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Deliyannides DA, Graff JA, Niño I, Lee S, Husain MM, Forester BP, Crocco E, Vahia IV, Devanand DP. Effects of lithium on serum Brain-Derived Neurotrophic Factor in Alzheimer's patients with agitation. Int J Geriatr Psychiatry 2023; 38:e6002. [PMID: 37732619 DOI: 10.1002/gps.6002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND There is ample evidence in animal models that lithium increases Brain-Derived Neurotrophic Factor (BDNF) with supporting evidence in human studies. Little is known, however, about the effects of lithium on BDNF in Alzheimer's Dementia (AD). In one study of patients with Mild Cognitive Impairment, serum BDNF increased after treatment with lithium. These patients also showed mild improvement in cognitive function. OBJECTIVES To evaluate low-dose lithium treatment of agitation in Alzheimer's disease (AD). METHOD We measured levels of BDNF in patients treated with lithium prior to and after a 12-week randomized placebo-controlled trial. RESULTS BDNF levels did not change significantly and were not associated with improvement in overall neuropsychiatric symptoms or in cognitive function. CONCLUSIONS More research is needed to understand the potential effects of lithium on BDNF in AD including whether its use might be dependent on the stage of cognitive decline and dementia.
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Affiliation(s)
- Deborah A Deliyannides
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
| | - Jamie A Graff
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Izael Niño
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Seonjoo Lee
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
- Department of Biostatistics, Columbia University Medical Center, New York, New York, USA
- Mental Health Data Science, New York State Psychiatric Institute, New York, New York, USA
| | - Mustafa M Husain
- Departments of Psychiatry and Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brent P Forester
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Massachusetts, USA
| | - Elizabeth Crocco
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ipsit V Vahia
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Massachusetts, USA
| | - Davangere P Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
- Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, New York, USA
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Devanand DP, Crocco E, Forester BP, Husain MM, Lee S, Vahia IV, Andrews H, Simon-Pearson L, Imran N, Luca L, Huey ED, Deliyannides DA, Pelton GH. Low Dose Lithium Treatment of Behavioral Complications in Alzheimer's Disease: Lit-AD Randomized Clinical Trial. Am J Geriatr Psychiatry 2022; 30:32-42. [PMID: 34059401 PMCID: PMC8586042 DOI: 10.1016/j.jagp.2021.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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] [Received: 04/08/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND A case series suggested efficacy for lithium to treat agitation in dementia, but no placebo-controlled trials have been conducted. OBJECTIVES To evaluate low-dose lithium treatment of agitation in Alzheimer's disease (AD). METHOD In a four-site trial, patients with AD and agitation/aggression score ≥4 on the Neuropsychiatric Inventory (NPI) were randomized, double-blind, to lithium carbonate 150-600 mg daily or placebo for 12 weeks. Primary efficacy outcome was change in NPI agitation/aggression; secondary efficacy outcome was treatment response (30% reduction in NPI score for agitation/aggression plus psychosis and a Clinical Global Impression (CGI) score of much or very much improved). Safety profile of lithium was assessed. RESULTS Fifty-eight of 77 patients (75.3%) completed the trial. In linear mixed effects model analyses, lithium was not significantly superior to placebo for agitation/aggression. Proportion of responders was 31.6% on lithium and 17.9% on placebo (χ2=1.26, p = 0.26). Moderate or marked improvement (CGI) was greater on lithium (10/38=36.8%) than placebo (0/39=0%, Fisher's exact test p <0.001). In exploratory analyses, improvement on lithium was greater than placebo on NPI delusions and irritability/lability (p's<0.05). Lithium showed greater reduction than placebo in patients with high Young Mania Rating Scale scores (β=5.06; 95%CI,1.18 to 8.94, p = 0.01). Oral dose and serum levels demonstrated similar associations with efficacy outcomes. Lithium did not differ significantly from placebo on safety outcomes. CONCLUSIONS Low-dose lithium was not efficacious in treating agitation but was associated with global clinical improvement and excellent safety. A larger trial may be warranted of likely lithium-responsive behavioral symptoms that overlap with mania.
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Affiliation(s)
- D. P. Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, USA; Department of Psychiatry, Columbia University Medical Center, New York, USA; Department of Neurology and Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, USA
| | - Elizabeth Crocco
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine Miami, Florida, USA
| | - Brent P. Forester
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Mustafa M. Husain
- Departments of Psychiatry and Neurology, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Seonjoo Lee
- Department of Psychiatry, Columbia University Medical Center, New York, USA; Mental Health Data Science, Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, USA
| | - Ipsit V. Vahia
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Howard Andrews
- Department of Psychiatry, Columbia University Medical Center, New York, USA; Mental Health Data Science, Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, USA
| | - Laura Simon-Pearson
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, USA
| | - Nadia Imran
- Departments of Psychiatry and Neurology, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Luminita Luca
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine Miami, Florida, USA
| | - Edward D. Huey
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, USA; Department of Psychiatry, Columbia University Medical Center, New York, USA; Department of Neurology and Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, USA
| | - Deborah A. Deliyannides
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, USA; Department of Psychiatry, Columbia University Medical Center, New York, USA
| | - Gregory H. Pelton
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, USA; Department of Psychiatry, Columbia University Medical Center, New York, USA
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Devanand DP, Crocco E, Forester BP, Husain M, Lee S, Huey ED, Pelton GH. Low‐dose lithium treatment of behavioral complications in Alzheimer’s disease: Lit‐AD randomized clinical trial. Alzheimers Dement 2021. [DOI: 10.1002/alz.055194] [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: 11/09/2022]
Affiliation(s)
- Davangere P Devanand
- New York State Psychiatric Institute, Columbia University Medical Center New York NY USA
- Columbia University Medical Center New York NY USA
| | | | | | | | - Seonjoo Lee
- New York State Psychiatric Institute New York NY USA
- Columbia University New York NY USA
| | - Edward D. Huey
- Columbia University Medical Center New York NY USA
- Columbia University New York NY USA
- Columbia Presbyterian New York NY USA
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DeBuc DC, Kandukuri J, Sinha A, Lee W, Crocco E, Sapahia R, Mendoza‐Santiesteban C, Smiddy WE, Garg RK, Kostic M, Alfonso MM, Baumel B, Rege A. Laser speckle‐based retinal imager as a potential screening tool for mild cognitive impairment. Alzheimers Dement 2021. [DOI: 10.1002/alz.055864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | | | | | - Wen‐Hsiang Lee
- Bascom Palmer Eye Institute University of Miami Miami FL USA
| | | | - Rishav Sapahia
- Bascom Palmer Eye Institute University of Miami Miami FL USA
| | | | | | - Rajesh K. Garg
- Comprehensive Diabetes Center University of Miami Miller School of Medicine Miami FL USA
| | - Maja Kostic
- Bascom Palmer Eye Institute University of Miami Miami FL USA
| | | | - Bernard Baumel
- University of Miami Miller School of Medicine Miami FL USA
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Kitaigorodsky M, Curiel Cid RE, Crocco E, Gorman KL, González-Jiménez CJ, Greig-Custo M, Barker WW, Duara R, Loewenstein DA. Changes in LASSI-L performance over time among older adults with amnestic MCI and amyloid positivity: A preliminary study. J Psychiatr Res 2021; 143:98-105. [PMID: 34464879 PMCID: PMC8557121 DOI: 10.1016/j.jpsychires.2021.08.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
There is a pressing need to develop measures that are sensitive to the earliest subtle cognitive changes of Alzheimer's disease (AD) to improve early detection and track disease progression. The Loewenstein-Acevedo Scales of Semantic Interference (LASSI-L) has been shown to successfully discriminate between cognitively unimpaired (CU) older adults and those with amnestic mild cognitive impairment (MCI) and to correlate with total and regional brain amyloid load. The present study investigated how the LASSI-L scores change over time among three distinct diagnostic groups. Eighty-six community-dwelling older adults underwent a baseline evaluation including: a clinical interview, a neuropsychological evaluation, Magnetic Resonance Imaging (MRI), and amyloid Positron Emission Tomography (PET). A follow up evaluation was conducted 12 months later. Initial mean values were calculated using one-way ANOVAs and chi-square analyses. Post-hoc comparisons were conducted using Tukey's Honestly Significant Difference (HSD). A 3 × 2 repeated measures analysis was utilized to examine differences in LASSI-L performance over time. The MCI amyloid positive group demonstrated a significantly greater decline in LASSI-L performance than the MCI amyloid negative and CU groups respectively. The scales that best differentiated the three groups included the Cued A2, which taps into maximum learning capacity, and Cued B2, which assesses the failure to recover from proactive semantic interference. Our findings further support the LASSI-L's discriminative validity.
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Affiliation(s)
| | | | - Elizabeth Crocco
- Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, USA
| | | | | | - Maria Greig-Custo
- Wien Center for Alzheimer's Disease & Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Warren W Barker
- Wien Center for Alzheimer's Disease & Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Ranjan Duara
- Wien Center for Alzheimer's Disease & Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - David A Loewenstein
- Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, USA; Wien Center for Alzheimer's Disease & Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
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Kitaigorodsky M, Crocco E, Curiel‐Cid RE, Leal G, Zheng D, Eustache MK, Greig‐Custo MT, Barker W, Duara R, Loewenstein DA. The relationship of semantic intrusions to different etiological subtypes of MCI and cognitively healthy older adults. Alzheimers Dement (Amst) 2021; 13:e12192. [PMID: 34084887 PMCID: PMC8144934 DOI: 10.1002/dad2.12192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/23/2021] [Accepted: 03/30/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION There is increasing evidence that susceptibility to proactive semantic interference (PSI) and the failure to recover from PSI (frPSI) as evidenced by intrusion errors may be early cognitive markers of both preclinical and prodromal Alzheimer's disease (AD). METHODS One hundred forty-five participants were administered extensive clinical and neuropsychological evaluations including the Loewenstein-Acevedo Scales for Semantic Interference and Learning (LASSI-L), a sensitive cognitive stress test measuring PSI and frPSI. Participants also underwent structural magnetic resonance imaging (MRI) and amyloid positron emission tomography/computed tomography (PET/CT) imaging. RESULTS PSI and frPSI errors were much more prevalent in the mild cognitive impairment (MCI)-AD (amyloid positive) group than the other diagnostic groups. The number of intrusion errors observed across the other MCI groups without amyloid pathology and those with normal cognition were comparable. DISCUSSION Semantic intrusion errors on the LASSI-L occur much less frequently in persons who have different types of non-AD-related MCI and may be used as an early cognitive marker of prodromal AD.
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Affiliation(s)
- Marcela Kitaigorodsky
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral SciencesUniversity of Miami Miller School of MedicineMiamiUSA
| | - Elizabeth Crocco
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral SciencesUniversity of Miami Miller School of MedicineMiamiUSA
| | - Rosie E. Curiel‐Cid
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral SciencesUniversity of Miami Miller School of MedicineMiamiUSA
- 1Florida Alzheimer's Disease Research CenterGainesvilleFloridaUSA
| | - Giselle Leal
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral SciencesUniversity of Miami Miller School of MedicineMiamiUSA
| | - Diane Zheng
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral SciencesUniversity of Miami Miller School of MedicineMiamiUSA
| | - Melissa K. Eustache
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral SciencesUniversity of Miami Miller School of MedicineMiamiUSA
| | - Maria T. Greig‐Custo
- 1Florida Alzheimer's Disease Research CenterGainesvilleFloridaUSA
- Wien Center for Alzheimer's Disease and Memory DisordersMount Sinai, Medical CenterNew YorkUSA
| | - William Barker
- 1Florida Alzheimer's Disease Research CenterGainesvilleFloridaUSA
- Wien Center for Alzheimer's Disease and Memory DisordersMount Sinai, Medical CenterNew YorkUSA
| | - Ranjan Duara
- 1Florida Alzheimer's Disease Research CenterGainesvilleFloridaUSA
- Wien Center for Alzheimer's Disease and Memory DisordersMount Sinai, Medical CenterNew YorkUSA
| | - David A. Loewenstein
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral SciencesUniversity of Miami Miller School of MedicineMiamiUSA
- 1Florida Alzheimer's Disease Research CenterGainesvilleFloridaUSA
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Kitaigorodsky M, Loewenstein D, Curiel Cid R, Crocco E, Gorman K, González-Jiménez C. A Teleneuropsychology Protocol for the Cognitive Assessment of Older Adults During COVID-19. Front Psychol 2021; 12:651136. [PMID: 34054655 PMCID: PMC8155705 DOI: 10.3389/fpsyg.2021.651136] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/16/2021] [Indexed: 12/21/2022] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic prompted the need for a teleneuropsychology protocol for the cognitive assessment of older adults, who are at increased risk for both COVID-19 and dementia. Prior recommendations for teleneuropsychological assessment did not consider many of the unique challenges posed by COVID-19. The field is still in need of clear guidelines and standards of care for the assessment of older adults under the current circumstances. Advantages of teleneuropsychological assessment during the COVID-19 pandemic include reduced risk of contracting the virus, eliminating travel time and reducing cost, and more rapid access to needed services. Challenges include disparities in technology access among patients, reduced control over the testing environment, impeded ability to make behavioral observations, and limited research on valid and reliable cognitive assessment measures. The aim of this perspective review is to propose a teleneuropsychological protocol to facilitate neuropsychological assessment utilizing a virtual platform. The proposed protocol has been successful with our clinical and research populations and may help neuropsychologists implement teleneuropsychology services without compromising validity or reliability. However, there is increasing need for research on teleneuropsychological assessment options for both clinical and research purposes.
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Affiliation(s)
- Marcela Kitaigorodsky
- Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL, United States
| | - David Loewenstein
- Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL, United States
| | - Rosie Curiel Cid
- Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL, United States
| | - Elizabeth Crocco
- Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL, United States
| | - Katherine Gorman
- Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL, United States
| | - Christian González-Jiménez
- Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL, United States
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Crocco E, Curiel-Cid RE, Kitaigorodsky M, González-Jiménez CJ, Zheng D, Duara R, Loewenstein DA. A Brief Version of the LASSI-L Detects Prodromal Alzheimer's Disease States. J Alzheimers Dis 2020; 78:789-799. [PMID: 33074233 DOI: 10.3233/jad-200790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The Loewenstein-Acevedo Scales for Semantic Interference and Learning (LASSI-L) is an increasingly utilized cognitive stress test designed to identify early cognitive changes associated with incipient neurodegenerative disease. OBJECTIVE To examine previously derived cut-points for cognitively unimpaired older adults that were suggestive of performance impairment on multiple subscales of the LASSI-L. These cut-points were applied to a new sample of older adults who were cognitive healthy controls (HC: n = 26) and those on the Alzheimer's disease (AD) continuum from early stage mild cognitive impairment (EMCI: n = 28), late stage MCI (LMCI: n = 18) to mild AD (AD: n = 27). METHODS All participants were administered the LASSI-L. All cognitively impaired participants were PET amyloid positive which likely reflects underlying AD neuropathology, while cognitively normal counterparts were deemed to have amyloid negative scans. RESULTS There was a monotonic relationship between the number of deficits on LASSI-L subscales and independent classification of study groups with greater severity of cognitive impairment. Importantly, taken together, impairment on maximum learning ability and measures of proactive semantic interference (both reflected by cued recall and intrusion errors) correctly classified 74.1% of EMCI, 94.4% of LMCI, and 96.3% of AD. Only 7.7% of HC were incorrectly classified as having impairments. CONCLUSION A modest number of LASSI-L subscales taking approximately 8 minutes to administer, had excellent discriminative ability using established cut-offs among individuals with presumptive stages of AD. This has potential implications for both clinical practice and clinical research settings targeting AD during early prodromal stages.
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Affiliation(s)
- Elizabeth Crocco
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,1Florida Alzheimer's Disease Research Center, Miami, FL, USA
| | - Rosie E Curiel-Cid
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,1Florida Alzheimer's Disease Research Center, Miami, FL, USA
| | - Marcela Kitaigorodsky
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christian J González-Jiménez
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Diane Zheng
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ranjan Duara
- 1Florida Alzheimer's Disease Research Center, Miami, FL, USA.,Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami, FL, USA
| | - David A Loewenstein
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,1Florida Alzheimer's Disease Research Center, Miami, FL, USA
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Czaja SJ, Loewenstein DA, Sabbag SA, Curiel RE, Crocco E, Harvey PD. A Novel Method for Direct Assessment of Everyday Competence Among Older Adults. J Alzheimers Dis 2018; 57:1229-1238. [PMID: 28304300 DOI: 10.3233/jad-161183] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recent findings indicate that impairments in functional performance do occur among individuals diagnosed with mild cognitive impairment (MCI). Most assessment strategies for everyday competence are associated with challenges with reliability, are typically in paper and pencil format, or require in-person administration by a trained professional. OBJECTIVE This paper reports on a novel technology-based assessment battery of everyday competence that includes ecologically valid simulations of daily activities important to independence. METHODS The sample included 85 non-cognitively impaired older adults aged 65+ and 62 older adults diagnosed with amnestic MCI (aMCI). Participants completed standard measures of cognitive abilities and the computerized battery of everyday tasks, which included simulations of a doctor's visit; and medication and financial management tasks. RESULTS The older adults with aMCI performed significantly poorer on all three tasks in the everyday task battery. Performance on these measures were also moderately correlated with standard measures of cognitive abilities and showed good test-retest reliability. CONCLUSIONS The results show that it is feasible to use a technology-based assessment battery of everyday tasks with both non-cognitively impaired older adults and older adults with MCI. The use of this type of battery can overcome many of the logistic constraints associated with current functional assessment protocols.
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Affiliation(s)
- Sara J Czaja
- Department of Psychiatry and Behavioral Sciences, Miami, FL, USA.,Center on Aging, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David A Loewenstein
- Department of Psychiatry and Behavioral Sciences, Miami, FL, USA.,Center on Aging, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Samir A Sabbag
- Department of Psychiatry and Behavioral Sciences, Miami, FL, USA.,Center on Aging, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rosie E Curiel
- Department of Psychiatry and Behavioral Sciences, Miami, FL, USA.,Center on Aging, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Elizabeth Crocco
- Department of Psychiatry and Behavioral Sciences, Miami, FL, USA.,Center on Aging, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, Miami, FL, USA.,Center on Aging, University of Miami Miller School of Medicine, Miami, FL, USA
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Curiel RE, Crocco E, Rosado M, Duara R, Greig MT, Raffo A, Loewenstein DA. A Brief Computerized Paired Associate Test for the Detection of Mild Cognitive Impairment in Community-Dwelling Older Adults. J Alzheimers Dis 2018; 54:793-9. [PMID: 27567839 DOI: 10.3233/jad-160370] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Semantic memory interference has been found to be a predictive cognitive marker of incipient AD. This is relevant given that developing assessment paradigms to identify subtle cognitive and functional deficits is a priority in preclinical Alzheimer's disease research. OBJECTIVE To examine the utility of a novel computerized paired associate test in distinguishing between mild cognitive impairment (MCI) and cognitively normal (CN) groups of older adults residing in the community. METHODS Participants that were CN (n = 64) or MCI (n = 34) were administered the Miami Test of Semantic Interference and Learning (MITSI-L). This novel instrument is a brief, computerized paired associate test that measured the strength of memory binding of semantically related word pairs and introduced a proactive semantic interference condition which required participants to make different associations between semantically similar targets. A series of ANOVAs explored differences on MITSI-L performance. Logistic regression and receiver operator curves (ROC) analyses were employed to further determine discriminative validity. RESULTS MCI participants had lower scores on all indices relative to CN elders. A composite of two subscores correctly classified 85.3% of MCI and 84.4% of CN participants. Area under the ROC was higher relative to the MMSE, immediate memory for passages, and several subtests of a sensitive memory measure, the LASSI-L. CONCLUSIONS The MITSI-L is a computerized test that can successfully differentiate MCI from CN participants. Area under the ROC curve exceeded that of global mental status and other memory measures. The effectiveness of the MITSI-L in detecting MCI, and its brief administration and portability render it worthy of further research.
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Affiliation(s)
- Rosie E Curiel
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Elizabeth Crocco
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marian Rosado
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ranjan Duara
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Maria T Greig
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Arlene Raffo
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David A Loewenstein
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
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Alexandra O, Myott M, Modesto M, Raffo A, Peñate A, Melo J, Curiel R, Crocco E, Loewenstein D. A-29Proactive Semantic Interference (PSI) Deficits, and the Inability to Recover from PSI on a Novel List-Learning Task Demonstrate Increased Sensitivity in Identifying Elderly Persons at Risk of Developing Alzheimer's Disease (AD). Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ethridge K, Capp K, Raffo A, Curiel R, Crocco E, Melo J, Rosado M, Duara R, Greig M, Loewenstein D. A-10The Miami Test of Semantic Interference and Learning (MITSI-L), a Novel Computerized Paired-Associates Test that Demonstrates Increased Sensitivity in Detecting Subtle Cognitive Impairments in MCI. Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Capp K, Ethridge K, Santos A, Ortega A, Myott M, Modesto M, Curiel R, Raffo A, Melo J, Crocco E, Wright C, Penate A, Lowenstein D. A-24Evaluating the Association of Early Alzheimer's Disease with Proactive Interference Ability and Magnetic Resonance Imaging (MRI) Scans. Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gamez M, Penate A, Raffo A, Loewenstein D, Curiel R, Melo J, Crocco E. A-33Cued Recall Performance on the LASSI-L, a Novel List-Learning Test, Is a Better Predictor of Early Alzheimer's Disease (AD) Than Performance on Free Recall Trials. Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Capp K, Diaz-Santos A, Raffo A, Curiel R, Crocco E, Melo J, Loewenstein D. A-23The Miami Prospective Memory Test (MPMT) in Discriminating Community-Dwelling Older Adults with Amnestic MCI from Cognitively Normal Elders. Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sun X, Dong C, Levin B, Crocco E, Loewenstein D, Zetterberg H, Blennow K, Wright CB. APOE ε4 carriers may undergo synaptic damage conferring risk of Alzheimer's disease. Alzheimers Dement 2016; 12:1159-1166. [PMID: 27321472 DOI: 10.1016/j.jalz.2016.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 08/28/2015] [Revised: 04/15/2016] [Accepted: 05/09/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Pathogenesis of Alzheimer's disease (AD) in apolipoprotein E ε4 (APOE ε4) carriers remains unclear. We hypothesize that APOE isoforms have differential effects on synaptic function. METHODS We compared levels of CSF neurogranin (Ng) between APOE ε4 carriers and noncarriers in 399 subjects with normal cognition, mild cognitive impairment (MCI), and AD. We examined associations between Ng levels and age, education, gender, CSF-Aβ42, and tau protein. RESULTS Neurogranin levels were significantly higher in APOE ε4 carriers compared to APOE ε4 noncarriers with MCI. Levels of Ng between the APOE ε4 carriers and APOE ε4 noncarriers with AD did not differ. Ng levels were correlated with MMSE and levels of tau and Aβ42. DISCUSSION Significantly higher CSF Ng levels in APOE ε4 carriers with MCI may reflect synaptic injury underlying early cognitive impairment. Neurogranin may be an early biomarker of AD and important for disease diagnosis and timing of intervention in APOE ε4 carriers.
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Affiliation(s)
- Xiaoyan Sun
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA; Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Chuanhui Dong
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA; Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bonnie Levin
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA; Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Elizabeth Crocco
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David Loewenstein
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University Gothenburg, Molndal, Sweden; Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK; Clinical Neurochemistry Laboratory Sahlgrenska University Hospital, Mölndal, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University Gothenburg, Molndal, Sweden; Clinical Neurochemistry Laboratory Sahlgrenska University Hospital, Mölndal, Sweden
| | - Clinton B Wright
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA; Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Curiel RE, Loewenstein D, Crocco E, Greig-Custo M, Rodriquez R, Czaja S, Rosado M, Barker WW, Duara R. P4‐116: A novel measure of cognitive change in preclinical Alzheimer's disease and its physiological correlates in normal and MCI elderly. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.1822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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]
Affiliation(s)
| | | | | | | | | | - Sara Czaja
- University of MiamiSchool of MedicineMiamiFLUSA
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Sarno M, Bure-Reyes A, Rosado M, Curiel R, Crocco E. A-20 * A Case Study of Frontotemporal Dementia: Cognitive Reserve and its Implications in Early Detection. Arch Clin Neuropsychol 2014. [DOI: 10.1093/arclin/acu038.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Crocco E, Curiel RE, Acevedo A, Czaja SJ, Loewenstein DA. An evaluation of deficits in semantic cueing and proactive and retroactive interference as early features of Alzheimer's disease. Am J Geriatr Psychiatry 2014; 22:889-97. [PMID: 23768680 PMCID: PMC4668200 DOI: 10.1016/j.jagp.2013.01.066] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 12/18/2012] [Accepted: 01/15/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To determine the degree to which susceptibility to different types of semantic interference may reflect the initial manifestations of early Alzheimer's disease (AD) beyond the effects of global memory impairment. METHODS Normal elderly (NE) subjects (n = 47), subjects with amnestic mild cognitive impairment (aMCI; n = 34), and subjects with probable AD (n = 40) were evaluated by using a unique cued recall paradigm that allowed for evaluation of both proactive and retroactive interference effects while controlling for global memory impairment (i.e., Loewenstein-Acevedo Scales of Semantic Interference and Learning [LASSI-L] procedure). RESULTS Controlling for overall memory impairment, aMCI subjects had much greater proactive and retroactive interference effects than NE subjects. LASSI-L indices of learning by using cued recall revealed high levels of sensitivity and specificity, with an overall correct classification rate of 90%. These measures provided better discrimination than traditional neuropsychological measures of memory function. CONCLUSIONS The LASSI-L paradigm is unique and unlike other assessments of memory in that items posed for cued recall are explicitly presented, and semantic interference and cueing effects can be assessed while controlling for initial level of memory impairment. This is a powerful procedure that allows the participant to serve as his or her own control. The high levels of discrimination between subjects with aMCI and normal cognition that exceeded traditional neuropsychological measures makes the LASSI-L worthy of further research in the detection of early AD.
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Affiliation(s)
- Elizabeth Crocco
- Center on Aging and Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Florida
| | - Rosie E. Curiel
- Center on Aging and Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Florida
| | - Amarilis Acevedo
- Department of Psychology, Nova Southeastern University, Davie, Florida
| | - Sara J. Czaja
- Center on Aging and Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Florida
| | - David A. Loewenstein
- Center on Aging and Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Florida
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Curiel R, Crocco E, Czaja S, Levin B, Wahlestedt C, Wright C, Loewenstein D. P2–268: Deficits in semantic cuing, proactive and retroactive interference as early features of Alzheimer's disease. Alzheimers Dement 2013. [DOI: 10.1016/j.jalz.2013.05.915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Sara Czaja
- University of Miami Miami Florida United States
| | - Bonnie Levin
- Department of Neurology Miami Florida United States
| | | | - Clinton Wright
- Evelyn F. McKnight Brain Institute Miami Florida United States
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Loewenstein D, Curiel R, Crocco E, Czaja S, Levin B, Wahlestedt C, Wright C. O2–04–05: Prospective memory deficits in English‐ and Spanish‐speaking patients with mild cognitive impairment (MCI) and PreMCI. Alzheimers Dement 2013. [DOI: 10.1016/j.jalz.2013.04.156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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]
Affiliation(s)
- David Loewenstein
- Miller School of Medicine, University of Miami Miami Florida United States
| | | | - Elizabeth Crocco
- Department of Psychiatry University of Miami Miami Florida United States
| | - Sara Czaja
- Miller School of Medicine, University of Miami Miami Florida United States
| | - Bonnie Levin
- Department of Neurology University of Miami Miami Florida United States
| | - Claes Wahlestedt
- Miller School of Medicine, University of Miami Miami Florida United States
| | - Clinton Wright
- Evelyn F. McKnight Brain Institute Miami Florida United States
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Kohli MA, John-Williams K, Rajbhandary R, Naj A, Whitehead P, Hamilton K, Carney RM, Wright C, Crocco E, Gwirtzman HE, Lang R, Beecham G, Martin ER, Gilbert J, Benatar M, Small GW, Mash D, Byrd G, Haines JL, Pericak-Vance MA, Züchner S. Repeat expansions in the C9ORF72 gene contribute to Alzheimer's disease in Caucasians. Neurobiol Aging 2012; 34:1519.e5-12. [PMID: 23107433 DOI: 10.1016/j.neurobiolaging.2012.10.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 10/01/2012] [Accepted: 10/02/2012] [Indexed: 12/12/2022]
Abstract
Recently, a hexanucleotide repeat expansion in the C9ORF72 gene has been identified to account for a significant portion of Caucasian families affected by frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS). Given the clinical overlap of FTD with Alzheimer's disease (AD), we hypothesized that C9ORF72 expansions might contribute to AD. In Caucasians, we found C9ORF72 expansions in the pathogenic range of FTD/ALS (>30 repeats) at a proportion of 0.76% in AD cases versus 0 in control subjects (p = 3.3E-03; 1182 cases, 1039 controls). In contrast, no large expansions were detected in individuals of African American ethnicity (291 cases, 620 controls). However, in the range of normal variation of C9ORF72 expansions (0-23 repeat copies), we detected significant differences in distribution and mean repeat counts between Caucasians and African Americans. Clinical and pathological re-evaluation of identified C9ORF72 expansion carriers revealed 9 clinical and/or autopsy confirmed AD and 2 FTD final diagnoses. Thus, our results support the notion that large C9ORF72 expansions lead to a phenotypic spectrum of neurodegenerative disease including AD.
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Affiliation(s)
- Martin A Kohli
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
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Pericak‐Vance M, Zuchner S, Kohli M, John‐Williams K, Naj A, Rajbhandary R, Whitehead PL, Hamilton‐Nelson K, Carney R, Wright C, Crocco E, Gwirtzman H, Lang R, Beecham G, Martin E, Gilbert J, Benatar M, Mash D, Byrd G, Haines J, Zuchner S. P4‐377: Large repeat expansions in the C9ORF72 gene contribute to a spectrum of neurodegenerative disorders including Alzheimer's disease in Caucasians, but not African‐Americans. Alzheimers Dement 2012. [DOI: 10.1016/j.jalz.2013.08.277] [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: 11/26/2022]
Affiliation(s)
| | - Stephan Zuchner
- University of MiamiMiller School of MedicineMiamiFloridaUnited States
| | - Martin Kohli
- HIHGUniversity of MiamiMiamiFloridaUnited States
| | - Krista John‐Williams
- John P. Hussman Institute of Human GenomicsUniversity of MiamiMiamiFloridaUnited States
| | - Adam Naj
- University of Miami Hussman Institute for Human GenomicsMiamiFloridaUnited States
| | | | - Patrice L. Whitehead
- John P. Hussman Institute of Human GenomicsUniversity of MiamiMiamiFloridaUnited States
| | | | - Regina Carney
- John P. Hussman Institute of Human GenomicsUniversity of MiamiMiamiFloridaUnited States
| | - Clinton Wright
- Evelyn F. McKnight Brain InstituteMiamiFloridaUnited States
| | | | - Harry Gwirtzman
- Center for Human Genetics ResearchNashvilleTennesseeUnited States
| | - Rosalyn Lang
- North Carolina Agricultural and Technical State UniversityGreensboroNorth CarolinaUnited States
| | | | - Eden Martin
- University of MiamiMiamiFloridaUnited States
| | | | - Michael Benatar
- University of MiamiMiller School of MedicineMiamiFloridaUnited States
| | - Deborah Mash
- University of MiamiDepartment of NeurologyMiamiFloridaUnited States
| | - Goldie Byrd
- North Carolina Agricultural and Technical State UniversityGreensboroNorth CarolinaUnited States
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Haines J, Naj A, Kohli M, Hamilton‐Nelson K, Rajbhandary R, Whitehead PL, Carney R, Crocco E, Wright C, Beecham G, Martin E, Gilbert J, Zuchner S, Pericak‐Vance M, Levin B. O5‐03‐01: Deep resequencing of 9 confirmed late‐onset Alzheimer's disease (LOAD) loci identifies multiple genomic regions with potentially functional variants. Alzheimers Dement 2012. [DOI: 10.1016/j.jalz.2012.05.1981] [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: 10/28/2022]
Affiliation(s)
- Jonathan Haines
- Vanderbilt University Medical CenterNashvilleTennesseeUnited States
| | - Adam Naj
- University of Miami Hussman Institute for Human GenomicsMiamiFloridaUnited States
| | - Martin Kohli
- University of Miami Hussman Institute for Human GenomicsMiamiFloridaUnited States
| | | | | | | | | | - Elizabeth Crocco
- Department of PsychiatryUniversity of MiamiMiamiFloridaUnited States
| | - Clinton Wright
- Department of NeurologyUniversity of MiamiMiamiFloridaUnited States
| | | | - Eden Martin
- University of Miami Hussman Institute for Human GenomicsMiamiFloridaUnited States
| | | | | | | | - Bonnie Levin
- Department of NeurologyUniversity of MiamiMiamiFloridaUnited States
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Loewenstein DA, Acevedo A, Small BJ, Agron J, Crocco E, Duara R. Stability of different subtypes of mild cognitive impairment among the elderly over a 2- to 3-year follow-up period. Dement Geriatr Cogn Disord 2009; 27:418-23. [PMID: 19365121 PMCID: PMC2814021 DOI: 10.1159/000211803] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2009] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND/AIMS To investigate the longitudinal stability and progression of different subtypes of mild cognitive impairment (MCI) in older adults. METHODS We classified 217 individuals with no cognitive impairment (NCI), amnestic MCI (aMCI) based on a single test (aMCI-1) or multiple tests (aMCI-2+), nonamnestic MCI (naMCI) based on a single test (naMCI-1) or multiple tests (naMCI-2+), or amnestic + nonamnestic MCI (a+naMCI), using their baseline neuropsychological test scores, and performed annual follow-up evaluations for up to 3 years. RESULTS None of the subjects with aMCI-2+ reverted to normal during follow-up, with 50% of these subjects remaining stable and 50% worsening over time. Similarly, less than 20% of subjects with aMCI-2+ and a+naMCI reverted to NCI during the follow-up period, whereas 50% of aMCI-1 and 37% with naMCI-1 reverted to NCI during this same period. CONCLUSION Reversion to NCI occurs much more frequently when the diagnosis of MCI is based on the results of a single neuropsychological test than when it is based on the results of more memory tests. In epidemiological studies and clinical trials the diagnosis of MCI will likely be more stable if impairment on more than one test is required for amnestic and/or nonamnestic domains.
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Affiliation(s)
- David A. Loewenstein
- Wein Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, Fla., and Department of Neurology, University of Miami, Tampa, Fla., USA,Center on Aging and Departments of Neurology and Psychiatry and Behavioral Sciences, Tampa, Fla., USA,Byrd Alzheimer's Center and Research Institute, Tampa, Fla., USA,*David Loewenstein, PhD, MRI Bldg, 2nd Floor, 4300 Alton Rd, Miami Beach, FL 33140 (USA), Fax +1 305 532 5241, E-Mail
| | - Amarilis Acevedo
- Center on Aging and Departments of Neurology and Psychiatry and Behavioral Sciences, Tampa, Fla., USA,Byrd Alzheimer's Center and Research Institute, Tampa, Fla., USA
| | - Brent J. Small
- Byrd Alzheimer's Center and Research Institute, Tampa, Fla., USA,University of South Florida, Tampa, Fla., USA
| | - Joscelyn Agron
- Center on Aging and Departments of Neurology and Psychiatry and Behavioral Sciences, Tampa, Fla., USA,Byrd Alzheimer's Center and Research Institute, Tampa, Fla., USA
| | - Elizabeth Crocco
- Center on Aging and Departments of Neurology and Psychiatry and Behavioral Sciences, Tampa, Fla., USA
| | - Ranjan Duara
- Wein Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, Fla., and Department of Neurology, University of Miami, Tampa, Fla., USA,Departments of Medicine, Neurology and Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami School of Medicine, Miami, Fla., Tampa, Fla., USA
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Loewenstein DA, Acevedo A, Agron J, Issacson R, Strauman S, Crocco E, Barker WW, Duara R. Cognitive profiles in Alzheimer's disease and in mild cognitive impairment of different etiologies. Dement Geriatr Cogn Disord 2006; 21:309-15. [PMID: 16490966 DOI: 10.1159/000091522] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2005] [Indexed: 11/19/2022] Open
Abstract
There has been increasing interest in determining whether amnestic, nonamnestic and multiple-domain subtypes of mild cognitive impairment (MCI) reflect different disease etiologies. In this study, we examined the extent to which cognitive profiles of nondemented patients with MCI diagnosed with prodromal Alzheimer's disease (AD) differed from those MCI patients diagnosed with vascular disease. We also compared these diagnostic groups to mildly demented patients diagnosed with AD and normal elderly controls. Results indicate that a majority of both MCI-AD and MCI-vascular patients experienced amnestic features and that multiple-domain was the most common presentation. MCI-AD and MCI-vascular groups did not differ on neuropsychological measures tapping memory, language, visuospatial skills/praxis or executive function. Further both MCI groups could be distinguished from dementia patients with regards to performance on measures of memory but not on non-memory measures. Considerable variability was observed in the degree of memory impairment among MCI patients with scores as much as 6 standard deviations below expected mean values. MCI-AD and MCI-vascular patients frequently exhibit both common and overlapping amnestic and nonamnestic features. The implication of these findings for future clinical research is discussed.
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Affiliation(s)
- David A Loewenstein
- Wein Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, Fla, USA.
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Abstract
Medication adherence is a substantial problem in the elderly. It may be even more important among elderly persons with memory problems, since other factors that lead to non-adherence may be compounded with the memory problems themselves. The objective was to determine whether a model that integrates research on medication adherence from several research domains is useful in understanding adherence in elderly patients. The methodology involved a cross-sectional observational study using a convenience sample of 63 patients drawn from a university-affiliated outpatient memory disorders clinic. The primary measure of medication adherence was caregivers' reports of patients' medication adherence. Patients and their caregivers were asked questions assessing their beliefs about the seriousness of each condition for which a medication was prescribed and the likely outcome of that condition without treatment. Additional data collected included presence of side effects, total number of medications taken, and patients' mood and cognitive status. Multilevel path analysis confirmed several model-based predictions. Caregivers' reports of adherence were predicted by estimates of disease outcome, the presence of side effects, and patients' relying on themselves to remember to take medications. Results partially confirm the integrative model in understanding medication adherence in these patients. Patients' beliefs about the likely effect of medication treatment for their condition and the presence of side effects influence reported medication adherence. Results thus suggest that efforts to educate patients about the likely response of their medical condition to treatment and to assess and deal with medication side effects might improve patient adherence.
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Affiliation(s)
- R L Ownby
- Department of Psychology, Georgia Institute of Technology, Atlanta, USA.
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Ownby RL, Crocco E, Acevedo A, John V, Loewenstein D. Depression and risk for Alzheimer disease: systematic review, meta-analysis, and metaregression analysis. ACTA ACUST UNITED AC 2006; 63:530-8. [PMID: 16651510 PMCID: PMC3530614 DOI: 10.1001/archpsyc.63.5.530] [Citation(s) in RCA: 956] [Impact Index Per Article: 53.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CONTEXT A history of depression may increase risk for developing Alzheimer disease (AD) later in life. Clarifying this relation might improve understanding of risk factors for and disease mechanisms in AD. OBJECTIVE To systematically review and complete a meta-analysis on the relation of depression and AD. DATA SOURCES We conducted electronic bibliographic searches of MEDLINE, PsychLit, EMBASE, and BIOSIS using search terms sensitive to studies of etiology combined with searches on terms related to depression and AD and reviewed reference lists of articles. STUDY SELECTION Studies with data contrasting depressed vs nondepressed patients who did and did not later develop AD were included. Studies that related continuous measures of depression and cognitive status were excluded. DATA EXTRACTION Numerical data were independently extracted by 3 reviewers. They also rated studies on a scale that assessed quality indicators for observational studies. Data on the interval between observation of depression and the diagnosis of AD were collected when available. DATA SYNTHESIS Meta-analytic evaluation with random-effects models resulted in pooled odds ratios of 2.03 (95% confidence interval, 1.73-2.38) for case-control and of 1.90 (95% confidence interval, 1.55-2.33) for cohort studies. Findings of increased risk were robust to sensitivity analyses. Interval between diagnoses of depression and AD was positively related to increased risk of developing AD, suggesting that rather than a prodrome, depression may be a risk factor for AD. CONCLUSIONS A history of depression may confer an increased risk for later developing AD. This relation may reflect an independent risk factor for the disease.
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Affiliation(s)
- Raymond L Ownby
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Fla 33140, USA.
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