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Rantins P, Ly M, Clark AL, Weigand AJ, Durazo AA, Merritt VC, Bangen KJ, Thomas KR. Research Letter: TBI Severity Moderates the Association Between Subjective and Objective Attention in Older Veterans. J Head Trauma Rehabil 2024; 39:239-246. [PMID: 37712765 PMCID: PMC10920393 DOI: 10.1097/htr.0000000000000897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
OBJECTIVE This study examined the moderating effect of traumatic brain injury (TBI) history on subjective and objective cognition across multiple cognitive domains. SETTING, PARTICIPANTS, AND DESIGN Participants included 242 Vietnam-era veterans with a history of no TBI (n = 86), mild TBI (n = 74), or moderate-to-severe TBI (n = 82) from the observational Department of Defense-Alzheimer's Disease Neuroimaging Initiative (DoD-ADNI) study. MAIN MEASURES Objective cognition was the outcome and was measured using neuropsychological measures in the domains of memory, attention/executive functioning, and language. Subjective cognition was measured using the memory, divided attention, and language subscales from the Everyday Cognition (ECog) measure. TBI severity status was the moderating variable. RESULTS Veterans with a history of moderate-to-severe TBI had a stronger negative association between subjective and objective attention relative to participants without a TBI ( P = .002). Although this association did not differ between mild TBI and no TBI history groups ( P = .100), the association between subjective and objective attention for the mild TBI group was intermediate to the no TBI and moderate-to-severe TBI history groups. TBI status did not moderate associations between subjective and objective memory or language. CONCLUSION Results highlight the importance of assessing subjective and objective cognition in older veterans and the relevance of attention in the context of TBI history. More work is needed to better understand the intersection of TBI and aging and how these factors may be used to guide individualized assessment and treatment approaches for older veterans.
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Affiliation(s)
- Peter Rantins
- VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Monica Ly
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San
Diego, La Jolla, CA, USA
| | - Alexandra L. Clark
- Department of Psychology, University of Texas at Austin,
Austin, TX, USA
| | - Alexandra J. Weigand
- San Diego State University/University of California, San
Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Alin Alshaheri Durazo
- VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Victoria C. Merritt
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San
Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health (CESAMH),
VA San Diego Healthcare System, San Diego, CA, USA
| | - Katherine J. Bangen
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San
Diego, La Jolla, CA, USA
| | - Kelsey R. Thomas
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San
Diego, La Jolla, CA, USA
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Edwards L, Thomas KR, Weigand AJ, Edmonds EC, Clark AL, Brenner EK, Banks SJ, Gilbert PE, Nation DA, Delano-Wood L, Bondi MW, Bangen KJ. Pulse pressure and APOE ε4 dose interact to affect cerebral blood flow in older adults without dementia. Cereb Circ Cogn Behav 2024; 6:100206. [PMID: 38328026 PMCID: PMC10847851 DOI: 10.1016/j.cccb.2024.100206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/20/2023] [Accepted: 01/14/2024] [Indexed: 02/09/2024]
Abstract
This study assessed whether the effect of vascular risk on cerebral blood flow (CBF) varies by gene dose of apolipoprotein (APOE) ε4 alleles. 144 older adults without dementia from the Alzheimer's Disease Neuroimaging Initiative underwent arterial spin labeling and T1-weighted MRI, APOE genotyping, fluorodeoxyglucose positron emission tomography (FDG-PET), lumbar puncture, and blood pressure (BP) assessment. Vascular risk was assessed using pulse pressure (systolic BP - diastolic BP). CBF was examined in six AD-vulnerable regions: entorhinal cortex, hippocampus, inferior temporal cortex, inferior parietal cortex, rostral middle frontal gyrus, and medial orbitofrontal cortex. Linear regressions tested the interaction between APOE ε4 dose and pulse pressure on CBF in each region, adjusting for age, sex, cognitive classification, antihypertensive medication use, FDG-PET, reference CBF region, and AD biomarker positivity. There was a significant interaction between pulse pressure and APOE ɛ4 dose on CBF in the entorhinal cortex, hippocampus, and inferior parietal cortex, such that higher pulse pressure was associated with lower CBF only among ε4 homozygous participants. These findings demonstrate that the association between pulse pressure and regional CBF differs by APOE ε4 dose, suggesting that targeting modifiable vascular risk factors may be particularly important for those genetically at risk for AD.
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Affiliation(s)
- Lauren Edwards
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Kelsey R. Thomas
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Alexandra J. Weigand
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Emily C. Edmonds
- Banner Alzheimer's Institute, Tucson, AZ, USA
- Departments of Neurology and Psychology, University of Arizona, Tucson, AZ, USA
| | - Alexandra L. Clark
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Einat K. Brenner
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Sarah J. Banks
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Paul E. Gilbert
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Daniel A. Nation
- Department of Psychology, University of California Irvine, Irvine, CA, USA
| | - Lisa Delano-Wood
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Mark W. Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Katherine J. Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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Thomas KR, Clark AL, Weigand AJ, Edwards L, Durazo AA, Membreno R, Luu B, Rantins P, Ly MT, Rotblatt LJ, Bangen KJ, Jak AJ. Cognition and Amyloid-β in Older Veterans: Characterization and Longitudinal Outcomes of Data-Derived Phenotypes. J Alzheimers Dis 2024; 99:417-427. [PMID: 38669550 DOI: 10.3233/jad-240077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Background Within older Veterans, multiple factors may contribute to cognitive difficulties. Beyond Alzheimer's disease (AD), psychiatric (e.g., PTSD) and health comorbidities (e.g., TBI) may also impact cognition. Objective This study aimed to derive subgroups based on objective cognition, subjective cognitive decline (SCD), and amyloid burden, and then compare subgroups on clinical characteristics, biomarkers, and longitudinal change in functioning and global cognition. Methods Cluster analysis of neuropsychological measures, SCD, and amyloid PET was conducted on 228 predominately male Vietnam-Era Veterans from the Department of Defense-Alzheimer's Disease Neuroimaging Initiative. Cluster-derived subgroups were compared on baseline characteristics as well as 1-year changes in everyday functioning and global cognition. Results The cluster analysis identified 3 groups. Group 1 (n = 128) had average-to-above average cognition with low amyloid burden. Group 2 (n = 72) had the lowest memory and language, highest SCD, and average amyloid burden; they also had the most severe PTSD, pain, and worst sleep quality. Group 3 (n = 28) had the lowest attention/executive functioning, slightly low memory and language, elevated amyloid and the worst AD biomarkers, and the fastest rate of everyday functioning and cognitive decline. CONCLUSIONS Psychiatric and health factors likely contributed to Group 2's low memory and language performance. Group 3 was most consistent with biological AD, yet attention/executive function was the lowest score. The complexity of older Veterans' co-morbid conditions may interact with AD pathology to show attention/executive dysfunction (rather than memory) as a prominent early symptom. These results could have important implications for the implementation of AD-modifying drugs in older Veterans.
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Affiliation(s)
- Kelsey R Thomas
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Alexandra L Clark
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Alexandra J Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Lauren Edwards
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Alin Alshaheri Durazo
- VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Rachel Membreno
- VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Britney Luu
- VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Peter Rantins
- VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Monica T Ly
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Lindsay J Rotblatt
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Katherine J Bangen
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Amy J Jak
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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Alshaheri Durazo A, Weigand AJ, Bangen KJ, Membreno R, Mudaliar S, Thomas KR. Type 2 Diabetes Moderates the Association Between Amyloid and 1-Year Change in Everyday Functioning in Older Veterans. J Alzheimers Dis 2024; 97:219-228. [PMID: 38160359 DOI: 10.3233/jad-230917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) affects ∼25% of Veterans, a prevalence rate double that of the general population. T2DM is associated with greater dementia risk and has been shown to exacerbate the impact of Alzheimer's disease (AD) risk factors on declines in daily functioning; however, there are few studies that investigate these patterns in older Veterans. OBJECTIVE This study sought to determine whether T2DM moderates the association between amyloid-β (Aβ) positron emission tomography (PET) and 1-year change in everyday functioning in older Veterans. METHODS One-hundred-ninety-eight predominately male Vietnam-Era Veterans without dementia from the Department of Defense-Alzheimer's Disease Neuroimaging Initiative (DoD-ADNI) with (n = 74) and without (n = 124) T2DM completed Aβ PET imaging and everyday functioning measures, including the Clinical Dementia Rating-Sum of Boxes (CDR-SB) and Everyday Cognition (ECog). Linear mixed effects models tested the moderating role of T2DM on the association between Aβ PET and 1-year change in everyday functioning. RESULTS The 3-way T2DM×Aβ PET×time interaction was significant for CDR-SB (p < 0.001) as well as the Memory (p = 0.007) and Language (p = 0.011) subscales from the ECog. Greater amyloid burden was associated with greater increases in functional difficulties, but only in Veterans with T2DM. CONCLUSIONS Higher Aβ was only associated with declines in everyday functioning over 1 year in Veterans with T2DM. Given that people with T2DM are more likely to have co-occurring cerebrovascular disease, the combination of multiple neuropathologies may result in faster declines. Future studies should examine how diabetes duration, severity, and medications impact these associations.
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Affiliation(s)
- Alin Alshaheri Durazo
- San Diego State University, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Alexandra J Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Katherine J Bangen
- VA San Diego Healthcare System, San Diego, CA, USA
- University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - Rachel Membreno
- San Diego State University, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Sunder Mudaliar
- VA San Diego Healthcare System, San Diego, CA, USA
- University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - Kelsey R Thomas
- VA San Diego Healthcare System, San Diego, CA, USA
- University of California, San Diego School of Medicine, La Jolla, CA, USA
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Bayram E, Weigand AJ, Flatt JD. Perceived Discrimination in Health Care for LGBTQIA+ People Living With Parkinson's Disease. J Gerontol B Psychol Sci Soc Sci 2023; 78:1459-1465. [PMID: 36896976 PMCID: PMC10461524 DOI: 10.1093/geronb/gbad046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVES People who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, other non-cisgender, and non-heterosexual identities (LGBTQIA+) experience discrimination when accessing health care. We investigated specific experiences of LGBTQIA+ people with Parkinson's disease (PwP) as they are less known. METHODS Data were obtained from Fox Insight for PwP identifying as LGBTQIA+ (n = 210), cisgender, heterosexual women (n = 2,373) or cisgender, heterosexual men (n = 2,453). Discrimination in Medical Settings Scale responses and reports of whether gender identity or sexual orientation played a role in the perceived discrimination were compared across the groups. RESULTS Parkinson's diagnosis age was the youngest for LGBTQIA+ PwP. Despite similar levels of education with cisgender, heterosexual men, LGBTQIA+ people had lower levels of income and were more likely to be unemployed. Cisgender, heterosexual women and LGBTQIA+ PwP reported greater discrimination than cisgender, heterosexual men. Compared to cisgender, heterosexual men; LGBTQIA+ people (25%) and cisgender, heterosexual women (20%) were more likely to report their gender affected how they were treated; LGBTQIA+ PwP (19%) were more likely to report their sexual orientation affected how they were treated. DISCUSSION Women and LGBTQIA+ PwP may be at a higher risk for discrimination in medical settings. Facing disparities while receiving health care based on gender or sexual orientation can affect the health care utilization of PwP. Health care providers should consider their behaviors and interactions with PwP to ensure inclusive and welcoming health care environments.
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Affiliation(s)
- Ece Bayram
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Alexandra J Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Jason D Flatt
- School of Public Health, Department of Social and Behavioral Health, University of Nevada Las Vegas, Las Vegas, Nevada, USA
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Weigand AJ, Ortiz G, Walker KS, Galasko DR, Bondi MW, Thomas KR. APOE differentially moderates cerebrospinal fluid and plasma phosphorylated tau181 associations with multi-domain cognition. Neurobiol Aging 2023; 125:1-8. [PMID: 36780762 DOI: 10.1016/j.neurobiolaging.2022.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 01/19/2023]
Abstract
Biofluid markers of phosphorylated tau181 (p-tau181) are increasingly popular for the detection of early Alzheimer's pathologic changes. However, the differential dynamics of cerebrospinal fluid (CSF) and plasma p-tau181 remain under investigation. We studied 727 participants from the Alzheimer's Disease Neuroimaging Initiative with plasma and CSF p-tau181 data, apolipoprotein (APOE) ε4 carrier status, amyloid positron emission tomography (PET) imaging, and neuropsychological data. Higher levels of plasma and CSF p-tau181 were observed among APOE ε4 carriers. CSF and plasma p-tau181 were significantly associated with memory, and this effect was greater in APOE ε4 carriers. However, whereas CSF p-tau181 was not significantly associated with language or attention/executive function among ε4 carriers or non-carriers, APOE ε4 status moderated the association of plasma p-tau181 with both language and attention/executive function. These findings lend support to the notion that p-tau181 biofluid markers are useful in measuring AD pathologic changes but also suggest that CSF and plasma p-tau181 have unique properties and dynamics that should be considered when using these markers in research and clinical practice.
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Affiliation(s)
- Alexandra J Weigand
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Gema Ortiz
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Kayla S Walker
- San Diego State University, Department of Psychology, San Diego, CA, USA
| | - Douglas R Galasko
- VA San Diego Healthcare System, San Diego, CA, USA; University of California San Diego, Department of Neurosciences, La Jolla, CA, USA
| | - Mark W Bondi
- VA San Diego Healthcare System, San Diego, CA, USA; University of California San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Kelsey R Thomas
- VA San Diego Healthcare System, San Diego, CA, USA; University of California San Diego, Department of Psychiatry, La Jolla, CA, USA.
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Ehrenberg AJ, Kelberman MA, Liu KY, Dahl MJ, Weinshenker D, Falgàs N, Dutt S, Mather M, Ludwig M, Betts MJ, Winer JR, Teipel S, Weigand AJ, Eschenko O, Hämmerer D, Leiman M, Counts SE, Shine JM, Robertson IH, Levey AI, Lancini E, Son G, Schneider C, Egroo MV, Liguori C, Wang Q, Vazey EM, Rodriguez-Porcel F, Haag L, Bondi MW, Vanneste S, Freeze WM, Yi YJ, Maldinov M, Gatchel J, Satpati A, Babiloni C, Kremen WS, Howard R, Jacobs HIL, Grinberg LT. Priorities for research on neuromodulatory subcortical systems in Alzheimer's disease: Position paper from the NSS PIA of ISTAART. Alzheimers Dement 2023; 19:2182-2196. [PMID: 36642985 PMCID: PMC10182252 DOI: 10.1002/alz.12937] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/08/2022] [Accepted: 12/19/2022] [Indexed: 01/17/2023]
Abstract
The neuromodulatory subcortical system (NSS) nuclei are critical hubs for survival, hedonic tone, and homeostasis. Tau-associated NSS degeneration occurs early in Alzheimer's disease (AD) pathogenesis, long before the emergence of pathognomonic memory dysfunction and cortical lesions. Accumulating evidence supports the role of NSS dysfunction and degeneration in the behavioral and neuropsychiatric manifestations featured early in AD. Experimental studies even suggest that AD-associated NSS degeneration drives brain neuroinflammatory status and contributes to disease progression, including the exacerbation of cortical lesions. Given the important pathophysiologic and etiologic roles that involve the NSS in early AD stages, there is an urgent need to expand our understanding of the mechanisms underlying NSS vulnerability and more precisely detail the clinical progression of NSS changes in AD. Here, the NSS Professional Interest Area of the International Society to Advance Alzheimer's Research and Treatment highlights knowledge gaps about NSS within AD and provides recommendations for priorities specific to clinical research, biomarker development, modeling, and intervention. HIGHLIGHTS: Neuromodulatory nuclei degenerate in early Alzheimer's disease pathological stages. Alzheimer's pathophysiology is exacerbated by neuromodulatory nuclei degeneration. Neuromodulatory nuclei degeneration drives neuropsychiatric symptoms in dementia. Biomarkers of neuromodulatory integrity would be value-creating for dementia care. Neuromodulatory nuclei present strategic prospects for disease-modifying therapies.
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Affiliation(s)
- Alexander J Ehrenberg
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, California, USA
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, California, USA
| | - Michael A Kelberman
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kathy Y Liu
- Division of Psychiatry, University College London, London, UK
| | - Martin J Dahl
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - David Weinshenker
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Neus Falgàs
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Global Brain Health Institute, University of California, San Francisco, San Francisco, California, USA
| | - Shubir Dutt
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Mara Mather
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA
| | - Mareike Ludwig
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany
- Center for Behavioral Brain Sciences, University of Magdeburg, Magdeburg, Germany
| | - Matthew J Betts
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany
- Center for Behavioral Brain Sciences, University of Magdeburg, Magdeburg, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Magdeburg, Germany
| | - Joseph R Winer
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Stefan Teipel
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Rostock, Germany
- Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany
| | - Alexandra J Weigand
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Oxana Eschenko
- Department of Computational Neuroscience, Max Planck Institute for Biological Cybernetics, Tuebingen, Germany
| | - Dorothea Hämmerer
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Magdeburg, Germany
- Department of Psychology, University of Innsbruck, Innsbruck, Austria
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Marina Leiman
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Magdeburg, Germany
| | - Scott E Counts
- Department of Translational Neuroscience, Michigan State University, Grand Rapids, Michigan, USA
- Department of Family Medicine, Michigan State University, Grand Rapids, Michigan, USA
- Michigan Alzheimer's Disease Research Center, Ann Arbor, Michigan, USA
| | - James M Shine
- Brain and Mind Center, The University of Sydney, Sydney, Australia
| | - Ian H Robertson
- Global Brain Health Institute, Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Allan I Levey
- Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, Georgia, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
- Goizueta Institute, Emory University, Atlanta, Georgia, USA
| | - Elisa Lancini
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Magdeburg, Germany
| | - Gowoon Son
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Christoph Schneider
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maxime Van Egroo
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Faculty of Health, Medicine, and Life Sciences, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Qin Wang
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Agusta University, Agusta, Georgia, USA
| | - Elena M Vazey
- Department of Biology, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | | | - Lena Haag
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Magdeburg, Germany
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Sven Vanneste
- Global Brain Health Institute, Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- Trinity College Institute for Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Whitney M Freeze
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neuropsychology and Psychiatry, Maastricht University, Maastricht, the Netherlands
| | - Yeo-Jin Yi
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Magdeburg, Germany
| | - Mihovil Maldinov
- Department of Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany
| | - Jennifer Gatchel
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Abhijit Satpati
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Claudio Babiloni
- Department of Physiology and Pharmacology "V. Erspamer,", Sapienza University of Rome, Rome, Italy
- Hospital San Raffaele Cassino, Cassino, Italy
| | - William S Kremen
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, California, USA
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | - Heidi I L Jacobs
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Faculty of Health, Medicine, and Life Sciences, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Lea T Grinberg
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
- Global Brain Health Institute, University of California, San Francisco, San Francisco, California, USA
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
- Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil
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Brenner EK, Thomas KR, Weigand AJ, Edwards L, Edmonds EC, Bondi MW, Bangen KJ. Cognitive reserve moderates the association between cerebral blood flow and language performance in older adults with mild cognitive impairment. Neurobiol Aging 2023; 125:83-89. [PMID: 36868071 PMCID: PMC10824498 DOI: 10.1016/j.neurobiolaging.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/13/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
Higher cognitive reserve (CR) may offer protection from cognitive changes associated with reduced cerebral blood flow (CBF). We investigated CR as a moderator of the effect of CBF on cognition in older adults with mild cognitive impairment (MCI; N = 46) and those who are cognitively unimpaired (CU; N = 101). Participants underwent arterial spin labeling MRI, which was used to quantify CBF in 4 a priori regions. Estimated verbal intelligence quotient (VIQ) served as a proxy for CR. Multiple linear regressions examined whether VIQ moderated associations between CBF and cognition and whether this differed by cognitive status. Outcomes included memory and language performance. There were 3-way interactions (CBF*VIQ*cognitive status) on category fluency when examining hippocampal, superior frontal, and inferior frontal CBF. Follow-up analyses revealed that, within the MCI but not CU group, there were CBF*VIQ interactions on fluency in all a priori regions examined, where there were stronger, positive associations between CBF and fluency at higher VIQ. Conclusion: In MCI, higher CR plays a role in strengthening CBF-fluency associations.
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Affiliation(s)
- Einat K Brenner
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
| | - Kelsey R Thomas
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Alexandra J Weigand
- UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, CA, USA
| | - Lauren Edwards
- UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, CA, USA
| | - Emily C Edmonds
- Banner Alzheimer's Institute, Tucson, AZ, USA; Departments of Neurology and Psychology, University of Arizona, Tucson, AZ, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Katherine J Bangen
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Research Service, VA San Diego Healthcare System, San Diego, CA, USA
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Edwards L, Thomas KR, Weigand AJ, Edmonds EC, Clark AL, Walker KS, Brenner EK, Nation DA, Maillard P, Bondi MW, Bangen KJ. White Matter Hyperintensity Volume and Amyloid-PET Synergistically Impact Memory Independent of Tau-PET in Older Adults Without Dementia. J Alzheimers Dis 2023; 94:695-707. [PMID: 37302031 PMCID: PMC10357163 DOI: 10.3233/jad-221209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) and cerebrovascular disease are common, co-existing pathologies in older adults. Whether the effects of cerebrovascular disease and AD biomarkers on cognition are additive or synergistic remains unclear. OBJECTIVE To examine whether white matter hyperintensity (WMH) volume moderates the independent association between each AD biomarker and cognition. METHODS In 586 older adults without dementia, linear regressions tested the interaction between amyloid-β (Aβ) positron emission tomography (PET) and WMH volume on cognition, independent of tau-PET. We also tested the interaction between tau-PET and WMH volume on cognition, independent of Aβ-PET. RESULTS Adjusting for tau-PET, the quadratic effect of WMH interacted with Aβ-PET to impact memory. There was no interaction between either the linear or quadratic effect of WMH and Aβ-PET on executive function. There was no interaction between WMH volume and tau-PET on either cognitive measure. CONCLUSION Results suggest that cerebrovascular lesions act synergistically with Aβ to affect memory, independent of tau, highlighting the importance of incorporating vascular pathology into biomarker assessment of AD.
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Affiliation(s)
- Lauren Edwards
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Kelsey R. Thomas
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Alexandra J. Weigand
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Emily C. Edmonds
- Banner Alzheimer’s Institute, Tucson, AZ, USA
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Alexandra L. Clark
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | | | - Einat K. Brenner
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Daniel A. Nation
- Department of Psychology, University of California Irvine, Irvine, CA, USA
| | - Pauline Maillard
- Department of Neurology, University of California, Davis, Davis, CA, USA
| | - Mark W. Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Katherine J. Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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Brenner EK, Weigand AJ, Edwards L, Thomas KR, Edmonds EC, Bondi MW, Bangen KJ. Brain Derived Neurotrophic Factor Interacts with White Matter Hyperintensities to Influence Processing Speed and Hippocampal Volume in Older Adults. J Alzheimers Dis 2023; 93:141-149. [PMID: 36970903 DOI: 10.3233/jad-221178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) is a neurotrophin that plays an important role in regulating synaptic activity and plasticity. OBJECTIVE Given that type-2 diabetes (T2DM) increases the risk of cognitive decline, and studies have suggested lower BDNF levels may be a risk factor of diabetic neurovascular complications, we sought to investigate total white matter hyperintensities (WMH) as a moderator of the effect of BDNF on hippocampal volume and cognition. METHODS Older adults without dementia from the Alzheimer's Disease Neuroimaging Initiative (N = 454 including 49 with T2DM and 405 without diabetes) underwent neuropsychological evaluation, magnetic resonance imaging to quantify hippocampal and WMH volumes, and blood draw to assess BDNF. RESULTS Adjusting for age, sex, and APOE ɛ4 carrier status, there was a significant interaction between total WMH and BDNF on bilateral hippocampal volume in the non-T2DM group (t = 2.63, p = 0.009). Examination of main effect models with a dichotomous high/low BNDF group revealed a significant main effect for low BDNF (t = -4.98, p < 0.001), such that as WMH increased, bilateral hippocampal volume decreased. There was also a significant interaction between total WMH and BDNF on processing speed in the non-T2DM group (t = 2.91, p = 0.004). There was a significant main effect for low BDNF (t = -3.55, p < 0.001) such that as WMH increased, processing speed decreased. The interactions were not significant in the T2DM group. CONCLUSION These results further elucidate the protective role that BDNF plays on cognition, as well as the cognitive effects of WMH.
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Affiliation(s)
- Einat K Brenner
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Alexandra J Weigand
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Lauren Edwards
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Kelsey R Thomas
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | | | - Mark W Bondi
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Katherine J Bangen
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
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Clark AL, Weigand AJ, Clay OJ, Owens J, Fiala J, Crowe M, Marsiske M, Thomas KR. Associations between social determinants of health and 10-year change in everyday functioning within Black/African American and White older adults enrolled in ACTIVE. Alz & Dem Diag Ass & Dis Mo 2022; 14:e12385. [PMID: 36514539 PMCID: PMC9732812 DOI: 10.1002/dad2.12385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/31/2022] [Accepted: 11/10/2022] [Indexed: 12/13/2022]
Abstract
Introduction Given prior work showing racial differences on baseline social determinants of health (SDoH) and 10-year trajectories of everyday functioning, we examined associations between SDoH and longitudinal everyday functioning performance in Black/African American and White older adults. Methods Participants were 2505 older adults (Mage = 73.5; 28% Black/African American) without dementia. SDoH included economic stability/status, education access/quality, health-care access, neighborhood/built environment, and social/community contexts. The Observed Tasks of Daily Living (OTDL) measured everyday functioning and was administered at baseline and 1-, 2-, 3-, 5-, and 10-year visits. Results Across the sample, social and community context and economic stability/status were associated with steeper age-related OTDL declines (βs = 0.05 to 0.07, Ps < 0.001). Lower levels of social and community context (β = 0.08, P = 0.002) and economic stability/status (β = 0.07, P = 0.04) were associated with OTDL linear age declines in Black/African American participants, but not in White participants (Ps > 0.30). Discussion Inequities across SDoH accelerate age-related declines in everyday functioning among Black/African American older adults.
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Affiliation(s)
- Alexandra L. Clark
- Department of PsychologyCollege of Liberal ArtsUniversity of Texas at AustinAustinTexasUSA
| | - Alexandra J. Weigand
- Department of PsychiatrySchool of MedicineUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Olivio J. Clay
- Department of Psychology, College of Arts and SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Joshua Owens
- Department of Clinical and Health Psychology, College of Public Health and Health ProfessionsUniversity of FloridaGainesvilleFloridaUSA
| | - Jacob Fiala
- Department of Clinical and Health Psychology, College of Public Health and Health ProfessionsUniversity of FloridaGainesvilleFloridaUSA
| | - Michael Crowe
- Department of Psychology, College of Arts and SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Michael Marsiske
- Department of Clinical and Health Psychology, College of Public Health and Health ProfessionsUniversity of FloridaGainesvilleFloridaUSA
| | - Kelsey R. Thomas
- Department of PsychiatrySchool of MedicineUniversity of California, San DiegoLa JollaCaliforniaUSA,Research Services, VA San Diego Healthcare System (VASDHS)San DiegoCaliforniaUSA
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12
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Ortiz G, Weigand AJ, Cooper S, Smirnov DS, Salmon DP, Galasko DR, Bangen KJ, Thomas KR. Neuropsychiatric symptoms impact associations between plasma neurofilament light and cognition in individuals with Lewy body pathology, but not in Alzheimer’s disease. Alzheimers Dement 2022. [DOI: 10.1002/alz.064400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Gema Ortiz
- VA San Diego Healthcare System San Diego CA USA
| | - Alexandra J. Weigand
- VA San Diego Healthcare System San Diego CA USA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology San Diego CA USA
- University of California, School of Medicine, San Diego San Diego CA USA
| | | | | | - David P. Salmon
- University of California San Diego La Jolla CA USA
- Shiley‐Marcos Alzheimer’s Disease Research Center La Jolla CA USA
| | - Douglas R. Galasko
- VA San Diego Healthcare System San Diego CA USA
- University of California San Diego La Jolla CA USA
- Shiley‐Marcos Alzheimer’s Disease Research Center La Jolla CA USA
| | - Katherine J. Bangen
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
| | - Kelsey R. Thomas
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
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13
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Thomas KR, Weigand AJ, Edwards LC, Edmonds EC, Bangen KJ, Ortiz G, Walker KS, Bondi MW. Tau levels are higher in objective subtle cognitive decline, but not subjective memory complaint. Alzheimers Dement 2022. [DOI: 10.1002/alz.066178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Kelsey R. Thomas
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
| | - Alexandra J. Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology San Diego CA USA
| | - Lauren C. Edwards
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology San Diego CA USA
| | | | - Katherine J. Bangen
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
| | - Gema Ortiz
- VA San Diego Healthcare System San Diego CA USA
| | - Kayla S. Walker
- VA San Diego Healthcare System San Diego CA USA
- San Diego State University San Diego CA USA
| | - Mark W. Bondi
- VA San Diego Healthcare System San Diego CA USA
- University of California San Diego La Jolla CA USA
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14
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Brenner EK, Edwards L, Thomas KR, Weigand AJ, Edmonds EC, Bondi MW, Bangen KJ. Cognitive Reserve Moderates the Association Between Cerebral Blood Flow and Language Performance in Older Adults with Mild Cognitive Impairment. Alzheimers Dement 2022. [DOI: 10.1002/alz.062810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Lauren Edwards
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology San Diego CA USA
| | - Kelsey R. Thomas
- University of California, San Diego La Jolla CA USA
- VA San Diego Healthcare System San Diego CA USA
| | - Alexandra J. Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology San Diego CA USA
| | | | - Mark W. Bondi
- VA San Diego Healthcare System San Diego CA USA
- University of California San Diego La Jolla CA USA
| | - Katherine J. Bangen
- University of California, San Diego La Jolla CA USA
- VA San Diego Healthcare System San Diego CA USA
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15
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Weigand AJ, Ortiz G, Walker KS, Galasko DR, Bondi MW, Thomas KR. Differential impact of APOE on associations between phosphorylated tau 181 and multi‐domain cognitive outcomes using cerebrospinal fluid and plasma markers. Alzheimers Dement 2022. [DOI: 10.1002/alz.067840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Alexandra J. Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology San Diego CA USA
| | - Gema Ortiz
- VA San Diego Healthcare System San Diego CA USA
| | - Kayla S. Walker
- VA San Diego Healthcare System San Diego CA USA
- San Diego State University San Diego CA USA
| | - Douglas R. Galasko
- VA San Diego Healthcare System San Diego CA USA
- Shiley‐Marcos Alzheimer's Disease Research Center La Jolla CA USA
- University of California San Diego La Jolla CA USA
| | - Mark W. Bondi
- VA San Diego Healthcare System San Diego CA USA
- University of California San Diego La Jolla CA USA
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Weigand AJ, Hamlin AM, Breton J, Clark AL. Cerebral blood flow, tau imaging, and memory associations in cognitively unimpaired older adults. Cereb Circ Cogn Behav 2022; 3:100153. [PMID: 36353072 PMCID: PMC9637859 DOI: 10.1016/j.cccb.2022.100153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/11/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Cerebral blood flow (CBF) has been independently linked to cognitive impairment and traditional Alzheimer's disease (AD) pathology (e.g., amyloid-beta [Aβ], tau) in older adults. However, less is known about the possible interactive effects of CBF, Aβ, and tau on memory performance. The present study examined whether CBF moderates the effect of Aβ and tau on objective and subjective memory within cognitively unimpaired (CU) older adults. METHODS Participants included 54 predominately white CU older adults from the Alzheimer's Disease Neuroimaging Initiative. Multiple linear regression models examined meta-temporal CBF associations with (1) meta-temporal tau PET adjusting for cortical Aβ PET and (2) and cortical Aβ PET adjusting for tau PET. The CBF and tau meta region was an average of 5 distinct temporal lobe regions. CBF interactions with Aβ or tau PET on memory performance were also examined. Covariates for all models included age, sex, education, pulse pressure, APOE-ε4 positivity, and imaging acquisition date differences. RESULTS CBF was significantly negatively associated with tau PET (t = -2.16, p = .04) but not Aβ PET (t = 0.98, p = .33). Results revealed a CBF by tau PET interaction such that there was a stronger effect of tau PET on objective (t = 2.51, p = .02) and subjective (t = -2.67, p = .01) memory outcomes among individuals with lower levels of CBF. CONCLUSIONS Cerebrovascular and tau pathologies may interact to influence cognitive performance. This study highlights the need for future vascular risk interventions, which could offer a scalable and cost-effective method for AD prevention.
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Affiliation(s)
- Alexandra J. Weigand
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, United States
| | - Abbey M. Hamlin
- Department of Psychology, College of Liberal Arts, University of Texas at Austin, 108 East Dean Keeton, SEA 3.234, Austin, TX 78712, United States
| | - Jordana Breton
- Department of Psychology, College of Liberal Arts, University of Texas at Austin, 108 East Dean Keeton, SEA 3.234, Austin, TX 78712, United States
| | - Alexandra L. Clark
- Department of Psychology, College of Liberal Arts, University of Texas at Austin, 108 East Dean Keeton, SEA 3.234, Austin, TX 78712, United States
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Weigand AJ, Edwards L, Thomas KR, Bangen KJ, Bondi MW. Comprehensive characterization of elevated tau PET signal in the absence of amyloid-beta. Brain Commun 2022; 4:fcac272. [PMID: 36382220 PMCID: PMC9651027 DOI: 10.1093/braincomms/fcac272] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 07/07/2022] [Accepted: 10/24/2022] [Indexed: 02/03/2023] Open
Abstract
Recently proposed biomarker-only diagnostic frameworks propose that amyloid-beta is necessary for placement on the Alzheimer's disease continuum, whereas tau in the absence of amyloid-beta is considered to be a non-Alzheimer's disease pathologic change. Similarly, the pathologic designation of tau in the absence of amyloid-beta is characterized as primary age-related tauopathy and separable from Alzheimer's disease. Our study sought to identify an early-to-moderate tau stage with minimal amyloid-beta using PET imaging and characterize these individuals in terms of clinical, cognitive and biological features. Seven hundred and three participants from the Alzheimer's Disease Neuroimaging Initiative were classified into one of the four groups (A-/T-, A-/T+, A+/T- and A+/T+) based on PET positivity or negativity for cortical amyloid-beta (A-/A+) and early-to-moderate stage (i.e. meta-temporal) tau (T-/T+). These groups were then compared on demographic and clinical features, vascular risk, multi-domain neuropsychological performance, multi-domain subjective cognitive complaints, apolipoprotein E epsilon-4 carrier status and cortical thickness across Alzheimer's disease-vulnerable regions. The proportion of participants classified in each group was as follows: 47.23% A-/T-, 13.51% A-/T+, 12.23% A+/T- and 27.03% A+/T+. Results indicated that the A-/T+ and A+/T+ groups did not statistically differ on age, sex, depression levels, vascular risk and cortical thickness across temporal and parietal regions. Additionally, both A-/T+ and A+/T+ groups showed significant associations between memory performance and cortical thickness of temporal regions. Despite the different pathologic terminology used for A-/T+ and A+/T+, these groups did not statistically differ on a number of clinical, cognitive and biomarker features. Although it remains unclear whether A-/T+ reflects a pathologic construct separable from Alzheimer's disease, our results provide evidence that this group typically characterized as 'non-Alzheimer's pathologic change' or 'primary age-related tauopathy' should be given increased attention, given some similarities in cognitive and biomarker characteristics to groups traditionally considered to be on the Alzheimer's continuum.
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Affiliation(s)
- Alexandra J Weigand
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, CA 92120, USA
| | - Lauren Edwards
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, CA 92120, USA
| | - Kelsey R Thomas
- VA San Diego Healthcare System, San Diego, CA 92161, USA,Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Katherine J Bangen
- VA San Diego Healthcare System, San Diego, CA 92161, USA,Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Mark W Bondi
- Correspondence to: Mark W. Bondi, PhD ABPP-CN, VA San Diego Healthcare System (116B) 3350 La Jolla Village Drive, San Diego, CA 92161, USA E-mail:
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Thomas KR, Weigand AJ, Edwards LC, Edmonds EC, Bangen KJ, Ortiz G, Walker KS, Bondi MW. Tau levels are higher in objective subtle cognitive decline but not subjective memory complaint. Alzheimers Res Ther 2022; 14:114. [PMID: 35996158 PMCID: PMC9394026 DOI: 10.1186/s13195-022-01060-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The 2018 NIA-AA Alzheimer's Disease (AD) Research Framework states that subtle cognitive decline in cognitively unimpaired individuals can be measured by subjective reports or evidence of objective decline on neuropsychological measures. Both subjective memory complaint (SMC) and objective subtle cognitive decline (Obj-SCD) have been shown to be associated with future cognitive decline and AD biomarkers. We examined whether there are differences in tau PET levels between (a) SMC- vs. SMC+ participants, (b) Obj-SCD- vs. Obj-SCD+ participants, and (c) participants with overlapping vs. discrepant SMC and Obj-SCD classifications. METHODS Cognitively unimpaired participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI; n = 236) were classified at baseline as positive or negative for SMC (SMC- n = 77; SMC+ n = 159) based on the first 12 items of the Cognitive Change Index and/or classified as positive or negative for Obj-SCD (Obj-SCD- n = 173; Obj-SCD+ n = 63) based on previously defined neuropsychological criteria. Analyses of covariance, adjusting for age, sex, APOE ε4 carrier status, and pulse pressure, examined the group differences in tau PET (AV-1451) using a composite standardized uptake variable ratio (SUVR) for regions consistent with Braak stage III/IV. The chi-squared tests examined the tau positivity rates across the groups. RESULTS Obj-SCD+ participants had higher tau continuous SUVR levels (p = .035, ηp2 = .019) and higher rates of tau positivity (15.8% Obj-SCD- vs. 30.2% Obj-SCD+) than Obj-SCD- participants. Neither tau levels (p = .381, ηp2 = .003) nor rates of tau positivity (18.2% SMC- and 20.1% SMC+) differed between the SMC groups. There was very little agreement between SMC and Obj-SCD classifications (42%; κ = 0.008, p = .862). Participants who were Obj-SCD+ without SMC had the highest tau PET levels and differed from participants who were SMC+ without Obj-SCD (p = .022). Tau levels in participants with both SMC and Obj-SCD did not differ from those with only Obj-SCD (p = .216). Tau positivity rates across the SMC-/Obj-SCD-, SMC+/Obj-SCD-, SMC-/Obj-SCD+, and SMC+/Obj-SCD+ groups were 10.5%, 18.1%, 40.0%, and 25.6%, respectively. CONCLUSION Participants with Obj-SCD had a greater tau PET burden than those without Obj-SCD, but SMC was not associated with higher tau levels. The combination of SMC and Obj-SCD did not have higher tau levels than Obj-SCD alone. Findings add to the evidence that the Obj-SCD classification is associated with AD biomarkers and faster cognitive decline in ADNI participants, but further work is needed to validate this approach in more representative/diverse cohorts.
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Affiliation(s)
- Kelsey R Thomas
- Research Service, VA San Diego Healthcare System, Building 13, 3350 La Jolla Village Drive (151), San Diego, CA, 92161, USA.
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA.
| | - Alexandra J Weigand
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Lauren C Edwards
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | | | - Katherine J Bangen
- Research Service, VA San Diego Healthcare System, Building 13, 3350 La Jolla Village Drive (151), San Diego, CA, 92161, USA
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
| | - Gema Ortiz
- Research Service, VA San Diego Healthcare System, Building 13, 3350 La Jolla Village Drive (151), San Diego, CA, 92161, USA
| | - Kayla S Walker
- Research Service, VA San Diego Healthcare System, Building 13, 3350 La Jolla Village Drive (151), San Diego, CA, 92161, USA
- San Diego State University, San Diego, CA, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
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Weigand AJ, Maass A, Eglit GL, Bondi MW. What's the cut-point?: a systematic investigation of tau PET thresholding methods. Alzheimers Res Ther 2022; 14:49. [PMID: 35382866 PMCID: PMC8985353 DOI: 10.1186/s13195-022-00986-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/09/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Tau positron emission tomography (PET) is increasing in popularity for biomarker characterization of Alzheimer's disease (AD), and recent frameworks rely on tau PET cut-points to stage individuals along the AD continuum. Given the lack of standardization in tau PET thresholding methods, this study sought to systematically canvass and characterize existing studies that have derived tau PET cut-points and then directly assess different methods of tau PET thresholding in terms of their concurrent validity. METHODS First, a literature search was conducted in PubMed to identify studies of AD and related clinical phenotypes that used the Flortaucipir (AV-1451) tau PET tracer to derive a binary cut-point for tau positivity. Of 540 articles screened and 47 full-texts reviewed, 23 cohort studies met inclusion criteria with a total of 6536 participants. Second, we derived and compared tau PET cut-points in a 2 × 2 × 2 design that systematically varied region (temporal meta-ROI and entorhinal cortex), analytic method (receiver operating characteristics and 2 standard deviations above comparison group), and criterion/comparison variable (amyloid-beta negative cognitively unimpaired or cognitively unimpaired only) using a sample of 453 older adults from the Alzheimer's Disease Neuroimaging Initiative. RESULTS For the systematic review, notable variability in sample characteristics, preprocessing methods, region of interest, and analytic approach were observed, which were accompanied by discrepancy in proposed tau PET cut points. The empirical follow-up indicated the cut-point derived based on 2 standard deviations above a either comparison group in either ROI best differentiated tau positive and negative groups on cerebrospinal fluid phosphorylated tau, Mini-Mental State Examination score, and delayed memory performance. CONCLUSIONS Given the impact of discrepant thresholds on tau positivity rates, biomarker staging, and eligibility for future clinical treatment trials, recommendations are offered to select cut-point derivations based on the unique goals and priorities of different studies.
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Affiliation(s)
- Alexandra J Weigand
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, USA
| | - Anne Maass
- German Center for Neurodegenerative Diseases, Magdeburg, Germany
| | - Graham L Eglit
- Research Service, VA San Diego Healthcare System, San Diego, USA
- Department of Psychiatry, University of California, San Diego, USA
| | - Mark W Bondi
- Research Service, VA San Diego Healthcare System, San Diego, USA.
- Department of Psychiatry, University of California, San Diego, USA.
- Neuropsychological Assessment Unit, University of California San Diego School of Medicine, VA San Diego Healthcare System (116B), 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.
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20
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Solders SK, Galinsky VL, Clark AL, Sorg SF, Weigand AJ, Bondi MW, Frank LR. Diffusion MRI tractography of the locus coeruleus-transentorhinal cortex connections using GO-ESP. Magn Reson Med 2022; 87:1816-1831. [PMID: 34792198 PMCID: PMC8810611 DOI: 10.1002/mrm.29088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE The locus coeruleus (LC) is implicated as an early site of protein pathogenesis in Alzheimer's disease (AD). Tau pathology is hypothesized to propagate in a prion-like manner along the LC-transentorhinal cortex (TEC) white matter (WM) pathway, leading to atrophy of the entorhinal cortex and adjacent cortical regions in a progressive and stereotypical manner. However, WM damage along the LC-TEC pathway may be an earlier observable change that can improve detection of preclinical AD. THEORY AND METHODS Diffusion-weighted MRI (dMRI) allows reconstruction of WM pathways in vivo, offering promising potential to examine this pathway and enhance our understanding of neural mechanisms underlying the preclinical phase of AD. However, standard dMRI analysis tools have generally been unable to reliably reconstruct this pathway. We apply a novel method, geometric-optics based entropy spectrum pathways (GO-ESP) and produce a new measure of connectivity: the equilibrium probability (EP). RESULTS We demonstrated reliable reconstruction of LC-TEC pathways in 50 cognitively normal older adults and showed a negative association between LC-TEC EP and cerebrospinal fluid tau. Using Human Connectome Project data, we demonstrated replicability of the method across acquisition schemes and scanners. Finally, we compared our findings with the only other existing LC-TEC tractography template, and replicated their pathway as well as investigated the source of these discrepant findings. CONCLUSIONS AD-related tau pathology may be detectable within GO-ESP-identified LC-TEC pathways. Furthermore, there may be multiple possible routes from LC to TEC, raising important questions for future research on the LC-TEC connectome and its role in AD pathogenesis.
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Affiliation(s)
- Seraphina K. Solders
- Neuroscience Graduate ProgramUniversity of California at San DiegoLa JollaCaliforniaUSA
- Center for Scientific Computation in ImagingUniversity of California at San DiegoLa JollaCaliforniaUSA
| | - Vitaly L. Galinsky
- Center for Scientific Computation in ImagingUniversity of California at San DiegoLa JollaCaliforniaUSA
| | | | - Scott F. Sorg
- Department of PsychiatrySchool of MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
- Research and Psychology ServicesVA San Diego Healthcare SystemSan DiegoCaliforniaUSA
| | - Alexandra J. Weigand
- San Diego State University/University of California at San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCaliforniaUSA
| | - Mark W. Bondi
- Department of PsychiatrySchool of MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
- Research and Psychology ServicesVA San Diego Healthcare SystemSan DiegoCaliforniaUSA
| | - Lawrence R. Frank
- Center for Scientific Computation in ImagingUniversity of California at San DiegoLa JollaCaliforniaUSA
- Department of RadiologyUniversity of California at San DiegoLa JollaCaliforniaUSA
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21
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Thomas KR, Weigand AJ, Cota IH, Edmonds EC, Wierenga CE, Bondi MW, Bangen KJ. Intrusion errors moderate the relationship between blood glucose and regional cerebral blood flow in cognitively unimpaired older adults. Brain Imaging Behav 2022; 16:219-227. [PMID: 34415491 PMCID: PMC8825619 DOI: 10.1007/s11682-021-00495-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 02/03/2023]
Abstract
Regional cerebral blood flow (CBF) has a complex relationship with cognitive functioning such that cognitively unimpaired individuals at risk for Alzheimer's disease (AD) may show regional hyperperfusion, while those with cognitive impairment typically show hypoperfusion. Diabetes and word-list intrusion errors are both linked to greater risk of cognitive decline and dementia. Our study examined associations between fasting blood glucose, word-list intrusion errors, and regional CBF. 113 cognitively unimpaired older adults had arterial spin labeling MRI to measure CBF in a priori AD vulnerable regions: medial temporal lobe (MTL), inferior parietal lobe (IPL), precuneus, medial orbitofrontal cortex (mOFC), and pericalcarine (control region). Hierarchical linear regressions, adjusting for demographics, vascular risk, and reference CBF region, examined the main effect of blood glucose on regional CBF as well as whether intrusions moderated this relationship. Higher glucose was associated with higher CBF in the precuneus (β = .134, 95% CI = .007 to .261, p = .039), IPL (β = .173, 95% CI = .072 to .276, p = .001), and mOFC (β = .182, 95% CI = .047 to .320, p = .009). There was no main effect of intrusions on CBF across regions. However, the glucose x intrusions interaction was significant such that having higher glucose levels and more intrusion errors was associated with reduced CBF in the MTL (β = -.186, 95% CI = -.334 to -.040, p = .013) and precuneus (β = -.146, 95% CI = -.273 to -.022, p = .022). These findings may reflect early neurovascular dysregulation, whereby higher CBF is needed to maintain unimpaired cognition in individuals with higher glucose levels. However, lower regional CBF in unimpaired participants with both higher glucose and more intrusions suggests a failure in this early compensatory mechanism that may signal a decrease in neural activity in AD vulnerable regions.
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Affiliation(s)
- Kelsey R Thomas
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (151), San Diego, CA, USA.
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
| | - Alexandra J Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Isabel H Cota
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (151), San Diego, CA, USA
| | - Emily C Edmonds
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (151), San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Christina E Wierenga
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (151), San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Katherine J Bangen
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive (151), San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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22
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Graves LV, Edmonds EC, Thomas KR, Weigand AJ, Cooper S, Stickel AM, Zlatar ZZ, Clark AL, Bondi MW. Diagnostic accuracy and differential associations between ratings of functioning and neuropsychological performance in non-Hispanic Black and White older adults. Clin Neuropsychol 2022; 36:287-310. [PMID: 34499580 PMCID: PMC8849565 DOI: 10.1080/13854046.2021.1971766] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ObjectiveWe recently demonstrated that relative to consensus-based methods, actuarial methods may improve diagnostic accuracy across the continuum of cognitively normal (CN), mild cognitive impairment (MCI), and dementia in the overall National Alzheimer's Coordinating Center (NACC) cohort. However, the generalizability and comparative utility of current methods of diagnosing MCI and dementia due to Alzheimer's disease and related disorders (ADRD) are significantly understudied in non-Hispanic Black (NHB) older adults. Thus, we extended our previous investigation to more specifically explore the utility of consensus-based and actuarial diagnostic methods in NHB older adults.Method: We compared baseline consensus and actuarial diagnostic rates, and associations of ratings of functioning with neuropsychological performance and diagnostic outcomes, in NHB (n = 963) and non-Hispanic White (NHW; n = 4577) older adults in the NACC cohort.Results: 60.0% of the NHB subsample, versus 29.2% of the NHW subsample, included participants who met actuarial criteria for MCI despite being classified as CN or impaired-not-MCI per consensus. Additionally, associations between ratings of functioning and neuropsychological performance were less consistent in NHB participants than in NHW participants.Conclusions: Our results provide evidence of differential degrees of association between reported functioning and neuropsychological performance in NHB and NHW older adults, which may contribute to racial group differences in diagnostic rates, and prompt consideration of the strengths and weaknesses of consensus-based and actuarial diagnostic approaches in assessing neurocognitive functioning in NHB older adults.
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Affiliation(s)
- Lisa V. Graves
- VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Emily C. Edmonds
- VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Kelsey R. Thomas
- VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Alexandra J. Weigand
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Shanna Cooper
- VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Ariana M. Stickel
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Zvinka Z. Zlatar
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Alexandra L. Clark
- VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Mark W. Bondi
- VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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Weigand AJ, Macomber AJ, Walker KS, Edwards L, Thomas KR, Bangen KJ, Nation DA, Bondi MW. Interactive Effects of Pulse Pressure and Tau Imaging on Longitudinal Cognition. J Alzheimers Dis 2022; 89:633-640. [PMID: 35938247 PMCID: PMC9904538 DOI: 10.3233/jad-220026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Studies have demonstrated that both tau and cardiovascular risk are associated with cognitive decline, but the possible synergistic effects of these pathologic markers remain unclear. OBJECTIVE To explore the interaction of AD biomarkers with a specific vascular risk marker (pulse pressure) on longitudinal cognition. METHODS Participants included 139 older adults from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Biomarkers of tau, amyloid-β (Aβ), and vascular risk (pulse pressure) were assessed. Neuropsychological assessment provided memory, language, and executive function domain composite scores at baseline and 1-year follow-up. Multiple linear regression examined interactive effects of pulse pressure with tau PET independent of Aβ PET and Aβ PET independent of tau PET on baseline and 1-year cognitive outcomes. RESULTS The interaction between pulse pressure and tau PET significantly predicted 1-year memory performance such that the combined effect of high pulse pressure and high tau PET levels was associated with lower memory at follow-up but not at baseline. In contrast, Aβ PET did not significantly interact with pulse pressure to predict baseline or 1-year outcomes in any cognitive domain. Main effects revealed a significant effect of tau PET on memory, and no significant effects of Aβ PET or pulse pressure on any cognitive domain. CONCLUSION Results indicate that tau and an indirect marker of arterial stiffening (pulse pressure) may synergistically contribute to memory decline, whereas Aβ may have a lesser role in predicting cognitive progression. Tau and vascular pathology (particularly in combination) may represent valuable targets for interventions intended to slow cognitive decline.
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Affiliation(s)
- Alexandra J. Weigand
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology
| | | | | | - Lauren Edwards
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology
| | - Kelsey R. Thomas
- Department of Psychiatry, University of California San Diego,VA San Diego Healthcare System; Department of Psychology
| | - Katherine J. Bangen
- Department of Psychiatry, University of California San Diego,VA San Diego Healthcare System; Department of Psychology
| | | | - Mark W. Bondi
- Department of Psychiatry, University of California San Diego,University of California Irvine
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24
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Thomas KR, Bangen KJ, Weigand AJ, Ortiz G, Walker KS, Salmon DP, Bondi MW, Edmonds EC. Cognitive Heterogeneity and Risk of Progression in Data-Driven Subtle Cognitive Decline Phenotypes. J Alzheimers Dis 2022; 90:323-331. [PMID: 36120785 PMCID: PMC9661321 DOI: 10.3233/jad-220684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is increasing recognition of cognitive and pathological heterogeneity in early-stage Alzheimer's disease and other dementias. Data-driven approaches have demonstrated cognitive heterogeneity in those with mild cognitive impairment (MCI), but few studies have examined this heterogeneity and its association with progression to MCI/dementia in cognitively unimpaired (CU) older adults. OBJECTIVE We identified cluster-derived subgroups of CU participants based on comprehensive neuropsychological data and compared baseline characteristics and rates of progression to MCI/dementia or a Dementia Rating Scale (DRS) of ≤129 across subgroups. METHODS Hierarchical cluster analysis was conducted on individual baseline neuropsychological test scores from 365 CU participants in the UCSD Shiley-Marcos Alzheimer's Disease Research Center longitudinal cohort. Cox regressions examined the risk of progression to consensus diagnosis of MCI or dementia, or to DRS score ≤129, by cluster group. RESULTS Cluster analysis identified 5 groups: All-Average (n = 139), Low-Visuospatial (n = 46), Low-Executive (n = 51), Low-Memory/Language (n = 83), and Low-All Domains (n = 46). Subgroups had unique demographic and clinical characteristics. Rates of progression to MCI/dementia or to DRS ≤129 were faster for all subgroups (Low-All Domains progressed the fastest > Low Memory/Language≥Low-Visuospatial and Low-Executive) relative to the All-Average subgroup. CONCLUSION Faster progression in the Low-Visuospatial, Low-Executive, and Low-Memory/Language groups compared to the All-Average group suggests that there are multiple pathways and/or unique subtle cognitive decline profiles that ultimately lead to a diagnosis of MCI/dementia. Use of comprehensive neuropsychological test batteries that assess several domains may be a key first step toward an individualized approach to early detection and fewer missed opportunities for early intervention.
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Affiliation(s)
- Kelsey R. Thomas
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Katherine J. Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Alexandra J. Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Gema Ortiz
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Kayla S. Walker
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - David P. Salmon
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Mark W. Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Emily C. Edmonds
- Banner Alzheimer’s Institute, Tucson, AZ, USA
- Department of Psychology, University of Arizona, Tucson, AZ, USA
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Thomas KR, Bangen KJ, Edmonds EC, Weigand AJ, Walker KS, Bondi MW, Galasko DR. Objective subtle cognitive decline is associated with a more rapid increase in plasma phosphorylated‐tau181 levels over time. Alzheimers Dement 2021. [DOI: 10.1002/alz.050039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Kelsey R. Thomas
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
| | - Katherine J. Bangen
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
| | - Emily C. Edmonds
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
| | - Alexandra J. Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology San Diego CA USA
| | - Kayla S. Walker
- San Diego State University, Advancing Diversity in Aging Research Program San Diego CA USA
| | - Mark W. Bondi
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
| | - Doug R. Galasko
- VA San Diego Healthcare System San Diego CA USA
- University of California, San Diego La Jolla CA USA
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Werhane ML, Thomas KR, Bangen KJ, Weigand AJ, Edmonds EC, Nation DA, Sundermann EE, Bondi MW, Delano-Wood L. Arterial Stiffening Moderates the Relationship Between Type-2 Diabetes Mellitus and White Matter Hyperintensity Burden in Older Adults With Mild Cognitive Impairment. Front Aging Neurosci 2021; 13:716638. [PMID: 34759811 PMCID: PMC8574966 DOI: 10.3389/fnagi.2021.716638] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Cerebrovascular dysfunction has been proposed as a possible mechanism underlying cognitive impairment in the context of type 2 diabetes mellitus (DM). Although magnetic resonance imaging (MRI) evidence of cerebrovascular disease, such as white matter hyperintensities (WMH), is often observed in DM, the vascular dynamics underlying this pathology remain unclear. Thus, we assessed the independent and combined effects of DM status and different vascular hemodynamic measures (i.e., systolic, diastolic, and mean arterial blood pressure and pulse pressure index [PPi]) on WMH burden in cognitively unimpaired (CU) older adults and those with mild cognitive impairment (MCI). Methods: 559 older adults (mean age: 72.4 years) from the Alzheimer's Disease Neuroimaging Initiative were categorized into those with diabetes (DM+; CU = 43, MCI = 34) or without diabetes (DM-; CU = 279; MCI = 203). Participants underwent BP assessment, from which all vascular hemodynamic measures were derived. T2-FLAIR MRI was used to quantify WMH burden. Hierarchical linear regression, adjusting for age, sex, BMI, intracranial volume, CSF amyloid, and APOE ε4 status, examined the independent and interactive effects of DM status and each vascular hemodynamic measure on total WMH burden. Results: The presence of DM (p = 0.046), but not PPi values (p = 0.299), was independently associated with greater WMH burden overall after adjusting for covariates. Analyses stratified by cognitive status revealed a significant DM status x PPi interaction within the MCI group (p = 0.001) such that higher PPi values predicted greater WMH burden in the DM + but not DM- group. No significant interactions were observed in the CU group (all ps > 0.05). Discussion: Results indicate that higher PPi values are positively associated with WMH burden in diabetic older adults with MCI, but not their non-diabetic or CU counterparts. Our findings suggest that arterial stiffening and reduced vascular compliance may have a role in development of cerebrovascular pathology within the context of DM in individuals at risk for future cognitive decline. Given the specificity of these findings to MCI, future exploration of the sensitivity of earlier brain markers of vascular insufficiency (i.e., prior to macrostructural white matter changes) to the effects of DM and arterial stiffness/reduced vascular compliance in CU individuals is warranted.
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Affiliation(s)
- Madeleine L. Werhane
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Kelsey R. Thomas
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Katherine J. Bangen
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Alexandra J. Weigand
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, United States
| | - Emily C. Edmonds
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Daniel A. Nation
- Department of Psychological Sciences, University of California, Irvine, Irvine, CA, United States
| | - Erin E. Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Mark W. Bondi
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Lisa Delano-Wood
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
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27
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Clark AL, Weigand AJ, Bangen KJ, Thomas KR, Eglit GM, Bondi MW, Delano‐Wood L. Higher cerebrospinal fluid tau is associated with history of traumatic brain injury and reduced processing speed in Vietnam-era veterans: A Department of Defense Alzheimer's Disease Neuroimaging Initiative (DOD-ADNI) study. Alzheimers Dement (Amst) 2021; 13:e12239. [PMID: 34692979 PMCID: PMC8515227 DOI: 10.1002/dad2.12239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/08/2021] [Accepted: 08/03/2021] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Our goal was to determine whether cognitive and cerebrospinal fluid (CSF) markers of tau and amyloid beta 1-42 (Aβ42) differ between Vietnam-era veterans with and without history of traumatic brain injury (TBI) and whether TBI moderates the association between CSF markers and neurocognitive functioning. METHODS A total of 102 male participants (52 TBI, 50 military controls [MCs]; mean age = 68) were included. Levels of CSF Aβ42, tau phosphorylated at the threonine 181 position (p-tau), and total tau (t-tau) were quantified. Group differences in CSF markers and cognition as well as the moderating effect of TBI on CSF and cognition associations were explored. RESULTS Relative to MCs, the TBI group showed significantly higher p-tau (P = .01) and t-tau (P = .02), but no differences in amyloid (P = .09). TBI history moderated the association between CSF tau and performance on a measure of processing speed (t-tau: P = .04; p-tau: P = .02). DISCUSSION Tau accumulation may represent a mechanism of dementia risk in older veterans with remote TBI.
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Affiliation(s)
- Alexandra L. Clark
- Department of PsychologyUniversity of Texas at AustinAustinTexasUSA
- Research and Psychology ServicesVA San Diego Healthcare System (VASDHS)La JollaCaliforniaUSA
- Department of Psychiatry, School of MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Alexandra J. Weigand
- Research and Psychology ServicesVA San Diego Healthcare System (VASDHS)La JollaCaliforniaUSA
- San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical PsychologySan Diego State University/University of CaliforniaSan DiegoCaliforniaUSA
| | - Katherine J. Bangen
- Research and Psychology ServicesVA San Diego Healthcare System (VASDHS)La JollaCaliforniaUSA
- Department of Psychiatry, School of MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Kelsey R. Thomas
- Research and Psychology ServicesVA San Diego Healthcare System (VASDHS)La JollaCaliforniaUSA
- Department of Psychiatry, School of MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Graham M.L. Eglit
- Research and Psychology ServicesVA San Diego Healthcare System (VASDHS)La JollaCaliforniaUSA
- Department of Psychiatry, School of MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Mark W. Bondi
- Research and Psychology ServicesVA San Diego Healthcare System (VASDHS)La JollaCaliforniaUSA
- Department of Psychiatry, School of MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Lisa Delano‐Wood
- Research and Psychology ServicesVA San Diego Healthcare System (VASDHS)La JollaCaliforniaUSA
- Department of Psychiatry, School of MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
- Center of Excellence for Stress and Mental HealthVASDHSLa JollaCaliforniaUSA
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Thomas KR, Bangen KJ, Edmonds EC, Weigand AJ, Walker KS, Bondi MW, Galasko DR. Objective subtle cognitive decline and plasma phosphorylated tau181: Early markers of Alzheimer's disease-related declines. Alzheimers Dement (Amst) 2021; 13:e12238. [PMID: 34692978 PMCID: PMC8515224 DOI: 10.1002/dad2.12238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Objectively-defined subtle cognitive decline (Obj-SCD) and plasma phosphorylated-tau181 (p-tau181) are promising early Alzheimer's disease (AD) markers. However, associations between Obj-SCD and p-tau181, and their combined prognostic potential, are unknown. METHODS Baseline and 4-year longitudinal p-tau181 changes were compared across cognitively unimpaired (CU; n = 402), Obj-SCD (n = 199), and mild cognitive impairment (MCI; n = 346) groups. CU and Obj-SCD participants were further classified as p-tau181-positive or negative. RESULTS CU and Obj-SCD has lower baseline p-tau181 than MCI and did not differ from one another. Longitudinally, Obj-SCD had the steepest p-tau181 increase. Obj-SCD/p-tau181-positive participants had the fastest rates of amyloid accumulation, cognitive decline, and functional decline. CONCLUSIONS Despite assumptions that cognitive changes invariably follow biomarker changes, early neuropsychological difficulties may emerge before/concurrently with plasma p-tau181 changes. Combining Obj-SCD and p-tau181, two potentially accessible early markers, was associated with the faster declines in AD-related outcomes.
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Affiliation(s)
- Kelsey R. Thomas
- Research ServiceVA San Diego Healthcare SystemSan DiegoCaliforniaUSA
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Katherine J. Bangen
- Research ServiceVA San Diego Healthcare SystemSan DiegoCaliforniaUSA
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Emily C. Edmonds
- Research ServiceVA San Diego Healthcare SystemSan DiegoCaliforniaUSA
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Alexandra J. Weigand
- San Diego State University/University of California Joint Doctoral Program in Clinical PsychologySan DiegoCaliforniaUSA
| | - Kayla S. Walker
- Research ServiceVA San Diego Healthcare SystemSan DiegoCaliforniaUSA
- Advancing Diversity in Aging Research (ADAR) ProgramSan Diego State UniversitySan DiegoCaliforniaUSA
| | - Mark W. Bondi
- Department of PsychiatryUniversity of California, San DiegoLa JollaCaliforniaUSA
- Psychology ServiceVA San Diego Healthcare SystemSan DiegoCaliforniaUSA
| | - Douglas R. Galasko
- Department of NeurosciencesUniversity of California San Diego School of MedicineLa JollaCaliforniaUSA
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Bangen KJ, Thomas KR, Sanchez DL, Edmonds EC, Weigand AJ, Delano-Wood L, Bondi MW. Entorhinal Perfusion Predicts Future Memory Decline, Neurodegeneration, and White Matter Hyperintensity Progression in Older Adults. J Alzheimers Dis 2021; 81:1711-1725. [PMID: 33967041 DOI: 10.3233/jad-201474] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Altered cerebral blood flow (CBF) has been linked to increased risk for Alzheimer's disease (AD). However, whether altered CBF contributes to AD risk by accelerating cognitive decline remains unclear. It also remains unclear whether reductions in CBF accelerate neurodegeneration and development of small vessel cerebrovascular disease. OBJECTIVE To examine associations between CBF and trajectories of memory performance, regional brain atrophy, and global white matter hyperintensity (WMH) volume. METHOD 147 Alzheimer's Disease Neuroimaging Initiative participants free of dementia underwent arterial spin labeling (ASL) magnetic resonance imaging (MRI) to measure CBF and serial neuropsychological and structural MRI examinations. Linear mixed effects models examined 5-year rate of change in memory and 4-year rate of change in regional brain atrophy and global WMH volumes as a function of baseline regional CBF. Entorhinal and hippocampal CBF were examined in separate models. RESULTS Adjusting for demographic characteristics, pulse pressure, apolipoprotein E ɛ4 positivity, cerebrospinal fluid p-tau/Aβ ratio, and neuronal metabolism (i.e., fluorodeoxyglucose standardized uptake value ratio), lower baseline entorhinal CBF predicted faster rates of decline in memory as well as faster entorhinal thinning and WMH progression. Hippocampal CBF did not predict cognitive or brain structure trajectories. CONCLUSION Findings highlight the importance of early cerebrovascular dysfunction in AD risk and suggest that entorhinal CBF as measured by noninvasive ASL MRI is a useful biomarker predictive of future cognitive decline and of risk of both.
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Affiliation(s)
- Katherine J Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Kelsey R Thomas
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Danielle L Sanchez
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Emily C Edmonds
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Alexandra J Weigand
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Lisa Delano-Wood
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
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Thomas KR, Osuna JR, Weigand AJ, Edmonds EC, Clark AL, Holmqvist S, Cota IH, Wierenga CE, Bondi MW, Bangen KJ. Regional hyperperfusion in older adults with objectively-defined subtle cognitive decline. J Cereb Blood Flow Metab 2021; 41:1001-1012. [PMID: 32615887 PMCID: PMC8054731 DOI: 10.1177/0271678x20935171] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/21/2020] [Accepted: 05/16/2020] [Indexed: 11/16/2022]
Abstract
Although cerebral blood flow (CBF) alterations are associated with Alzheimer's disease (AD), CBF patterns across prodromal stages of AD remain unclear. Therefore, we investigated patterns of regional CBF in 162 Alzheimer's Disease Neuroimaging Initiative participants characterized as cognitively unimpaired (CU; n = 80), objectively-defined subtle cognitive decline (Obj-SCD; n = 31), or mild cognitive impairment (MCI; n = 51). Arterial spin labeling MRI quantified regional CBF in a priori regions of interest: hippocampus, inferior temporal gyrus, inferior parietal lobe, medial orbitofrontal cortex, and rostral middle frontal gyrus. Obj-SCD participants had increased hippocampal and inferior parietal CBF relative to CU and MCI participants and increased inferior temporal CBF relative to MCI participants. CU and MCI groups did not differ in hippocampal or inferior parietal CBF, but CU participants had increased inferior temporal CBF relative to MCI participants. There were no CBF group differences in the two frontal regions. Thus, we found an inverted-U pattern of CBF signal across prodromal AD stages in regions susceptible to early AD pathology. Hippocampal and inferior parietal hyperperfusion in Obj-SCD may reflect early neurovascular dysregulation, whereby higher CBF is needed to maintain cognitive functioning relative to MCI participants, yet is also reflective of early cognitive inefficiencies that distinguish Obj-SCD from CU participants.
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Affiliation(s)
- Kelsey R Thomas
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Jessica R Osuna
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Alexandra J Weigand
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Emily C Edmonds
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Alexandra L Clark
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Sophia Holmqvist
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Isabel H Cota
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Christina E Wierenga
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Katherine J Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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Clark AL, Weigand AJ, Thomas KR, Solders SK, Delano-Wood L, Bondi MW, Bernier RA, Sundermann EE, Banks SJ, Bangen KJ. Elevated Inflammatory Markers and Arterial Stiffening Exacerbate Tau but Not Amyloid Pathology in Older Adults with Mild Cognitive Impairment. J Alzheimers Dis 2021; 80:1451-1463. [PMID: 33682714 DOI: 10.3233/jad-201382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Age-related cerebrovascular and neuroinflammatory processes have been independently identified as key mechanisms of Alzheimer's disease (AD), although their interactive effects have yet to be fully examined. OBJECTIVE The current study examined 1) the influence of pulse pressure (PP) and inflammatory markers on AD protein levels and 2) links between protein biomarkers and cognitive function in older adults with and without mild cognitive impairment (MCI). METHODS This study included 218 ADNI (81 cognitively normal [CN], 137 MCI) participants who underwent lumbar punctures, apolipoprotein E (APOE) genotyping, and cognitive testing. Cerebrospinal (CSF) levels of eight pro-inflammatory markers were used to create an inflammation composite, and amyloid-beta 1-42 (Aβ42), phosphorylated tau (p-tau), and total tau (t-tau) were quantified. RESULTS Multiple regression analyses controlling for age, education, and APOE ɛ4 genotype revealed significant PP x inflammation interactions for t-tau (B = 0.88, p = 0.01) and p-tau (B = 0.84, p = 0.02); higher inflammation was associated with higher levels of tau within the MCI group. However, within the CN group, analyses revealed a significant PP x inflammation interaction for Aβ42 (B = -1.01, p = 0.02); greater inflammation was associated with higher levels of Aβ42 (indicative of lower cerebral amyloid burden) in those with lower PP. Finally, higher levels of tau were associated with poorer memory performance within the MCI group only (p s < 0.05). CONCLUSION PP and inflammation exert differential effects on AD CSF proteins and provide evidence that vascular risk is associated with greater AD pathology across our sample of CN and MCI older adults.
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Affiliation(s)
- Alexandra L Clark
- Research Services, VA San Diego Healthcare System, San Diego, CA, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, School of Medicine, Department of Psychiatry, La Jolla, CA, USA
| | - Alexandra J Weigand
- Research Services, VA San Diego Healthcare System, San Diego, CA, USA.,San Diego State University/University of California, San Diego (SDSU/UCSD), La Jolla, CA, USA
| | - Kelsey R Thomas
- Research Services, VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, School of Medicine, Department of Psychiatry, La Jolla, CA, USA
| | - Seraphina K Solders
- Department of Neuroscience, University of California, San Diego, La Jolla, CA, USA
| | - Lisa Delano-Wood
- Research Services, VA San Diego Healthcare System, San Diego, CA, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, School of Medicine, Department of Psychiatry, La Jolla, CA, USA
| | - Mark W Bondi
- Research Services, VA San Diego Healthcare System, San Diego, CA, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, School of Medicine, Department of Psychiatry, La Jolla, CA, USA
| | - Rachel A Bernier
- Department of Neuroscience, University of California, San Diego, La Jolla, CA, USA
| | - Erin E Sundermann
- University of California San Diego, School of Medicine, Department of Psychiatry, La Jolla, CA, USA
| | - Sarah J Banks
- Department of Neuroscience, University of California, San Diego, La Jolla, CA, USA
| | - Katherine J Bangen
- Research Services, VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, School of Medicine, Department of Psychiatry, La Jolla, CA, USA
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Bangen KJ, Thomas KR, Weigand AJ, Edmonds EC, Clark AL, Solders S, Delano-Wood L, Galasko DR, Bondi MW. Elevated plasma neurofilament light predicts a faster rate of cognitive decline over 5 years in participants with objectively-defined subtle cognitive decline and MCI. Alzheimers Dement 2021; 17:1756-1762. [PMID: 33860596 DOI: 10.1002/alz.12324] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Neurofilament light (NFL) reflects neuroaxonal damage and is implicated in mild cognitive impairment (MCI) and Alzheimer's disease (AD). Little is known about NFL in pre-MCI stages, such as in individuals with objectively-defined subtle cognitive decline (Obj-SCD). METHODS Two hundred ninety-four participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI) underwent baseline blood draw and serial neuropsychological testing over 5 years of follow-up. RESULTS Individuals with Obj-SCD and MCI showed elevated baseline plasma NFL relative to the cognitively normal (CN) group. Across the sample, elevated NFL predicted faster rate of cognitive and functional decline. Within the Obj-SCD and MCI groups, higher NFL levels predicted faster rate of decline in memory and preclinical AD composite score compared to the CN group. DISCUSSION Findings demonstrate the utility of plasma NFL as a biomarker of early AD-related changes, and provide support for the use of Obj-SCD criteria in clinical research to better capture subtle cognitive changes.
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Affiliation(s)
- Katherine J Bangen
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Kelsey R Thomas
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Alexandra J Weigand
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA.,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Emily C Edmonds
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Alexandra L Clark
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Seraphina Solders
- Department of Neuroscience, University of California, San Diego, La Jolla, California, USA
| | - Lisa Delano-Wood
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Douglas R Galasko
- Department of Neuroscience, University of California, San Diego, La Jolla, California, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, California, USA
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Bangen KJ, Delano-Wood L, Deoni SCL, Clark AL, Evangelista ND, Hoffman SN, Sorg SF, Holmqvist S, Osuna J, Weigand AJ, Jak AJ, Bondi MW, Lamar M. Decreased myelin content of the fornix predicts poorer memory performance beyond vascular risk, hippocampal volume, and fractional anisotropy in nondemented older adults. Brain Imaging Behav 2021; 15:2563-2571. [PMID: 33638111 PMCID: PMC8500888 DOI: 10.1007/s11682-021-00458-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/18/2022]
Abstract
Alterations to cerebral white matter tracts have been associated with cognitive decline in aging and Alzheimer's disease (AD). In particular, the fornix has been implicated as especially vulnerable given that it represents the primary outflow tract of the hippocampus. Despite this, little work has focused on the fornix using a potential early marker of white matter degeneration-myelin water fraction (MWF; an in vivo marker of myelin content). Therefore, we sought to (1) clarify associations between MWF in the fornix and memory functioning, and (2) examine whether fornix MWF relates to memory performance above and beyond hippocampal volume and conventional imaging measures of white matter that may not be as specific to alterations in myelin content. Forty nondemented older adults (mean age = 72.9 years) underwent an MRI exam and neuropsychological assessment. Multicomponent driven equilibrium single pulse observation of T1 and T2 (mcDESPOT) was used to quantify fornix MWF and diffusion tensor imaging (DTI) was used to measure fornix fractional anisotropy (FA). Adjusting for age, sex, education, and vascular risk factors, linear regression models revealed that, lower fornix MWF was significantly associated with poorer memory functioning (β = 0.405, p = .007) across our sample of older adults. Notably, fornix MWF remained a significant predictor of memory functioning (β = 0.380, p = .015) even after adjusting for fornix DTI FA and hippocampal volume (in addition to the above covariates). Given the observed associations between myelin and memory in older adults without dementia, MWF may be a useful early marker of dementia risk.
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Affiliation(s)
- Katherine J Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA. .,Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, Mail Code 151B, La Jolla, CA, 92093-9151, USA.
| | - Lisa Delano-Wood
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, Mail Code 151B, La Jolla, CA, 92093-9151, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Sean C L Deoni
- Department of Pediatrics, Brown University, Providence, RI, USA
| | - Alexandra L Clark
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, Mail Code 151B, La Jolla, CA, 92093-9151, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Nicole D Evangelista
- Center for Cognitive Aging and Memory, Department of Clinical and Health Psychology, McKnight Brain Institute, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Samantha N Hoffman
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Scott F Sorg
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, Mail Code 151B, La Jolla, CA, 92093-9151, USA
| | - Sophia Holmqvist
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Jessica Osuna
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, Mail Code 151B, La Jolla, CA, 92093-9151, USA
| | - Alexandra J Weigand
- Center for Cognitive Aging and Memory, Department of Clinical and Health Psychology, McKnight Brain Institute, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Amy J Jak
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, Mail Code 151B, La Jolla, CA, 92093-9151, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, Mail Code 151B, La Jolla, CA, 92093-9151, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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Sundermann EE, Thomas KR, Bangen KJ, Weigand AJ, Eppig JS, Edmonds EC, Wong CG, Bondi MW, Delano-Wood L. Prediabetes Is Associated With Brain Hypometabolism and Cognitive Decline in a Sex-Dependent Manner: A Longitudinal Study of Nondemented Older Adults. Front Neurol 2021; 12:551975. [PMID: 33679574 PMCID: PMC7933503 DOI: 10.3389/fneur.2021.551975] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Abstract
Although type 2 diabetes is a well-known risk factor for Alzheimer's disease (AD), little is known about how its precursor-prediabetes-impacts neuropsychological function and brain health. Thus, we examined the relationship between prediabetes and AD-related biological and cognitive/clinical markers in a well-characterized sample drawn from the Alzheimer's Disease Neuroimaging Initiative. Additionally, because women show higher rates of AD and generally more atherogenic lipid profiles than men, particularly in the context of diabetes, we examined whether sex moderates any observed associations. The total sample of 911 nondemented and non-diabetic participants [normal control = 540; mild cognitive impairment (MCI) = 371] included 391 prediabetic (fasting blood glucose: 100-125 mg/dL) and 520 normoglycemic individuals (age range: 55-91). Linear mixed effects models, adjusted for demographics and vascular and AD risk factors, examined the independent and interactive effects of prediabetes and sex on 2-6 year trajectories of FDG-PET measured cerebral metabolic glucose rate (CMRglu), hippocampal/intracranial volume ratio (HV/IV), cerebrospinal fluid phosphorylated tau-181/amyloid-β1-42 ratio (p-tau181/Aβ1-42), cognitive function (executive function, language, and episodic memory) and the development of dementia. Analyses were repeated in the MCI subsample. In the total sample, prediabetic status had an adverse effect on CMRglu across time regardless of sex, whereas prediabetes had an adverse effect on executive function across time in women only. Within the MCI subsample, prediabetic status was associated with lower CMRglu and poorer executive function and language performance across time within women, whereas these associations were not seen within men. In the total sample and MCI subsample, prediabetes did not relate to HV/IV, p-tau181/Aβ1-42, memory function or dementia risk regardless of sex; however, among incident dementia cases, prediabetic status related to earlier age of dementia onset in women but not in men. Results suggest that prediabetes may affect cognition through altered brain metabolism, and that women may be more vulnerable to the negative effects of glucose intolerance.
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Affiliation(s)
- Erin E Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Kelsey R Thomas
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Katherine J Bangen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Alexandra J Weigand
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Joel S Eppig
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Emily C Edmonds
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Christina G Wong
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Lisa Delano-Wood
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
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Clark AL, Weigand AJ, Bangen KJ, Merritt VC, Bondi MW, Delano-Wood L. Repetitive mTBI is associated with age-related reductions in cerebral blood flow but not cortical thickness. J Cereb Blood Flow Metab 2021; 41:431-444. [PMID: 32248731 PMCID: PMC8369996 DOI: 10.1177/0271678x19897443] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Mild traumatic brain injury (mTBI) is a risk factor for Alzheimer's disease (AD), and evidence suggests cerebrovascular dysregulation initiates deleterious neurodegenerative cascades. We examined whether mTBI history alters cerebral blood flow (CBF) and cortical thickness in regions vulnerable to early AD-related changes. Seventy-four young to middle-aged Veterans (mean age = 34, range = 23-48) underwent brain scans. Participants were divided into: (1) Veteran Controls (n = 27), (2) 1-2 mTBIs (n = 26), and (2) 3+ mTBIs (n = 21) groups. Resting CBF was measured using MP-PCASL. T1 structural scans were processed with FreeSurfer. CBF and cortical thickness estimates were extracted from nine AD-vulnerable regions. Regression analyses examined whether mTBI moderated the association between age, CBF, and cortical thickness. Regressions adjusting for sex and posttraumatic stress revealed mTBI moderated the association between age and CBF of the precuneus as well as superior and inferior parietal cortices (p's < .05); increasing age was associated with lower CBF in the 3+ mTBIs group, but not in the VCs or 1-2 mTBIs groups. mTBI did not moderate associations between age and cortical thickness (p's >.05). Repetitive mTBI is associated with cerebrovascular dysfunction in AD-vulnerable regions and may accelerate pathological aging trajectories.
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Affiliation(s)
- Alexandra L Clark
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,School of Medicine, Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Alexandra J Weigand
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Katherine J Bangen
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,School of Medicine, Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Victoria C Merritt
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,School of Medicine, Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Mark W Bondi
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,School of Medicine, Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Lisa Delano-Wood
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.,School of Medicine, Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
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Weigand AJ, Thomas KR, Bangen KJ, Eglit GML, Delano-Wood L, Gilbert PE, Brickman AM, Bondi MW. APOE interacts with tau PET to influence memory independently of amyloid PET in older adults without dementia. Alzheimers Dement 2021; 17:61-69. [PMID: 32886451 DOI: 10.1002/alz.12173] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Apolipoprotein E (APOE) interacts with Alzheimer's disease pathology to promote disease progression. We investigated the moderating effect of APOE on independent associations of amyloid and tau positron emission tomography (PET) with cognition. METHODS For 297 nondemented older adults from the Alzheimer's Disease Neuroimaging Initiative, regression equations modeled associations between cognition and (1) cortical amyloid beta (Aβ) PET levels adjusting for tau and (2) medial temporal lobe (MTL) tau PET levels adjusting for Aβ, including interactions with APOE ε4-carrier status. RESULTS Adjusting for tau PET, Aβ was not associated with cognition and did not interact with APOE. In contrast, adjusting for Aβ PET, MTL tau was associated with all cognitive domains. Further, there was a stronger moderating effect of APOE on MTL tau and memory associations in ε4-carriers, even among Aβ-negative individuals. DISCUSSION Findings suggest that APOE may interact with tau independently of Aβ and that elevated MTL tau confers negative cognitive consequences in Aβ-negative ε4 carriers.
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Affiliation(s)
- Alexandra J Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program, San Diego
| | - Kelsey R Thomas
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Katherine J Bangen
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Graham M L Eglit
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Lisa Delano-Wood
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Paul E Gilbert
- Department of Psychology, San Diego State University, California, USA
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Mark W Bondi
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
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Weigand AJ, Nation DA, Delano‐Wood L, Bangen KJ, Galasko DR, Bondi MW. Elevated pulse pressure predicts longitudinal accumulation of tau PET in older adults without dementia. Alzheimers Dement 2020. [DOI: 10.1002/alz.042175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alexandra J. Weigand
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology San Diego CA USA
| | | | | | | | | | - Mark W. Bondi
- University of California, San Diego School of Medicine San Diego CA USA
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Solders SK, Clark AL, Weigand AJ, Sorg SF, Galinsky V, Frank LR, Bondi MW. The locus coeruleus: In‐vivo characterization with advanced MRI methods and associations with memory in older adults at risk for Alzheimer’s disease. Alzheimers Dement 2020. [DOI: 10.1002/alz.045511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Seraphina K. Solders
- University of California San Diego, School of Medicine San Diego CA USA
- University of California San Diego, Neurosciences Graduate Program San Diego CA USA
| | - Alexandra L. Clark
- University of California San Diego, School of Medicine San Diego CA USA
- Research and Psychology Services VA San Diego Healthcare System (VASDHS) San Diego CA USA
| | - Alexandra J. Weigand
- University of California San Diego, School of Medicine San Diego CA USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology San Diego CA USA
| | - Scott F. Sorg
- University of California San Diego, School of Medicine San Diego CA USA
- Research and Psychology Services VA San Diego Healthcare System (VASDHS) San Diego CA USA
| | - Vitaly Galinsky
- University of California, San Diego Center for Scientific Computation in Imaging San Diego CA USA
| | - Lawrence R. Frank
- University of California, San Diego Center for Scientific Computation in Imaging San Diego CA USA
| | - Mark W. Bondi
- University of California San Diego, School of Medicine San Diego CA USA
- Research and Psychology Services VA San Diego Healthcare System (VASDHS) San Diego CA USA
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Affiliation(s)
- Alexandra J. Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology San Diego CA USA
| | | | | | - Mark W. Bondi
- Research and Psychology Services, VA San Diego Healthcare System (VASDHS) San Diego CA USA
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Graves LV, Edmonds EC, Thomas KR, Weigand AJ, Cooper S, Bondi MW. Evidence for the Utility of Actuarial Neuropsychological Criteria Across the Continuum of Normal Aging, Mild Cognitive Impairment, and Dementia. J Alzheimers Dis 2020; 78:371-386. [PMID: 32986674 PMCID: PMC7683095 DOI: 10.3233/jad-200778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: Research suggests that actuarial neuropsychological criteria improve the accuracy of mild cognitive impairment (MCI) diagnoses relative to conventional diagnostic methods. Objective: We sought to examine the utility of actuarial criteria relative to consensus diagnostic methods used in the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set (UDS), and more broadly across the continuum of normal aging, MCI, and dementia. Methods: We compared rates of cognitively normal (CN), MCI, and dementia diagnoses at baseline using actuarial versus consensus diagnostic methods in 1524 individuals from the NACC UDS. Results: Approximately one-third (33.59%) of individuals diagnosed as CN and more than one-fifth (22.03%) diagnosed with dementia based on consensus methods, met actuarial criteria for MCI. Many participants diagnosed with MCI via consensus methods also appeared to represent possible diagnostic errors. Notably, the CNa/CNc group (i.e., participants diagnosed as CN based on both actuarial [a] and consensus [c] criteria) had a lower proportion of apolipoprotein E ɛ4 carriers than the MCIa/MCIc group, which in turn had a lower proportion of ɛ4 carriers than the dementia (Dem)a/Demc group. Proportions of ɛ4 carriers were comparable between the CNa/CNc and CNa/MCIc, MCIa/MCIc and MCIa/CNc, MCIa/MCIc and MCIa/Demc, and Dema/Demc and Dema/MCIc groups. These results were largely consistent with diagnostic agreement/discrepancy group comparisons on neuropsychological performance. Conclusion: The present results extend previous findings and suggest that actuarial neuropsychological criteria may enhance diagnostic accuracy relative to consensus methods, and across the wider continuum of normal aging, MCI, and dementia. Findings have implications for both clinical practice and research.
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Affiliation(s)
- Lisa V Graves
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Emily C Edmonds
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Kelsey R Thomas
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Alexandra J Weigand
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Shanna Cooper
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Mark W Bondi
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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Weigand AJ, Bondi MW, Thomas KR, Campbell NL, Galasko DR, Salmon DP, Sewell D, Brewer JB, Feldman HH, Delano-Wood L. Association of anticholinergic medications and AD biomarkers with incidence of MCI among cognitively normal older adults. Neurology 2020; 95:e2295-e2304. [PMID: 32878992 DOI: 10.1212/wnl.0000000000010643] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 05/18/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To determine the cognitive consequences of anticholinergic medications (aCH) in cognitively normal older adults as well as interactive effects of genetic and CSF Alzheimer disease (AD) risk factors. METHODS A total of 688 cognitively normal participants from the Alzheimer's Disease Neuroimaging Initiative were evaluated (mean age 73.5 years, 49.6% female). Cox regression examined risk of progression to mild cognitive impairment (MCI) over a 10-year period and linear mixed effects models examined 3-year rates of decline in memory, executive function, and language as a function of aCH. Interactions with APOE ε4 genotype and CSF biomarker evidence of AD pathology were also assessed. RESULTS aCH+ participants had increased risk of progression to MCI (hazard ratio [HR] 1.47, p = 0.02), and there was a significant aCH × AD risk interaction such that aCH+/ε4+ individuals showed greater than 2-fold increased risk (HR 2.69, p < 0.001) for incident MCI relative to aCH-/ε4-), while aCH+/CSF+) individuals demonstrated greater than 4-fold (HR 4.89, p < 0.001) increased risk relative to aCH-/CSF-. Linear mixed effects models revealed that aCH predicted a steeper slope of decline in memory (t = -2.35, p = 0.02) and language (t = -2.35, p = 0.02), with effects exacerbated in individuals with AD risk factors. CONCLUSIONS aCH increased risk of incident MCI and cognitive decline, and effects were significantly enhanced among individuals with genetic risk factors and CSF-based AD pathophysiologic markers. Findings underscore the adverse impact of aCH medications on cognition and the need for deprescribing trials, particularly among individuals with elevated risk for AD.
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Affiliation(s)
- Alexandra J Weigand
- From the San Diego Joint Doctoral Program in Clinical Psychology (A.J.W.), San Diego State University/University of California; Veterans Affairs San Diego Healthcare System (M.W.B., D.R.G., L.D.-W.); Department of Psychiatry (M.W.B., K.R.T., D.R.G., D.S., L.D.-W.), Alzheimer's Disease Research Center (M.W.B., D.R.G., D.P.S., D.S., J.B.B., H.H.F., L.D.-W.), and Department of Neurosciences (D.R.G., D.P.S., J.B.B., H.H.F.), University of California, San Diego; Center for Aging Research (N.L.C.), Regenstrief Institute, Inc. and Indiana University, Indianapolis; and Department of Pharmacy Practice (N.L.C.), Purdue University, West Lafayette, IN
| | - Mark W Bondi
- From the San Diego Joint Doctoral Program in Clinical Psychology (A.J.W.), San Diego State University/University of California; Veterans Affairs San Diego Healthcare System (M.W.B., D.R.G., L.D.-W.); Department of Psychiatry (M.W.B., K.R.T., D.R.G., D.S., L.D.-W.), Alzheimer's Disease Research Center (M.W.B., D.R.G., D.P.S., D.S., J.B.B., H.H.F., L.D.-W.), and Department of Neurosciences (D.R.G., D.P.S., J.B.B., H.H.F.), University of California, San Diego; Center for Aging Research (N.L.C.), Regenstrief Institute, Inc. and Indiana University, Indianapolis; and Department of Pharmacy Practice (N.L.C.), Purdue University, West Lafayette, IN
| | - Kelsey R Thomas
- From the San Diego Joint Doctoral Program in Clinical Psychology (A.J.W.), San Diego State University/University of California; Veterans Affairs San Diego Healthcare System (M.W.B., D.R.G., L.D.-W.); Department of Psychiatry (M.W.B., K.R.T., D.R.G., D.S., L.D.-W.), Alzheimer's Disease Research Center (M.W.B., D.R.G., D.P.S., D.S., J.B.B., H.H.F., L.D.-W.), and Department of Neurosciences (D.R.G., D.P.S., J.B.B., H.H.F.), University of California, San Diego; Center for Aging Research (N.L.C.), Regenstrief Institute, Inc. and Indiana University, Indianapolis; and Department of Pharmacy Practice (N.L.C.), Purdue University, West Lafayette, IN
| | - Noll L Campbell
- From the San Diego Joint Doctoral Program in Clinical Psychology (A.J.W.), San Diego State University/University of California; Veterans Affairs San Diego Healthcare System (M.W.B., D.R.G., L.D.-W.); Department of Psychiatry (M.W.B., K.R.T., D.R.G., D.S., L.D.-W.), Alzheimer's Disease Research Center (M.W.B., D.R.G., D.P.S., D.S., J.B.B., H.H.F., L.D.-W.), and Department of Neurosciences (D.R.G., D.P.S., J.B.B., H.H.F.), University of California, San Diego; Center for Aging Research (N.L.C.), Regenstrief Institute, Inc. and Indiana University, Indianapolis; and Department of Pharmacy Practice (N.L.C.), Purdue University, West Lafayette, IN
| | - Douglas R Galasko
- From the San Diego Joint Doctoral Program in Clinical Psychology (A.J.W.), San Diego State University/University of California; Veterans Affairs San Diego Healthcare System (M.W.B., D.R.G., L.D.-W.); Department of Psychiatry (M.W.B., K.R.T., D.R.G., D.S., L.D.-W.), Alzheimer's Disease Research Center (M.W.B., D.R.G., D.P.S., D.S., J.B.B., H.H.F., L.D.-W.), and Department of Neurosciences (D.R.G., D.P.S., J.B.B., H.H.F.), University of California, San Diego; Center for Aging Research (N.L.C.), Regenstrief Institute, Inc. and Indiana University, Indianapolis; and Department of Pharmacy Practice (N.L.C.), Purdue University, West Lafayette, IN
| | - David P Salmon
- From the San Diego Joint Doctoral Program in Clinical Psychology (A.J.W.), San Diego State University/University of California; Veterans Affairs San Diego Healthcare System (M.W.B., D.R.G., L.D.-W.); Department of Psychiatry (M.W.B., K.R.T., D.R.G., D.S., L.D.-W.), Alzheimer's Disease Research Center (M.W.B., D.R.G., D.P.S., D.S., J.B.B., H.H.F., L.D.-W.), and Department of Neurosciences (D.R.G., D.P.S., J.B.B., H.H.F.), University of California, San Diego; Center for Aging Research (N.L.C.), Regenstrief Institute, Inc. and Indiana University, Indianapolis; and Department of Pharmacy Practice (N.L.C.), Purdue University, West Lafayette, IN
| | - Daniel Sewell
- From the San Diego Joint Doctoral Program in Clinical Psychology (A.J.W.), San Diego State University/University of California; Veterans Affairs San Diego Healthcare System (M.W.B., D.R.G., L.D.-W.); Department of Psychiatry (M.W.B., K.R.T., D.R.G., D.S., L.D.-W.), Alzheimer's Disease Research Center (M.W.B., D.R.G., D.P.S., D.S., J.B.B., H.H.F., L.D.-W.), and Department of Neurosciences (D.R.G., D.P.S., J.B.B., H.H.F.), University of California, San Diego; Center for Aging Research (N.L.C.), Regenstrief Institute, Inc. and Indiana University, Indianapolis; and Department of Pharmacy Practice (N.L.C.), Purdue University, West Lafayette, IN
| | - James B Brewer
- From the San Diego Joint Doctoral Program in Clinical Psychology (A.J.W.), San Diego State University/University of California; Veterans Affairs San Diego Healthcare System (M.W.B., D.R.G., L.D.-W.); Department of Psychiatry (M.W.B., K.R.T., D.R.G., D.S., L.D.-W.), Alzheimer's Disease Research Center (M.W.B., D.R.G., D.P.S., D.S., J.B.B., H.H.F., L.D.-W.), and Department of Neurosciences (D.R.G., D.P.S., J.B.B., H.H.F.), University of California, San Diego; Center for Aging Research (N.L.C.), Regenstrief Institute, Inc. and Indiana University, Indianapolis; and Department of Pharmacy Practice (N.L.C.), Purdue University, West Lafayette, IN
| | - Howard H Feldman
- From the San Diego Joint Doctoral Program in Clinical Psychology (A.J.W.), San Diego State University/University of California; Veterans Affairs San Diego Healthcare System (M.W.B., D.R.G., L.D.-W.); Department of Psychiatry (M.W.B., K.R.T., D.R.G., D.S., L.D.-W.), Alzheimer's Disease Research Center (M.W.B., D.R.G., D.P.S., D.S., J.B.B., H.H.F., L.D.-W.), and Department of Neurosciences (D.R.G., D.P.S., J.B.B., H.H.F.), University of California, San Diego; Center for Aging Research (N.L.C.), Regenstrief Institute, Inc. and Indiana University, Indianapolis; and Department of Pharmacy Practice (N.L.C.), Purdue University, West Lafayette, IN
| | - Lisa Delano-Wood
- From the San Diego Joint Doctoral Program in Clinical Psychology (A.J.W.), San Diego State University/University of California; Veterans Affairs San Diego Healthcare System (M.W.B., D.R.G., L.D.-W.); Department of Psychiatry (M.W.B., K.R.T., D.R.G., D.S., L.D.-W.), Alzheimer's Disease Research Center (M.W.B., D.R.G., D.P.S., D.S., J.B.B., H.H.F., L.D.-W.), and Department of Neurosciences (D.R.G., D.P.S., J.B.B., H.H.F.), University of California, San Diego; Center for Aging Research (N.L.C.), Regenstrief Institute, Inc. and Indiana University, Indianapolis; and Department of Pharmacy Practice (N.L.C.), Purdue University, West Lafayette, IN.
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Campbell MC, Myers PS, Weigand AJ, Foster ER, Cairns NJ, Jackson JJ, Lessov‐Schlaggar CN, Perlmutter JS. Parkinson disease clinical subtypes: key features & clinical milestones. Ann Clin Transl Neurol 2020; 7:1272-1283. [PMID: 32602253 PMCID: PMC7448190 DOI: 10.1002/acn3.51102] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/15/2020] [Accepted: 05/22/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Based on multi-domain classification of Parkinson disease (PD) subtypes, we sought to determine the key features that best differentiate subtypes and the utility of PD subtypes to predict clinical milestones. METHODS Prospective cohort of 162 PD participants with ongoing, longitudinal follow-up. Latent class analysis (LCA) delineated subtypes based on score patterns across baseline motor, cognitive, and psychiatric measures. Discriminant analyses identified key features that distinguish subtypes at baseline. Cox regression models tested PD subtype differences in longitudinal conversion to clinical milestones, including deep brain stimulation (DBS), dementia, and mortality. RESULTS LCA identified distinct subtypes: "motor only" (N = 63) characterized by primary motor deficits; "psychiatric & motor" (N = 17) characterized by prominent psychiatric symptoms and moderate motor deficits; "cognitive & motor" (N = 82) characterized by impaired cognition and moderate motor deficits. Depression, executive function, and apathy best discriminated subtypes. Since enrollment, 22 had DBS, 48 developed dementia, and 46 have died. Although there were no subtype differences in rate of DBS, dementia occurred at a higher rate in the "cognitive & motor" subtype. Surprisingly, mortality risk was similarly elevated for both "cognitive & motor" and "psychiatric & motor" subtypes compared to the "motor only" subtype (relative risk = 3.15, 2.60). INTERPRETATION Psychiatric and cognitive features, rather than motor deficits, distinguish clinical PD subtypes and predict greater risk of subsequent dementia and mortality. These results emphasize the value of multi-domain assessments to better characterize clinical variability in PD. Further, differences in dementia and mortality rates demonstrate the prognostic utility of PD subtypes.
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Affiliation(s)
- Meghan C. Campbell
- Department of NeurologyWashington University School of MedicineSt. LouisMO
- Department of RadiologyWashington University School of MedicineSt. LouisMO
| | - Peter S. Myers
- Department of NeurologyWashington University School of MedicineSt. LouisMO
| | - Alexandra J. Weigand
- Department of Psychological and Brain SciencesWashington University in St. LouisSt. LouisMO
| | - Erin R. Foster
- Department of NeurologyWashington University School of MedicineSt. LouisMO
- Program in Occupational TherapyWashington University School of MedicineSt. LouisMO
- Department of PsychiatryWashington University School of MedicineSt. LouisMO
| | - Nigel J. Cairns
- Department of NeurologyWashington University School of MedicineSt. LouisMO
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Joshua J. Jackson
- Department of Psychological and Brain SciencesWashington University in St. LouisSt. LouisMO
| | | | - Joel S. Perlmutter
- Department of NeurologyWashington University School of MedicineSt. LouisMO
- Department of RadiologyWashington University School of MedicineSt. LouisMO
- Program in Occupational TherapyWashington University School of MedicineSt. LouisMO
- Department of NeuroscienceWashington University School of MedicineSt. LouisMO
- Program in Physical TherapyWashington University School of MedicineSt. LouisMO
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Eglit GML, Weigand AJ, Nation DA, Bondi MW, Bangen KJ. Hypertension and Alzheimer's disease: indirect effects through circle of Willis atherosclerosis. Brain Commun 2020; 2:fcaa114. [PMID: 33543127 PMCID: PMC7846096 DOI: 10.1093/braincomms/fcaa114] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 02/07/2023] Open
Abstract
Hypertension is common among older adults and is believed to increase susceptibility to Alzheimer's disease, but mechanisms underlying this relationship are unclear. Hypertension also promotes circle of Willis atherosclerosis, which contributes to cerebral hypoperfusion and arterial wall stiffening, two potential mechanisms linking hypertension to Alzheimer's disease. To examine the role of circle of Willis atherosclerosis in the association between hypertension and Alzheimer's disease neuropathology, we analysed post-mortem neuropathological data on 2198 decedents from the National Alzheimer's Coordinating Center database [mean (standard deviation) age at last visit 80.51 (1.95) and 47.1% female] using joint simultaneous (i.e. mediation) modelling. Within the overall sample and among Alzheimer's dementia decedents, hypertension was indirectly associated with increased neuritic plaques and neurofibrillary tangles through its association with circle of Willis atherosclerosis. Similar indirect effects were observed for continuous measures of systolic and diastolic blood pressure. These results suggest that hypertension may promote Alzheimer's disease pathology indirectly through intracranial atherosclerosis by limiting cerebral blood flow and/or dampening perivascular clearance. Circle of Willis atherosclerosis may be an important point of convergence between vascular risk factors, cerebrovascular changes and Alzheimer's disease neuropathology.
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Affiliation(s)
- Graham M L Eglit
- Veteran Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - Alexandra J Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA 92120, USA
| | - Daniel A Nation
- Department of Psychological Science, University of California, Irvine, Irvine, CA 92697, USA
- Institute for Memory Disorders and Neurological Impairments, University of California, Irvine, Irvine, CA 92697, USA
| | - Mark W Bondi
- Veteran Affairs San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
| | - Katherine J Bangen
- Veteran Affairs San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
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Edmonds EC, Weigand AJ, Hatton SN, Marshall AJ, Thomas KR, Ayala DA, Bondi MW, McDonald CR. Patterns of longitudinal cortical atrophy over 3 years in empirically derived MCI subtypes. Neurology 2020; 94:e2532-e2544. [PMID: 32393648 DOI: 10.1212/wnl.0000000000009462] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 12/04/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We previously identified 4 empirically derived mild cognitive impairment (MCI) subtypes via cluster analysis within the Alzheimer's Disease Neuroimaging Initiative (ADNI) and demonstrated high correspondence between patterns of cortical thinning at baseline and each cognitive subtype. We aimed to determine whether our MCI subtypes demonstrate unique longitudinal atrophy patterns. METHODS ADNI participants (295 with MCI and 134 cognitively normal [CN]) underwent annual structural MRI and neuropsychological assessments. General linear modeling compared vertex-wise differences in cortical atrophy rates between each MCI subtype and the CN group. Linear mixed models examined trajectories of cortical atrophy over 3 years within lobar regions of interest. RESULTS Compared to the CN group, those with amnestic MCI (memory deficit) initially demonstrated greater atrophy rates within medial temporal lobe regions that became more widespread over time. Those with dysnomic/amnestic MCI (naming/memory deficits) showed greater atrophy rates largely localized to temporal lobe regions. The mixed MCI (impairment in all cognitive domains) group showed greater atrophy rates in widespread regions at all time points. The cluster-derived normal group, who had intact neuropsychological performance and normal cortical thickness at baseline despite their MCI diagnosis via conventional diagnostic criteria, continued to show normal cognition and minimal cortical atrophy over 3 years. CONCLUSIONS ADNI's purported amnestic MCI sample produced more refined cognitive subtypes with unique longitudinal cortical atrophy rates. These novel MCI subtypes reliably reflect underlying atrophy, reduce false-positive diagnostic errors, and improve prediction of clinical course. Such improvements have implications for the selection of participants for clinical trials and for providing more precise risk assessment for individuals diagnosed with MCI.
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Affiliation(s)
- Emily C Edmonds
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., M.W.B.); Department of Psychiatry (E.C.E., S.N.H., K.R.T., M.W.B., C.R.M.), Center for Multimodal Imaging and Genetics (S.N.H., A.M., C.R.M.), Department of Neurosciences (S.N.H.), and Center for Behavior Genetics of Aging (S.N.H.), University of California San Diego, La Jolla; Joint Doctoral Program in Clinical Psychology (A.J.W., J.E.), San Diego State University/University of California San Diego; Department of Psychology (A.J.M.), University of Southern California, Los Angeles; and Department of Biology (D.A.A.), San Diego State University, CA.
| | - Alexandra J Weigand
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., M.W.B.); Department of Psychiatry (E.C.E., S.N.H., K.R.T., M.W.B., C.R.M.), Center for Multimodal Imaging and Genetics (S.N.H., A.M., C.R.M.), Department of Neurosciences (S.N.H.), and Center for Behavior Genetics of Aging (S.N.H.), University of California San Diego, La Jolla; Joint Doctoral Program in Clinical Psychology (A.J.W., J.E.), San Diego State University/University of California San Diego; Department of Psychology (A.J.M.), University of Southern California, Los Angeles; and Department of Biology (D.A.A.), San Diego State University, CA
| | - Sean N Hatton
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., M.W.B.); Department of Psychiatry (E.C.E., S.N.H., K.R.T., M.W.B., C.R.M.), Center for Multimodal Imaging and Genetics (S.N.H., A.M., C.R.M.), Department of Neurosciences (S.N.H.), and Center for Behavior Genetics of Aging (S.N.H.), University of California San Diego, La Jolla; Joint Doctoral Program in Clinical Psychology (A.J.W., J.E.), San Diego State University/University of California San Diego; Department of Psychology (A.J.M.), University of Southern California, Los Angeles; and Department of Biology (D.A.A.), San Diego State University, CA
| | - Anisa J Marshall
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., M.W.B.); Department of Psychiatry (E.C.E., S.N.H., K.R.T., M.W.B., C.R.M.), Center for Multimodal Imaging and Genetics (S.N.H., A.M., C.R.M.), Department of Neurosciences (S.N.H.), and Center for Behavior Genetics of Aging (S.N.H.), University of California San Diego, La Jolla; Joint Doctoral Program in Clinical Psychology (A.J.W., J.E.), San Diego State University/University of California San Diego; Department of Psychology (A.J.M.), University of Southern California, Los Angeles; and Department of Biology (D.A.A.), San Diego State University, CA
| | - Kelsey R Thomas
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., M.W.B.); Department of Psychiatry (E.C.E., S.N.H., K.R.T., M.W.B., C.R.M.), Center for Multimodal Imaging and Genetics (S.N.H., A.M., C.R.M.), Department of Neurosciences (S.N.H.), and Center for Behavior Genetics of Aging (S.N.H.), University of California San Diego, La Jolla; Joint Doctoral Program in Clinical Psychology (A.J.W., J.E.), San Diego State University/University of California San Diego; Department of Psychology (A.J.M.), University of Southern California, Los Angeles; and Department of Biology (D.A.A.), San Diego State University, CA
| | - Daniela A Ayala
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., M.W.B.); Department of Psychiatry (E.C.E., S.N.H., K.R.T., M.W.B., C.R.M.), Center for Multimodal Imaging and Genetics (S.N.H., A.M., C.R.M.), Department of Neurosciences (S.N.H.), and Center for Behavior Genetics of Aging (S.N.H.), University of California San Diego, La Jolla; Joint Doctoral Program in Clinical Psychology (A.J.W., J.E.), San Diego State University/University of California San Diego; Department of Psychology (A.J.M.), University of Southern California, Los Angeles; and Department of Biology (D.A.A.), San Diego State University, CA
| | - Mark W Bondi
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., M.W.B.); Department of Psychiatry (E.C.E., S.N.H., K.R.T., M.W.B., C.R.M.), Center for Multimodal Imaging and Genetics (S.N.H., A.M., C.R.M.), Department of Neurosciences (S.N.H.), and Center for Behavior Genetics of Aging (S.N.H.), University of California San Diego, La Jolla; Joint Doctoral Program in Clinical Psychology (A.J.W., J.E.), San Diego State University/University of California San Diego; Department of Psychology (A.J.M.), University of Southern California, Los Angeles; and Department of Biology (D.A.A.), San Diego State University, CA
| | - Carrie R McDonald
- From the Veterans Affairs San Diego Healthcare System (E.C.E., K.R.T., M.W.B.); Department of Psychiatry (E.C.E., S.N.H., K.R.T., M.W.B., C.R.M.), Center for Multimodal Imaging and Genetics (S.N.H., A.M., C.R.M.), Department of Neurosciences (S.N.H.), and Center for Behavior Genetics of Aging (S.N.H.), University of California San Diego, La Jolla; Joint Doctoral Program in Clinical Psychology (A.J.W., J.E.), San Diego State University/University of California San Diego; Department of Psychology (A.J.M.), University of Southern California, Los Angeles; and Department of Biology (D.A.A.), San Diego State University, CA
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Thomas KR, Bangen KJ, Weigand AJ, Edmonds EC, Wong CG, Cooper S, Delano-Wood L, Bondi MW. Objective subtle cognitive difficulties predict future amyloid accumulation and neurodegeneration. Neurology 2020; 94:e397-e406. [PMID: 31888974 PMCID: PMC7079691 DOI: 10.1212/wnl.0000000000008838] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/16/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To determine the temporal sequence of objectively defined subtle cognitive difficulties (Obj-SCD) in relation to amyloidosis and neurodegeneration, the current study examined the trajectories of amyloid PET and medial temporal neurodegeneration in participants with Obj-SCD relative to cognitively normal (CN) and mild cognitive impairment (MCI) groups. METHOD A total of 747 Alzheimer's Disease Neuroimaging Initiative participants (305 CN, 153 Obj-SCD, 289 MCI) underwent neuropsychological testing and serial amyloid PET and structural MRI examinations. Linear mixed effects models examined 4-year rate of change in cortical 18F-florbetapir PET, entorhinal cortex thickness, and hippocampal volume in those classified as Obj-SCD and MCI relative to CN. RESULT Amyloid accumulation was faster in the Obj-SCD group than in the CN group; the MCI and CN groups did not significantly differ from each other. The Obj-SCD and MCI groups both demonstrated faster entorhinal cortical thinning relative to the CN group; only the MCI group exhibited faster hippocampal atrophy than CN participants. CONCLUSION Relative to CN participants, Obj-SCD was associated with faster amyloid accumulation and selective vulnerability of entorhinal cortical thinning, whereas MCI was associated with faster entorhinal and hippocampal atrophy. Findings suggest that Obj-SCD, operationally defined using sensitive neuropsychological measures, can be identified prior to or during the preclinical stage of amyloid deposition. Further, consistent with the Braak neurofibrillary staging scheme, Obj-SCD status may track with early entorhinal pathologic changes, whereas MCI may track with more widespread medial temporal change. Thus, Obj-SCD may be a sensitive and noninvasive predictor of encroaching amyloidosis and neurodegeneration, prior to frank cognitive impairment associated with MCI.
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Affiliation(s)
- Kelsey R Thomas
- From Veterans Affairs San Diego Healthcare System (K.R.T., K.J.B., A.J.W., E.C.E., C.G.W., S.C., L.D.-W., M.W.B.); Department of Psychiatry (K.R.T., K.J.B., A.J.W., E.C.E., C.G.W., S.C., L.D.-W., M.W.B.), University of California, San Diego, School of Medicine, La Jolla; and San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology (A.J.W.)
| | - Katherine J Bangen
- From Veterans Affairs San Diego Healthcare System (K.R.T., K.J.B., A.J.W., E.C.E., C.G.W., S.C., L.D.-W., M.W.B.); Department of Psychiatry (K.R.T., K.J.B., A.J.W., E.C.E., C.G.W., S.C., L.D.-W., M.W.B.), University of California, San Diego, School of Medicine, La Jolla; and San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology (A.J.W.)
| | - Alexandra J Weigand
- From Veterans Affairs San Diego Healthcare System (K.R.T., K.J.B., A.J.W., E.C.E., C.G.W., S.C., L.D.-W., M.W.B.); Department of Psychiatry (K.R.T., K.J.B., A.J.W., E.C.E., C.G.W., S.C., L.D.-W., M.W.B.), University of California, San Diego, School of Medicine, La Jolla; and San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology (A.J.W.)
| | - Emily C Edmonds
- From Veterans Affairs San Diego Healthcare System (K.R.T., K.J.B., A.J.W., E.C.E., C.G.W., S.C., L.D.-W., M.W.B.); Department of Psychiatry (K.R.T., K.J.B., A.J.W., E.C.E., C.G.W., S.C., L.D.-W., M.W.B.), University of California, San Diego, School of Medicine, La Jolla; and San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology (A.J.W.)
| | - Christina G Wong
- From Veterans Affairs San Diego Healthcare System (K.R.T., K.J.B., A.J.W., E.C.E., C.G.W., S.C., L.D.-W., M.W.B.); Department of Psychiatry (K.R.T., K.J.B., A.J.W., E.C.E., C.G.W., S.C., L.D.-W., M.W.B.), University of California, San Diego, School of Medicine, La Jolla; and San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology (A.J.W.)
| | - Shanna Cooper
- From Veterans Affairs San Diego Healthcare System (K.R.T., K.J.B., A.J.W., E.C.E., C.G.W., S.C., L.D.-W., M.W.B.); Department of Psychiatry (K.R.T., K.J.B., A.J.W., E.C.E., C.G.W., S.C., L.D.-W., M.W.B.), University of California, San Diego, School of Medicine, La Jolla; and San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology (A.J.W.)
| | - Lisa Delano-Wood
- From Veterans Affairs San Diego Healthcare System (K.R.T., K.J.B., A.J.W., E.C.E., C.G.W., S.C., L.D.-W., M.W.B.); Department of Psychiatry (K.R.T., K.J.B., A.J.W., E.C.E., C.G.W., S.C., L.D.-W., M.W.B.), University of California, San Diego, School of Medicine, La Jolla; and San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology (A.J.W.)
| | - Mark W Bondi
- From Veterans Affairs San Diego Healthcare System (K.R.T., K.J.B., A.J.W., E.C.E., C.G.W., S.C., L.D.-W., M.W.B.); Department of Psychiatry (K.R.T., K.J.B., A.J.W., E.C.E., C.G.W., S.C., L.D.-W., M.W.B.), University of California, San Diego, School of Medicine, La Jolla; and San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology (A.J.W.).
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Thomas KR, Bangen KJ, Weigand AJ, Edmonds EC, Sundermann E, Wong CG, Eppig JS, Werhane ML, Delano-Wood L, Bondi MW. Type 2 Diabetes Interacts With Alzheimer Disease Risk Factors to Predict Functional Decline. Alzheimer Dis Assoc Disord 2020; 34:10-17. [PMID: 31305320 PMCID: PMC6952586 DOI: 10.1097/wad.0000000000000332] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The current study examined the interactive effect of type 2 diabetes and Alzheimer disease (AD) risk factors on the rate of functional decline in cognitively normal participants from the Alzheimer's Disease Neuroimaging Initiative. METHODS Participants underwent annual assessments that included the Functional Activities Questionnaire, an informant-rated measure of everyday functioning. Multilevel modeling, controlling for demographic variables and ischemic risk, examined the interactive effects of diabetes status (diabetes, n=69; no diabetes, n=744) and AD risk factors in the prediction of 5-year longitudinal change in everyday functioning. One model was run for each AD risk factor, including: objectively-defined subtle cognitive decline (Obj-SCD), and genetic susceptibility [apolipoprotein E ε4 (APOE ε4) as well as cerebrospinal fluid β-amyloid (Aβ), total tau (tau), and hyperphosphorylated tau (p-tau). RESULTS The 3-way diabetes×AD risk factor×time interaction predicted increased rates of functional decline in models that examined Obj-SCD, APOE ε4, tau, and p-tau positivity, but not Aβ positivity. CONCLUSIONS Participants with both diabetes and at least 1 AD risk factor (ie, Obj-SCD, APOE ε4, tau, and p-tau positivity) demonstrated faster functional decline compared with those without both risk factors (diabetes or AD). These findings have implications for early identification of, and perhaps earlier intervention for, diabetic individuals at risk for future functional difficulty.
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Affiliation(s)
- Kelsey R. Thomas
- Veterans Affairs San Diego Healthcare System, San Diego, CA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Katherine J. Bangen
- Veterans Affairs San Diego Healthcare System, San Diego, CA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Alexandra J. Weigand
- Veterans Affairs San Diego Healthcare System, San Diego, CA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Emily C. Edmonds
- Veterans Affairs San Diego Healthcare System, San Diego, CA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Erin Sundermann
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Christina G. Wong
- Veterans Affairs San Diego Healthcare System, San Diego, CA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Joel S. Eppig
- Veterans Affairs San Diego Healthcare System, San Diego, CA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Madeleine L. Werhane
- Veterans Affairs San Diego Healthcare System, San Diego, CA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Lisa Delano-Wood
- Veterans Affairs San Diego Healthcare System, San Diego, CA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Mark W. Bondi
- Veterans Affairs San Diego Healthcare System, San Diego, CA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA
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Weigand AJ, Bangen KJ, Thomas KR, Delano-Wood L, Gilbert PE, Brickman AM, Bondi MW. Is tau in the absence of amyloid on the Alzheimer's continuum?: A study of discordant PET positivity. Brain Commun 2019; 2:fcz046. [PMID: 32051933 PMCID: PMC7001143 DOI: 10.1093/braincomms/fcz046] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/15/2019] [Accepted: 11/25/2019] [Indexed: 12/14/2022] Open
Abstract
The amyloid cascade model of Alzheimer’s disease posits the primacy of amyloid beta deposition preceding tau-mediated neurofibrillary tangle formation. The amyloid-tau-neurodegeneration biomarker-only diagnostic framework similarly requires the presence of amyloid beta for a diagnosis on the Alzheimer’s continuum. However, medial temporal lobe tau pathology in the absence of amyloid beta is frequently observed at autopsy in cognitively normal individuals, a phenomenon that may reflect a consequence of aging and has been labelled ‘primary age-related tauopathy’. Alternatively, others argue that this tauopathy reflects an early stage of the developmental continuum leading to Alzheimer’s disease. We used positron emission tomography imaging to investigate amyloid beta and tau positivity and associations with cognition to better inform the conceptualization of biomarker changes in Alzheimer’s pathogenesis. Five hundred twenty-three individuals from the Alzheimer’s Disease Neuroimaging Initiative who had undergone flortaucipir positron emission tomography imaging were selected to derive positron emission tomography positivity thresholds using conditional inference decision tree regression. A subsample of 301 individuals without dementia (i.e. those with normal cognition or mild cognitive impairment) had also undergone florbetapir positron emission tomography imaging within 12 months and were categorized into one of the four groups based on cortical amyloid and Braak stage I/II tau positivity: A−/T−, A+/T−, A−/T+, or A+/T+. Tau positivity in the absence of amyloid beta positivity (i.e. A−/T+) comprised the largest group, representing 45% of the sample. In contrast, only 6% of the sample was identified as A+/T−, and the remainder of the sample fell into A−/T− (22%) or A+/T+ (27%) categories. A−/T− and A+/T− groups had the best cognitive performances across memory, language and executive function; the A−/T+ group showed small-to-moderate relative decreases in cognition; and the A+/T+ group had the worst cognitive performances. Furthermore, there were negative associations between Braak stage I/II tau values and all cognitive domains only in the A−/T+ and A+/T+ groups, with strongest associations for the A+/T+ group. Among our sample of older adults across the Alzheimer’s pathological spectrum, 7-fold fewer individuals have positron emission tomography evidence of amyloid beta pathology in the absence of tau pathology than the converse, challenging prevailing models of amyloid beta’s primacy in Alzheimer’s pathogenesis. Given that cognitive performance in the A−/T+ group was poorer than in individuals without either pathology, our results suggest that medial temporal lobe tau without cortical amyloid beta may reflect an early stage on the Alzheimer’s pathological continuum.
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Affiliation(s)
- Alexandra J Weigand
- San Diego State University/University of California San Diego Joint Doctoral Program, San Diego, CA 92182, USA
| | - Katherine J Bangen
- VA San Diego Healthcare System, San Diego, CA 92161, USA.,Department of Psychiatry, University of California, San Diego, CA 92161, USA
| | - Kelsey R Thomas
- VA San Diego Healthcare System, San Diego, CA 92161, USA.,Department of Psychiatry, University of California, San Diego, CA 92161, USA
| | - Lisa Delano-Wood
- VA San Diego Healthcare System, San Diego, CA 92161, USA.,Department of Psychiatry, University of California, San Diego, CA 92161, USA
| | - Paul E Gilbert
- Department of Psychology, San Diego State University, San Diego, CA 92182, USA
| | - Adam M Brickman
- Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Mark W Bondi
- VA San Diego Healthcare System, San Diego, CA 92161, USA.,Department of Psychiatry, University of California, San Diego, CA 92161, USA
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Bangen KJ, Thomas KR, Weigand AJ, Sanchez DL, Delano-Wood L, Edmonds EC, Carmichael OT, Schwarz CG, Brickman AM, Bondi MW. Pattern of regional white matter hyperintensity volume in mild cognitive impairment subtypes and associations with decline in daily functioning. Neurobiol Aging 2019; 86:134-142. [PMID: 31791658 DOI: 10.1016/j.neurobiolaging.2019.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 09/04/2019] [Accepted: 10/26/2019] [Indexed: 01/18/2023]
Abstract
White matter hyperintensities (WMHs), a marker of small-vessel cerebrovascular disease, increase risk for mild cognitive impairment (MCI). Less is known about whether regional WMHs distinguish MCI subtypes and predict decline in everyday functioning. About 618 Alzheimer's Disease Neuroimaging Initiative participants (301 cognitively normal [CN]; 232 amnestic MCI [aMCI]; 85 nonamnestic MCI [naMCI]) underwent neuropsychological testing, MRI, and assessment of everyday functioning. aMCI participants showed greater temporal (p = 0.002) and occipital WMHs (p = 0.030) relative to CN whereas naMCI participants had greater frontal (p = 0.045), temporal (p = 0.003), parietal (p = 0.018), and occipital (p < 0.001) WMH compared with CN. Relative to those with aMCI, individuals with naMCI showed greater occipital WMH (p = 0.013). Greater WMH in temporal (p = 0.001) and occipital regions (p = 0.006) was associated with faster decline in everyday functioning across the sample. Temporal lobe WMHs were disproportionately associated with accelerated functional decline among naMCI (p = 0.045). Regional WMH volumes vary across cognitive groups and predict functional decline. Cerebrovascular markers may help identify individuals at risk for decline and distinguish subtypes of cognitive impairment.
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Affiliation(s)
- Katherine J Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA.
| | - Kelsey R Thomas
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Alexandra J Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Danielle L Sanchez
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Lisa Delano-Wood
- Department of Psychiatry, University of California, San Diego, CA, USA; Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Emily C Edmonds
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | | | | | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA; Gertrude H. Sergievsky Center, Columbia University, New York, NY, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, CA, USA; Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
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Thomas KR, Edmonds EC, Eppig JS, Wong CG, Weigand AJ, Bangen KJ, Jak AJ, Delano-Wood L, Galasko DR, Salmon DP, Edland SD, Bondi MW. MCI-to-normal reversion using neuropsychological criteria in the Alzheimer's Disease Neuroimaging Initiative. Alzheimers Dement 2019; 15:1322-1332. [PMID: 31495605 DOI: 10.1016/j.jalz.2019.06.4948] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 05/06/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The low mild cognitive impairment (MCI) to cognitively normal (CN) reversion rate in the Alzheimer's Disease Neuroimaging Initiative (2-3%) suggests the need to examine reversion by other means. We applied comprehensive neuropsychological criteria (NP criteria) to determine the resulting MCI to CN reversion rate. METHODS Participants with CN (n = 641) or MCI (n = 569) were classified at baseline and year 1 using NP criteria. Demographic, neuropsychological, and Alzheimer's disease biomarker variables as well as progression to dementia were examined across stable CN, reversion, and stable MCI groups. RESULTS NP criteria produced a one-year reversion rate of 15.8%. Reverters had demographics, Alzheimer's disease biomarkers, and risk-of-progression most similar to the stable CN group and showed the most improvement on neuropsychological measures from baseline to year 1. DISCUSSION NP criteria produced a reversion rate that is consistent with, albeit modestly improved from, reversion rates in meta-analyses. Reverters' biomarker profiles and progression rates suggest that NP criteria accurately tracked with underlying pathophysiologic status.
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Affiliation(s)
- Kelsey R Thomas
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Veteran Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Emily C Edmonds
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Veteran Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Joel S Eppig
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Christina G Wong
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Veteran Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Alexandra J Weigand
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Katherine J Bangen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Veteran Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Amy J Jak
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Veteran Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Lisa Delano-Wood
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Veteran Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Douglas R Galasko
- Veteran Affairs San Diego Healthcare System, San Diego, CA, USA; Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - David P Salmon
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Steven D Edland
- Department of Biostatistics, University of California, San Diego, La Jolla, CA, USA; Department of Family and Preventative Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Veteran Affairs San Diego Healthcare System, San Diego, CA, USA.
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Bangen KJ, Thomas KR, Delano-Wood L, Weigand AJ, Sanchez DL, Edmonds EC, Brickman AM, Bondi MW. P3-473: REGIONAL WHITE MATTER HYPERINTENSITY VOLUME DISTINGUISHES AMONG MILD COGNITIVE IMPAIRMENT SUBTYPES AND PREDICTS DECLINE IN DAILY FUNCTIONING. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Katherine J. Bangen
- University of California, San Diego; San Diego CA USA
- VA San Diego Healthcare System; San Diego CA USA
| | - Kelsey R. Thomas
- VA San Diego Healthcare System; San Diego CA USA
- University of California San Diego; La Jolla CA USA
| | - Lisa Delano-Wood
- VA San Diego Healthcare System; San Diego CA USA
- University of California San Diego; La Jolla CA USA
- Shiley-Marcos Alzheimer's Disease Research Center; La Jolla CA USA
| | | | | | - Emily C. Edmonds
- VA San Diego Healthcare System; San Diego CA USA
- University of California San Diego; La Jolla CA USA
| | | | - Mark W. Bondi
- University of California, San Diego; San Diego CA USA
- VA San Diego Healthcare System; San Diego CA USA
- Shiley-Marcos Alzheimer's Disease Research Center; La Jolla CA USA
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