MBI-C sub-domain characteristics among CN and MCI were examined. Regression models evaluated the relationships between MBI-C sub-domain scores with CVRFs. RESULTS The prevalence of MBI and mean MBI-C total score were significantly higher among MCI than CN (34.4%versus 20.3%, p = 0.022 and 7.01 versus 4.12, p = 0.04). The highest and lowest-rated sub-domains among CN and MCI were impulse dyscontrol and abnormal thoughts and perception respectively. Within the MCI cohort, a higher proportion of individuals with diabetes mellitus (DM) had MBI compared to individuals without DM (28.1%versus 10.4%, p = 0.025). The interaction of DM and MCI cohort resulted in significantly higher mean MBI-C total, decreased motivation, emotional dysregulation, impulse dyscontrol, and abnormal thoughts and perception sub-domain scores. CONCLUSION The prevalence of MBI is higher among a Singapore cohort compared to Caucasian cohorts. The associations of DM with both the presence and severity of MBI among MCI suggest that DM may be a risk factor for MBI. The optimization of DM may be a potential therapeutic approach to improve clinical outcomes among MCI with MBI.
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Affiliation(s)
- See Ann Soo
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Imperial College London, Nanyang Technological University, Singapore, Singapore
| | - Fennie Wong
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Seyed Ehsan Saffari
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Center for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Chathuri Yatawara
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Zahinoor Ismail
- Hotchkiss Brain Institute and O'Brien Institute for Public Health, Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, University of Calgary, AB, Canada
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Imperial College London, Nanyang Technological University, Singapore, Singapore
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6
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Cacabelos R, Carril JC, Corzo L, Fernández-Novoa L, Pego R, Cacabelos N, Cacabelos P, Alcaraz M, Tellado I, Naidoo V. Influence of Pathogenic and Metabolic Genes on the Pharmacogenetics of Mood Disorders in Alzheimer's Disease. Pharmaceuticals (Basel) 2021; 14:ph14040366. [PMID: 33920985 PMCID: PMC8071277 DOI: 10.3390/ph14040366] [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] [Received: 03/22/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 01/16/2023] Open
Abstract
Background: Mood disorders represent a risk factor for dementia and are present in over 60% of cases with Alzheimer’s disease (AD). More than 80% variability in drug pharmacokinetics and pharmacodynamics is associated with pharmacogenetics. Methods: Anxiety and depression symptoms were assessed in 1006 patients with dementia (591 females, 415 males) and the influence of pathogenic (APOE) and metabolic (CYP2D6, CYP2C19, and CYP2C9) gene variants on the therapeutic outcome were analyzed after treatment with a multifactorial regime in a natural setting. Results and Conclusions: (i) Biochemical, hematological, and metabolic differences may contribute to changes in drug efficacy and safety; (ii) anxiety and depression are more frequent and severe in females than males; (iii) both females and males respond similarly to treatment, showing significant improvements in anxiety and depression; (iv) APOE-3 carriers are the best responders and APOE-4 carriers tend to be the worst responders to conventional treatments; and (v) among CYP2D6, CYP2C19, and CYP2C9 genophenotypes, normal metabolizers (NMs) and intermediate metabolizers (IMs) are significantly better responders than poor metabolizers (PMs) and ultra-rapid metabolizers (UMs) to therapeutic interventions that modify anxiety and depression phenotypes in dementia. APOE-4 carriers and CYP-related PMs and UMs deserve special attention for their vulnerability and poor response to current treatments.
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7
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Cacabelos R. Pharmacogenomics of Cognitive Dysfunction and Neuropsychiatric Disorders in Dementia. Int J Mol Sci 2020; 21:E3059. [PMID: 32357528 PMCID: PMC7246738 DOI: 10.3390/ijms21093059] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 02/07/2023] Open
Abstract
Symptomatic interventions for patients with dementia involve anti-dementia drugs to improve cognition, psychotropic drugs for the treatment of behavioral disorders (BDs), and different categories of drugs for concomitant disorders. Demented patients may take >6-10 drugs/day with the consequent risk for drug-drug interactions and adverse drug reactions (ADRs >80%) which accelerate cognitive decline. The pharmacoepigenetic machinery is integrated by pathogenic, mechanistic, metabolic, transporter, and pleiotropic genes redundantly and promiscuously regulated by epigenetic mechanisms. CYP2D6, CYP2C9, CYP2C19, and CYP3A4/5 geno-phenotypes are involved in the metabolism of over 90% of drugs currently used in patients with dementia, and only 20% of the population is an extensive metabolizer for this tetragenic cluster. ADRs associated with anti-dementia drugs, antipsychotics, antidepressants, anxiolytics, hypnotics, sedatives, and antiepileptic drugs can be minimized by means of pharmacogenetic screening prior to treatment. These drugs are substrates, inhibitors, or inducers of 58, 37, and 42 enzyme/protein gene products, respectively, and are transported by 40 different protein transporters. APOE is the reference gene in most pharmacogenetic studies. APOE-3 carriers are the best responders and APOE-4 carriers are the worst responders; likewise, CYP2D6-normal metabolizers are the best responders and CYP2D6-poor metabolizers are the worst responders. The incorporation of pharmacogenomic strategies for a personalized treatment in dementia is an effective option to optimize limited therapeutic resources and to reduce unwanted side-effects.
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Affiliation(s)
- Ramon Cacabelos
- EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, 15165-Bergondo, Corunna, Spain
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8
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Brown EE, Rashidi-Ranjbar N, Caravaggio F, Gerretsen P, Pollock BG, Mulsant BH, Rajji TK, Fischer CE, Flint A, Mah L, Herrmann N, Bowie CR, Voineskos AN, Graff-Guerrero A. Brain Amyloid PET Tracer Delivery is Related to White Matter Integrity in Patients with Mild Cognitive Impairment. J Neuroimaging 2019; 29:721-729. [PMID: 31270885 DOI: 10.1111/jon.12646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/31/2019] [Accepted: 06/14/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Amyloid deposition, tau neurofibrillary tangles, and cerebrovascular dysfunction are important pathophysiologic features in Alzheimer's disease. Pittsburgh compound B ([11 C]-PIB) is a positron emission tomography (PET) radiotracer used to quantify amyloid deposition in vivo. In addition, certain models of [11 C]-PIB delivery reflect cerebral blood flow rather than amyloid plaques. As cerebral blood flow and perfusion deficits are associated with white matter pathology, we hypothesized that [11 C]-PIB delivery in white matter regions may reflect white matter integrity. METHODS We obtained [11 C]-PIB-PET scans and quantified white matter hyperintensities and global fractional anisotropy on magnetic resonance images as biomarkers of white matter pathology in 34 older participants with mild cognitive impairment with or without a history of major depressive disorder. We analyzed the [11 C]-PIB time-activity curve data with models associated with cerebral blood flow: the early maximum standard uptake value and the relative delivery parameter R1. We used a global white matter region of interest. RESULTS Both of the partial-volume corrected PET parameters were correlated with white matter hyperintensities and fractional anisotropy. CONCLUSION Future studies are warranted to explore whether [11 C]-PIB PET is a "triple biomarker" that may provide information about amyloid deposition, cerebral blood flow, and white matter pathology.
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Affiliation(s)
- Eric E Brown
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Neda Rashidi-Ranjbar
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Fernando Caravaggio
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Philip Gerretsen
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Bruce G Pollock
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Tarek K Rajji
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Corinne E Fischer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Research, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Alastair Flint
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Linda Mah
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Rotman Research Institute, Baycrest Health Sciences Centre, Toronto, Ontario, Canada
| | - Nathan Herrmann
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Christopher R Bowie
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Queen's University, Kingston, Ontario, Canada
| | - Aristotle N Voineskos
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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