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Shaaban CE, Lin HS, Terry M, Ren D, Lingler JH. COVID-19 pandemic's relationship with enrollment at US Alzheimer's Disease Research Centers. Alzheimers Dement 2024; 20:2408-2419. [PMID: 38298163 PMCID: PMC11032582 DOI: 10.1002/alz.13706] [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: 08/23/2023] [Revised: 11/13/2023] [Accepted: 12/14/2023] [Indexed: 02/02/2024]
Abstract
INTRODUCTION We aimed to characterize the COVID-19 pandemic's relationship with enrollment in US Alzheimer's Disease Research Centers (ADRCs). METHODS Using data on 10,105 participants from 30 ADRCs, we conducted interrupted time series analyses to assess the relationship of the pandemic with enrollment and calculate projected dates of enrollment recovery. RESULTS Participants enrolled during the pandemic (vs pre-pandemic) were more likely to have dementia and be referred by health professionals. The pandemic was associated with a 77% drop in enrollment, with projected trend recovery in March 2024 and 100% recovery in September 2024. COVID was associated with a 91% drop in Black/African American participants, compared to 71% in White participants. Enrollment of both Hispanic and female participants was declining 1.4% and 0.3%/month pre-pandemic. DISCUSSION Funders and researchers should account for ongoing COVID-19 impact on ADRD research enrollment. Strategies to speed enrollment recovery are needed, especially for Black/African American and Hispanic groups. HIGHLIGHTS Tested COVID pandemic association with enrollment at Alzheimer's Disease Research Centers. During versus pre-pandemic enrollees differed on demographic and clinical variables. Interrupted time series analyses: immediate 77% drop in enrollment related to COVID. Recovery projections: trend recovery in March 2024, 100% recovery in September 2024. Enrollment of African American and Hispanic participants should be prioritized.
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Affiliation(s)
- C. Elizabeth Shaaban
- Department of EpidemiologySchool of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
- Alzheimer's Disease Research CenterUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Hsing‐Hua Sylvia Lin
- Department of EpidemiologySchool of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Anesthesiology & Perioperative MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Melita Terry
- Alzheimer's Disease Research CenterUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Neurology, School of MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Dianxu Ren
- Department of Health & Community Systems, School of NursingUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Jennifer H. Lingler
- Alzheimer's Disease Research CenterUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Health & Community Systems, School of NursingUniversity of PittsburghPittsburghPennsylvaniaUSA
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Royse SK, Snitz BE, Hengenius JB, Huppert TJ, Roush RE, Ehrenkranz RE, Wilson JD, Bertolet M, Reese AC, Cisneros G, Potopenko K, Becker JT, Cohen AD, Shaaban CE. Unhealthy white matter connectivity, cognition, and racialization in older adults. Alzheimers Dement 2024; 20:1483-1496. [PMID: 37828730 PMCID: PMC10947965 DOI: 10.1002/alz.13494] [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: 04/16/2023] [Revised: 09/06/2023] [Accepted: 09/10/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION White matter hyperintensities (WMH) may promote clinical Alzheimer's disease (AD) disparities between Black American (BA) and non-Hispanic White (nHW) populations. Using a novel measurement, unhealthy white matter connectivity (UWMC), we interrogated racialized group differences in associations between WMH in AD pathology-affected regions and cognition. METHODS UWMC is the proportion of white matter fibers that pass through WMH for every pair of brain regions. Individual regression models tested associations of UWMC in beta-amyloid (Aβ) or tau pathology-affected regions with cognition overall, stratified by racialized group, and with a racialized group interaction. RESULTS In 201 older adults ranging from cognitively unimpaired to AD, BA participants exhibited greater UWMC and worse cognition than nHW participants. UWMC was negatively associated with cognition in 17 and 5 Aβ- and tau-affected regions, respectively. Racialization did not modify these relationships. DISCUSSION Differential UWMC burden, not differential UWMC-and-cognition associations, may drive clinical AD disparities between racialized groups. HIGHLIGHTS Unhealthy white matter connectivity (UWMC) in Alzheimer's disease (AD) pathology-affected brain regions is associated with cognition. Relationships between UWMC and cognition are similar between Black American (BA) and non-Hispanic White (nHW) individuals. More UWMC may partially drive higher clinical AD burden in BA versus nHW populations. UWMC risk factors, particularly social and environmental, should be identified.
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Affiliation(s)
- Sarah K. Royse
- Department of EpidemiologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of RadiologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Beth E. Snitz
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - James B. Hengenius
- Department of EpidemiologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Theodore J. Huppert
- Department of Electrical EngineeringUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Rebecca E. Roush
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | | | - James D. Wilson
- Department of Mathematics and StatisticsUniversity of San FranciscoSan FranciscoCaliforniaUSA
| | - Marnie Bertolet
- Department of EpidemiologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of BiostatisticsUniversity of PittsburghPittsburghPennsylvaniaUSA
| | | | - Geraldine Cisneros
- Department of PsychologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Katey Potopenko
- Department of PsychologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - James T. Becker
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of BiostatisticsUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Ann D. Cohen
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
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Tang H, Guo J, Shaaban CE, Feng Z, Wu Y, Magoc T, Hu X, Donahoo WT, DeKosky ST, Bian J. Heterogeneous treatment effects of metformin on risk of dementia in patients with type 2 diabetes: A longitudinal observational study. Alzheimers Dement 2024; 20:975-985. [PMID: 37830443 PMCID: PMC10917005 DOI: 10.1002/alz.13480] [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: 02/08/2023] [Revised: 08/14/2023] [Accepted: 08/20/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Little is known about the heterogeneous treatment effects of metformin on dementia risk in people with type 2 diabetes (T2D). METHODS Participants (≥ 50 years) with T2D and normal cognition at baseline were identified from the National Alzheimer's Coordinating Center database (2005-2021). We applied a doubly robust learning approach to estimate risk differences (RD) with a 95% confidence interval (CI) for dementia risk between metformin use and no use in the overall population and subgroups identified through a decision tree model. RESULTS Among 1393 participants, 104 developed dementia over a 4-year median follow-up. Metformin was significantly associated with a lower risk of dementia in the overall population (RD, -3.2%; 95% CI, -6.2% to -0.2%). We identified four subgroups with varied risks for dementia, defined by neuropsychiatric disorders, non-steroidal anti-inflammatory drugs, and antidepressant use. DISCUSSION Metformin use was significantly associated with a lower risk of dementia in individuals with T2D, with significant variability among subgroups.
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Affiliation(s)
- Huilin Tang
- Department of Pharmaceutical Outcomes and PolicyUniversity of Florida College of PharmacyGainesvilleFloridaUSA
| | - Jingchuan Guo
- Department of Pharmaceutical Outcomes and PolicyUniversity of Florida College of PharmacyGainesvilleFloridaUSA
- Center for Drug Evaluation and SafetyUniversity of FloridaGainesvilleFloridaUSA
| | - C. Elizabeth Shaaban
- Department of EpidemiologySchool of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
- Alzheimer's Disease Research CenterUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Zheng Feng
- Department of Health Outcomes and Biomedical InformaticsCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Yonghui Wu
- Department of Health Outcomes and Biomedical InformaticsCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Tanja Magoc
- Clinical and Translational Science InstituteUniversity of FloridaGainesvilleFloridaUSA
| | - Xia Hu
- DATA LabDepartment of Computer ScienceRice UniversityHoustonTexasUSA
| | - William T Donahoo
- Department of MedicineCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Steven T. DeKosky
- Department of Neurology and McKnight Brain InstituteCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA
- Florida Alzheimer's Disease Research Center (ADRC)University of FloridaGainesvilleFloridaUSA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical InformaticsCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA
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Gogola A, Lopresti BJ, Tudorascu D, Snitz B, Minhas D, Doré V, Ikonomovic MD, Shaaban CE, Matan C, Bourgeat P, Mason NS, Aizenstein H, Mathis CA, Klunk WE, Rowe CC, Lopez OL, Cohen AD, Villemagne VL. Biostatistical Estimation of Tau Threshold Hallmarks (BETTH) Algorithm for Human Tau PET Imaging Studies. J Nucl Med 2023; 64:1798-1805. [PMID: 37709531 PMCID: PMC10626371 DOI: 10.2967/jnumed.123.265941] [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: 04/26/2023] [Revised: 08/03/2023] [Indexed: 09/16/2023] Open
Abstract
A methodology for determining tau PET thresholds is needed to confidently detect early tau deposition. We compared multiple threshold-determining methods in participants who underwent either 18F-flortaucipir or 18F-MK-6240 PET scans. Methods: 18F-flortaucipir (n = 798) and 18F-MK-6240 (n = 216) scans were processed and sampled to obtain regional SUV ratios. Subsamples of the cohorts were based on participant diagnosis, age, amyloid-β status (positive or negative), and neurodegeneration status (positive or negative), creating older-adult (age ≥ 55 y) cognitively unimpaired (amyloid-β-negative, neurodegeneration-negative) and cognitively impaired (mild cognitive impairment/Alzheimer disease, amyloid-β-positive, neurodegeneration-positive) groups, and then were further subsampled via matching to reduce significant differences in diagnostic prevalence, age, and Mini-Mental State Examination score. We used the biostatistical estimation of tau threshold hallmarks (BETTH) algorithm to determine sensitivity and specificity in 6 composite regions. Results: Parametric double receiver operating characteristic analysis yielded the greatest joint sensitivity in 5 of the 6 regions, whereas hierarchic clustering, gaussian mixture modeling, and k-means clustering all yielded perfect joint specificity (2.00) in all regions. Conclusion: When 18F-flortaucipir and 18F-MK-6240 are used, Alzheimer disease-related tau status is best assessed using 2 thresholds, a sensitivity one based on parametric double receiver operating characteristic analysis and a specificity one based on gaussian mixture modeling, delimiting an uncertainty zone indicating participants who may require further evaluation.
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Affiliation(s)
- Alexandra Gogola
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania;
| | - Brian J Lopresti
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dana Tudorascu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Beth Snitz
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Davneet Minhas
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vincent Doré
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Melbourne, Victoria, Australia
| | - Milos D Ikonomovic
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; and
| | - C Elizabeth Shaaban
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cristy Matan
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pierrick Bourgeat
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Melbourne, Victoria, Australia
| | - N Scott Mason
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chester A Mathis
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William E Klunk
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christopher C Rowe
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
| | - Oscar L Lopez
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ann D Cohen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Victor L Villemagne
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
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Shaaban CE, Rosano C, Zhu X, Rutherford BR, Witonsky KR, Rosso AL, Yaffe K, Brown PJ. Discordant Biological and Chronological Age: Implications for Cognitive Decline and Frailty. J Gerontol A Biol Sci Med Sci 2023; 78:2152-2161. [PMID: 37480573 PMCID: PMC10613009 DOI: 10.1093/gerona/glad174] [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: 11/22/2022] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Older adults with discordant biological and chronological ages (BA and CA) may vary in cognitive and physical function from those with concordant BA and CA. METHODS To make our approach clinically accessible, we created easy-to-interpret participant groups in the Health, Aging, and Body Composition Study (N = 2 458, 52% female participants, 65% White participants, age: 73.5 ± 2.8) based on medians of CA, and a previously validated BA index comprised of readily available clinical tests. Joint models estimated associations of BA-CA group with cognition (Modified Mini-Mental State Examination [3MS] and Digit Symbol Substitution Test [DSST]) and frailty over 10 years. RESULTS The sample included the following: 32%, Young group (BA and CA < median); 21%, Prematurely Aging group (BA ≥ median, CA < median), 27%, Old group (BA and CA ≥ median), and 20%, Resilient group (BA < median, CA ≥ median). In education-adjusted models of cognition, among those with CA < median, the Prematurely Aging group performed worse than the Young at baseline (3MS and DSST p < .0001), but among those with CA ≥ median, the Resilient group did not outperform the Old group (3MS p = .31; DSST p = .25). For frailty, the Prematurely Aging group performed worse than the Young group at baseline (p = .0001), and the Resilient group outperformed the Old group (p = .003). For all outcomes, groups did not differ on change over time based on the same pairwise comparisons (p ≥ .40). CONCLUSIONS Discordant BA and CA identify groups who have greater cognitive and physical functional decline or are more protected than their CA would suggest. This information can be used for risk stratification.
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Affiliation(s)
- C Elizabeth Shaaban
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Xiaonan Zhu
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bret R Rutherford
- Neurobiology and Therapeutics of Aging Division, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York, USA
| | - Kailyn R Witonsky
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrea L Rosso
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Departments of Psychiatry and Neurology, University of California, San Francisco, California, USA
| | - Patrick J Brown
- Neurobiology and Therapeutics of Aging Division, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York, USA
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Tang H, Shao H, Shaaban CE, Yang K, Brown J, Anton S, Wu Y, Bress A, Donahoo WT, DeKosky ST, Bian J, Guo J. Newer glucose-lowering drugs and risk of dementia: A systematic review and meta-analysis of observational studies. J Am Geriatr Soc 2023; 71:2096-2106. [PMID: 36821780 PMCID: PMC10363181 DOI: 10.1111/jgs.18306] [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: 07/27/2022] [Revised: 01/01/2023] [Accepted: 01/28/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Preclinical studies have suggested potential beneficial effects of newer glucose-lowering drugs (GLDs) including dipeptidyl peptidase (DPP)-4 inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), and sodium glucose co-transporter-2 (SGLT2) inhibitors, in protecting humans against cognitive decline and dementia. However, population studies aiming to demonstrate such cognitive benefits from newer GLDs have produced mixed findings. This meta-analysis aimed to evaluate the association between newer GLDs and risk of dementia in adults with type 2 diabetes (T2D). METHODS Electronic databases were searched up to March 11, 2022 to include observational studies that examined the association between DPP-4 inhibitors, GLP-1RAs, and SGLT2 inhibitors and risk of dementia (including all-cause dementia, Alzheimer's disease [AD], and vascular dementia [VD]) in people with T2D. We conducted a random-effects meta-analysis to calculate the relative risk (RR) with 95% confidence interval (CI) for each class of newer GLD. RESULTS Ten studies (from nine articles) involving 819,511 individuals with T2D were included. Three studies found that SGLT2 inhibitor users had a lower risk of all-cause dementia than non-SGLT2 inhibitor users (RR, 0.62; 95% CI, 0.39-0.97). Five studies found that users versus nonusers of GLP-1RAs were associated with a significant reduction in the risk of all-cause dementia (RR, 0.72; 95% CI, 0.54-0.97). However, a meta-analysis for AD and VD was unavailable for SGLT2 inhibitors and GLP-1RAs because only one study was included for each drug. In seven studies, users vs. nonusers of DPP-4 inhibitors were significantly associated with a decreased risk of all-cause dementia (RR, 0.84; 95% CI, 0.74-0.94) and VD (RR, 0.59; 95% CI, 0.47-0.75) but not AD (RR, 0.82; 95% CI, 0.63-1.08). CONCLUSION Newer GLDs were associated with a decreased risk of all-cause dementia in people with T2D. Because of the observational nature and significant heterogeneity between studies, the results should be interpreted with caution. Further research is warranted to confirm our findings.
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Affiliation(s)
- Huilin Tang
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Hui Shao
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
| | - C. Elizabeth Shaaban
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Keming Yang
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua Brown
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
| | - Stephen Anton
- Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Yonghui Wu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Adam Bress
- Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - William T Donahoo
- Division of Endocrinology, Diabetes and Metabolism, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Steven T DeKosky
- Department of Neurology and McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida USA
- 1Florida Alzheimer’s Disease Research Center (ADRC), University of Florida, Gainesville, Florida, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Jingchuan Guo
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
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Elahi FM, Alladi S, Black SE, Claassen JAHR, DeCarli C, Hughes TM, Moonen J, Pajewski NM, Price BR, Satizabal C, Shaaban CE, Silva NCBS, Snyder HM, Sveikata L, Williamson JD, Wolters FJ, Hainsworth AH. Clinical trials in vascular cognitive impairment following SPRINT-MIND: An international perspective. Cell Rep Med 2023; 4:101089. [PMID: 37343515 PMCID: PMC10314118 DOI: 10.1016/j.xcrm.2023.101089] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 04/07/2022] [Revised: 08/19/2022] [Accepted: 05/24/2023] [Indexed: 06/23/2023]
Abstract
A large interventional trial, the Systolic Blood Pressure Intervention Trial sub-study termed Memory and Cognition in Decreased Hypertension (SPRINT-MIND), found reduced risk of cognitive impairment in older adults with intensive, relative to standard, blood-pressure-lowering targets (systolic BP < 120 vs. <140 mm Hg). In this perspective, we discuss key questions and make recommendations for clinical practice and for clinical trials, following SPRINT-MIND. Future trials should embody cognitive endpoints appropriate to the participant group, ideally with adaptive designs that ensure robust answers for cognitive and cardiovascular endpoints. Reliable data from diverse populations, including the oldest-old (age > 80 years), will maximize external validity and global implementation of trial findings. New biomarkers will improve phenotyping to stratify patients to optimal treatments. Currently no antihypertensive drug class stands out for dementia risk reduction. Multi-domain interventions, incorporating lifestyle change (exercise, diet) alongside medications, may maximize global impact. Given the low cost and wide availability of antihypertensive drugs, intensive BP reduction may be a cost-effective means to reduce dementia risk in diverse, aging populations worldwide.
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Affiliation(s)
- Fanny M Elahi
- Friedman Brain Institute, Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Suvarna Alladi
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka 560030, India
| | - Sandra E Black
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Jurgen A H R Claassen
- Department of Geriatric Medicine and Donders Institute for Medical Neuroscience, Radboud University Medical Center, 6525 EN Nijmegen, the Netherlands
| | - Charles DeCarli
- Department of Neurology and Center for Neuroscience, University of California at Davis, Sacramento, CA 95817, USA
| | - Timothy M Hughes
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Justine Moonen
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, the Netherlands
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC 27154, USA
| | | | - Claudia Satizabal
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX 78229, USA
| | - C Elizabeth Shaaban
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Nárlon C B S Silva
- Djavad Mowafaghian Centre for Brain Health, Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Heather M Snyder
- Alzheimer's Association, 225 N Michigan Avenue, Chicago, IL 60603, USA
| | - Lukas Sveikata
- J.P. Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Genève, Switzerland; Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jeff D Williamson
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA; Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27154, USA
| | - Frank J Wolters
- Departments of Epidemiology and Radiology & Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, the Netherlands
| | - Atticus H Hainsworth
- Neurology, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK; Molecular and Clinical Sciences Research Institute, St George's University of London, London SW17 0RE, UK.
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Malec SA, Taneja SB, Albert SM, Elizabeth Shaaban C, Karim HT, Levine AS, Munro P, Callahan TJ, Boyce RD. Causal feature selection using a knowledge graph combining structured knowledge from the biomedical literature and ontologies: a use case studying depression as a risk factor for Alzheimer's disease. J Biomed Inform 2023; 142:104368. [PMID: 37086959 DOI: 10.1016/j.jbi.2023.104368] [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] [Received: 07/19/2022] [Revised: 03/03/2023] [Accepted: 04/17/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Causal feature selection is essential for estimating effects from observational data. Identifying confounders is a crucial step in this process. Traditionally, researchers employ content-matter expertise and literature review to identify confounders. Uncontrolled confounding from unidentified confounders threatens validity, conditioning on intermediate variables (mediators) weakens estimates, and conditioning on common effects (colliders) induces bias. Additionally, without special treatment, erroneous conditioning on variables combining roles introduces bias. However, the vast literature is growing exponentially, making it infeasible to assimilate this knowledge. To address these challenges, we introduce a novel knowledge graph (KG) application enabling causal feature selection by combining computable literature-derived knowledge with biomedical ontologies. We present a use case of our approach specifying a causal model for estimating the total causal effect of depression on the risk of developing Alzheimer's disease (AD) from observational data. METHODS We extracted computable knowledge from a literature corpus using three machine reading systems and inferred missing knowledge using logical closure operations. Using a KG framework, we mapped the output to target terminologies and combined it with ontology-grounded resources. We translated epidemiological definitions of confounder, collider, and mediator into queries for searching the KG and summarized the roles played by the identified variables. We compared the results with output from a complementary method and published observational studies and examined a selection of confounding and combined role variables in-depth. RESULTS Our search identified 128 confounders, including 58 phenotypes, 47 drugs, 35 genes, 23 collider, and 16 mediator phenotypes. However, only 31 of the 58 confounder phenotypes were found to behave exclusively as confounders, while the remaining 27 phenotypes played other roles. Obstructive sleep apnea emerged as a potential novel confounder for depression and AD. Anemia exemplified a variable playing combined roles. CONCLUSION Our findings suggest combining machine reading and KG could augment human expertise for causal feature selection. However, the complexity of causal feature selection for depression with AD highlights the need for standardized field-specific databases of causal variables. Further work is needed to optimize KG search and transform the output for human consumption.
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Affiliation(s)
- Scott A Malec
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Sanya B Taneja
- Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA USA
| | - Steven M Albert
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - C Elizabeth Shaaban
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Helmet T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA USA
| | - Arthur S Levine
- Department of Neurobiology, School of Medicine, University of Pittsburgh, Pittsburgh, PA USA; The Brain Institute, School of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Paul Munro
- School of Computing and Information, University of Pittsburgh, Pittsburgh, PA USA
| | - Tiffany J Callahan
- Department of Biomedical informatics, Columbia University, New York, NY USA
| | - Richard D Boyce
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA USA; Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA USA
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9
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Schliep KC, Shaaban CE, Meeks H, Fraser A, Smith KR, Majersik JJ, Foster NL, Wactawski‐Wende J, Østbye T, Tschanz J, Padbury JF, Sharma S, Zhang Y, Facelli JC, Abdelrahman CS, Theilen L, Varner MW. Hypertensive disorders of pregnancy and subsequent risk of Alzheimer's disease and other dementias. Alzheimers Dement (Amst) 2023; 15:e12443. [PMID: 37223334 PMCID: PMC10201212 DOI: 10.1002/dad2.12443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/26/2023] [Indexed: 05/25/2023]
Abstract
Introduction Women with hypertensive disorders of pregnancy (HDP) have an increased risk of cardiovascular disease. Whether HDP is also associated with later-life dementia has not been fully explored. Methods Using the Utah Population Database, we performed an 80-year retrospective cohort study of 59,668 parous women. Results Women with, versus without, HDP, had a 1.37 higher risk of all-cause dementia (95% confidence interval [CI]: 1.26, 1.50) after adjustment for maternal age at index birth, birth year, and parity. HDP was associated with a 1.64 higher risk of vascular dementia (95% CI: 1.19, 2.26) and 1.49 higher risk of other dementia (95% CI: 1.34, 1.65) but not Alzheimer's disease dementia (adjusted hazard ratio = 1.04; 95% CI: 0.87, 1.24). Gestational hypertension and preeclampsia/eclampsia showed similar increased dementia risk. Nine mid-life cardiometabolic and mental health conditions explained 61% of HDP's effect on subsequent dementia risk. Discussion Improved HDP and mid-life care could reduce the risk of dementia.
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Affiliation(s)
- Karen C. Schliep
- Department of Family and Preventative MedicineUniversity of UtahSalt Lake CityUtahUSA
| | - C. Elizabeth Shaaban
- Department of EpidemiologySchool of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Huong Meeks
- Department of Population SciencesHuntsman Cancer InstituteSalt Lake CityUtahUSA
| | - Alison Fraser
- Department of Population SciencesHuntsman Cancer InstituteSalt Lake CityUtahUSA
| | - Ken R. Smith
- Department of Family and Consumer StudiesUniversity of UtahSalt Lake CityUtahUSA
| | | | | | - Jean Wactawski‐Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health ProfessionsUniversity at BuffaloThe State University of New YorkBuffaloNew YorkUSA
| | - Truls Østbye
- Community and Family Medicine and Community HealthNursing and Global HealthDuke UniversityDurhamNorth CarolinaUSA
| | - JoAnn Tschanz
- Department of PsychologyUtah State UniversityLoganUtahUSA
| | - James F. Padbury
- Department of PediatricsUniversity of California San Francisco School of MedicineSan FranciscoCaliforniaUSA
| | - Surrendra Sharma
- Department of PediatricsWomen & Infants HospitalAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Yue Zhang
- Department of Internal MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Julio C. Facelli
- Department of Biomedical InformaticsUniversity of Utah HealthSalt Lake CityUtahUSA
| | - C. Samir Abdelrahman
- Department of Biomedical InformaticsUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Lauren Theilen
- Department of Obstetrics and GynecologyUniversity of UtahSalt Lake CityUtahUSA
| | - Michael W. Varner
- Department of Obstetrics and GynecologyUniversity of UtahSalt Lake CityUtahUSA
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10
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Mielke MM, Aggarwal NT, Vila‐Castelar C, Agarwal P, Arenaza‐Urquijo EM, Brett B, Brugulat‐Serrat A, DuBose LE, Eikelboom WS, Flatt J, Foldi NS, Franzen S, Gilsanz P, Li W, McManus AJ, van Lent DM, Milani SA, Shaaban CE, Stites SD, Sundermann E, Suryadevara V, Trani J, Turner AD, Vonk JMJ, Quiroz YT, Babulal GM. Consideration of sex and gender in Alzheimer's disease and related disorders from a global perspective. Alzheimers Dement 2022; 18:2707-2724. [PMID: 35394117 PMCID: PMC9547039 DOI: 10.1002/alz.12662] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [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: 12/23/2021] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 01/31/2023]
Abstract
Sex or gender differences in the risk of Alzheimer's disease and related dementias (ADRD) differ by world region, suggesting that there are potentially modifiable risk factors for intervention. However, few epidemiological or clinical ADRD studies examine sex differences; even fewer evaluate gender in the context of ADRD risk. The goals of this perspective are to: (1) provide definitions of gender, biologic sex, and sexual orientation. and the limitations of examining these as binary variables; (2) provide an overview of what is known with regard to sex and gender differences in the risk, prevention, and diagnosis of ADRD; and (3) discuss these sex and gender differences from a global, worldwide perspective. Identifying drivers of sex and gender differences in ADRD throughout the world is a first step in developing interventions unique to each geographical and sociocultural area to reduce these inequities and to ultimately reduce global ADRD risk. HIGHLIGHTS: The burden of dementia is unevenly distributed geographically and by sex and gender. Scientific advances in genetics and biomarkers challenge beliefs that sex is binary. Discrimination against women and sex and gender minority (SGM) populations contributes to cognitive decline. Sociocultural factors lead to gender inequities in Alzheimer's disease and related dementias (ADRD) worldwide.
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Affiliation(s)
- Michelle M. Mielke
- Division of Epidemiology, Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Neelum T. Aggarwal
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Clara Vila‐Castelar
- Department of Psychiatry, Harvard Medical SchoolMassachusetts General HospitalMassachusettsBostonUSA
| | - Puja Agarwal
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Internal MedicineRush University Medical CenterChicagoIllinoisUSA
| | - Eider M. Arenaza‐Urquijo
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
- IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- CIBER Fragilidad y Envejecimiento Saludable (CIBERFES)MadridSpain
| | - Benjamin Brett
- Department of NeurosurgeryMedical College of WisconsinWisconsinMilwaukeeUSA
| | - Anna Brugulat‐Serrat
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
- IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- CIBER Fragilidad y Envejecimiento Saludable (CIBERFES)MadridSpain
- Atlantic Fellow for Equity in Brain HealthThe University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lyndsey E. DuBose
- Department of Medicine, Division of GeriatricsUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Willem S. Eikelboom
- Department of NeurologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Jason Flatt
- Social and Behavioral Health Program, School of Public HealthUniversity of Nevada, Las VegasLas VegasNevadaUSA
| | - Nancy S. Foldi
- Department of Psychology, Queens College and The Graduate CenterCity University of New YorkNew YorkUSA
- Department of PsychiatryNew York University Long Island School of MedicineNew YorkUSA
| | - Sanne Franzen
- Department of NeurologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Paola Gilsanz
- Kaiser Permanente Division of ResearchOaklandCaliforniaUSA
| | - Wei Li
- Department of Clinical and Diagnostic SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Alison J. McManus
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Debora Melo van Lent
- UT Health San AntonioGlenn Biggs Institute for Alzheimer's and Neurodegenerative diseasesSan AntonioTexasUSA
- Framingham Heart StudyFraminghamMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
| | - Sadaf Arefi Milani
- Division of Geriatrics & Palliative Medicine, Department of Internal MedicineUniversity of Texas Medical BranchGalvestonTexasUSA
| | - C. Elizabeth Shaaban
- Department of EpidemiologyGraduate School of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Shana D. Stites
- Department of PsychiatryPerlman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Erin Sundermann
- Department of PsychiatryUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Vidyani Suryadevara
- Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Jean‐Francoise Trani
- Department of Public HealthWashington University in St. LouisSt. LouisMissouriUSA
| | - Arlener D. Turner
- Department of Psychiatry & Behavioral SciencesUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Jet M. J. Vonk
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
- Julius Center for Health Sciences and Primary CareDepartment of EpidemiologyUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
| | - Yakeel T. Quiroz
- Department of Psychiatry, Harvard Medical SchoolMassachusetts General HospitalMassachusettsBostonUSA
- Grupo de Neurociencias de Antioquia of Universidad de AntioquiaMedellinColumbiaUSA
| | - Ganesh M. Babulal
- Department of NeurologyWashington University in St. LouisSt. LouisMississippiUSA
- Department of Clinical Research and LeadershipThe George Washington University School of Medicine and Health SciencesWashingtonDCUSA
- Department of Psychology, Faculty of HumanitiesUniversity of JohannesburgJohannesburgSouth Africa
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11
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Shaaban CE, Dennis TL, Gabrielson S, Miller LJ, Zellers DF, Levine AS, Rosano C. Retention, mobility, and successful transition to independence of health sciences postdocs. PLoS One 2022; 17:e0276389. [PMID: 36318574 PMCID: PMC9624420 DOI: 10.1371/journal.pone.0276389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/26/2022] [Accepted: 10/05/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Obtaining a tenure track faculty position (TTFP) after postdoctoral appointment (PDA) completion is considered an indicator of successful transition to independence (TTI). Whether cross-institutional mobility (CIM)-moving to a different institution from that of the PDA-contributes to TTI is unclear, as data evaluating retention and mobility is lacking. We tested the hypothesis that, for postdocs (PDs) at R1 institutions, CIM is a significant predictor of successful TTI defined as TTFP-status 3 years post-PDA. MATERIALS AND METHODS Using University of Pittsburgh data for health sciences PDs we tested the association of CIM at PDA completion (moved to a different institution (CIM = 1) or retained at Pitt (CIM = 0)) with TTFP-status 3 years post-PDA (TTFP, non-TTFP, or left faculty position) using multinomial logistic regression models. RESULTS Among all 622 Pitt PDs, 3-year retention in a faculty position at Pitt was 21%, while 14% had a faculty position outside of Pitt. Among the analytic sample of PDs with an academic career outcome during the study period (N = 238; 50% women, 8% underrepresented minorities (URM)), at baseline PDA completion 39% moved to a different institution (CIM = 1), and 61% remained at Pitt (CIM = 0) in any job type. Those with CIM = 1 had greater odds of having a TTFP at follow-up than those with CIM = 0 [adjusted OR (95% CI): 4.4 (2.1, 9.2)]. DISCUSSION One fifth of Pitt PDs were retained by Pitt as faculty. While Pitt PDs were equally likely to get a faculty position whether they were retained at Pitt or left, those who left had greater odds of obtaining a TTFP. Future work with longer follow-up times, expanded markers of TTI, and samples from other R1 institutions is needed to better understand the reason for these results. This knowledge can lead to better support for the next generation of PDs as they successfully transition to faculty.
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Affiliation(s)
- C. Elizabeth Shaaban
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
- * E-mail:
| | - Tammy L. Dennis
- Office of Academic Career Development, Health Sciences, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Stephen Gabrielson
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Laura J. Miller
- Office of Academic Career Development, Health Sciences, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Darlene F. Zellers
- Office of Academic Career Development, Health Sciences, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Arthur S. Levine
- Brain Institute, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Caterina Rosano
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
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12
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Shaaban CE, Tudorascu DL, Glymour MM, Cohen AD, Thurston RC, Snyder HM, Hohman TJ, Mukherjee S, Yu L, Snitz BE. A guide for researchers seeking training in retrospective data harmonization for population neuroscience studies of Alzheimer's disease and related dementias. Front Neuroimaging 2022; 1:978350. [PMID: 37464990 PMCID: PMC10353763 DOI: 10.3389/fnimg.2022.978350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Due to needs surrounding rigor and reproducibility, subgroup specific disease knowledge, and questions of external validity, data harmonization is an essential tool in population neuroscience of Alzheimer's disease and related dementias (ADRD). Systematic harmonization of data elements is necessary to pool information from heterogeneous samples, and such pooling allows more expansive evaluations of health disparities, more precise effect estimates, and more opportunities to discover effective prevention or treatment strategies. The key goal of this Tutorial in Population Neuroimaging Curriculum, Instruction, and Pedagogy article is to guide researchers in creating a customized population neuroscience of ADRD harmonization training plan to fit their needs or those of their mentees. We provide brief guidance for retrospective data harmonization of multiple data types in this area, including: (1) clinical and demographic, (2) neuropsychological, and (3) neuroimaging data. Core competencies and skills are reviewed, and resources are provided to fill gaps in training as well as data needs. We close with an example study in which harmonization is a critical tool. While several aspects of this tutorial focus specifically on ADRD, the concepts and resources are likely to benefit population neuroscientists working in a range of research areas.
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Affiliation(s)
- C. Elizabeth Shaaban
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Dana L. Tudorascu
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Ann D. Cohen
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rebecca C. Thurston
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Heather M. Snyder
- Medical and Scientific Relations, Alzheimer’s Association, Chicago, IL, United States
| | - Timothy J. Hohman
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | - Lan Yu
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Beth E. Snitz
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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13
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Brinkley TE, Stites SD, Hunsberger HC, Karvonen-Gutierrez CA, Li M, Shaaban CE, Thorpe RJ, Kritchevsky SB. Research Centers Collaborative Network Workshop on Sex and Gender Differences in Aging. Innov Aging 2022; 6:igac055. [PMID: 36267320 PMCID: PMC9579719 DOI: 10.1093/geroni/igac055] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Indexed: 02/03/2023] Open
Abstract
Aging affects men and women differently; however, the impact of sex and gender on the aging process is not well understood. Moreover, these 2 concepts are often conflated, which further contributes to a lack of clarity on this important issue. In an effort to better understand the relevance of sex and gender in aging research, the Research Centers Collaborative Network sponsored a 1.5-day conference on sex and gender differences in aging that brought together key thought leaders from the 6 National Institute on Aging center programs. The meeting included sessions on comparing males and females, pathophysiological differences, sex/gender in clinical care, and gender and health in the social context. Presenters from a wide array of disciplines identified opportunities for multidisciplinary research to address current gaps in the field and highlighted the need for a more systematic approach to understanding the how and why of sex/gender differences, as well as the health implications of these differences and the sex/gender biases that affect clinical treatment and outcomes. This article summarizes the proceedings of the workshop and provides several recommendations to move the field forward, such as better data collection tools to assess the intersection of sex and gender in epidemiological research; a life course perspective with attention to fetal/developmental origins and key life stages; innovative animal models to distinguish contributions from sex hormones versus sex chromosomes; and integration of sex/gender into teaching and clinical practice. Ultimately, successful implementation of these recommendations will require thoughtful investigations across the translational spectrum and increased collaborations among those with expertise in sex and gender differences.
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Affiliation(s)
- Tina E Brinkley
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Shana D Stites
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Holly C Hunsberger
- Department of Foundational Science and Humanities, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | | | - Mengting Li
- School of Nursing, Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - C Elizabeth Shaaban
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Roland J Thorpe
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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14
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Shaaban CE, Fan E, Klatt BN, Cohen AD, Snitz BE, Yu Z, Lopresti BJ, Villemagne VL, Klunk WE, Aizenstein HJ, Rosso AL. Brain health correlates of mobility-related confidence. Exp Gerontol 2022; 163:111776. [PMID: 35339632 PMCID: PMC9109136 DOI: 10.1016/j.exger.2022.111776] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/22/2021] [Accepted: 03/21/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mobility is important for independence in older age. While brain health correlates of objectively measured mobility-related features like gait and balance have been reported, we aimed to test neuroimaging and cognitive correlates of subjective measures of mobility-related confidence. METHODS We carried out a cross-sectional observational study comprised of N = 29 cognitively unimpaired older adult participants, mean age 75.8 ± 5.8, 52% female, 24% non-white. We measured cognition, hippocampal volume, white matter hyperintensities, cerebral amyloid-β (Aβ), and gait and balance confidence. We tested associations using unadjusted Spearman correlations and correlations partialling out covariates of interest one at a time. RESULTS Greater gait confidence was associated with better attention (unadjusted ρ = 0.37, p = 0.05; partially attenuated by adjustment for age, APOE4, anxiety, motivation, gait speed, or Aβ); executive performance (unadjusted ρ = 0.35, p = 0.06; partially attenuated by adjustment for age, APOE4, gait speed, or Aβ); and lower Aβ levels (unadjusted ρ = -0.40, p = 0.04; partially attenuated by adjustment for age, depressive symptoms, motivation, or gait speed). Greater balance confidence was associated with better global cognition (unadjusted ρ = 0.41, p = 0.03; partially attenuated by adjustment for APOE4, gait speed, or Aβ); attention (unadjusted ρ = 0.46, p = 0.01; robust to adjustment); and lower Aβ levels (unadjusted ρ = -0.35, p = 0.07; partially attenuated by adjustment for age, education, APOE4, depressive symptoms, anxiety, motivation, or gait speed). CONCLUSIONS Self-reported mobility-related confidence is associated with neuroimaging and cognitive measures and would be easy for providers to use in clinical evaluations. These associations should be further evaluated in larger samples, and longitudinal studies can help determine temporality of declines.
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Affiliation(s)
| | - Erica Fan
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brooke N Klatt
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ann D Cohen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beth E Snitz
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zheming Yu
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian J Lopresti
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - William E Klunk
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Andrea L Rosso
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
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15
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Smith A, Shaaban CE, Bartels SL, Brum WS, Welikovitch LA, Folarin RO. ISTAART Professional Interest Area to Elevate Early Career Researchers and University College London survey turns a spotlight on early career researcher life and challenges. Alzheimers Dement 2022; 18:1279-1280. [PMID: 35611832 DOI: 10.1002/alz.12691] [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] [Received: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Adam Smith
- Institute of Neurology, University College London, London, UK
| | - C Elizabeth Shaaban
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sara Laureen Bartels
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, the Netherlands
| | - Wagner S Brum
- Graduate Program in Biological Sciences: Biochemistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Lindsay A Welikovitch
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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16
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Silva NCBS, Bracko O, Nelson AR, de Oliveira FF, Robison LS, Shaaban CE, Hainsworth AH, Price BR. Vascular cognitive impairment and dementia: An early career researcher perspective. Alzheimers Dement (Amst) 2022; 14:e12310. [PMID: 35496373 PMCID: PMC9043906 DOI: 10.1002/dad2.12310] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 01/07/2023]
Abstract
The field of vascular contributions to cognitive impairment and dementia (VCID) is evolving rapidly. Research in VCID encompasses topics aiming to understand, prevent, and treat the detrimental effects of vascular disease burden in the human brain. In this perspective piece, early career researchers (ECRs) in the field provide an overview of VCID, discuss past and present efforts, and highlight priorities for future research. We emphasize the following critical points as the field progresses: (a) consolidate existing neuroimaging and fluid biomarkers, and establish their utility for pharmacological and non-pharmacological interventions; (b) develop new biomarkers, and new non-clinical models that better recapitulate vascular pathologies; (c) amplify access to emerging biomarker and imaging techniques; (d) validate findings from previous investigations in diverse populations, including those at higher risk of cognitive impairment (e.g., Black, Hispanic, and Indigenous populations); and (e) conduct randomized controlled trials within diverse populations with well-characterized vascular pathologies emphasizing clinically meaningful outcomes.
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Affiliation(s)
- Nárlon C. Boa Sorte Silva
- Djavad Mowafaghian Centre for Brain HealthDepartment of Physical TherapyFaculty of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Oliver Bracko
- Department of BiologyThe University of MiamiCoral GablesFloridaUSA
| | - Amy R. Nelson
- Department of Physiology and Cell BiologyUniversity of South AlabamaMobileAlabamaUSA
| | | | - Lisa S. Robison
- Department of Psychology and NeuroscienceNova Southeastern UniversityFort LauderdaleFloridaUSA
| | | | - Atticus H. Hainsworth
- Molecular & Clinical Sciences Research InstituteSt George's University of London, UKDepartment of NeurologySt George's University Hospitals NHS Foundation Trust LondonLondonUK
| | - Brittani R. Price
- Department of NeuroscienceTufts University School of MedicineBostonMassachusettsUSA
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17
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Shaaban CE, Snitz BE, Tudorascu DL, Lopresti BJ, Royse SK, Yu Z, Aizenstein HJ, Klunk WE, Cohen AD. Sex and cerebral small vessel disease‐specific longitudinal trajectories of amyloid, tau, and neurodegeneration. Alzheimers Dement 2021. [DOI: 10.1002/alz.056291] [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: 11/05/2022]
Affiliation(s)
| | - Beth E Snitz
- University of Pittsburgh Pittsburgh PA USA
- Alzheimer's Disease Research Center Pittsburgh PA USA
| | | | | | - Sarah K Royse
- University of Pittsburgh School of Medicine Pittsburgh PA USA
| | - Zheming Yu
- University of Pittsburgh Pittsburgh PA USA
| | - Howard J Aizenstein
- University of Pittsburgh Pittsburgh PA USA
- Alzheimer's Disease Research Center Pittsburgh PA USA
| | - William E Klunk
- University of Pittsburgh Pittsburgh PA USA
- Alzheimer's Disease Research Center Pittsburgh PA USA
| | - Ann D Cohen
- University of Pittsburgh Pittsburgh PA USA
- Alzheimer's Disease Research Center Pittsburgh PA USA
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18
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Shaaban CE, Taneja SB, Witonsky KF, Malec SA, Karim HT, Pratt S, Levine AS, Munro P, Boyce RD, Albert SM. Does clinical data capture modifiable midlife risk factors for Alzheimer’s disease? Alzheimers Dement 2021. [DOI: 10.1002/alz.055756] [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: 11/07/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Paul Munro
- University of Pittsburgh Pittsburgh PA USA
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19
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Shaaban CE, Rosano C, Cohen AD, Huppert T, Butters MA, Hengenius J, Parks WT, Catov JM. Cognition and Cerebrovascular Reactivity in Midlife Women With History of Preeclampsia and Placental Evidence of Maternal Vascular Malperfusion. Front Aging Neurosci 2021; 13:637574. [PMID: 34017243 PMCID: PMC8129174 DOI: 10.3389/fnagi.2021.637574] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/09/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Preeclampsia is emerging as a sex-specific risk factor for cerebral small vessel disease (SVD) and dementia, but the reason is unknown. We assessed the relationship of maternal vascular malperfusion (MVM), a marker of placental SVD, with cognition and cerebral SVD in women with and without preeclampsia. We hypothesized women with both preeclampsia and MVM would perform worst on information processing speed and executive function. Methods: Women (n = 45; mean 10.5 years post-delivery; mean age: 41 years; 42.2% Black) were classified as preeclampsia-/MVM-, preeclampsia+/MVM-, or preeclampsia+/MVM+. Information processing speed, executive function, and memory were assessed. In a pilot sub-study of cerebrovascular reactivity (CVR; n = 22), cerebral blood flow during room-air breathing and breath-hold induced hypercapnia were obtained via arterial spin labeling MRI. Non-parametric tests and regression models were used to test associations. Results: Between-group cognitive differences were significant for information processing speed (p = 0.02); preeclampsia+/MVM+ had the lowest scores. Cerebral blood flow increased from room-air to breath-hold, globally and in all regions in the three groups, except the preeclampsia+/MVM+ parietal region (p = 0.12). Lower parietal CVR (less change from room-air breathing to breath-holding) was correlated with poorer information processing speed (partial ρ = 0.63, p = 0.005) and executive function (ρ = 0.50, p = 0.03) independent of preeclampsia/MVM status. Conclusion: Compared to women without preeclampsia and MVM, midlife women with both preeclampsia and MVM have worse information processing speed and may have blunted parietal CVR, an area important for information processing speed and executive function. MVM in women with preeclampsia is a promising sex-specific indicator of cerebrovascular integrity in midlife.
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Affiliation(s)
- C Elizabeth Shaaban
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, United States
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ann D Cohen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Theodore Huppert
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - James Hengenius
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - W Tony Parks
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Janet M Catov
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, United States
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Shaaban CE, Rosano C, Shattuck-Heidorn H, Godina S, Wu M, Rosso A. Do Gendered Psychosocial Factors Explain Sex Differences in White Matter Hyperintensities? Innov Aging 2020. [PMCID: PMC7743672 DOI: 10.1093/geroni/igaa057.2693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Women have a greater burden than men of white matter hyperintensities (WMH), a marker of cerebral small vessel disease (cSVD). Psychosocial factors including education, household income, neighborhood socioeconomic status (nSES), happiness, and depression may differ by gender and could explain women’s higher burden of WMH. In a cohort of older adults (N=250, median age=82, 58% women, 39% Black), we found that women had lower education, household income, nSES and were less happy and more depressed. Race stratified Spearman correlations showed women had greater whole brain WMH volume in white participants only (white: rho=0.23, p=0.004; Black: rho=-0.05, p=0.64). In partial Spearman correlations, education, happiness, and depression attenuated but did not fully explain the relationship when added individually or all together to the model for whites (fully adjusted rho=0.19, p=0.03). Gendered psychosocial factors may partially explain sex differences in WMH; interventions targeting these factors may reduce cSVD burden, particularly in white women.
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Affiliation(s)
| | - Caterina Rosano
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | | | - Sara Godina
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
| | - Minjie Wu
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Andrea Rosso
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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Shaaban CE, Chang CH, Ganguli M. Physical activity and vascular cognitive health: Who may benefit most? Alzheimers Dement 2020. [DOI: 10.1002/alz.046244] [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: 11/08/2022]
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22
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Rosso AL, Metti AL, Faulkner K, Redfern M, Yaffe K, Launer L, Elizabeth Shaaban C, Nadkarni NK, Rosano C. Complex Walking Tasks and Risk for Cognitive Decline in High Functioning Older Adults. J Alzheimers Dis 2020; 71:S65-S73. [PMID: 30814353 DOI: 10.3233/jad-181140] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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: 11/15/2022]
Abstract
BACKGROUND Performance on complex walking tasks may provide a screen for future cognitive decline. OBJECTIVE To identify walking tasks that are most strongly associated with subsequent cognitive decline. METHODS Community-dwelling older adults with Modified Mini-Mental State (3MS) >85 at baseline (n = 223; mean age = 78.7, 52.5% women, 25.6% black) completed usual-pace walking and three complex walking tasks (fast-pace, narrow-path, visuospatial dual-task). Slope of 3MS scores for up to 9 subsequent years (average = 5.2) were used to calculate a cognitive maintainer (slope ≥0) or decliner (slope <0) outcome variable. Logistic regression models assessed associations between gait speeds and being a cognitive decliner. A sensitivity analysis in a subsample of individuals (n = 66) confirmed results with adjudicated mild cognitive impairment (MCI) or dementia at 8-9 years post-walking assessment. RESULTS Cognitive decliners were 52.5% of the sample and on average were slower for all walking tasks compared to maintainers. In models adjusted for demographic and health variables, faster fast-pace (OR = 0.87 per 0.1 m/s, 95% CI: 0.78, 0.97) and dual-task (OR = 0.84 per 0.1 m/s, 95% CI: 0.73, 0.96) gait speeds were associated with lower likelihood of being a cognitive decliner. Usual-pace gait speed was not associated (OR = 0.96 per 0.1 m/s, 95% CI: 0.85, 1.08). Results were nearly identical in analyses with adjudicated MCI or dementia as the outcome. CONCLUSION Fast-pace and dual-task walking may provide simple and effective tools for assessing risk for cognitive decline in older individuals with high cognitive function. Such screening tools are important for strategies to prevent or delay onset of clinically meaningful change.
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Affiliation(s)
- Andrea L Rosso
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrea L Metti
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kimberly Faulkner
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mark Redfern
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kristine Yaffe
- Department of Psychiatry, Neurology and Epidemiology, University of California, San Francisco, CA, USA
| | - Lenore Launer
- Intramural Research Program, National Institute on Aging, Bethesda, MD, USA
| | - C Elizabeth Shaaban
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Neelesh K Nadkarni
- Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Cui C, Mackey RH, Shaaban CE, Kuller LH, Lopez OL, Sekikawa A. Associations of body composition with incident dementia in older adults: Cardiovascular Health Study-Cognition Study. Alzheimers Dement 2020; 16:1402-1411. [PMID: 32803916 DOI: 10.1002/alz.12125] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 11/14/2019] [Revised: 05/03/2020] [Accepted: 05/06/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION A body of literature reported associations between late-life general adiposity measures (eg, body mass index) and dementia. Little is known about the association of late-life body composition with dementia risk. METHODS We determined this association among cognitively normal participants from the Cardiovascular Health Study- Cognition Study. Body composition was assessed by dual-energy x-ray absorptiometry in 1994-1995. Dementia was ascertained at annual follow-up from 1998-1999 to 2013. Associations of body composition with incident dementia were assessed by the Fine-Gray model. RESULT Among 344 participants (mean age 78, 62.2% women), body composition was significantly different between men and women, despite similar body mass indexes (BMIs). Increased dementia risk was significantly associated with lower lean mass in men and marginally with low appendicular lean mass in women. DISCUSSION Decreased lean mass was an indicator of increased dementia risk in older adults. Studies should test whether preventing lean mass loss in older adults reduces dementia risk.
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Affiliation(s)
- Chendi Cui
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Rachel H Mackey
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - C Elizabeth Shaaban
- Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, USA
| | - Lewis H Kuller
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Oscar L Lopez
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Akira Sekikawa
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
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24
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Affiliation(s)
- C Elizabeth Shaaban
- From the Department of Epidemiology (C.E.S.), University of Pittsburgh, PA; Center for the Neural Basis of Cognition (C.E.S.), University of Pittsburgh, PA; and Department of Stroke & Neurology (J.M.), Tel-Aviv Sourasky Medical Center, Israel.
| | - Jeremy Molad
- From the Department of Epidemiology (C.E.S.), University of Pittsburgh, PA; Center for the Neural Basis of Cognition (C.E.S.), University of Pittsburgh, PA; and Department of Stroke & Neurology (J.M.), Tel-Aviv Sourasky Medical Center, Israel
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25
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Shaaban CE, Aizenstein HJ, Jorgensen DR, Mahbubani RLM, Meckes NA, Erickson KI, Glynn NW, Mettenburg J, Guralnik J, Newman AB, Ibrahim TS, Laurienti PJ, Vallejo AN, Rosano C. Physical Activity and Cerebral Small Vein Integrity in Older Adults. Med Sci Sports Exerc 2020; 51:1684-1691. [PMID: 30817709 DOI: 10.1249/mss.0000000000001952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Identifying promoters of cerebral small vein integrity is important to counter vascular contributions to cognitive impairment and dementia. PURPOSE In this preliminary investigation, the effects of a randomized 24-month physical activity (PA) intervention on changes in cerebral small vein integrity were compared to those of a health education (HE) control. METHODS Cerebral small vein integrity was measured in 24 older adults (n = 8, PA; n = 16, HE) using ultra-high field MRI before and at the end of the 24-month intervention. Deep medullary veins were defined as straight or tortuous; percent change in straight length, tortuous length, and tortuosity ratio were computed. Microbleed count and white matter hyperintensities were also rated. RESULTS Accelerometry-based values of PA increased by 17.2% in the PA group but declined by 28.0% in the HE group. The PA group, but not the HE group, had a significant increase in straight vein length from baseline to 24-month follow-up (P = 0.02 and P = 0.21, respectively); the between-group difference in percent change in straight length was significant (increase: median, 93.6%; interquartile range, 112.9 for PA; median, 28.4%; interquartile range, 90.6 for HE; P = 0.07). Between group differences in other markers were nonsignificant. CONCLUSIONS Increasing PA in late-life may promote cerebral small vein integrity. This should be confirmed in larger studies.
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Affiliation(s)
- C Elizabeth Shaaban
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA
| | - Howard Jay Aizenstein
- Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Dana R Jorgensen
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA
| | | | - Nicole A Meckes
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Kirk I Erickson
- Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA.,Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | | | - Jack Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Tamer S Ibrahim
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Paul J Laurienti
- Laboratory for Complex Brain Networks, Wake Forest University School of Medicine, Winston-Salem, NC.,Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Abbe N Vallejo
- Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA.,Department of Immunology, University of Pittsburgh, Pittsburgh, PA
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA
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26
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Shaaban CE, Metti A, Barha C, Yaffe K, Rosano C. MARKERS AND BIOMARKERS OF DEMENTIA BDNF GENOTYPE AND CHANGES IN WHITE MATTER HYPERINTENSITIES AND HIPPOCAMPAL MICROSTRUCTURE IN OLDER MEN AND WOMEN. Innov Aging 2019. [PMCID: PMC6841489 DOI: 10.1093/geroni/igz038.2172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Brain-derived neurotrophic factor (BDNF) may protect against cerebral gray and white matter impairments in older age. The val66met genetic polymorphism of BDNF is recently emerging as an early marker of brain structural integrity. However, evidence is sparse, cross-sectional, and mostly in men. In a longitudinal cohort study of community-dwelling older adults (N=139, mean age=81.6, 58% female, 58% white, mean follow-up=3.4 years), we estimated the overall and sex-stratified effects of BDNF val66met polymorphism on changes in cognition and gray and white matter macro- and micro-structure. Annualized percent change was computed for volume of white matter (WM) hyperintensities and gray matter (GM), fractional anisotropy of normal appearing WM, and mean diffusivity (MD) of GM in whole brain and memory and executive control function networks. Significant associations were adjusted for variables differing by genotype (race, APOE4, diabetes, triglycerides, smoking). Compared to met carriers, val homozygotes had slower annual whole brain WMH accrual (median (IQR) 31.4% (61.7) vs. 60.7% (92.4)), stronger in women. Met carriers had slower annual accrual of hippocampal MD (median (IQR) 1.26% (0.92) vs. 1.85% (1.09) for right hippocampus, stronger for women, and 1.45% (1.06) vs. 1.97% (1.22) for left hippocampus, stronger for men) compared to val homozygotes. Associations were robust to covariates’ adjustment. BDNF polymorphism was not associated with cognitive changes. BDNF polymorphism may help in early identification of those more likely to resist accrual of WMH and loss of hippocampal microstructural integrity, with effects varying by sex.
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Affiliation(s)
- C Elizabeth Shaaban
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
| | - Andrea Metti
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
| | - Cindy Barha
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Kristine Yaffe
- UCSF School of Medicine, San Francisco, California, United States
| | - Caterina Rosano
- University of Pittsburgh, PIttsburgh, Pennsylvania, United States
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Alber J, Alladi S, Bae HJ, Barton DA, Beckett LA, Bell JM, Berman SE, Biessels GJ, Black SE, Bos I, Bowman GL, Brai E, Brickman AM, Callahan BL, Corriveau RA, Fossati S, Gottesman RF, Gustafson DR, Hachinski V, Hayden KM, Helman AM, Hughes TM, Isaacs JD, Jefferson AL, Johnson SC, Kapasi A, Kern S, Kwon JC, Kukolja J, Lee A, Lockhart SN, Murray A, Osborn KE, Power MC, Price BR, Rhodius-Meester HF, Rondeau JA, Rosen AC, Rosene DL, Schneider JA, Scholtzova H, Shaaban CE, Silva NC, Snyder HM, Swardfager W, Troen AM, van Veluw SJ, Vemuri P, Wallin A, Wellington C, Wilcock DM, Xie SX, Hainsworth AH. White matter hyperintensities in vascular contributions to cognitive impairment and dementia (VCID): Knowledge gaps and opportunities. Alzheimers Dement (N Y) 2019; 5:107-117. [PMID: 31011621 PMCID: PMC6461571 DOI: 10.1016/j.trci.2019.02.001] [Citation(s) in RCA: 212] [Impact Index Per Article: 42.4] [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] [Indexed: 11/23/2022]
Abstract
White matter hyperintensities (WMHs) are frequently seen on brain magnetic resonance imaging scans of older people. Usually interpreted clinically as a surrogate for cerebral small vessel disease, WMHs are associated with increased likelihood of cognitive impairment and dementia (including Alzheimer's disease [AD]). WMHs are also seen in cognitively healthy people. In this collaboration of academic, clinical, and pharmaceutical industry perspectives, we identify outstanding questions about WMHs and their relation to cognition, dementia, and AD. What molecular and cellular changes underlie WMHs? What are the neuropathological correlates of WMHs? To what extent are demyelination and inflammation present? Is it helpful to subdivide into periventricular and subcortical WMHs? What do WMHs signify in people diagnosed with AD? What are the risk factors for developing WMHs? What preventive and therapeutic strategies target WMHs? Answering these questions will improve prevention and treatment of WMHs and dementia.
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Affiliation(s)
- Jessica Alber
- Department of Biomedical and Pharmaceutical Sciences, George & Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, USA
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Hee-Joon Bae
- Cerebrovascular Disease Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - David A. Barton
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Laurel A. Beckett
- Department of Public Health Sciences, School of Medicine University of California, Davis, CA, USA
| | | | - Sara E. Berman
- Wisconsin Alzheimer's Disease Research Center, Medical Scientist Training Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sandra E. Black
- Department of Medicine, University of Toronto, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Isabelle Bos
- Department of Psychiatry & Neuropsychology, Alzheimer Centre Limburg, School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Gene L. Bowman
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Neurology, Oregon Health & Science University, Portland, OR, 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, NY, USA
| | - Brandy L. Callahan
- Department of Psychology, University of Calgary & Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Roderick A. Corriveau
- Department of Psychology, University of Calgary & Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Silvia Fossati
- Departments of Neurology and Psychiatry, NYU School of Medicine, New York, NY, USA
| | - Rebecca F. Gottesman
- Division of Cerebrovascular Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Deborah R. Gustafson
- Section for NeuroEpidemiology, State University of New York - Downstate Medical Center, Brooklyn, NY, USA
| | | | - Kathleen M. Hayden
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Alex M. Helman
- University of Kentucky, Sanders-Brown Center on Aging, Lexington, KY, USA
| | - Timothy M. Hughes
- Department of Internal Medicine – Section of Gerontology and Geriatric Medicine, and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeremy D. Isaacs
- St George's University of London and Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Angela L. Jefferson
- Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sterling C. Johnson
- Department of Medicine-Geriatrics, Institute on Aging, University of Wisconsin-Madison, Madison, WI, USA
| | - Alifiya Kapasi
- Department of Pathology (Neuropathology), Rush Alzheimer's Disease Center, Chicago, IL, USA
| | - Silke Kern
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Jay C. Kwon
- Department of Neurology, Changwon Fatima Hospital, Changwon, Korea
| | - Juraj Kukolja
- Department of Neurology and Clinical Neurophysiology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Athene Lee
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Samuel N. Lockhart
- Department of Internal Medicine – Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Anne Murray
- Berman Center for Outcomes and Clinical Research, 20298 Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - Katie E. Osborn
- Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melinda C. Power
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Brittani R. Price
- Sanders Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Hanneke F.M. Rhodius-Meester
- Alzheimer Center, Department of Neurology, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - Allyson C. Rosen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Douglas L. Rosene
- Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Julie A. Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago IL, USA
| | | | - C. Elizabeth Shaaban
- Department of Epidemiology, Graduate School of Public Health & Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Narlon C.B.S. Silva
- School of Kinesiology, Western Centre for Public Health & Family Medicine, London, ON, Canada
| | - Heather M. Snyder
- Division of Medical and Scientific Relations, Alzheimer's Association, Chicago, IL, USA
| | - Walter Swardfager
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Aron M. Troen
- Institute of Biochemistry Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture Food and Environment, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Susanne J. van Veluw
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Anders Wallin
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Cheryl Wellington
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Donna M. Wilcock
- Sanders-Brown Center on Aging, Department of Physiology, University of Kentucky, Lexington, KY, USA
| | - Sharon Xiangwen Xie
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Atticus H. Hainsworth
- Molecular & Clinical Sciences Research Institute, St George's University of London and Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
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Shaaban CE, Jorgensen DR, Gianaros PJ, Mettenburg J, Rosano C. Cerebrovascular disease: Neuroimaging of cerebral small vessel disease. Progress in Molecular Biology and Translational Science 2019; 165:225-255. [DOI: 10.1016/bs.pmbts.2019.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Metti AL, Best JR, Shaaban CE, Ganguli M, Rosano C. Longitudinal changes in physical function and physical activity in older adults. Age Ageing 2018; 47:558-564. [PMID: 29546417 PMCID: PMC6693378 DOI: 10.1093/ageing/afy025] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 08/28/2017] [Revised: 01/11/2018] [Accepted: 02/21/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND physical function (PF) and physical activity (PA) both decline as adults age and have been linked to negative outcomes, including dementia, depression and cardiovascular diseases. Although declines in each are associated with numerous negative outcomes, the longitudinal relationship between these two measures is unclear. OBJECTIVE to examine the dynamic, bidirectional associations between declines in PF and PA. DESIGN prospective cohort. SETTING the Monongahela-Youghiogheny Healthy Aging Team (MYHAT) study. SUBJECTS about 1,404 men and women, 76.96 ± 7.2 years, 62.4% female and 95.2% white. METHODS over nine annual assessment cycles, PF was evaluated via the timed Up-and-Go task and PA via a self-reported questionnaire. Piecewise latent growth models examined bidirectional associations between PA and PF to determine whether the initial values (intercept) or early slope (cycles 1-5) (in either PF or PA) predicted later slope (cycles 5-9) (in either PF or PA). RESULTS initial PF significantly predicted early (standardised β= -0.10, P < 0.001) and later (standardised β= -0.09, P = 0.01) PA slopes. Initial PA significantly predicted later (standardised β = -0.09, P = 0.04) but not early PF slope. Associations were independent of baseline memory test scores, baseline cognitive status, later cognitive status and age. Early physical function slope neither predicts later PA slope nor did early PA slope predict later PF slope (both P values >0.10). CONCLUSIONS the relationship between PF and PA is bidirectional, with PF more consistently predicting declines of PA, both in the short- and long-term. Intervening on PF impairments may improve PA engagement, which could in turn promote PF and translate to beneficial effects on cognitive function, cardiovascular health and mood.
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Affiliation(s)
- Andrea L Metti
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - John R Best
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - C Elizabeth Shaaban
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary Ganguli
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Fowler NR, Shaaban CE, Torke AM, Lane KA, Saba S, Barnato AE. "I'm Not Sure We Had A Choice": Decision Quality and The Use of Cardiac Implantable Electronic Devices In Older Adults With Cognitive Impairment. ACTA ACUST UNITED AC 2018. [PMID: 29521380 PMCID: PMC5839643 DOI: 10.26502/fccm.92920032] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background The decision to implant a cardiac device in a person with Alzheimer’s disease or related dementia requires considering the possible trade-offs of quality of life (QOL) and quantity of life. This study measured the decision-making experience of patients with and without cognitive impairment (CI) who received a cardiac device and their family members who were involved in the decision. Methods and Results Semi-structured interviews and questionnaires were administered with 15 patient-family member dyads. Interviews revealed few conversations between physicians, patients and family members about the patient’s cognitive status or about the benefits, risks, and long-term implications of the device for someone with CI. Participants largely stated that the decision to get the device was based on the patient’s functional status at the time of the implant, and not on expectations about future functioning. Patients with CI had more regret, measured with the Decision Regret Scale (DRS), (p=0.037) and family members of patients without CI reported more decisional conflict, measured with the Decisional Conflict Scale (p=0.057). Conclusions Although CI impacts life expectancy and QOL, cognitive status was largely not discussed prior to device implant. Few differences were found between the experiences of dyads that included patients with or without CI.
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Affiliation(s)
- Nicole R. Fowler
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Corresponding Author: Nicole R. Fowler, Indiana University School of Medicine, Indiana University Center for Aging Research, 1101 West 10th Street, Indianapolis, IN 46202, USA, Telephone: (317) 274-9021;
| | - C. Elizabeth Shaaban
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alexia M. Torke
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kathleen A. Lane
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Samir Saba
- Division of Cardiology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amber E. Barnato
- The Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Jorgensen DR, Shaaban CE, Wiley CA, Gianaros PJ, Mettenburg J, Rosano C. A population neuroscience approach to the study of cerebral small vessel disease in midlife and late life: an invited review. Am J Physiol Heart Circ Physiol 2018; 314:H1117-H1136. [PMID: 29393657 DOI: 10.1152/ajpheart.00535.2017] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Aging in later life engenders numerous changes to the cerebral microvasculature. Such changes can remain clinically silent but are associated with greater risk for negative health outcomes over time. Knowledge is limited about the pathogenesis, prevention, and treatment of potentially detrimental changes in the cerebral microvasculature that occur with advancing age. In this review, we summarize literature on aging of the cerebral microvasculature, and we propose a conceptual framework to fill existing research gaps and advance future work on this heterogeneous phenomenon. We propose that the major gaps in this area are attributable to an incomplete characterization of cerebrovascular pathology, the populations being studied, and the temporality of exposure to risk factors. Specifically, currently available measures of age-related cerebral microvasculature changes are indirect, primarily related to parenchymal damage rather than direct quantification of small vessel damage, limiting the understanding of cerebral small vessel disease (cSVD) itself. Moreover, studies seldom account for variability in the health-related conditions or interactions with risk factors, which are likely determinants of cSVD pathogenesis. Finally, study designs are predominantly cross-sectional and/or have relied on single time point measures, leaving no clear evidence of time trajectories of risk factors or of change in cerebral microvasculature. We argue that more resources should be invested in 1) developing methodological approaches and basic science models to better understand the pathogenic and etiological nature of age-related brain microvascular diseases and 2) implementing state-of-the-science population study designs that account for the temporal evolution of cerebral microvascular changes in diverse populations across the lifespan.
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Affiliation(s)
- Dana R Jorgensen
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - C Elizabeth Shaaban
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Clayton A Wiley
- Department of Pathology, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Peter J Gianaros
- Departments of Psychology and Psychiatry, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Joseph Mettenburg
- Department of Radiology, University of Pittsburgh, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania
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Shaaban CE, Aizenstein HJ, Jorgensen DR, MacCloud RL, Meckes NA, Erickson KI, Glynn NW, Mettenburg J, Guralnik J, Newman AB, Ibrahim TS, Laurienti PJ, Vallejo AN, Rosano C. In Vivo Imaging of Venous Side Cerebral Small-Vessel Disease in Older Adults: An MRI Method at 7T. AJNR Am J Neuroradiol 2017; 38:1923-1928. [PMID: 28775055 DOI: 10.3174/ajnr.a5327] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 05/28/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE Traditional neuroimaging markers of small-vessel disease focus on late-stage changes. We aimed to adapt a method of venular assessment at 7T for use in older adults. We hypothesized that poorer venular morphologic characteristics would be related to other small-vessel disease neuroimaging markers and a higher prevalence of small-vessel disease-Alzheimer disease risk factors. MATERIALS AND METHODS Venules were identified in periventricular ROIs on SWI and defined as tortuous or straight. The tortuosity ratio was defined as total tortuous venular length divided by total straight venular length. White matter hyperintensity burden (visually rated from 0 to 3) and the number of microbleeds (0, 1, >1) were determined. Differences in tortuous and straight venular lengths were evaluated. Relationships with demographic variables, allele producing the e4 type of apolipoprotein E (APOE4), growth factors, pulse pressure, physical activity, and Modified Mini-Mental State Examination were assessed via Spearman correlations. RESULTS Participants had 42% more tortuous venular tissue than straight (median, 1.42; 95% CI, 1.13-1.62). APOE4 presence was associated with a greater tortuosity ratio (ρ = 0.454, P = .001), and these results were robust to adjustment for confounders and multiple comparisons. Associations of the tortuosity ratio with sex and vascular endothelial growth factor did not survive adjustment. Associations of the tortuosity ratio with other variables of interest were not significant. CONCLUSIONS Morphologic measures of venules at 7T could be useful biomarkers of the early stages of small-vessel disease and Alzheimer disease. Longitudinal studies should examine the impact of apolipoprotein E and vascular endothelial growth factor on the risk of venular damage.
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Affiliation(s)
- C E Shaaban
- From the Graduate School of Public Health, Department of Epidemiology (C.E.S., D.R.J., N.W.G., A.B.N., C.R.).,Center for the Neural Basis of Cognition (C.E.S., H.J.A., D.R.J., K.I.E., C.R.)
| | - H J Aizenstein
- Center for the Neural Basis of Cognition (C.E.S., H.J.A., D.R.J., K.I.E., C.R.).,Departments of Psychiatry (H.J.A., R.L.M.)
| | - D R Jorgensen
- From the Graduate School of Public Health, Department of Epidemiology (C.E.S., D.R.J., N.W.G., A.B.N., C.R.).,Center for the Neural Basis of Cognition (C.E.S., H.J.A., D.R.J., K.I.E., C.R.)
| | - R L MacCloud
- From the Graduate School of Public Health, Department of Epidemiology (C.E.S., D.R.J., N.W.G., A.B.N., C.R.).,Departments of Psychiatry (H.J.A., R.L.M.)
| | | | - K I Erickson
- Center for the Neural Basis of Cognition (C.E.S., H.J.A., D.R.J., K.I.E., C.R.).,Psychology (K.I.E.)
| | - N W Glynn
- From the Graduate School of Public Health, Department of Epidemiology (C.E.S., D.R.J., N.W.G., A.B.N., C.R.)
| | | | - J Guralnik
- Department of Epidemiology and Public Health (J.G.), University of Maryland School of Medicine, Baltimore, Maryland
| | - A B Newman
- From the Graduate School of Public Health, Department of Epidemiology (C.E.S., D.R.J., N.W.G., A.B.N., C.R.)
| | - T S Ibrahim
- Radiology (J.M., T.S.I.).,Bioengineering (T.S.I.)
| | - P J Laurienti
- Laboratory for Complex Brain Networks (P.J.L.).,Department of Radiology (P.J.L.), Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - A N Vallejo
- Immunology (A.N.V.). University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Pediatrics (A.N.V.), Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - C Rosano
- From the Graduate School of Public Health, Department of Epidemiology (C.E.S., D.R.J., N.W.G., A.B.N., C.R.) .,Center for the Neural Basis of Cognition (C.E.S., H.J.A., D.R.J., K.I.E., C.R.)
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Shaaban CE, Rosso AL, Aizenstein HJ, Newman AB, Rosano C. [P2–128]: NEUROIMAGING SIGNATURE OF DOPAMINE SYSTEM COMT GENOTYPE IN OLDER ADULTS. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.778] [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: 11/29/2022]
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Shaaban CE, Aizenstein HJ, Vallejo AN, Erickson KI, Newman AB, Rosano C. [P1–608]: RESPONSE OF VENOUS‐SIDE MICROVASCULATURE IN OLDER ADULTS TO PHYSICAL ACTIVITY INTERVENTION: A STUDY AT 7T. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.624] [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: 10/18/2022]
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Rosano C, Guralnik J, Pahor M, Glynn NW, Newman AB, Ibrahim TS, Erickson K, Cohen R, Shaaban CE, MacCloud RL, Aizenstein HJ. Hippocampal Response to a 24-Month Physical Activity Intervention in Sedentary Older Adults. Am J Geriatr Psychiatry 2017; 25:209-217. [PMID: 27986412 PMCID: PMC5568026 DOI: 10.1016/j.jagp.2016.11.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [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: 04/08/2016] [Revised: 10/07/2016] [Accepted: 11/03/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Greater hippocampal volume is observed in healthy older adults after short-term structured exercise. Whether long-term exposure to real-world physical activity (PA) programs has similar effects for sedentary older adults with impaired mobility and comorbid conditions is not known. HYPOTHESIS A long-term moderate intensity regimen of PA is related to larger volume of the hippocampus in older adults at risk for mobility disability. We further explore whether these associations are modified by factors known to be related to dementia. METHODS Twenty-six sedentary adults at risk for mobility disability participated in a 24-month randomized intervention program of physical activity (PA, N = 10, age: 74.9 years, 7 women) or health education (HE, N = 16, age: 76.8 years, 14 women). Volumes of total hippocampus, dentate gyrus, and cornu ammonis were measured at baseline and at 24-month follow-up using 7-Tesla magnetic resonance imaging. Between-group volumetric differences at 24 months were adjusted for sessions attended and baseline volumes. The contribution of each dementia-related factor was tested separately for education, APOE, diabetes, cardiovascular diseases, white matter hyperintensities, and brain atrophy. RESULTS Between-group differences were significant for left hippocampus, left cornu ammonis, and right hippocampus. Adjustment for regional baseline volume attenuated the associations to statistically nonsignificant for right hippocampus and left conru ammonis; associations for left hippocampus were robust for all adjustments. Results were similar after adjustment for dementia-related factors. CONCLUSIONS In this group of sedentary older adults there was a hippocampal response to a long-term program of moderate-intensity PA. Future studies should examine whether hippocampal response could explain the beneficial effects of PA on cognition for vulnerable older adults.
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Affiliation(s)
- Caterina Rosano
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
| | - Jack Guralnik
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Marco Pahor
- College of Medicine, University of Florida, Gainesville, FL
| | - Nancy W Glynn
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Anne B Newman
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Tamer S Ibrahim
- Departments of Bioengineering and Radiology, Swanson School of Engineering and School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Kirk Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Ronald Cohen
- College of Medicine, University of Florida, Gainesville, FL
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