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Petersen M, Coenen M, DeCarli C, De Luca A, van der Lelij E, Barkhof F, Benke T, Chen CPLH, Dal-Bianco P, Dewenter A, Duering M, Enzinger C, Ewers M, Exalto LG, Fletcher EF, Franzmeier N, Hilal S, Hofer E, Koek HL, Maier AB, Maillard PM, McCreary CR, Papma JM, Pijnenburg YAL, Schmidt R, Smith EE, Steketee RME, van den Berg E, van der Flier WM, Venkatraghavan V, Venketasubramanian N, Vernooij MW, Wolters FJ, Xu X, Horn A, Patil KR, Eickhoff SB, Thomalla G, Biesbroek JM, Biessels GJ, Cheng B. Enhancing Cognitive Performance Prediction through White Matter Hyperintensity Connectivity Assessment: A Multicenter Lesion Network Mapping Analysis of 3,485 Memory Clinic Patients. medRxiv 2024:2024.03.28.24305007. [PMID: 38586023 PMCID: PMC10996741 DOI: 10.1101/2024.03.28.24305007] [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] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Introduction White matter hyperintensities of presumed vascular origin (WMH) are associated with cognitive impairment and are a key imaging marker in evaluating cognitive health. However, WMH volume alone does not fully account for the extent of cognitive deficits and the mechanisms linking WMH to these deficits remain unclear. We propose that lesion network mapping (LNM), enables to infer if brain networks are connected to lesions, and could be a promising technique for enhancing our understanding of the role of WMH in cognitive disorders. Our study employed this approach to test the following hypotheses: (1) LNM-informed markers surpass WMH volumes in predicting cognitive performance, and (2) WMH contributing to cognitive impairment map to specific brain networks. Methods & results We analyzed cross-sectional data of 3,485 patients from 10 memory clinic cohorts within the Meta VCI Map Consortium, using harmonized test results in 4 cognitive domains and WMH segmentations. WMH segmentations were registered to a standard space and mapped onto existing normative structural and functional brain connectome data. We employed LNM to quantify WMH connectivity across 480 atlas-based gray and white matter regions of interest (ROI), resulting in ROI-level structural and functional LNM scores. The capacity of total and regional WMH volumes and LNM scores in predicting cognitive function was compared using ridge regression models in a nested cross-validation. LNM scores predicted performance in three cognitive domains (attention and executive function, information processing speed, and verbal memory) significantly better than WMH volumes. LNM scores did not improve prediction for language functions. ROI-level analysis revealed that higher LNM scores, representing greater disruptive effects of WMH on regional connectivity, in gray and white matter regions of the dorsal and ventral attention networks were associated with lower cognitive performance. Conclusion Measures of WMH-related brain network connectivity significantly improve the prediction of current cognitive performance in memory clinic patients compared to WMH volume as a traditional imaging marker of cerebrovascular disease. This highlights the crucial role of network effects, particularly in attentionrelated brain regions, improving our understanding of vascular contributions to cognitive impairment. Moving forward, refining WMH information with connectivity data could contribute to patient-tailored therapeutic interventions and facilitate the identification of subgroups at risk of cognitive disorders.
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Affiliation(s)
- Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mirthe Coenen
- University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | | | - Alberto De Luca
- University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
- Image Sciences Institute, Division Imaging and Oncology, UMC Utrecht
| | | | | | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, the Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, UK
| | - Thomas Benke
- Clinic of Neurology, Medical University Innsbruck, Austria
| | - Christopher P. L. H. Chen
- Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Memory, Aging and Cognition Center, National University Health System, Singapore
| | | | - Anna Dewenter
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
- Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Christian Enzinger
- Division of General Neurology, Department of Neurology, Medical University Graz, Austria
- Division of Neuroradiology, Interventional and Vascular Radiology, Department of Radiology, Medical University of Graz, Austria
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
| | - Lieza G. Exalto
- University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | | | - Nicolai Franzmeier
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
| | - Saima Hilal
- Memory, Aging and Cognition Center, National University Health System, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Edith Hofer
- Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Austria
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria
| | - Huiberdina L. Koek
- University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Andrea B. Maier
- Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Memory, Aging and Cognition Center, National University Health System, Singapore
| | | | - Cheryl R. McCreary
- Department of Clinical Neurosciences and Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Janne M. Papma
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Yolande A. L. Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Reinhold Schmidt
- Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Austria
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria
| | - Eric E. Smith
- Department of Clinical Neurosciences and Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Rebecca M. E. Steketee
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Esther van den Berg
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Vikram Venkatraghavan
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Narayanaswamy Venketasubramanian
- Memory, Aging and Cognition Center, National University Health System, Singapore
- Raffles Neuroscience Center, Raffles Hospital, Singapore, Singapore
| | - Meike W. Vernooij
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Frank J. Wolters
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Xin Xu
- Memory, Aging and Cognition Center, National University Health System, Singapore
- School of Public Health and the Second Affiliated Hospital of School of Medicine, Zhejiang University, China
| | - Andreas Horn
- Charité - Universitätsmedizin Berlin, Movement Disorders and Neuromodulation Unit, Department of Neurology with Experimental Neurology, 10117 Berlin, Germany
- Center for Brain Circuit Therapeutics, Department of Neurology, Psychiatry, and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Kaustubh R. Patil
- Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Jülich, Germany
| | - Simon B. Eickhoff
- Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Jülich, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J. Matthijs Biesbroek
- University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
- Department of Neurology, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Geert Jan Biessels
- University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Wolters FJ, Labrecque JA. Potential impact of unblinding on observed treatment effects in Alzheimer's disease trials. Alzheimers Dement 2024; 20:3119-3125. [PMID: 38380503 PMCID: PMC11032516 DOI: 10.1002/alz.13690] [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: 09/13/2023] [Revised: 11/22/2023] [Accepted: 12/13/2023] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Adverse effects of monoclonal antibodies against amyloid beta are common, and may affect validity of randomized controlled trials (RCTs) through unblinding of participants. METHODS We used observations from published phase 3 RCTs in Alzheimer's disease to calculate the magnitude of unblinding effects on cognition that would be required to explain observed cognitive benefits in RCTs. RESULTS In trials of lecanemab, aducanumab, and donanemab, incidence of amyloid-related imaging abnormalities with active treatment ranged from 22% to 44%, the vast majority of which presumably led to unblinding. Effects of unblinding on the Clinical Dementia Rating Sum of Boxes required to fully explain observed drug effects ranged from 1.1 point (95% confidence interval: 0.2-2.0) with aducanumab, to 3.3 points (2.1-4.4) with donanemab and 3.7 points (2.0-5.6) with lecanemab. Infusion-related reactions were common, with potential unblinding effects particularly for lecanemab. Similar patterns were observed for the Alzheimer's Disease Assessment Scale Cognitive subscale. DISCUSSION Psychological treatment effects due to unblinding may explain a substantial share of observed treatment effects in RCTs.
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Affiliation(s)
- Frank J. Wolters
- Department of EpidemiologyErasmus MC – University Medical Centre RotterdamRotterdamthe Netherlands
- Department of Radiology & Nuclear MedicineErasmus MC – University Medical Centre RotterdamRotterdamthe Netherlands
| | - Jeremy A. Labrecque
- Department of EpidemiologyErasmus MC – University Medical Centre RotterdamRotterdamthe Netherlands
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Biesbroek JM, Coenen M, DeCarli C, Fletcher EM, Maillard PM, Barkhof F, Barnes J, Benke T, Chen CPLH, Dal‐Bianco P, Dewenter A, Duering M, Enzinger C, Ewers M, Exalto LG, Franzmeier N, Hilal S, Hofer E, Koek HL, Maier AB, McCreary CR, Papma JM, Paterson RW, Pijnenburg YAL, Rubinski A, Schmidt R, Schott JM, Slattery CF, Smith EE, Sudre CH, Steketee RME, Teunissen CE, van den Berg E, van der Flier WM, Venketasubramanian N, Venkatraghavan V, Vernooij MW, Wolters FJ, Xin X, Kuijf HJ, Biessels GJ. Amyloid pathology and vascular risk are associated with distinct patterns of cerebral white matter hyperintensities: A multicenter study in 3132 memory clinic patients. Alzheimers Dement 2024; 20:2980-2989. [PMID: 38477469 PMCID: PMC11032573 DOI: 10.1002/alz.13765] [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: 10/30/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION White matter hyperintensities (WMH) are associated with key dementia etiologies, in particular arteriolosclerosis and amyloid pathology. We aimed to identify WMH locations associated with vascular risk or cerebral amyloid-β1-42 (Aβ42)-positive status. METHODS Individual patient data (n = 3,132; mean age 71.5 ± 9 years; 49.3% female) from 11 memory clinic cohorts were harmonized. WMH volumes in 28 regions were related to a vascular risk compound score (VRCS) and Aß42 status (based on cerebrospinal fluid or amyloid positron emission tomography), correcting for age, sex, study site, and total WMH volume. RESULTS VRCS was associated with WMH in anterior/superior corona radiata (B = 0.034/0.038, p < 0.001), external capsule (B = 0.052, p < 0.001), and middle cerebellar peduncle (B = 0.067, p < 0.001), and Aß42-positive status with WMH in posterior thalamic radiation (B = 0.097, p < 0.001) and splenium (B = 0.103, p < 0.001). DISCUSSION Vascular risk factors and Aß42 pathology have distinct signature WMH patterns. This regional vulnerability may incite future studies into how arteriolosclerosis and Aß42 pathology affect the brain's white matter. HIGHLIGHTS Key dementia etiologies may be associated with specific patterns of white matter hyperintensities (WMH). We related WMH locations to vascular risk and cerebral Aβ42 status in 11 memory clinic cohorts. Aβ42 positive status was associated with posterior WMH in splenium and posterior thalamic radiation. Vascular risk was associated with anterior and infratentorial WMH. Amyloid pathology and vascular risk have distinct signature WMH patterns.
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Vom Hofe I, Stricker BH, Vernooij MW, Ikram MK, Ikram MA, Wolters FJ. Antidepressant use in relation to dementia risk, cognitive decline, and brain atrophy. Alzheimers Dement 2024. [PMID: 38561253 DOI: 10.1002/alz.13807] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/01/2024] [Accepted: 02/26/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION We aimed to assess the effect of antidepressant use on dementia risk, cognitive decline, and brain atrophy. METHODS In this prospective cohort study, we included 5511 dementia-free participants (Mini-Mental State Examination [MMSE] > 25) of the Rotterdam study (57.5% women, mean age 70.6 years). Antidepressant use was extracted from pharmacy records from 1991 until baseline (2002-2008). Incident dementia was monitored from baseline until 2018, with repeated cognitive assessment and magnetic resonance imaging (MRI) every 4 years. RESULTS Compared to never use, any antidepressant use was not associated with dementia risk (hazard ratio [HR] 1.14, 95% confidence interval [CI] 0.92-1.41), or with accelerated cognitive decline or atrophy of white and gray matter. Compared to never use, dementia risk was somewhat higher with tricyclic antidepressants (HR 1.36, 95% CI 1.01-1.83) than with selective serotonin reuptake inhibitors (HR 1.12, 95% CI 0.81-1.54), but without dose-response relationships, accelerated cognitive decline, or atrophy in either group. DISCUSSION Antidepressant medication in adults without indication of cognitive impairment was not consistently associated with long-term adverse cognitive effects. HIGHLIGHTS Antidepressant medications are frequently prescribed, especially among older adults. In this study, antidepressant use was not associated with long-term dementia risk. Antidepressant use was not associated with cognitive decline or brain atrophy. Our results support safe prescription in an older, cognitively healthy population.
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Affiliation(s)
- Ilse Vom Hofe
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine and Alzheimer Centre Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine and Alzheimer Centre Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
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Kelly L, Brown C, Michalik D, Hawkes CA, Aldea R, Agarwal N, Salib R, Alzetani A, Ethell DW, Counts SE, de Leon M, Fossati S, Koronyo‐Hamaoui M, Piazza F, Rich SA, Wolters FJ, Snyder H, Ismail O, Elahi F, Proulx ST, Verma A, Wunderlich H, Haack M, Dodart JC, Mazer N, Carare RO. Clearance of interstitial fluid (ISF) and CSF (CLIC) group-part of Vascular Professional Interest Area (PIA), updates in 2022-2023. Cerebrovascular disease and the failure of elimination of Amyloid-β from the brain and retina with age and Alzheimer's disease: Opportunities for therapy. Alzheimers Dement 2024; 20:1421-1435. [PMID: 37897797 PMCID: PMC10917045 DOI: 10.1002/alz.13512] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 10/30/2023]
Abstract
This editorial summarizes advances from the Clearance of Interstitial Fluid and Cerebrospinal Fluid (CLIC) group, within the Vascular Professional Interest Area (PIA) of the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART). The overarching objectives of the CLIC group are to: (1) understand the age-related physiology changes that underlie impaired clearance of interstitial fluid (ISF) and cerebrospinal fluid (CSF) (CLIC); (2) understand the cellular and molecular mechanisms underlying intramural periarterial drainage (IPAD) in the brain; (3) establish novel diagnostic tests for Alzheimer's disease (AD), cerebral amyloid angiopathy (CAA), retinal amyloid vasculopathy, amyloid-related imaging abnormalities (ARIA) of spontaneous and iatrogenic CAA-related inflammation (CAA-ri), and vasomotion; and (4) establish novel therapies that facilitate IPAD to eliminate amyloid β (Aβ) from the aging brain and retina, to prevent or reduce AD and CAA pathology and ARIA side events associated with AD immunotherapy.
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Affiliation(s)
- Louise Kelly
- Faculty of MedicineUniversity of SouthamptonSouthamptonHampshireUK
| | | | - Daniel Michalik
- Faculty of MedicineUniversity of SouthamptonSouthamptonHampshireUK
| | | | - Roxana Aldea
- Roche Pharma Research & Early DevelopmentRoche Innovation Center BaselBaselSwitzerland
| | - Nivedita Agarwal
- Neuroradiology sectionScientific Institute IRCCS Eugenio MedeaBosisio Parini, LCItaly
| | - Rami Salib
- Faculty of MedicineUniversity of SouthamptonSouthamptonHampshireUK
| | - Aiman Alzetani
- Faculty of MedicineUniversity of SouthamptonSouthamptonHampshireUK
| | | | - Scott E. Counts
- Dept. Translational NeuroscienceDept. Family MedicineMichigan State UniversityGrand RapidsMichiganUSA
| | - Mony de Leon
- Brain Health Imaging InstituteDepartment of RadiologyWeill Cornell MedicineNew YorkNew YorkUSA
| | | | - Maya Koronyo‐Hamaoui
- Departments of NeurosurgeryNeurology, and Biomedical SciencesMaxine Dunitz Neurosurgical Research InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | | | | | | | - Heather Snyder
- Alzheimer's AssociationMedical & Scientific RelationsChicagoIllinoisUSA
| | - Ozama Ismail
- Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Fanny Elahi
- Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | | | - Ajay Verma
- Formation Venture Engineering FoundryTopsfieldMassachusettsUSA
| | | | | | | | | | - Roxana O. Carare
- Faculty of MedicineUniversity of SouthamptonSouthamptonHampshireUK
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Krefman AE, Stephen J, Carolan P, Sedaghat S, Mansolf M, Soumare A, Gross AL, Aiello AE, Singh-Manoux A, Ikram MA, Helmer C, Tzourio C, Satizabal C, Levine DA, Lloyd-Jones D, Briceño EM, Sorond FA, Wolters FJ, Himali J, Launer LJ, Zhao L, Haan M, Lopez OL, Debette S, Seshadri S, Judd SE, Hughes TM, Gudnason V, Scholtens D, Allen NB. Cohort Profile: Dementia Risk Prediction Project (DRPP). Int J Epidemiol 2024; 53:dyae012. [PMID: 38339864 PMCID: PMC10858348 DOI: 10.1093/ije/dyae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Affiliation(s)
- Amy E Krefman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John Stephen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Padraig Carolan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sanaz Sedaghat
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Maxwell Mansolf
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Aïcha Soumare
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allison E Aiello
- Robert N Butler Columbia Aging Center and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Archana Singh-Manoux
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Catherine Helmer
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, CHU Bordeaux, Bordeaux, France
| | - Christophe Tzourio
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, CHU Bordeaux, Bordeaux, France
| | - Claudia Satizabal
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases and Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX, USA
- The Framingham Heart Study, Framingham, MA, USA
| | - Deborah A Levine
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily M Briceño
- Department of Physical Medicine & Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Farzaneh A Sorond
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Departments of Radiology & Nuclear Medicine, and Alzheimer Centre Erasmus MC, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Jayandra Himali
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases and Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX, USA
- The Framingham Heart Study, Framingham, MA, USA
| | - Lenore J Launer
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mary Haan
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Oscar L Lopez
- Departments of Neurology and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stéphanie Debette
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases and Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX, USA
- The Framingham Heart Study, Framingham, MA, USA
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy M Hughes
- Departments of Internal Medicine and Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Denise Scholtens
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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van den Beukel TC, Wolters FJ, Siebert U, Spiering W, Ikram MA, Vernooij MW, de Jong PA, Bos D. Intracranial arteriosclerosis and the risk of dementia: A population-based cohort study. Alzheimers Dement 2024; 20:869-879. [PMID: 37814499 PMCID: PMC10916985 DOI: 10.1002/alz.13496] [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: 06/17/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND The impact of intracranial arteriosclerosis on dementia remains largely unclear. METHODS In 2339 stroke-free and dementia-free participants (52.2% women, mean age 69.5 years) from the general population, we assessed intracranial carotid artery calcification (ICAC) and vertebrobasilar artery calcification (VBAC) as proxy for arteriosclerosis. Associations with dementia were assessed using Cox models. In addition, indirect effects through cerebral small vessel disease (cSVD) and subcortical brain structure volumes were assessed using causal mediation analyses. RESULTS During a median of 13.4 years (25th-75th percentiles 9.9-14.5) of follow-up, 282 participants developed dementia. Both ICAC presence (hazard ratio [HR]: 1.53, 95% confidence interval [CI]: 1.00-2.32]) and volume (HR per standard deviation: 1.19, 95% CI: 1.01-1.40) increased dementia risk. For VBAC, severe calcifications increased dementia risk (HR for third vs first volume tertile: 1.89, 95% CI: 1.00-3.59). These effects were mediated partly through increased cSVD (percentage mediated for ICAC: 13% and VBAC: 24%). DISCUSSION Intracranial arteriosclerosis increases the risk of dementia.
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Affiliation(s)
- Tim C. van den Beukel
- Department of EpidemiologyErasmus Medical CenterRotterdamCAThe Netherlands
- Department of Radiology and Nuclear MedicineErasmus Medical CenterRotterdamCAThe Netherlands
- Department of Radiology and Nuclear MedicineUniversity Medical Center UtrechtUtrechtGAThe Netherlands
| | - Frank J. Wolters
- Department of EpidemiologyErasmus Medical CenterRotterdamCAThe Netherlands
- Department of NeurologyErasmus Medical CenterRotterdamCAThe Netherlands
- Alzheimer CenterErasmus Medical CenterRotterdamCAThe Netherlands
| | - Uwe Siebert
- Center for Health Decision Science, Departments of Epidemiology and Health Policy & ManagementHarvard T.H. Chan School of Public Health, BostonBostonMassachusettsUSA
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology AssessmentUMIT TIROL ‐ University for Health Sciences and TechnologyAustria
- Program on Cardiovascular Research, Institute for Technology Assessment and Department of Radiology, Massachusetts General HospitalHarvard Medical School, BostonBostonMassachusettsUSA
| | - Wilko Spiering
- Department of Vascular MedicineUniversity Medical Center UtrechtUtrechtGAThe Netherlands
| | - M. Arfan Ikram
- Department of EpidemiologyErasmus Medical CenterRotterdamCAThe Netherlands
| | - Meike W. Vernooij
- Department of EpidemiologyErasmus Medical CenterRotterdamCAThe Netherlands
- Department of Radiology and Nuclear MedicineErasmus Medical CenterRotterdamCAThe Netherlands
| | - Pim A. de Jong
- Department of Radiology and Nuclear MedicineUniversity Medical Center UtrechtUtrechtGAThe Netherlands
| | - Daniel Bos
- Department of EpidemiologyErasmus Medical CenterRotterdamCAThe Netherlands
- Department of Radiology and Nuclear MedicineErasmus Medical CenterRotterdamCAThe Netherlands
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
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8
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van Arendonk J, Wolters FJ, Neitzel J, Vinke EJ, Vernooij MW, Ghanbari M, Ikram MA. Plasma neurofilament light chain in relation to 10-year change in cognition and neuroimaging markers: a population-based study. GeroScience 2024; 46:57-70. [PMID: 37535203 PMCID: PMC10828339 DOI: 10.1007/s11357-023-00876-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/10/2023] [Indexed: 08/04/2023] Open
Abstract
Neurofilament light chain (NfL) is a promising biomarker for risk stratification and disease monitoring of dementia, but its utility in the preclinical disease stage remains uncertain. We determined the association of plasma NfL with (change in) neuroimaging markers and cognition in the population-based Rotterdam Study, using linear and logistic regression and mixed-effects models. Plasma NfL levels were measured using the Simoa NF-light™ assay in 4705 dementia-free participants (mean age 71.9 years, 57% women), who underwent cognitive assessment and brain MRI with repeated assessments over a 10-year follow-up period. Higher plasma NfL was associated with worse cognitive performance at baseline (g-factor: β = - 0.12 (- 0.15; - 0.09), p < 0.001), and accelerated cognitive decline during follow-up on the Stroop color naming task (β = 0.04 (0.02; 0.06), p < 0.001), with a smaller trend for decline in global cognition (g-factor β = - 0.02 (- 0.04; 0.00), p = 0.044). In the subset of 975 participants with brain MRI, higher NfL was associated with poorer baseline white matter integrity (e.g., global mean diffusivity: β = 0.12 (0.06; 0.19), p < 0.001), with similar trends for volume of white matter hyperintensities (β = 0.09 (0.02; 0.16), p = 0.011) and presence of lacunes (OR = 1.55 (1.13; 2.14), p = 0.007). Plasma NfL was not associated with volumes or thickness of the total gray matter, hippocampus, or Alzheimer signature regions. In conclusion, higher plasma NfL levels are associated with cognitive decline and larger burden of primarily white matter pathology in the general population.
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Affiliation(s)
- Joyce van Arendonk
- Department of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, the Netherlands
| | - Frank J Wolters
- Department of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, the Netherlands
| | - Julia Neitzel
- Department of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, the Netherlands
- Department of Epidemiology, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Elisabeth J Vinke
- Department of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, the Netherlands
| | - Meike W Vernooij
- Department of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, the Netherlands
| | - Mohsen Ghanbari
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, the Netherlands.
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9
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Sudre CH, Van Wijnen K, Dubost F, Adams H, Atkinson D, Barkhof F, Birhanu MA, Bron EE, Camarasa R, Chaturvedi N, Chen Y, Chen Z, Chen S, Dou Q, Evans T, Ezhov I, Gao H, Girones Sanguesa M, Gispert JD, Gomez Anson B, Hughes AD, Ikram MA, Ingala S, Jaeger HR, Kofler F, Kuijf HJ, Kutnar D, Lee M, Li B, Lorenzini L, Menze B, Molinuevo JL, Pan Y, Puybareau E, Rehwald R, Su R, Shi P, Smith L, Tillin T, Tochon G, Urien H, van der Velden BHM, van der Velpen IF, Wiestler B, Wolters FJ, Yilmaz P, de Groot M, Vernooij MW, de Bruijne M. Where is VALDO? VAscular Lesions Detection and segmentatiOn challenge at MICCAI 2021. Med Image Anal 2024; 91:103029. [PMID: 37988921 DOI: 10.1016/j.media.2023.103029] [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: 07/01/2022] [Revised: 08/09/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
Imaging markers of cerebral small vessel disease provide valuable information on brain health, but their manual assessment is time-consuming and hampered by substantial intra- and interrater variability. Automated rating may benefit biomedical research, as well as clinical assessment, but diagnostic reliability of existing algorithms is unknown. Here, we present the results of the VAscular Lesions DetectiOn and Segmentation (Where is VALDO?) challenge that was run as a satellite event at the international conference on Medical Image Computing and Computer Aided Intervention (MICCAI) 2021. This challenge aimed to promote the development of methods for automated detection and segmentation of small and sparse imaging markers of cerebral small vessel disease, namely enlarged perivascular spaces (EPVS) (Task 1), cerebral microbleeds (Task 2) and lacunes of presumed vascular origin (Task 3) while leveraging weak and noisy labels. Overall, 12 teams participated in the challenge proposing solutions for one or more tasks (4 for Task 1-EPVS, 9 for Task 2-Microbleeds and 6 for Task 3-Lacunes). Multi-cohort data was used in both training and evaluation. Results showed a large variability in performance both across teams and across tasks, with promising results notably for Task 1-EPVS and Task 2-Microbleeds and not practically useful results yet for Task 3-Lacunes. It also highlighted the performance inconsistency across cases that may deter use at an individual level, while still proving useful at a population level.
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Affiliation(s)
- Carole H Sudre
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, University College London, London, United Kingdom; Centre for Medical Image Computing, University College London, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
| | - Kimberlin Van Wijnen
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Florian Dubost
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Hieab Adams
- Department of Clinical Genetics and Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - David Atkinson
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Frederik Barkhof
- Centre for Medical Image Computing, University College London, London, United Kingdom; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Mahlet A Birhanu
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Esther E Bron
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Robin Camarasa
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, University College London, London, United Kingdom
| | - Yuan Chen
- Department of Radiology, University of Massachusetts Medical School, Worcester, USA
| | - Zihao Chen
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Shuai Chen
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Qi Dou
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, China
| | - Tavia Evans
- Department of Clinical Genetics and Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Ivan Ezhov
- Department of Informatics, Technische Universitat Munchen, Munich, Germany; TranslaTUM - Central Institute for Translational Cancer Research, Technical University of Munich, Germany
| | - Haojun Gao
- Department of Radiology, Zhejiang University, Hangzhou, China
| | | | - Juan Domingo Gispert
- Barcelonaß Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red Bioingeniería, Biomateriales y Nanomedicina, (CIBER-BBN), Barcelona, Spain
| | | | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, University College London, London, United Kingdom
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Silvia Ingala
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - H Rolf Jaeger
- Institute of Neurology, University College London, London, United Kingdom
| | - Florian Kofler
- Department of Informatics, Technische Universitat Munchen, Munich, Germany; Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany; TranslaTUM - Central Institute for Translational Cancer Research, Technical University of Munich, Germany
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Denis Kutnar
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Bo Li
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Luigi Lorenzini
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Bjoern Menze
- Department of Informatics, Technische Universitat Munchen, Munich, Germany; Department of Quantitative Biomedicine, University of Zurich, Switzerland
| | - Jose Luis Molinuevo
- Barcelonaß Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain; H. Lundbeck A/S, Copenhagen, Denmark
| | - Yiwei Pan
- Department of Electronic and Information Engineering, Harbin Institute of Technology at Shenzhen, Shenzhen, China
| | | | - Rafael Rehwald
- Institute of Neurology, University College London, London, United Kingdom
| | - Ruisheng Su
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Pengcheng Shi
- Department of Electronic and Information Engineering, Harbin Institute of Technology at Shenzhen, Shenzhen, China
| | | | - Therese Tillin
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, University College London, London, United Kingdom
| | | | - Hélène Urien
- ISEP-Institut Supérieur d'Électronique de Paris, Issy-les-Moulineaux, France
| | | | - Isabelle F van der Velpen
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Frank J Wolters
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Pinar Yilmaz
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Marius de Groot
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands; GlaxoSmithKline Research, Stevenage, United Kingdom
| | - Meike W Vernooij
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Marleen de Bruijne
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands; Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
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10
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Frentz I, van Arendonk J, Leeuwis AE, Vernooij MW, van der Flier WM, Bos D, De Deyn PP, Wolters FJ, Ikram MA. Interaction Between Arteriosclerosis and Amyloid-β on Cognitive Function. J Alzheimers Dis 2024; 97:953-961. [PMID: 38217596 PMCID: PMC10836547 DOI: 10.3233/jad-230604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Dementia is a multifactorial disease, with Alzheimer's disease (AD) and vascular pathology often co-occurring in many individuals with dementia. Yet, the interplay between AD and vascular pathology in cognitive decline is largely undetermined. OBJECTIVE The aim of the present study was to examine the joint effect of arteriosclerosis and AD pathology on cognition in the general population without dementia. METHODS We determined the interaction between blood-based AD biomarkers and CT-defined arteriosclerosis on cognition in 2,229 dementia-free participants of the population-based Rotterdam Study (mean age: 68.9 years, 52% women) cross-sectionally. RESULTS Amyloid-β (Aβ)42 and arterial calcification were associated with cognitive performance. After further adjustment for confounders in a model that combined all biomarkers, only arterial calcification remained independently associated with cognition. There was a significant interaction between arterial calcification and Aβ42 and between arterial calcification and the ratio of Aβ42/40. Yet, estimates attenuated, and interactions were no longer statistically significant after adjustment for cardio metabolic risk factors. CONCLUSIONS Arteriosclerosis and AD display additive interaction-effects on cognition in the general population, that are due in part to cardio metabolic risk factors. These findings suggest that joint assessment of arteriosclerosis and AD pathology is important for understanding of disease etiology in individuals with cognitive impairment.
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Affiliation(s)
- Ingeborg Frentz
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Neurology, UMCG, Groningen, The Netherlands
| | - Joyce van Arendonk
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus MC, GD Rotterdam, The Netherlands
| | - Anna E. Leeuwis
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Meike W. Vernooij
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus MC, GD Rotterdam, The Netherlands
| | - Wiesje M. van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Epidemiology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Daniel Bos
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus MC, GD Rotterdam, The Netherlands
| | - Peter Paul De Deyn
- Department of Neurology, UMCG, Groningen, The Netherlands
- Alzheimer Centre Groningen, UMCG, Groningen, The Netherlands
| | - Frank J. Wolters
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus MC, GD Rotterdam, The Netherlands
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
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11
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Coenen M, Biessels GJ, DeCarli C, Fletcher EF, Maillard PM, Barkhof F, Barnes J, Benke T, Boomsma JMF, P L H Chen C, Dal-Bianco P, Dewenter A, Duering M, Enzinger C, Ewers M, Exalto LG, Franzmeier N, Groeneveld O, Hilal S, Hofer E, Koek HL, Maier AB, McCreary CR, Papma JM, Paterson RW, Pijnenburg YAL, Rubinski A, Schmidt R, Schott JM, Slattery CF, Smith EE, Sudre CH, Steketee RME, van den Berg E, van der Flier WM, Venketasubramanian N, Vernooij MW, Wolters FJ, Xin X, Biesbroek JM, Kuijf HJ. Spatial distributions of white matter hyperintensities on brain MRI: A pooled analysis of individual participant data from 11 memory clinic cohorts. Neuroimage Clin 2023; 40:103547. [PMID: 38035457 PMCID: PMC10698002 DOI: 10.1016/j.nicl.2023.103547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/03/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION The spatial distribution of white matter hyperintensities (WMH) on MRI is often considered in the diagnostic evaluation of patients with cognitive problems. In some patients, clinicians may classify WMH patterns as "unusual", but this is largely based on expert opinion, because detailed quantitative information about WMH distribution frequencies in a memory clinic setting is lacking. Here we report voxel wise 3D WMH distribution frequencies in a large multicenter dataset and also aimed to identify individuals with unusual WMH patterns. METHODS Individual participant data (N = 3525, including 777 participants with subjective cognitive decline, 1389 participants with mild cognitive impairment and 1359 patients with dementia) from eleven memory clinic cohorts, recruited through the Meta VCI Map Consortium, were used. WMH segmentations were provided by participating centers or performed in Utrecht and registered to the Montreal Neurological Institute (MNI)-152 brain template for spatial normalization. To determine WMH distribution frequencies, we calculated WMH probability maps at voxel level. To identify individuals with unusual WMH patterns, region-of-interest (ROI) based WMH probability maps, rule-based scores, and a machine learning method (Local Outlier Factor (LOF)), were implemented. RESULTS WMH occurred in 82% of voxels from the white matter template with large variation between subjects. Only a small proportion of the white matter (1.7%), mainly in the periventricular areas, was affected by WMH in at least 20% of participants. A large portion of the total white matter was affected infrequently. Nevertheless, 93.8% of individual participants had lesions in voxels that were affected in less than 2% of the population, mainly located in subcortical areas. Only the machine learning method effectively identified individuals with unusual patterns, in particular subjects with asymmetric WMH distribution or with WMH at relatively rarely affected locations despite common locations not being affected. DISCUSSION Aggregating data from several memory clinic cohorts, we provide a detailed 3D map of WMH lesion distribution frequencies, that informs on common as well as rare localizations. The use of data-driven analysis with LOF can be used to identify unusual patterns, which might serve as an alert that rare causes of WMH should be considered.
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Affiliation(s)
- Mirthe Coenen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands.
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Charles DeCarli
- Department of Neurology, University of California at Davis, USA
| | - Evan F Fletcher
- Department of Neurology, University of California at Davis, USA
| | | | - Frederik Barkhof
- Radiology & Nuclear Medicine, Amsterdam UMC, Location Vrije Universiteit, the Netherlands; UCL Institute of Neurology, London, UK
| | - Josephine Barnes
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Thomas Benke
- Clinic of Neurology, Medical University Innsbruck, Austria
| | - Jooske M F Boomsma
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Christopher P L H Chen
- Department of Pharmacology, National University of Singapore, Singapore, Singapore; Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
| | | | - Anna Dewenter
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany; Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Christian Enzinger
- Division of General Neurology, Department of Neurology, Medical University Graz, Austria; Division of Neuroradiology, Interventional and Vascular Radiology, Department of Radiology, Medical University of Graz, Austria
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Lieza G Exalto
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Nicolai Franzmeier
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Onno Groeneveld
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands; Department of Neurology, Isala, Meppel, the Netherlands
| | - Saima Hilal
- Department of Pharmacology, National University of Singapore, Singapore, Singapore; Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Edith Hofer
- Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Austria; Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria
| | - Huiberdina L Koek
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Andrea B Maier
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore; Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore; Department of Clinical Neurosciences and Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl R McCreary
- Department of Clinical Neurosciences and Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Janne M Papma
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Ross W Paterson
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Yolande A L Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Anna Rubinski
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Reinhold Schmidt
- Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Austria
| | - Jonathan M Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Catherine F Slattery
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Eric E Smith
- Department of Clinical Neurosciences and Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Carole H Sudre
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK; Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK; School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Rebecca M E Steketee
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Esther van den Berg
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Narayanaswamy Venketasubramanian
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore; Raffles Neuroscience Center, Raffles Hospital, Singapore, Singapore
| | - Meike W Vernooij
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Frank J Wolters
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Xu Xin
- Department of Pharmacology, National University of Singapore, Singapore, Singapore; Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
| | - J Matthijs Biesbroek
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands; Department of Neurology, Diakonessenhuis Hospital, Utrecht, the Netherlands
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
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12
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Wiersinga JHI, Rhodius-Meester HFM, Wolters FJ, Trappenburg MC, Lemstra AW, Barkhof F, Peters MJL, van der Flier WM, Muller M. Orthostatic hypotension and its association with cerebral small vessel disease in a memory clinic population. J Hypertens 2023; 41:1738-1744. [PMID: 37589676 DOI: 10.1097/hjh.0000000000003525] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
BACKGROUND Orthostatic hypotension (OH), an impaired blood pressure (BP) response to postural change, has been associated with cognitive decline and dementia, possibly through cerebral small vessel disease (CSVD). We hypothesized that longer duration of BP drop and a larger BP drop is associated with increased risk of CSVD. METHODS This cross-sectional study included 3971 memory clinic patients (mean age 68 years, 45% female, 42% subjective cognitive complaints, 17% mild cognitive impairment, 41% dementia) from the Amsterdam Ageing Cohort and Amsterdam Dementia Cohort. Early OH (EOH) was defined as a drop in BP of ±20 mmHg systolic and/or 10 mmHg diastolic only at 1 min after standing, and delayed/prolonged OH (DPOH) at 1 and/or 3 min after standing. Presence of CSVD [white matter hyperintensities (WMH), lacunes, microbleeds] was assessed with MRI ( n = 3584) or CT brain (n = 389). RESULTS The prevalence of early OH was 9% and of delayed/prolonged OH 18%. Age- and sex-adjusted logistic regression analyses showed that delayed/prolonged OH, but not early OH, was significantly associated with a higher burden of WMH (OR, 95%CI: 1.21, 1.00-1.46) and lacunes (OR, 95%CI 1.34, 1.06-1.69), but not microbleeds (OR, 95%CI 1.22, 0.89-1.67). When adjusting for supine SBP, these associations attenuated (ORs, 95%CI for WMH 1.04, 0.85-1.27; for lacunes 1.21, 0.91-1.62; for microbleeds 0.95, 0.68-1.31). A larger drop in SBP was associated with increased risk of WMH and microbleeds, however, when adjusted for supine SBP, this effect diminished. CONCLUSIONS Among memory clinic patients, DPOH is more common than EOH. While longer duration and larger magnitude of BP drop coincided with a higher burden of CSVD, these associations were largely explained by high supine BP.
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Affiliation(s)
- Julia H I Wiersinga
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Internal Medicine section Geriatrics
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes
| | - Hanneke F M Rhodius-Meester
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Internal Medicine section Geriatrics
- Amsterdam UMC location Vrije Universiteit Amsterdam, Alzheimer Center Amsterdam & Department of Neurology, Amsterdam, The Netherlands
- Oslo University Hospital, Department of Geriatric Medicine, Ullevål, Oslo, Norway
| | - Frank J Wolters
- Erasmus Medical Center, Department of Epidemiology, Rotterdam
- Erasmus Medical Center, Departments of Radiology & Nuclear Medicine and Alzheimer Center Erasmus MC, Rotterdam, The Netherlands
| | - Marijke C Trappenburg
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Internal Medicine section Geriatrics
- Amstelland Hospital, Department of Internal Medicine section Geriatrics, Amstelveen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Radiology, Amsterdam, The Netherlands
| | - Afina W Lemstra
- Amsterdam UMC location Vrije Universiteit Amsterdam, Alzheimer Center Amsterdam & Department of Neurology, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Amsterdam UMC location Vrije Universiteit Amsterdam, Alzheimer Center Amsterdam & Department of Neurology, Amsterdam, The Netherlands
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- Amsterdam Neuroscience, Neurodegeneration, Brain Imaging, Amsterdam
| | - Mike J L Peters
- UMC Utrecht, University of Utrecht, Department of Internal Medicine section Geriatrics, Utrecht
| | - Wiesje M van der Flier
- Amsterdam UMC location Vrije Universiteit Amsterdam, Alzheimer Center Amsterdam & Department of Neurology, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Brain Imaging, Amsterdam
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam
| | - Majon Muller
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Internal Medicine section Geriatrics
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes
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Brück CC, Wolters FJ, Ikram MA, de Kok IMCM. Projections of costs and quality adjusted life years lost due to dementia from 2020 to 2050: A population-based microsimulation study. Alzheimers Dement 2023; 19:4532-4541. [PMID: 36916447 DOI: 10.1002/alz.13019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/15/2023]
Abstract
INTRODUCTION Efficient healthcare planning requires reliable projections of the future increase in costs and quality-adjusted life years (QALYs) lost due to dementia. METHODS We used the microsimulation model MISCAN-Dementia to simulate life histories and dementia occurrence using population-based Rotterdam Study data and nationwide birth cohort demographics. We estimated costs and QALYs lost in the Netherlands from 2020 to 2050, incorporating literature estimates of cost and utility for patients and caregivers by dementia severity and care setting. RESULTS Societal costs and QALYs lost due to dementia are estimated to double between 2020 and 2050. Costs are incurred predominantly through institutional (34%), formal home (31%), and informal home care (20%). Lost QALYs are mostly due to shortened life expectancy (67%) and, to a lesser extent, quality of life with severe dementia (14%). DISCUSSION To limit healthcare costs and quality of life losses due to dementia, interventions are needed that slow symptom progression and reduce care dependency.
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Affiliation(s)
- Chiara C Brück
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine and Alzheimer Center, Erasmus MC, Rotterdam, The Netherlands
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van Nieuwkerk AC, Delewi R, Wolters FJ, Muller M, Daemen M, Biessels GJ. Cognitive Impairment in Patients With Cardiac Disease: Implications for Clinical Practice. Stroke 2023; 54:2181-2191. [PMID: 37272393 DOI: 10.1161/strokeaha.123.040499] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cognitive impairment is common in patients with cardiovascular disease. One in 3 patients presenting at cardiology clinics have some degree of cognitive impairment, depending on the cardiac condition, comorbidities, and age. In up to half of these cases cognitive impairment may go unrecognized; however, it may affect self-management and treatment adherence. The high prevalence of cognitive impairment in patients with cardiac disease is likely due to shared risk factors, as well as direct consequences of cardiac dysfunction on the brain. Moreover, cardiac interventions may have beneficial as well as adverse effects on cognitive functioning. In this review, we describe prevalence and risk factors for cognitive impairment in patients with several common cardiac conditions: heart failure, coronary artery disease, and aortic valve stenosis. We discuss the potential effects of guideline-based treatments on cognition and identify open questions and unmet needs. Given the high prevalence of unrecognized cognitive impairment in cardiac patients, we recommend a stepwise approach to improve detection and management of cognitive impairment.
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Affiliation(s)
- Astrid C van Nieuwkerk
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, the Netherlands (A.C.v.N., R.D.)
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, the Netherlands (A.C.v.N., R.D., M.M.)
| | - Ronak Delewi
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, the Netherlands (A.C.v.N., R.D.)
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, the Netherlands (A.C.v.N., R.D., M.M.)
| | - Frank J Wolters
- Department of Epidemiology (F.J.W.), Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Radiology & Nuclear Medicine and Alzheimer Centre Erasmus MC (F.J.W.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Majon Muller
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, the Netherlands (A.C.v.N., R.D., M.M.)
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Internal Medicine section Geriatrics, the Netherlands (M.M.)
| | - Mat Daemen
- Department of Pathology, Amsterdam University Medical Center, Locations AMC and VUmc, University of Amsterdam, the Netherlands (M.D.)
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center, the Netherlands (G.J.B.)
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Maddock J, Gallo F, Wolters FJ, Stafford J, Marseglia A, Dekhtyar S, Lenart-Bugla M, Verspoor E, Perry M, Samtani S, Vernooij-Dassen M, Wolf-Ostermann K, Melis R, Brodaty H, Ikram MA, Welmer AK, Davis D, Ploubidis GB, Richards M, Patalay P. Social Health and Change in Cognitive Capability among Older Adults: Findings from Four European Longitudinal Studies. Gerontology 2023; 69:1330-1346. [PMID: 37497894 DOI: 10.1159/000531969] [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: 01/19/2023] [Accepted: 06/28/2023] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION In this study, we examine whether social health markers measured at baseline are associated with differences in cognitive capability and the rate of cognitive decline over an 11-to-18-year period among older adults and compare results across studies. METHODS We applied an integrated data analysis approach to 16,858 participants (mean age 65 years; 56% female) from the National Survey for Health and Development (NSHD), the English Longitudinal Study of Aging (ELSA), the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), and the Rotterdam Study. We used multilevel models to examine social health in relation to cognitive capability and the rate of cognitive decline. RESULTS Pooled estimates show distinct relationships between markers of social health and cognitive domains, e.g., a large network size (≥6 people vs. none) was associated with higher executive function (0.17 standard deviation [SD] [95% CI: 0.00, 0.34], I2 = 27%) but not with memory (0.08 SD [95% CI: -0.02, 0.18], I2 = 19%). We also observed pooled associations between being married or cohabiting, having a large network size, and participating in social activities with slower decline in cognitive capability. However, estimates were close to zero, e.g., 0.01 SD/year (95% CI: 0.01, 0.02) I2 = 19% for marital status and executive function. There were clear study-specific differences: results for average processing speed were the most homogenous, and results for average memory were the most heterogeneous. CONCLUSION Overall, markers of good social health have a positive association with cognitive capability. However, we found differential associations between specific markers of social health and cognitive domains and differences between studies. These findings highlight the importance of examining between-study differences and considering the context specificity of findings in developing and deploying interventions.
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Affiliation(s)
- Jane Maddock
- MRC Unit for Lifelong Health and Ageing at UCL, Faculty of Population Health, University College London, London, UK
| | - Federico Gallo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow, Russian Federation
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC Rotterdam, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam, Rotterdam, The Netherlands
| | - Jean Stafford
- MRC Unit for Lifelong Health and Ageing at UCL, Faculty of Population Health, University College London, London, UK
| | - Anna Marseglia
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Serhiy Dekhtyar
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden
| | | | - Eline Verspoor
- Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke Perry
- Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Suraj Samtani
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Sydney, Australia
| | - Myrra Vernooij-Dassen
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Karin Wolf-Ostermann
- Institute for Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Leibniz ScienceCampus Digital Public Health, Bremen, Germany
| | - Rene Melis
- Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Sydney, Australia
| | | | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Medical Psychology, Karolinska University Hospital, Stockholm, Sweden
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing at UCL, Faculty of Population Health, University College London, London, UK
| | - George B Ploubidis
- Centre for Longitudinal Studies, UCL Institute of Education, University College London, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, Faculty of Population Health, University College London, London, UK
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing at UCL, Faculty of Population Health, University College London, London, UK
- Centre for Longitudinal Studies, UCL Institute of Education, University College London, London, UK
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16
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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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17
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Coenen M, Kuijf HJ, Huenges Wajer IMC, Duering M, Wolters FJ, Fletcher EF, Maillard PM, Barkhof F, Barnes J, Benke T, Boomsma JMF, Chen CPLH, Dal-Bianco P, Dewenter A, Enzinger C, Ewers M, Exalto LG, Franzmeier N, Groeneveld O, Hilal S, Hofer E, Koek DL, Maier AB, McCreary CR, Padilla CS, Papma JM, Paterson RW, Pijnenburg YAL, Rubinski A, Schmidt R, Schott JM, Slattery CF, Smith EE, Steketee RME, Sudre CH, van den Berg E, van der Flier WM, Venketasubramanian N, Vernooij MW, Xin X, DeCarli C, Biessels GJ, Biesbroek JM. Strategic white matter hyperintensity locations for cognitive impairment: A multicenter lesion-symptom mapping study in 3525 memory clinic patients. Alzheimers Dement 2023; 19:2420-2432. [PMID: 36504357 DOI: 10.1002/alz.12827] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 04/19/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Impact of white matter hyperintensities (WMH) on cognition likely depends on lesion location, but a comprehensive map of strategic locations is lacking. We aimed to identify these locations in a large multicenter study. METHODS Individual patient data (n = 3525) from 11 memory clinic cohorts were harmonized. We determined the association of WMH location with attention and executive functioning, information processing speed, language, and verbal memory performance using voxel-based and region of interest tract-based analyses. RESULTS WMH in the left and right anterior thalamic radiation, forceps major, and left inferior fronto-occipital fasciculus were significantly related to domain-specific impairment, independent of total WMH volume and atrophy. A strategic WMH score based on these tracts inversely correlated with performance in all domains. DISCUSSION The data show that the impact of WMH on cognition is location-dependent, primarily involving four strategic white matter tracts. Evaluation of WMH location may support diagnosing vascular cognitive impairment. HIGHLIGHTS We analyzed white matter hyperintensities (WMH) in 3525 memory clinic patients from 11 cohorts The impact of WMH on cognition depends on location We identified four strategic white matter tracts A single strategic WMH score was derived from these four strategic tracts The strategic WMH score was an independent determinant of four cognitive domains.
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Affiliation(s)
- Mirthe Coenen
- Department of Neurology and Neurosurgery, UMC Utrecht, Brain Center, Utrecht, The Netherlands
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Irene M C Huenges Wajer
- Department of Neurology and Neurosurgery, UMC Utrecht, Brain Center, Utrecht, The Netherlands
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
- Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Frank J Wolters
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Evan F Fletcher
- Department of Neurology, University of California at Davis, Davis, California, USA
| | - Pauline M Maillard
- Department of Neurology, University of California at Davis, Davis, California, USA
| | - Frederik Barkhof
- Radiology & Nuclear Medicine, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands
- UCL Institute of Neurology, London, UK
| | - Josephine Barnes
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Thomas Benke
- Clinic of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Jooske M F Boomsma
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Christopher P L H Chen
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
| | - Peter Dal-Bianco
- Department of Neurology, Medical University Vienna, Vienna, Austria
| | - Anna Dewenter
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Christian Enzinger
- Division of General Neurology, Department of Neurology, Medical University Graz, Graz, Austria
- Division of Neuroradiology, Interventional and Vascular Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Lieza G Exalto
- Department of Neurology and Neurosurgery, UMC Utrecht, Brain Center, Utrecht, The Netherlands
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nicolai Franzmeier
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Onno Groeneveld
- Department of Neurology and Neurosurgery, UMC Utrecht, Brain Center, Utrecht, The Netherlands
- Department of Neurology, Isala MS Centre, Isala Hospital, Meppel, The Netherlands
| | - Saima Hilal
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Edith Hofer
- Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Graz, Austria
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Dineke L Koek
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrea B Maier
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
- Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheryl R McCreary
- Department of Clinical Neurosciences and Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Catarina S Padilla
- Department of Neurology and Neurosurgery, UMC Utrecht, Brain Center, Utrecht, The Netherlands
| | - Janne M Papma
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ross W Paterson
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Yolande A L Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anna Rubinski
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Reinhold Schmidt
- Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Graz, Austria
| | - Jonathan M Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Catherine F Slattery
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Eric E Smith
- Department of Clinical Neurosciences and Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Rebecca M E Steketee
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Carole H Sudre
- MRC Unit for Lifelong Health and Ageing, the Centre for Medical Image Computing, UCL, London, UK
| | - Esther van den Berg
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Narayanaswamy Venketasubramanian
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
- Raffles Neuroscience Center, Raffles Hospital, Singapore, Singapore
| | - Meike W Vernooij
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Xu Xin
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
| | - Charles DeCarli
- Department of Neurology, University of California at Davis, Davis, California, USA
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, UMC Utrecht, Brain Center, Utrecht, The Netherlands
| | - J Matthijs Biesbroek
- Department of Neurology and Neurosurgery, UMC Utrecht, Brain Center, Utrecht, The Netherlands
- Department of Neurology, Diakonessenhuis Hospital, Utrecht, The Netherlands
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18
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Mooldijk SS, Licher S, Wolters FJ. Improving Clinical Applicability of Mortality Prediction Models Among Persons With Dementia. JAMA Intern Med 2023; 183:498. [PMID: 36972062 DOI: 10.1001/jamainternmed.2023.0173] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Sanne S Mooldijk
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Silvan Licher
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
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19
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Claus JJ, Berghout BBP, Ikram MK, Wolters FJ. Validity of stroke severity assessment using medical records in a population-based cohort. J Stroke Cerebrovasc Dis 2023; 32:106992. [PMID: 36801651 DOI: 10.1016/j.jstrokecerebrovasdis.2023.106992] [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: 08/19/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 02/20/2023] Open
Abstract
OBJECTIVES Stroke severity is an important prognostic indicator of morbidity and mortality, but often not recorded outside of specialised stroke centres. We aimed to develop a scoring rule and validate standardised assessment of the National Institutes of Health Stroke Scale (NIHSS) from medical records. METHODS We developed a standardised assessment of the NIHSS from medical records. Four trained raters independently assessed the charts of 100 patients with first-ever stroke, randomly selected from the population-based Rotterdam Study cohort. Interrater agreement was determined using the intraclass correlation coefficient (ICC), and Fleiss' kappa for major versus minor stroke. We validated the scoring method against 29 prospective, clinical NIHSS ratings, using Kendall's tau and Cohen's kappa. RESULTS Of 100 included patients with stroke (mean age 80 years, 62% women), 71 (71%) were admitted to hospital and 9 (9%) were seen in outpatient clinic, whereas 20 (20%) were treated exclusively by their general practitioner or nursing home physician. Interrater agreement for retrospective, chart-based NIHSS ratings was excellent when assessed continuously (ICC: 0.90), and for minor versus major stroke (for NIHSS>3: κ=0.79, NIHSS>5: κ=0.78). Interrater agreement was good both for hospital-based and out-of-hospital settings (ICC: 0.97 and 0.75 respectively). Overall, assessment from medical records was in excellent agreement with prospective NIHSS ratings (τ=0.83; NIHSS>3: κ=0.93, and NIHSS>5: κ=0.93). However, for severe stroke (NIHSS>10) retrospective assessment tended to underestimate severity by 1-3 points on the NIHSS, which was accompanied by a somewhat lower interrater agreement for those more severe cases (NIHSS>10: κ=0.62). CONCLUSIONS Assessment of stroke severity according to the NIHSS on the basis of medical records is feasible and reliable in population-based cohorts of patients with stroke. These findings facilitate more individualised risk estimates in observational studies that lack prospective ascertainment of stroke severity.
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Affiliation(s)
- Jacqueline J Claus
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands; Department of Neurology, Erasmus MC, Rotterdam, the Netherlands
| | - Brian B P Berghout
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands; Department of Neurology, Erasmus MC, Rotterdam, the Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands; Department of Neurology, Erasmus MC, Rotterdam, the Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands.
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20
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Starmans NL, Wolters FJ, Leeuwis AE, Bron EE, Brunner La Rocca HP, Staals J, Biessels GJ, Kappelle LJ. Twenty-four hour blood pressure variability and the prevalence and the progression of cerebral white matter hyperintensities. J Cereb Blood Flow Metab 2023; 43:801-811. [PMID: 36597406 PMCID: PMC10108197 DOI: 10.1177/0271678x221149937] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Blood pressure variability (BPV) is related to cerebral white matter hyperintensities (WMH), but longitudinal studies assessing WMH progression are scarce. Patients with cardiovascular disease and control participants of the Heart-Brain Connection Study underwent 24-hour ambulatory blood pressure monitoring and repeated brain MRI at baseline and after 2 years. Using linear regression, we determined whether different measures of BPV (standard deviation, coefficient of variation, average real variability (ARV), variability independent of the mean) and nocturnal dipping were associated with WMH and whether this association was mediated or moderated by baseline cerebral perfusion. Among 177 participants (mean age: 65.9 ± 8.1 years, 33.9% female), the absence of diastolic nocturnal dipping was associated with higher WMH volume at baseline (β = 0.208, 95%CI: 0.025-0.392), but not with WMH progression among 91 participants with follow-up imaging. None of the BPV measures were associated with baseline WMH. Only 24-hour diastolic ARV was significantly associated with WMH progression (β = 0.144, 95%CI: 0.030-0.258), most profound in participants with low cerebral perfusion at baseline (p-interaction = 0.042). In conclusion, absent diastolic nocturnal dipping and 24-hour diastolic ARV were associated with higher WMH volume. Whilst requiring replication, these findings suggest that blood pressure patterns and variability may be a target for prevention of small vessel disease.
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Affiliation(s)
- Naomi Lp Starmans
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands.,Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Annebet E Leeuwis
- Alzheimer Centre Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, VU University Medical Centre, Amsterdam, the Netherlands
| | - Esther E Bron
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | | | - Julie Staals
- Department of Neurology and School for Cardiovascular Diseases (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, the Netherlands
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21
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Licher S, Wolters FJ, Pavlović J, Kavousi M, Leening MJG, Ikram MK, Ikram MA. Effects of Eligibility Criteria on Patient Selection and Treatment Implications from 10 Multidomain Dementia Prevention Trials: A Population-Based Study. Neuroepidemiology 2023; 57:14-24. [PMID: 36398446 PMCID: PMC10064383 DOI: 10.1159/000528120] [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: 09/05/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Dementia prevention trials have so far shown little benefit of multidomain interventions against cognitive decline. Recruitment strategies in these trials often centre around dementia risk or cardiovascular risk profile, but it is uncertain whether this leads to inclusion of individuals who may benefit most from the intervention. We determined the effects of eligibility criteria on the recruitment of potential trial participants in the general population. METHODS In a systematic search until January 1, 2022, we identified all published and ongoing large (≥500 participants), phase-3 multidomain trials for the prevention of cognitive decline or dementia. We applied trial eligibility criteria to 5,381 participants of the population-based Rotterdam Study (mean age: 72 years, 58% women), to compare participant characteristics, predicted risk of cardiovascular disease, and dementia risk, between trial eligible and ineligible persons. RESULTS We identified 10 trials, of which 5 had been published (DR's EXTRA, FINGER, preDIVA, MAPT, and HATICE) and 5 are ongoing (US-POINTER, MIND-CHINA, MYB, AgeWell.de, and J-Mint). Among all Rotterdam Study participants, eligibility across published trials ranged from 48% for MAPT to 87% for preDIVA, in line with original trial reports. Variability in eligibility was wider for ongoing trials, from 1% for US-POINTER to over 94% for MYB trial. Over 70% of trial eligible individuals are recommended preventive intervention in routine care based on their cardiovascular risk, similar for lipid-lowering (71%) and blood pressure-lowering treatment (73%). Ten-year risks of dementia were similar for eligible compared to ineligible individuals (12 vs. 11%). CONCLUSION Multidomain dementia prevention trials fail to preferentially include those at the highest risk of dementia and mostly include individuals who qualify for interventions already on the basis of cardiovascular prevention guidelines. These findings call for better targeted enrolment of individuals for whom trial results can improve clinical decision-making.
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Affiliation(s)
- Silvan Licher
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jelena Pavlović
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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22
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Zhu F, Wolters FJ, Yaqub A, Leening MJG, Ghanbari M, Boersma E, Ikram MA, Kavousi M. Plasma Amyloid-β in Relation to Cardiac Function and Risk of Heart Failure in General Population. JACC Heart Fail 2023; 11:93-102. [PMID: 36372727 DOI: 10.1016/j.jchf.2022.09.006] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/31/2022] [Accepted: 09/07/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Amyloid-β (Aβ) may be related to cardiac function. However, there are limited data on the association of plasma Aβ with cardiac function and risk of heart failure (HF) in the general population. OBJECTIVES This study sought to determine the associations of plasma amyloid-β40 (Aβ40) and amyloid-β42 (Aβ42) with echocardiographic measurements of cardiac dysfunction and with incident HF in the general population. METHODS The study included 4,156 participants of the population-based Rotterdam Study (mean age: 71.4 years; 57.1% women), who had plasma Aβ samples collected between 2002 and 2005 and had no established dementia and HF at baseline. Multivariable linear regression models were used to explore the cross-sectional association of plasma Aβ with echocardiographic measures. Participants were followed up until December 2016. Cox proportional hazards models were used to assess the association of Aβ levels with incident HF. Models were adjusted for cardiovascular risk factors. RESULTS A per 1-SD increase in log-transformed plasma Aβ40 was associated with a 0.39% (95% CI: -0.68 to -0.10) lower left ventricular ejection fraction and a 0.70 g/m2 (95% CI: 0.06-1.34) larger left ventricular mass indexed by body surface area. Aβ42 was not significantly associated with echocardiographic measures cross-sectionally. During follow-up (median: 10.2 years), 472 incident HF cases were identified. A per 1-SD increase in log-transformed Aβ40 was associated with a 32% greater risk of HF (HR: 1.32; 95% CI: 1.15-1.51), and the association was significant in men, but not in women. Higher plasma Aβ42 levels were associated with an increased risk of HF (HR: 1.12; 95% CI: 1.02-1.24), although the association was attenuated after further adjustment for concomitant Aβ40 (HR: 1.03; 95% CI: 0.92-1.16). CONCLUSIONS Higher levels of Aβ40 were associated with worse cardiac function and higher risk of new onset HF in the general population, in particular among men.
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Affiliation(s)
- Fang Zhu
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Amber Yaqub
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mohsen Ghanbari
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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23
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vom Hofe IEM, Stricker B, Vernooij MW, Ikram MA, Wolters FJ. Antidepressant use in relation to long‐term dementia risk and imaging markers of neurodegeneration: a population‐based study of potential adverse effects. Alzheimers Dement 2022. [DOI: 10.1002/alz.064077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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24
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Frentz I, van Arendonk J, Leeuwis AE, Vernooij MW, van der Flier WM, Bos D, De Deyn PP, Wolters FJ, Ikram MA. The joint association of arteriosclerosis and plasma amyloid with cognitive function: the population‐based Rotterdam Study. Alzheimers Dement 2022. [DOI: 10.1002/alz.066497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Ingeborg Frentz
- Erasmus University Medical Center Rotterdam Netherlands
- University Medical Center Groningen Groningen Netherlands
| | | | - Anna E Leeuwis
- Alzheimer center Amsterdam, Department of Neurology, Amsterdam Neuroscience, VU University medical center, Amsterdam UMC Amsterdam Netherlands
| | - Meike W. Vernooij
- Erasmus University Medical Center Rotterdam Netherlands
- Department of Epidemiology, Erasmus University Medical Center Rotterdam Netherlands
| | - Wiesje M. van der Flier
- Alzheimer center Amsterdam, Department of Neurology, Amsterdam Neuroscience, VU University medical center, Amsterdam UMC Amsterdam Netherlands
| | - Daniel Bos
- Erasmus MC University Medical Center Rotterdam Netherlands
- Department of Epidemiology, Erasmus University Medical Center Rotterdam Netherlands
| | - Peter Paul De Deyn
- University Medical Center Groningen, Neurology and Alzheimer Center Groningen Netherlands
| | - Frank J. Wolters
- Department of Epidemiology, Erasmus University Medical Center Rotterdam Netherlands
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus MC Rotterdam Rotterdam Netherlands
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25
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Yaqub A, Wolters FJ, Collaboration C. Cardiac function and neuropathological substrates on MRI across age span: A Cross‐Cohort Collaboration (CCC). Alzheimers Dement 2022. [DOI: 10.1002/alz.067570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Amber Yaqub
- Department of Epidemiology, Erasmus University Medical Center Rotterdam Netherlands
| | - Frank J. Wolters
- Department of Epidemiology, Erasmus University Medical Center Rotterdam Netherlands
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26
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van den Berg E, Vernooij MW, Mattace‐Raso FU, Wolters FJ. Sharpening the tools for the assessment of vascular cognitive impairment. Alzheimers Dement 2022; 19:1587-1588. [PMID: 36416073 DOI: 10.1002/alz.12847] [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: 05/29/2022] [Revised: 08/23/2022] [Accepted: 09/13/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Esther van den Berg
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center Rotterdam the Netherlands
| | - Meike W. Vernooij
- Department of Radiology & Nuclear Medicine and Alzheimer Center Erasmus MC Erasmus MC University Medical Center Rotterdam the Netherlands
| | - Francesco U.S. Mattace‐Raso
- Department of Geriatrics and Alzheimer Center Erasmus MC Erasmus MC University Medical Center Rotterdam the Netherlands
| | - Frank J. Wolters
- Department of Radiology & Nuclear Medicine and Alzheimer Center Erasmus MC Erasmus MC University Medical Center Rotterdam the Netherlands
- Department of Epidemiology Erasmus MC University Medical Center Rotterdam the Netherlands
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27
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Zhu F, Wolters FJ, Yaqub A, Boersma H, Ikram MA, Kavousi M. Plasma amyloid-beta in relation to cardiac function and risk of heart failure in the general population. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.873] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Amyloid-β is a major hallmark of Alzheimer's disease, and its pathology has been hypothesized as a multiple organ syndrome that may also affect cardiac function. There are limited data on association of plasma amyloid-β with cardiac dysfunction and risk of HF in the general population.
Objective
To determine the association of plasma amyloid-β40 (Aβ40) and amyloid-β42 (Aβ42) with echocardiographic measurements of cardiac dysfunction, and with incident heart failure (HF) in the general population.
Methods
We included 4156 participants of the population-based cohort (mean age 71.4 years, 57.1% women), who had plasma amyloid-β measured between 2002 and 2005, and were free of dementia and HF at baseline. Multivariable linear regression models were used to explore the associations of plasma Aβ40 and Aβ42 with echocardiographic measures. Participants were followed for the occurrence of HF until December 2016. Cause-specific hazard models were used to assess the association of plasma amyloid-β with incident HF and competing risk event. Models were adjusted for cardiovascular risk factors.
Results
Higher plasma Aβ40 concentrations were associated with lower left ventricular ejection fraction (β, −0.39; 95% CI, −0.68 to −0.10) and larger left ventricular mass (β, 0.70; 95% CI, 0.06 to 1.34). Aβ42 was not significantly associated with echocardiographic measures cross-sectionally. During follow-up (median 10.2 years), 472 incident HF cases were identified. Higher plasma Aβ40 was associated with an increased risk of incident HF (HR, 1.32; 95% CI, 1.15 to 1.51), more profound in men than in women (P value for interaction: 0.022). One SD increase in Aβ40 was associated with a 31% increase in the hazard of HF in men (HR, 1.32; 95% CI, 1.14 to 1.54) but the association was not significant in women (HR, 1.06; 95% CI, 0.93 to 1.20). Higher plasma Aβ42 concentrations were associated with increased risk of HF (HR, 1.12; 95% CI, 1.02 to 1.24), while further adjustment for concomitant Aβ40 attenuated this association (HR, 1.03; 95% CI, 0.92 to 1.16).
Conclusion
Higher levels of plasma Aβ40 were independently associated with worse cardiac function and higher risk of new-onset HF in the general population, in particular among men.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): The Netherlands Organization for Health Research and Development (ZonMw); the Dutch Heart Foundation;This study is further funded by the European Union's Horizon 2020 research and innovation programme as part of the Common mechanisms and pathways in Stroke and Alzheimer's disease (CoSTREAM) project.
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Affiliation(s)
- F Zhu
- Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - F J Wolters
- Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - A Yaqub
- Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - H Boersma
- Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - M A Ikram
- Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - M Kavousi
- Erasmus University Medical Centre , Rotterdam , The Netherlands
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28
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Brück CC, Wolters FJ, Ikram MA, de Kok IMCM. Projected prevalence and incidence of dementia accounting for secular trends and birth cohort effects: a population-based microsimulation study. Eur J Epidemiol 2022; 37:807-814. [PMID: 35731313 PMCID: PMC9215138 DOI: 10.1007/s10654-022-00878-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Abstract
There is need for accurate projections of the future dementia burden to prepare healthcare systems and policymakers. Existing projections only account for population ageing, not for observed declines in age-specific dementia incidence of 13% per decade. We developed a dementia microsimulation model that synthesizes population-based data from the Rotterdam Study with changes in demographics between birth cohorts from the early 1900s onwards. We determined dementia prevalence and incidence until 2050 for three different dementia incidence trend scenarios: (1) stable age-specific incidence, (2) linear decline by 13% per decade, (3) nonlinear declines averaging 13% per decade. Assuming a stable age-specific incidence resulted in a 130% increase in incidence and 118% in prevalence between 2020 and 2050. By contrast, the linearly declining trend resulted in substantially smaller increases of 58% in incidence (95%CI: 29–87%), and 43% in prevalence (95%CI: 13–66%), corresponding to 39% lower incidence and 36% lower prevalence by 2050 than in the stable-incidence scenario. Results for various non-linear declines fell between the stable and linear trend. The future burden of dementia is highly susceptible to achievable changes in age-specific incidence. Extension of previously established secular trends globally would reduce widely upheld projections of new dementia cases until 2050 by 39%.
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Affiliation(s)
- Chiara Celine Brück
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Inge M C M de Kok
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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29
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Yaqub A, Ikram M, Wolters FJ. [Population attributable fraction: a guideline for disease prevention]. Ned Tijdschr Geneeskd 2022; 166:D6755. [PMID: 35899721] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The improvement of public health relies on effective strategies for disease prevention, but the optimal preventive strategy is often difficult to determine. The population attributable fraction is a tool that allows policy makers to prioritise among different interventions by quantifying the share of disease in the population that is due to one specific risk factor. In this article, we discuss the computation of the population attributable fraction, as well as its advantages, limitations, and challenges for proper interpretation. We further compare the population attributable fraction to the etiologic fraction, which concerns the impact of a risk factor of disease at the individual level. We illustrate the importance of either measure, as well as differences between them, on the basis of scenarios in which community medicine and patient-centred care might not always be in agreement.
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Affiliation(s)
| | | | - Frank J Wolters
- Erasmus MC, afd. Epidemiologie, Rotterdam
- Contact: Frank J. Wolters
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30
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Yaqub A, Darweesh SKL, Dommershuijsen LJ, Vernooij MW, Ikram MK, Wolters FJ, Ikram MA. Risk factors, neuroimaging correlates and prognosis of the motoric cognitive risk syndrome: a population-based comparison with mild cognitive impairment. Eur J Neurol 2022; 29:1587-1599. [PMID: 35147272 PMCID: PMC9306517 DOI: 10.1111/ene.15281] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/08/2022] [Indexed: 11/27/2022]
Abstract
Background and purpose This study was undertaken to compare risk factors, neuroimaging characteristics and prognosis between two clinical prodromes of dementia, namely, the motoric cognitive risk syndrome (MCRS) and mild cognitive impairment (MCI). Methods Between 2009 and 2015, dementia‐free participants of the population‐based Rotterdam Study were classified with a dementia prodrome if they had subjective cognitive complaints and scored >1 SD below the population mean of gait speed (MCRS) or >1.5 SD below the population mean of cognitive test scores (MCI). Using multinomial logistic regression models, we determined cross‐sectional associations of risk factors and structural neuroimaging markers with MCRS and MCI, followed by subdistribution hazard models, to determine risk of incident dementia until 2016. Results Of 3025 included participants (mean age = 70.4 years, 54.7% women), 231 had MCRS (7.6%), 132 had MCI (4.4%), and 62 (2.0%) fulfilled criteria for both. Although many risk factors were shared, a higher body mass index predisposed to MCRS, whereas male sex and hypercholesterolemia were associated with MCI only. Gray matter volumes, hippocampal volumes, white matter hyperintensities, and structural white matter integrity were worse in both MCRS and MCI. During a mean follow‐up of 3.9 years, 71 individuals developed dementia and 200 died. Five‐year cumulative risk of dementia was 7.0% (2.5%–11.5%) for individuals with MCRS, versus 13.3% (5.8%–20.8%) with MCI and only 2.3% (1.5%–3.1%) in unaffected individuals. Conclusions MCRS is associated with imaging markers of neurodegeneration and risk of dementia, even in the absence of MCI, highlighting the potential of motor function assessment in early risk stratification for dementia.
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Affiliation(s)
- Amber Yaqub
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Sirwan K L Darweesh
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
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31
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Waziry R, Dufouil C, Hofman A, Ikram K, Debette S, Wolters FJ, Fani L, Romero RJ, Aparicio HJ, Lioutas V, Viswanathan A, Sullivan K, Goudsmit J, Seshardi S, Ikram MA. Abstract 72: Risk Of Dementia Following First-ever Hemorrhagic Or Ischemic Stroke In The General Population. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.72] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
To assess risk of dementia after first-ever hemorrhagic or ischemic strokes in three prospective cohort studies (Three City, Framingham Heart Study and Rotterdam Study).
Methods:
Prospective data on incident hemorrhagic or ischemic strokes and matched stroke free comparison was used for each stroke subtype. 5-year risk of dementia after hemorrhagic or ischemic stroke was assessed using a matched case-cohort design. A random effects meta-analysis was used to combine hazard ratios for each study and variations in risk stratified by
APOE
ε4 allele were assessed. A direct comparison of risk of dementia after hemorrhagic compared with ischemic strokes was evaluated. In a sensitivity analysis Fine & Gray models were conducted after adjusting for competing deaths and subdistribution hazard ratios were computed. Pre-event and post-event cumulative incidence of dementia at 3, 6, 12, 24, 36 and 60 months were assessed.
Results:
A total of 4,922 persons, including 247 incident hemorrhagic strokes and 1,427 ischemic strokes were included. The combined hazard ratios of dementia were 2.78 (95% CI 1.28, 6.03) after hemorrhagic and 3.35 (1.51, 7.43) after ischemic stroke compared to stroke free individuals. The combined risk of dementia was 0.71 (0.14, 3.68) after hemorrhagic compared with ischemic stroke. Among individuals with
APOE
ε4 allele, the risk of dementia was 3.88 (1.16, 12.98) after hemorrhagic stroke and 2.10 (1.28, 3.42) after ischemic stroke compared to stroke-free individuals. The cumulative incidence post-event for hemorrhagic strokes flattened between 6 and 24 months with slight increase thereafter, in-contrast to a steady increase in dementia risk over time after ischemic strokes.
Conclusions:
No difference was observed in overall 5-year risk of dementia after hemorrhagic or ischemic stroke, while the risk was about 3 times higher compared to stroke-free individuals of similar risk profiles.
APOE
ε4 allele doubles the risk of dementia among hemorrhagic stroke survivors. Risk of dementia after ischemic stroke follows a stepwise pattern overtime, in contrast, dementia risk after hemorrhagic stroke is highest in the early phase.
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Affiliation(s)
| | | | | | | | | | | | - Lana Fani
- Erasmus Univ, Rotterdam, Netherlands
| | | | | | | | | | | | | | - Sudha Seshardi
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, Texas, TX
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Frenzel S, Bis JC, Gudmundsson EF, O’Donnell A, Simino J, Yaqub A, Bartz TM, Brusselle GGO, Bülow R, DeCarli CS, Ewert R, Gharib SA, Ghosh S, Gireud-Goss M, Gottesman RF, Ikram MA, Knopman DS, Launer LJ, London SJ, Longstreth W, Lopez OL, Melo van Lent D, O’Connor G, Satizabal CL, Shrestha S, Sigurdsson S, Stubbe B, Talluri R, Vasan RS, Vernooij MW, Völzke H, Wiggins KL, Yu B, Beiser AS, Gudnason V, Mosley T, Psaty BM, Wolters FJ, Grabe HJ, Seshadri S. Associations of Pulmonary Function with MRI Brain Volumes: A Coordinated Multi-Study Analysis. J Alzheimers Dis 2022; 90:1073-1083. [PMID: 36213999 PMCID: PMC9712227 DOI: 10.3233/jad-220667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous studies suggest poor pulmonary function is associated with increased burden of cerebral white matter hyperintensities and brain atrophy among elderly individuals, but the results are inconsistent. OBJECTIVE To study the cross-sectional associations of pulmonary function with structural brain variables. METHODS Data from six large community-based samples (N = 11,091) were analyzed. Spirometric measurements were standardized with respect to age, sex, height, and ethnicity using reference equations of the Global Lung Function Initiative. Associations of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and their ratio FEV1/FVC with brain volume, gray matter volume, hippocampal volume, and volume of white matter hyperintensities were investigated using multivariable linear regressions for each study separately and then combined using random-effect meta-analyses. RESULTS FEV1 and FVC were positively associated with brain volume, gray matter volume, and hippocampal volume, and negatively associated with white matter hyperintensities volume after multiple testing correction, with little heterogeneity present between the studies. For instance, an increase of FVC by one unit was associated with 3.5 ml higher brain volume (95% CI: [2.2, 4.9]). In contrast, results for FEV1/FVC were more heterogeneous across studies, with significant positive associations with brain volume, gray matter volume, and hippocampal volume, but not white matter hyperintensities volume. Associations of brain variables with both FEV1 and FVC were consistently stronger than with FEV1/FVC, specifically with brain volume and white matter hyperintensities volume. CONCLUSION In cross-sectional analyses, worse pulmonary function is associated with smaller brain volumes and higher white matter hyperintensities burden.
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Affiliation(s)
- Stefan Frenzel
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Joshua C. Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Adrienne O’Donnell
- Framingham Heart Study, Framingham, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jeannette Simino
- Gertrude C. Ford Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Data Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Amber Yaqub
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Traci M. Bartz
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Guy G. O. Brusselle
- Department of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Robin Bülow
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Charles S. DeCarli
- Department of Neurology and Center for Neuroscience, University of California at Davis, Sacramento, CA, USA
- Imaging of Dementia and Aging (IDeA) Laboratory, Department of Neurology, University of California-Davis, Davis, CA, USA
| | - Ralf Ewert
- Department of Internal Medicine B, Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Greifswald, Germany
| | - Sina A. Gharib
- Center for Lung Biology, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Saptaparni Ghosh
- Framingham Heart Study, Framingham, MA, USA
- Department of Neurology, Boston University Schoolof Medicine, Boston, MA, USA
| | - Monica Gireud-Goss
- Glenn Biggs Institute for Alzheimer and Neurodegenerative Diseases, The University of Texas Health Science Center at San Antonio, SanAntonio, TX, USA
| | - Rebecca F. Gottesman
- Stroke, Cognition, and Neuroepidemiology (SCAN) section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Lenore J. Launer
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD, USA
| | - Stephanie J. London
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, NC, USA
| | - W.T. Longstreth
- Department of Neurology, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Oscar L. Lopez
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Debora Melo van Lent
- Framingham Heart Study, Framingham, MA, USA
- Department of Neurology, Boston University Schoolof Medicine, Boston, MA, USA
- Glenn Biggs Institute for Alzheimer and Neurodegenerative Diseases, The University of Texas Health Science Center at San Antonio, SanAntonio, TX, USA
| | - George O’Connor
- Framingham Heart Study, Framingham, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Claudia L. Satizabal
- Glenn Biggs Institute for Alzheimer and Neurodegenerative Diseases, The University of Texas Health Science Center at San Antonio, SanAntonio, TX, USA
- Department of Population Health Sciences, The University of Texas Health Science Center at San Antonio, SanAntonio, TX, USA
| | - Srishti Shrestha
- Gertrude C. Ford Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Neurology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Beate Stubbe
- Department of Internal Medicine B, Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Greifswald, Germany
| | - Rajesh Talluri
- Department of Data Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ramachandran S. Vasan
- Framingham Heart Study, Framingham, MA, USA
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Meike W. Vernooij
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Kerri L. Wiggins
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Bing Yu
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Alexa S. Beiser
- Framingham Heart Study, Framingham, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Department of Neurology, Boston School of Medicine, Boston, MA, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Thomas Mosley
- Gertrude C. Ford Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Neurology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Medicine, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Frank J. Wolters
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hans J. Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Disease (DZNE), partner site Rostock/Greifswald, Germany
| | - Sudha Seshadri
- Framingham Heart Study, Framingham, MA, USA
- Department of Neurology, Boston University Schoolof Medicine, Boston, MA, USA
- Glenn Biggs Institute for Alzheimer and Neurodegenerative Diseases, The University of Texas Health Science Center at San Antonio, SanAntonio, TX, USA
- Department of Neurology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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33
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Velek P, Splinter MJ, Ikram MK, Ikram MA, Leening MJG, van der Lei J, Hartman TO, Peters LL, Tange H, Rutten FH, van Weert H, Wolters FJ, Bindels PJE, Licher S, de Schepper EIT. Changes in the Diagnosis of Stroke and Cardiovascular Conditions in Primary Care During First 2 COVID-19 Waves in the Netherlands. Neurology 2021; 98:e564-e572. [PMID: 34965968 PMCID: PMC8829962 DOI: 10.1212/wnl.0000000000013145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/23/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although there is evidence of disruption in acute cerebrovascular and cardiovascular care during the COVID-19 pandemic, its downstream effect in primary care is less clear. We investigated how the pandemic affected utilization of cerebrovascular and cardiovascular care in general practices (GPs) and determined changes in GP-recorded diagnoses of selected cerebrovascular and cardiovascular outcomes. METHODS From electronic health records of 166,929 primary care patients aged 30 or over within the Rotterdam region, the Netherlands, we extracted the number of consultations related to cerebrovascular and cardiovascular care, and first diagnoses of selected cerebrovascular and cardiovascular risk factors (hypertension, diabetes, lipid disorders), conditions and events (angina, atrial fibrillation, TIA, myocardial infarction, stroke). We quantified changes in those outcomes during the first COVID-19 wave (March-May 2020) and thereafter (June-December 2020) by comparing them to the same period in 2016-2019. We also estimated the number of potentially missed diagnoses for each outcome. RESULTS The number of GP consultations related to cerebrovascular and cardiovascular care declined by 38% (0.62, 95% CI: 0.56-0.68) during the first wave, as compared to expected counts based on pre-pandemic levels. Substantial declines in the number of new diagnoses were observed for cerebrovascular events: 37% for TIA (0.63, 0.41-0.96), and 29% for stroke (0.71, 0.59 to 0.84), while no significant changes were observed for cardiovascular events (myocardial infarction (0.91, 0.74-1.14), angina (0.77, 0.48-1.25)). The counts across individual diagnoses recovered following June 2020, but the number of GP consultations related to cerebrovascular and cardiovascular care remained lower than expected also throughout the June-December period (0.93, 0.88-0.98). DISCUSSION While new diagnoses of acute cardiovascular events remained stable during the COVID19 pandemic, diagnoses of cerebrovascular events declined substantially compared to pre-pandemic levels, possibly due to incorrect perception of risk by patients. These findings emphasize the need to improve symptom recognition of cerebrovascular events among the general public and to encourage urgent presentation despite any physical distancing measures.
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Affiliation(s)
- Premysl Velek
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands .,Department of General Practice, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Marije J Splinter
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Cardiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Johan van der Lei
- Department of Medical Informatics, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Tim Olde Hartman
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Lilian L Peters
- Department of General Practice & Elderly Medicine/ Midwifery Science, University Medical Centre Groningen, Groningen, The Netherlands.,Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health, The Netherlands
| | - Huibert Tange
- Department of Family Practice, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Frans H Rutten
- Department of General Practice, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Henk van Weert
- Department of General Practice, Amsterdam Public Health, Amsterdam Universities Medical Centre, Amsterdam, The Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Silvan Licher
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Evelien I T de Schepper
- Department of General Practice, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
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34
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Mooldijk SS, Licher S, Wolters FJ. Patient, disease, and study characteristics in contemporary dementia research: A systematic review on external validity. Alzheimers Dement 2021. [DOI: 10.1002/alz.051642] [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: 11/06/2022]
Affiliation(s)
| | - Silvan Licher
- Erasmus MC University Medical Center Rotterdam Netherlands
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35
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Yaqub A, Darweesh SK, Dommershuijsen LJ, Wolters FJ, Ikram MA. Aetiology and prognosis of the motoric cognitive risk syndrome: A population‐based comparison with mild cognitive impairment. Alzheimers Dement 2021. [DOI: 10.1002/alz.054311] [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)
- Amber Yaqub
- Department of Epidemiology, Erasmus University Medical Center Rotterdam Netherlands
| | | | | | - Frank J. Wolters
- Department of Epidemiology, Erasmus University Medical Center Rotterdam Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center Rotterdam Netherlands
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center Rotterdam Netherlands
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36
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Licher S, Wolters FJ, Pavlović J, Kavousi M, Leening MJG, Ikram MK, Ikram MA. Are we targeting the right population? Application of eligibility criteria of 10 dementia prevention trials to the general population. Alzheimers Dement 2021. [DOI: 10.1002/alz.050821] [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)
- Silvan Licher
- Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands Rotterdam Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus University Medical Center Rotterdam Netherlands
| | - Jelena Pavlović
- Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands Rotterdam Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands Rotterdam Netherlands
| | - Maarten JG Leening
- Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands Rotterdam Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC Rotterdam Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands Rotterdam Netherlands
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37
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van Arendonk J, Wolters FJ, Neitzel J, Vinke EJ, Vernooij MW, Ikram MA, Ghanbari M. Plasma neurofilament light chain (NfL) relates to preclinical changes in cognition, structural white matter integrity and markers of cerebral small‐vessel disease: A population‐based study. Alzheimers Dement 2021. [DOI: 10.1002/alz.053611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | | | - Julia Neitzel
- Erasmus MC University Medical Center Rotterdam Netherlands
| | | | | | - M. Arfan Ikram
- Erasmus MC University Medical Center Rotterdam Netherlands
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38
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Khan SR, Yaqub A, Wolters FJ, Ikram MK, Dalm VA, Chaker L, Ikram MA. The association of serum immunoglobulins with cognition and dementia: The Rotterdam Study. Alzheimers Dement 2021. [DOI: 10.1002/alz.053612] [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)
- Samer R. Khan
- Department of Epidemiology, Erasmus University Medical Center Rotterdam Netherlands
- Department of Internal Medicine, Division of Clinical Immunology, Erasmus University Medical Center Rotterdam Netherlands
| | - Amber Yaqub
- Department of Epidemiology, Erasmus University Medical Center Rotterdam Netherlands
| | - Frank J. Wolters
- Department of Epidemiology, Erasmus University Medical Center Rotterdam Netherlands
| | - M. Kamran Ikram
- Department of Neurology, Erasmus MC Rotterdam Netherlands
- Department of Epidemiology, Erasmus MC Rotterdam Netherlands
| | - Virgil A.S.H. Dalm
- Department of Internal Medicine, Division of Clinical Immunology, Erasmus University Medical Center Rotterdam Netherlands
- Department of Immunology, Erasmus University Medical Center Rotterdam Netherlands
| | - Layal Chaker
- Department of Epidemiology, Erasmus University Medical Center Rotterdam Netherlands
- Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center Rotterdam Netherlands
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus MC Rotterdam Netherlands
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39
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Wolters FJ, Ikram MA, Bos D, Raso FM, Vernooij MW. Unfulfilled potential for secondary prevention of cognitive decline in individuals with covert brain infarcts: A population‐based study. Alzheimers Dement 2021. [DOI: 10.1002/alz.053794] [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)
- Frank J Wolters
- Department of Epidemiology, Erasmus University Medical Center Rotterdam Netherlands
| | - M Arfan Ikram
- Erasmus MC University Medical Center Rotterdam Netherlands
| | - Daniel Bos
- Erasmus MC University Medical Center Rotterdam Netherlands
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40
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Brück CC, Wolters FJ, Ikram MA, de Kok IMCM. How do dementia risk differences between birth cohorts affect future incidence predictions: A microsimulation study. Alzheimers Dement 2021. [DOI: 10.1002/alz.052018] [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)
- Chiara C Brück
- Department of Public Health, Erasmus MC Rotterdam Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus University Medical Center Rotterdam Netherlands
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus MC Rotterdam Netherlands
| | - Inge MCM de Kok
- Department of Public Health, Erasmus MC Rotterdam Netherlands
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41
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Splinter MJ, Velek P, Ikram MK, Kieboom BCT, Peeters RP, Bindels PJE, Ikram MA, Wolters FJ, Leening MJG, de Schepper EIT, Licher S. Prevalence and determinants of healthcare avoidance during the COVID-19 pandemic: A population-based cross-sectional study. PLoS Med 2021; 18:e1003854. [PMID: 34813591 PMCID: PMC8610236 DOI: 10.1371/journal.pmed.1003854] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/26/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND During the Coronavirus Disease 2019 (COVID-19) pandemic, the number of consultations and diagnoses in primary care and referrals to specialist care declined substantially compared to prepandemic levels. Beyond deferral of elective non-COVID-19 care by healthcare providers, it is unclear to what extent healthcare avoidance by community-dwelling individuals contributed to this decline in routine healthcare utilisation. Moreover, it is uncertain which specific symptoms were left unheeded by patients and which determinants predispose to healthcare avoidance in the general population. In this cross-sectional study, we assessed prevalence of healthcare avoidance during the pandemic from a patient perspective, including symptoms that were left unheeded, as well as determinants of healthcare avoidance. METHODS AND FINDINGS On April 20, 2020, a paper COVID-19 survey addressing healthcare utilisation, socioeconomic factors, mental and physical health, medication use, and COVID-19-specific symptoms was sent out to 8,732 participants from the population-based Rotterdam Study (response rate 73%). All questionnaires were returned before July 10, 2020. By hand, prevalence of healthcare avoidance was subsequently verified through free text analysis of medical records of general practitioners. Odds ratios (ORs) for avoidance were determined using logistic regression models, adjusted for age, sex, and history of chronic diseases. We found that 1,142 of 5,656 included participants (20.2%) reported having avoided healthcare. Of those, 414 participants (36.3%) reported symptoms that potentially warranted urgent evaluation, including limb weakness (13.6%), palpitations (10.8%), and chest pain (10.2%). Determinants related to avoidance were older age (adjusted OR 1.14 [95% confidence interval (CI) 1.08 to 1.21]), female sex (1.58 [1.38 to 1.82]), low educational level (primary education versus higher vocational/university 1.21 [1.01 to 1.46), poor self-appreciated health (per level decrease 2.00 [1.80 to 2.22]), unemployment (versus employed 2.29 [1.54 to 3.39]), smoking (1.34 [1.08 to 1.65]), concern about contracting COVID-19 (per level increase 1.28 [1.19 to 1.38]) and symptoms of depression (per point increase 1.13 [1.11 to 1.14]) and anxiety (per point increase 1.16 [1.14 to 1.18]). Study limitations included uncertainty about (perceived) severity of the reported symptoms and potentially limited generalisability given the ethnically homogeneous study population. CONCLUSIONS In this population-based cross-sectional study, 1 in 5 individuals avoided healthcare during lockdown in the COVID-19 pandemic, often for potentially urgent symptoms. Healthcare avoidance was strongly associated with female sex, fragile self-appreciated health, and high levels of depression and anxiety. These results emphasise the need for targeted public education urging these vulnerable patients to timely seek medical care for their symptoms to mitigate major health consequences.
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Affiliation(s)
- Marije J. Splinter
- Department of Epidemiology, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Premysl Velek
- Department of Epidemiology, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of General Practice, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M. Kamran Ikram
- Department of Epidemiology, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Neurology, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Brenda C. T. Kieboom
- Department of Epidemiology, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of General Practice, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Robin P. Peeters
- Department of Internal Medicine, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Patrick J. E. Bindels
- Department of General Practice, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Frank J. Wolters
- Department of Epidemiology, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maarten J. G. Leening
- Department of Epidemiology, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Cardiology, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Evelien I. T. de Schepper
- Department of General Practice, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Silvan Licher
- Department of Epidemiology, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
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Luijten SPR, Compagne KCJ, van Es ACGM, Roos YBWEM, Majoie CBLM, van Oostenbrugge RJ, van Zwam WH, Dippel DWJ, Wolters FJ, van der Lugt A, Bos D. Brain atrophy and endovascular treatment effect in acute ischemic stroke: a secondary analysis of the MR CLEAN trial. Int J Stroke 2021; 17:17474930211054964. [PMID: 34711105 PMCID: PMC9483187 DOI: 10.1177/17474930211054964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Brain atrophy is suggested to impair the potential for functional recovery after acute ischemic stroke. We assessed whether the effect of endovascular treatment is modified by brain atrophy in patients with acute ischemic stroke due to large vessel occlusion. METHODS We used data from MR CLEAN, a multicenter trial including patients with acute ischemic stroke due to anterior circulation large vessel occlusion randomized to endovascular treatment plus medical care (intervention) versus medical care alone (control). We segmented total brain volume (TBV) and intracranial volume (ICV) on baseline non-contrast computed tomography (n = 410). Next, we determined the degree of atrophy as the proportion of brain volume in relation to head size (1 - TBV/ICV) × 100%, analyzed as continuous variable and in tertiles. The primary outcome was a shift towards better functional outcome on the modified Rankin Scale expressed as adjusted common odds ratio. Treatment effect modification was tested using an interaction term between brain atrophy (as continuous variable) and treatment allocation. RESULTS We found that brain atrophy significantly modified the effect of endovascular treatment on functional outcome (P for interaction = 0.04). Endovascular treatment led to larger shifts towards better functional outcome in the higher compared to the lower range of atrophy (adjusted common odds ratio, 1.86 [95% CI: 0.97-3.56] in the lowest tertile vs. 1.97 [95% CI: 1.03-3.74] in the middle tertile vs. 3.15 [95% CI: 1.59-6.24] in the highest tertile). CONCLUSION Benefit of endovascular treatment is larger in the higher compared to the lower range of atrophy, demonstrating that advanced atrophy should not be used as an argument to withhold endovascular treatment.
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Affiliation(s)
- Sven PR Luijten
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kars CJ Compagne
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Adriaan CGM van Es
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvo BWEM Roos
- Department of Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Charles BLM Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Wim H van Zwam
- Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Diederik WJ Dippel
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frank J Wolters
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Daniel Bos
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Abstract
BACKGROUND The burden of dementia is changing due to population aging and changes in incidence and risk factor profiles. Reliable projections of future disease burden require accurate estimates of disease duration across different stages of dementia severity. OBJECTIVE To provide an overview of current evidence on severity stage and disease duration in patients with dementia. METHODS We reviewed the literature on duration of mild cognitive impairment (MCI), dementia, and various dementia severity stages. Data on study setting, country, sample size, severity stages, dementia type, and definition of disease duration was collected. Weighted averages and Q-statistics were calculated within severity stages and duration definitions. RESULTS Of 732 screened articles, 15 reported the duration of one or more severity stages and only half of those reported severity stage onset to conversion to the following stage. In those studies, MCI, very mild dementia, and mild dementia stages lasted 3-4 years and moderate and severe dementia stages lasted 1-2 years. Information on the disease duration was reported in 93 (13%) of screened articles and varied from 1 to 17 years. Reporting of dementia severity stage and disease duration in the literature was highly heterogeneous, which was accounted for only in part by dementia type, study setting, or continent of data collection. CONCLUSION The duration of dementia disease stages shortens with advancing stage. However, reliable modelling of future dementia burden and informing of intervention strategies will require more consistently reported duration estimates from studies that follow individuals longitudinally throughout their entire disease course.
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Affiliation(s)
- Chiara C Brück
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Inge M C M de Kok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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44
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Mooldijk SS, Yaqub A, Wolters FJ, Licher S, Koudstaal PJ, Ikram MK, Ikram MA. Life expectancy with and without dementia in persons with mild cognitive impairment in the community. J Am Geriatr Soc 2021; 70:481-489. [PMID: 34664261 PMCID: PMC9298312 DOI: 10.1111/jgs.17520] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/13/2021] [Accepted: 09/24/2021] [Indexed: 12/01/2022]
Abstract
Background Various clinical studies have provided estimates of life expectancy of patients with mild cognitive impairment (MCI) from outpatient clinics, but whether these apply to community‐dwelling individuals at home or in primary care is uncertain. Methods Within the population‐based Rotterdam Study, we studied life expectancy with and without dementia in 648 community‐dwelling persons with MCI and 6410 without MCI. Participants aged 60 years and older were assessed for MCI at baseline (2002–2014) and subsequently followed for the onset of dementia and death. We used multistate life tables to determine age‐specific life expectancy with and without dementia by sex, educational attainment, and MCI subtype. Results Total life expectancy for MCI ranged from 21.4 years (95% CI: 19.0–23.6) at age 60 to 2.6 years (1.6–3.6) at age 95. With advancing age, an increasing proportion of these years was lived with dementia (2.9 years [1.8–4.0] at age 60; 1.2 [0.2–2.2] at age 95). Women and higher educated individuals lived longer and lived more years with dementia. No differences in total life expectancy were observed by MCI subtype, although individuals with amnestic MCI lived a larger proportion of those years with dementia. Conclusions Prognosis of MCI, in terms of life years lived with and without dementia, is more favorable in the general population than described in prior clinical observations, due likely to a substantial proportion of individuals with MCI in the clinic not seeking medical attention in an earlier stage.
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Affiliation(s)
- Sanne S Mooldijk
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Amber Yaqub
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Silvan Licher
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
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45
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Abstract
Importance For informed decision making on diagnosis and treatment of dementia, physicians and their patients rely on the generalizability of evidence from published studies to clinical practice. However, it is uncertain whether everyday care of elderly patients with dementia is sufficiently captured in contemporary research. Objective To systematically review contemporary dementia research in terms of study and patient characteristics in order to assess generalizability of research findings. Evidence Review PubMed was searched for dementia studies published in the top 100 journals in the fields of neurology and neuroscience, geriatrics, psychiatry, and general medicine between September 1, 2018, and August 31, 2019. Two reviewers extracted study characteristics, including setting, number of participants, age at diagnosis, and use of biomarkers. Findings Among 513 identified studies, 211 (41%) included fewer than 50 individuals with dementia and were excluded. The remaining 302 studies included a median (interquartile range) of 214 patients (98-628) with a mean (SD) age at diagnosis of 74.1 years (8.0). Age at diagnosis differed with study setting. Patients in the 180 clinic-based studies had a mean (SD) age of 71.8 (6.4) years at time of diagnosis compared with 80.6 (4.7) years among patients in the 79 population-based studies (mean difference, 8.8 years; 95% CI, 7.3-10.2). Use of magnetic resonance imaging, positron emission tomography imaging, and cerebrospinal fluid imaging was mostly done in clinic-based studies (80% to 96%) and consequently in relatively young patients (mean [SD] age, 71.6 [5.1] years). A longitudinal design was more common in population-based studies than in clinic-based studies (82 % vs 40%). Most studies originated from North America and Europe (89%), including almost exclusively White participants (among 74 studies [22%] reporting on ethnicity: median [interquartile range], 89% [78-97]). The 3 most studied cohorts represented 21% of all included study populations. Conclusions and Relevance Contemporary dementia research is limited in terms of racial and geographic diversity and draws largely from clinic-based populations with relatively young patients. Greater inclusivity and deeper phenotyping in unselected cohorts could improve generalizability as well as diagnosis and development of effective treatments for all patients with dementia.
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Affiliation(s)
- Sanne S Mooldijk
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Silvan Licher
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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46
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Donkel SJ, Wolters FJ, Ikram MA, de Maat MPM. Circulating Myeloperoxidase (MPO)-DNA complexes as marker for Neutrophil Extracellular Traps (NETs) levels and the association with cardiovascular risk factors in the general population. PLoS One 2021; 16:e0253698. [PMID: 34379628 PMCID: PMC8357174 DOI: 10.1371/journal.pone.0253698] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 12/21/2020] [Accepted: 06/11/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Neutrophil extracellular traps (NETs) are DNA scaffolds enriched with antimicrobial proteins. NETs have been implicated in the development of various diseases, such as cardiovascular disease. Here, we investigate the association of demographic and cardiovascular (CVD) risk factors with NETs in the general population. Material and methods Citrated plasma was collected from 6449 participants, aged ≥55 years, as part of the prospective population-based Rotterdam Study. NETs were quantified by measuring MPO-DNA complex using an ELISA. We used linear regression to determine the associations between MPO-DNA complex and age, sex, cardio-metabolic risk factors, and plasma markers of inflammation and coagulation. Results MPO-DNA complex levels were weakly associated with age (log difference per 10 year increase: -0.04 mAU/mL, 95% confidence interval [CI] -0.06;-0.02), a history of coronary heart disease (yes versus no: -0.10 mAU/mL, 95% CI -0.17;-0.03), the use of lipid-lowering drugs (yes versus no: -0.06 mAU/mL, 95% CI -0.12;-0.01), and HDL-cholesterol (per mmol/l increase: -0.07 mAU/mL/, 95% CI -0.12;-0.03). Conclusions Older age, a history of coronary heart disease, the use of lipid-lowering drugs and higher HDL-cholesterol are weakly correlated with lower plasma levels of NETs. These findings show that the effect of CVD risk factors on NETs levels in a general population is only small and may not be of clinical relevance. This supports that NETs may play a more important role in an acute phase of disease than in a steady state situation.
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Affiliation(s)
- Samantha J. Donkel
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frank J. Wolters
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Moniek P. M. de Maat
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
- * E-mail:
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47
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Wolters FJ, Volovici V. The US Preventive Services Task Force Recommendation Statement About Screening Asymptomatic Adults for Carotid Stenosis. JAMA 2021; 326:88. [PMID: 34228069 DOI: 10.1001/jama.2021.6495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Frank J Wolters
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Victor Volovici
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands
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48
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Ma Y, Zhou J, Kavousi M, Lipsitz LA, Mattace-Raso F, Westerhof BE, Wolters FJ, Wu JW, Manor B, Ikram MK, Goudsmit J, Hofman A, Ikram MA. Lower complexity and higher variability in beat-to-beat systolic blood pressure are associated with elevated long-term risk of dementia: The Rotterdam Study. Alzheimers Dement 2021; 17:1134-1144. [PMID: 33860609 DOI: 10.1002/alz.12288] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/02/2020] [Accepted: 12/06/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION We hypothesized that subclinical disruption in blood pressure (BP) dynamics, captured by lower complexity and higher variability, may contribute to dementia risk, above and beyond BP levels. METHODS This prospective cohort study followed 1835 older adults from 1997 to 2016, with BP complexity quantified by sample entropy and BP variability quantified by coefficient of variation using beat-to-beat BP measured at baseline. RESULTS Three hundred thirty-four participants developed dementia over 20 years. Reduced systolic BP (SBP) complexity was associated with a higher risk of dementia (hazard ratio [HR] comparing extreme quintiles: 1.55; 95% confidence interval [CI]: 1.09-2.20). Higher SBP variability was also associated with a higher risk of dementia (HR comparing extreme quintiles: 1.57; 95% CI: 1.11-2.22. These findings were observed after adjusting for age, sex, apolipoprotein E (APOE) genotype, mean SBP, and other confounding factors. DISCUSSIONS Our findings suggest that lower complexity and higher variability of beat-to-beat SBP are potential novel risk factors or biomarkers for dementia.
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Affiliation(s)
- Yuan Ma
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA.,Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Junhong Zhou
- Beth Israel Deaconess Medical Center, Harvard Medical School, and Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Boston, USA
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lewis A Lipsitz
- Beth Israel Deaconess Medical Center, Harvard Medical School, and Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Boston, USA
| | - Francesco Mattace-Raso
- Division of Geriatrics, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Berend E Westerhof
- Cardiovascular and Respiratory Physiology, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Julia W Wu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Brad Manor
- Beth Israel Deaconess Medical Center, Harvard Medical School, and Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Boston, USA
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jaap Goudsmit
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, USA.,Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA.,Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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49
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Heidemann BE, Wolters FJ, Kavousi M, Gruppen EG, Dullaart RP, Marais AD, Visseren FL, Koopal C. Adiposity and the development of dyslipidemia in APOE ε2 homozygous subjects: A longitudinal analysis in two population-based cohorts. Atherosclerosis 2021; 325:57-62. [PMID: 33892328 DOI: 10.1016/j.atherosclerosis.2021.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/19/2021] [Accepted: 04/01/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Familial dysbetalipoproteinemia (FD), characterized by remnant lipoprotein accumulation and premature cardiovascular disease, occurs in homozygous carriers of the APOE ε2 allele, but genetic predisposition alone does not suffice for the clinical phenotype. Cross-sectional studies suggest that a second metabolic hit - notably adiposity or insulin resistance - is required, but the association between these risk factors and development of FD has not been studied prospectively. METHODS For this study, we evaluated 18,987 subjects from two large prospective Dutch population-based cohorts (PREVEND and Rotterdam Study) of whom 118 were homozygous APOE ε2 carriers. Of these, 69 subjects were available for prospective analyses. Dyslipidemia - likely to be FD - was defined as fasting triglyceride (TG) levels >3 mmol/L in untreated subjects or use of lipid lowering medication. The effect of weight, body mass index (BMI), waist circumference, type 2 diabetes mellitus and non-TG metabolic syndrome on development of dyslipidemia was investigated. RESULTS Eleven of the 69 ε2ε2 subjects (16%) developed dyslipidemia - likely FD - during follow-up. Age-, sex- and cohort-adjusted risk factors for the development of FD were BMI (OR 1.19; 95%CI 1.04-1.39), waist circumference (OR 1.26 95%CI 1.01-1.61) and presence of non-TG metabolic syndrome (OR 4.39; 95%CI 1.04-18.4) at baseline. Change in adiposity during follow-up was not associated with development of dyslipidemia. CONCLUSIONS Adiposity increases the risk of developing an FD-like lipid phenotype in homozygous APOE ε2 subjects. These results stress the importance of healthy body weight in subjects at risk of developing FD.
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Affiliation(s)
- Britt E Heidemann
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eke G Gruppen
- Department of Endocrinology, University of Groningen and University Medical Center Groningen, University of Groningen, the Netherlands
| | - Robin Pf Dullaart
- Department of Endocrinology, University of Groningen and University Medical Center Groningen, University of Groningen, the Netherlands
| | - A David Marais
- Division of Chemical Pathology, Faculty of Health Sciences, University of Cape Town, South Africa, Cape Town, South Africa
| | - Frank Lj Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - Charlotte Koopal
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands
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50
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Leng X, Hurford R, Feng X, Chan KL, Wolters FJ, Li L, Soo YO, Wong KSL, Mok VC, Leung TW, Rothwell PM. Intracranial arterial stenosis in Caucasian versus Chinese patients with TIA and minor stroke: two contemporaneous cohorts and a systematic review. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-325630. [PMID: 33785575 PMCID: PMC8142447 DOI: 10.1136/jnnp-2020-325630] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/21/2020] [Accepted: 01/04/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intracranial arterial stenosis (ICAS) is an important cause of stroke worldwide. Separate reports in Caucasians and Asians with stroke/transient ischaemic attack (TIA) have suggested lower ICAS prevalence in Caucasians, but there has been no direct comparisons of the two ethnic groups with the same criteria to define ICAS. METHODS Acute minor stroke or TIA patients in two cohorts respectively recruiting patients in Oxford (2011-2018, predominantly Caucasians) and Hong Kong (2011-2015, predominantly Chinese) were compared. ICAS was defined as ≥50% stenosis/occlusion in any major intracranial artery in MR/CT angiography. Prevalence, distribution and risk factors of ICAS were compared between the two cohorts. We also systematically reviewed literature on ICAS prevalence in stroke/TIA patients in different populations. RESULTS Among 1287 patients from Oxford and 691 from Hong Kong (mean age 69 vs 66), ICAS prevalence was higher in Chinese than in Caucasians (43.0% vs 20.0%; OR 3.02; 95% CI 2.47 to 3.70; p<0.001), independent of age (age-adjusted OR 3.73; 95% CI 3.00 to 4.63; p<0.001) and vascular risk factors (multivariable-adjusted OR 3.21; 95% CI 2.56 to 4.02; p<0.001). This ethnic difference was greater (p interaction=0.005) at age <70 years (OR 5.33; 95% CI 3.79 to 7.50; p<0.001) than at ≥70 years (OR 2.81; 95% CI 2.11 to 3.74; p<0.001). ICAS prevalence increased with age and with vascular risk factors in both cohorts, with equivalent prevalence in Chinese aged <60 years and Caucasians aged ≥80, and in Chinese with no vascular risk factor and Caucasians with two vascular risk factors. ICAS locations also differed between Chinese and Caucasian patients. CONCLUSIONS Chinese are more susceptible to ICAS than Caucasians, with an earlier onset age and a higher prevalence, independent of vascular risk factors.
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Affiliation(s)
- Xinyi Leng
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Robert Hurford
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Xueyan Feng
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Lung Chan
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Frank J Wolters
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Linxin Li
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Yannie Oy Soo
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Sing Lawrence Wong
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent Ct Mok
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas W Leung
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter M Rothwell
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
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