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Mielke MM, Frank RD, Christenson LR, Fields JA, Rocca WA, Garovic VD. Association of Hypertensive Disorders of Pregnancy With Cognition in Later Life. Neurology 2023; 100:e2017-e2026. [PMID: 36859405 PMCID: PMC10186223 DOI: 10.1212/wnl.0000000000207134] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/17/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Studies of hypertensive disorders of pregnancy (HDP), including gestational or chronic hypertension (GH/CH) and preeclampsia/eclampsia (PE/E), suggest associations with early-life and mid-life cognition but have been limited by self-report or use of diagnostic codes, exclusion of nulliparous women, and lack of measurement of cognition in later life. We examined the effects of any HDP, GH/CH, PE/E, and nulliparity on cognition in later life. METHODS Participants included 2,239 women (median age 73) enrolled in the Mayo Clinic Study of Aging with medical record-abstracted pregnancy information. A cognitive battery of 9 tests was conducted every 15 months. Global cognitive and domain-specific z scores (memory, executive/attention, visuospatial, and language) were outcomes. Linear mixed-effect models evaluated associations between pregnancy history (all normotensive, any HPD, HPD subtype [GH/CH, PE/E], or nulliparous) and cognitive decline, adjusting for age and education. Additional models adjusted for APOE, smoking, hypertension, dyslipidemia, body mass index (BMI), diabetes, stroke, and heart disease. Interactions between pregnancy history and age or education on cognitive performance were examined. RESULTS Of the 2,239 women, 1,854 (82.8%) had at least 1 pregnancy (1,607 all normotensive, 100 GH/CH, and 147 PE/E); 385 (17.2%) were nulliparous. Cognitive performance did not cross-sectionally differ for women with a history of any HDP, GH/CH, or PE/E vs women with a history of all normotensive pregnancies; women who were nulliparous had lower global and domain-specific cognition (all p < 0.05) in age- and education-adjusted models. There was an interaction (p = 0.015) between nulliparity and education such that the lower cognitive performance was most pronounced among nulliparous women with ≤12 years of education (beta = -0.42, p < 0.001) vs 12 + years (b = -0.11, p = 0.049). Longitudinally, women with any HDP had greater declines in global cognition and attention/executive z scores compared with women with all normotensive pregnancies. When stratified by HDP type, only women with PE/E had greater declines in global cognition (beta = -0.04, p < 0.001), language (beta = -0.03, p = 0.001), and attention (beta = -0.04, p < 0.001) z scores. Adjustment for vascular risk factors, BMI, smoking, and APOE did not attenuate results. DISCUSSION Women with a history of HDP, especially PE/E, are at greater risk of cognitive decline in later life.
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Affiliation(s)
- Michelle M Mielke
- From the Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Quantitative Health Sciences (R.D.F., L.R.C., W.A.R.), Mayo Clinic, Rochester, MN; Division of Neurocognitive Disorders, Department of Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Department of Neurology and Women's Health Research Center (W.A.R.), Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension and Department of Obstetrics and Gynecology (V.D.G.), Mayo Clinic, Rochester, MN
| | - Ryan D Frank
- From the Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Quantitative Health Sciences (R.D.F., L.R.C., W.A.R.), Mayo Clinic, Rochester, MN; Division of Neurocognitive Disorders, Department of Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Department of Neurology and Women's Health Research Center (W.A.R.), Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension and Department of Obstetrics and Gynecology (V.D.G.), Mayo Clinic, Rochester, MN
| | - Luke R Christenson
- From the Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Quantitative Health Sciences (R.D.F., L.R.C., W.A.R.), Mayo Clinic, Rochester, MN; Division of Neurocognitive Disorders, Department of Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Department of Neurology and Women's Health Research Center (W.A.R.), Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension and Department of Obstetrics and Gynecology (V.D.G.), Mayo Clinic, Rochester, MN
| | - Julie A Fields
- From the Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Quantitative Health Sciences (R.D.F., L.R.C., W.A.R.), Mayo Clinic, Rochester, MN; Division of Neurocognitive Disorders, Department of Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Department of Neurology and Women's Health Research Center (W.A.R.), Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension and Department of Obstetrics and Gynecology (V.D.G.), Mayo Clinic, Rochester, MN
| | - Walter A Rocca
- From the Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Quantitative Health Sciences (R.D.F., L.R.C., W.A.R.), Mayo Clinic, Rochester, MN; Division of Neurocognitive Disorders, Department of Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Department of Neurology and Women's Health Research Center (W.A.R.), Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension and Department of Obstetrics and Gynecology (V.D.G.), Mayo Clinic, Rochester, MN
| | - Vesna D Garovic
- From the Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Quantitative Health Sciences (R.D.F., L.R.C., W.A.R.), Mayo Clinic, Rochester, MN; Division of Neurocognitive Disorders, Department of Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Department of Neurology and Women's Health Research Center (W.A.R.), Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension and Department of Obstetrics and Gynecology (V.D.G.), Mayo Clinic, Rochester, MN
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Cleven L, Syrjanen JA, Geda YE, Christenson LR, Petersen RC, Vassilaki M, Woll A, Krell-Roesch J. Association between physical activity and longitudinal change in body mass index in middle-aged and older adults. BMC Public Health 2023; 23:202. [PMID: 36717834 PMCID: PMC9885704 DOI: 10.1186/s12889-023-15119-7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/22/2022] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND In middle-aged and particularly older adults, body mass index (BMI) is associated with various health outcomes. We examined associations between physical activity (PA) and longitudinal BMI change in persons aged ≥ 50 years. METHODS The sample included 5159 community-dwelling individuals aged ≥ 50 years (50.5% males, mean (SD) age 73.0 (10.2) years at baseline) who were enrolled in the Mayo Clinic Study of Aging (MCSA). Participants had information on PA within one year of baseline assessment, BMI at baseline, and potential follow-up assessments (mean (SD) follow-up 4.6 (3.7) years). Linear mixed-effect models were used to calculate the association between PA (moderate-vigorous physical activity, MVPA; and all PA composite score) and the longitudinal change in BMI, adjusted for baseline age, sex, education and medical comorbidities. In addition to interactions between years since baseline and PA, we also included 2- and 3-way interactions with baseline age to further assess whether age modifies the trajectory of BMI over time. RESULTS We observed a decrease in BMI among participants engaging at a mean amount of PA (i.e. , MVPA 2.7; all PA: 6.8) and with a mean age (i.e., 73 years) at baseline (MVPA: estimate = -0.047, 95% CI -0.059, -0.034; all PA: estimate = -0.047, 95% CI -0.060, -0.035), and this decline is accelerated with increasing age. Participants with a mean age (i.e., 73 years) that engage at an increased amount of MVPA or all PA at baseline (i.e., one SD above the mean) do not decrease as fast with regard to BMI (MVPA: estimate = -0.006; all PA: estimate = -0.016), and higher levels of MVPA or all PA at baseline (i.e., two SD above the mean) were even associated with an increase in BMI (MVPA: estimate = 0.035; all PA: estimate = 0.015). Finally, MVPA but not all PA is beneficial at slowing BMI decline with increasing age. CONCLUSION PA, particularly at moderate-vigorous intensity, is associated with slower decline in longitudinal BMI trajectories. This implies that engaging in PA may be beneficial for healthy body weight regulation in middle and late adulthood.
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Affiliation(s)
- Laura Cleven
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany.
| | - Jeremy A. Syrjanen
- grid.66875.3a0000 0004 0459 167XDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - Yonas E. Geda
- grid.427785.b0000 0001 0664 3531Department of Neurology and the Franke Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix, AZ USA
| | - Luke R. Christenson
- grid.66875.3a0000 0004 0459 167XDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - Ronald C. Petersen
- grid.66875.3a0000 0004 0459 167XDepartment of Neurology, Mayo Clinic, Rochester, MN USA
| | - Maria Vassilaki
- grid.66875.3a0000 0004 0459 167XDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - Alexander Woll
- grid.7892.40000 0001 0075 5874Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Janina Krell-Roesch
- grid.7892.40000 0001 0075 5874Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany ,grid.66875.3a0000 0004 0459 167XDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
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Vassilaki M, Fu S, Christenson LR, Garg M, Petersen RC, St. Sauver J, Sohn S. Characterizing Performance Gaps of a Code-Based Dementia Algorithm in a Population-Based Cohort of Cognitive Aging. J Alzheimers Dis 2023; 95:931-940. [PMID: 37638438 PMCID: PMC10590260 DOI: 10.3233/jad-230344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND Multiple algorithms with variable performance have been developed to identify dementia using combinations of billing codes and medication data that are widely available from electronic health records (EHR). If the characteristics of misclassified patients are clearly identified, modifying existing algorithms to improve performance may be possible. OBJECTIVE To examine the performance of a code-based algorithm to identify dementia cases in the population-based Mayo Clinic Study of Aging (MCSA) where dementia diagnosis (i.e., reference standard) is actively assessed through routine follow-up and describe the characteristics of persons incorrectly categorized. METHODS There were 5,316 participants (age at baseline (mean (SD)): 73.3 (9.68) years; 50.7% male) without dementia at baseline and available EHR data. ICD-9/10 codes and prescription medications for dementia were extracted between baseline and one year after an MCSA dementia diagnosis or last follow-up. Fisher's exact or Kruskal-Wallis tests were used to compare characteristics between groups. RESULTS Algorithm sensitivity and specificity were 0.70 (95% CI: 0.67, 0.74) and 0.95 (95% CI: 0.95, 0.96). False positives (i.e., participants falsely diagnosed with dementia by the algorithm) were older, with higher Charlson comorbidity index, more likely to have mild cognitive impairment (MCI), and longer follow-up (versus true negatives). False negatives (versus true positives) were older, more likely to have MCI, or have more functional limitations. CONCLUSIONS We observed a moderate-high performance of the code-based diagnosis method against the population-based MCSA reference standard dementia diagnosis. Older participants and those with MCI at baseline were more likely to be misclassified.
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Affiliation(s)
- Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Sunyang Fu
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - Muskan Garg
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Ronald C. Petersen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Sunghwan Sohn
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, USA
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Pink A, Krell‐Roesch J, Syrjanen JA, Christenson LR, Lowe VJ, Vemuri P, Fields JA, Stokin GB, Kremers WK, Scharf EL, Jack CR, Knopman DS, Petersen RC, Vassilaki M, Geda YE. Interactions Between Neuropsychiatric Symptoms and Alzheimer's Disease Neuroimaging Biomarkers in Predicting Longitudinal Cognitive Decline. Psychiatr Res Clin Pract 2023; 5:4-15. [PMID: 36909142 PMCID: PMC9997077 DOI: 10.1176/appi.prcp.20220036] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/13/2022] [Accepted: 12/16/2022] [Indexed: 01/22/2023] Open
Abstract
Objective To examine interactions between Neuropsychiatric symptoms (NPS) with Pittsburgh Compound B (PiB) and fluorodeoxyglucose positron emission tomography (FDG-PET) in predicting cognitive trajectories. Methods We conducted a longitudinal study in the setting of the population-based Mayo Clinic Study of Aging in Olmsted County, MN, involving 1581 cognitively unimpaired (CU) persons aged ≥50 years (median age 71.83 years, 54.0% males, 27.5% APOE ɛ4 carriers). NPS at baseline were assessed using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Brain glucose hypometabolism was defined as a SUVR ≤ 1.47 (measured by FDG-PET) in regions typically affected in Alzheimer's disease. Abnormal cortical amyloid deposition was measured using PiB-PET (SUVR ≥ 1.48). Neuropsychological testing was done approximately every 15 months, and we calculated global and domain-specific (memory, language, attention, and visuospatial skills) cognitive z-scores. We ran linear mixed-effect models to examine the associations and interactions between NPS at baseline and z-scored PiB- and FDG-PET SUVRs in predicting cognitive z-scores adjusted for age, sex, education, and previous cognitive testing. Results Individuals at the average PiB and without NPS at baseline declined over time on cognitive z-scores. Those with increased PiB at baseline declined faster (two-way interaction), and those with increased PiB and NPS declined even faster (three-way interaction). We observed interactions between time, increased PiB and anxiety or irritability indicating accelerated decline on global z-scores, and between time, increased PiB and several NPS (e.g., agitation) showing faster domain-specific decline, especially on the attention domain. Conclusions NPS and increased brain amyloid deposition synergistically interact in accelerating global and domain-specific cognitive decline among CU persons at baseline.
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Affiliation(s)
- Anna Pink
- First Department of MedicineParacelsus Medical UniversitySalzburgAustria
| | - Janina Krell‐Roesch
- Department of Quantitative Health SciencesMayo Clinic RochesterRochesterMinnesotaUSA
- Institute of Sports and Sports ScienceKarlsruhe Institute of TechnologyKarlsruheGermany
| | - Jeremy A. Syrjanen
- Department of Quantitative Health SciencesMayo Clinic RochesterRochesterMinnesotaUSA
| | - Luke R. Christenson
- Department of Quantitative Health SciencesMayo Clinic RochesterRochesterMinnesotaUSA
| | - Val J. Lowe
- Department of RadiologyMayo Clinic RochesterRochesterMinnesotaUSA
| | | | - Julie A. Fields
- Department of Psychiatry and PsychologyMayo Clinic RochesterRochesterMinnesotaUSA
| | - Gorazd B. Stokin
- International Clinical Research Center/St. Anne HospitalBrnoCzech Republic
| | - Walter K. Kremers
- Department of Quantitative Health SciencesMayo Clinic RochesterRochesterMinnesotaUSA
| | - Eugene L. Scharf
- Department of NeurologyMayo Clinic RochesterRochesterMinnesotaUSA
| | - Clifford R. Jack
- Department of RadiologyMayo Clinic RochesterRochesterMinnesotaUSA
| | - David S. Knopman
- Department of NeurologyMayo Clinic RochesterRochesterMinnesotaUSA
| | - Ronald C. Petersen
- Department of Quantitative Health SciencesMayo Clinic RochesterRochesterMinnesotaUSA
- Department of NeurologyMayo Clinic RochesterRochesterMinnesotaUSA
| | - Maria Vassilaki
- Department of Quantitative Health SciencesMayo Clinic RochesterRochesterMinnesotaUSA
| | - Yonas E. Geda
- Department of NeurologyFranke Global Neuroscience Education CenterBarrow Neurological InstitutePhoenixArizonaUSA
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Dugani SB, Christenson LR, Aakre JA, Bui HH, Vella A, Mielke MM. Association of plasma ceramides with prevalent and incident type 2 diabetes mellitus in middle and older aged adults. Diabetes Res Clin Pract 2021; 179:108991. [PMID: 34333058 PMCID: PMC8478833 DOI: 10.1016/j.diabres.2021.108991] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 12/30/2022]
Abstract
AIMS The role of ceramides in the pathogenesis of type 2 diabetes mellitus (T2DM) is incompletely characterized. Given that ceramides represent therapeutic targets to disrupt the euglycemia-T2DM transition, we aimed to characterize their association with prevalent and incident T2DM in a novel cohort. METHODS We examined the cross-sectional and longitudinal association of baseline ceramides with prevalent and incident T2DM among 1423 adults (47% women; median (range) baseline age 72 (51-95) years) in the Mayo Clinic Study of Aging cohort. We examined the associations of ceramides with prevalent T2DM (adjusted odds ratio [95% confidence interval]) at baseline and incident T2DM (adjusted hazard ratio [95% confidence interval]) during median follow-up of 6.2 years, after adjusting for demographic and metabolic factors. RESULTS Among 1423 adults, there were 222 prevalent and 37 incident cases of T2DM. In cross-sectional analyses, higher levels of ceramide C16:0 were associated with lower odds of prevalent T2DM (aOR 0.84 [0.71-0.99];P = 0.03) whereas C18:0 (aOR 1.27 [1.06-1.42];P = 0.01), C18:0/16:0 (aOR 1.41 [1.22-1.62]; P < 0.001) and C18:0/24:0 (aOR 1.22 [1.05-1.41]; P = 0.01) were associated with higher odds. In Cox hazard regression models, C18:0/16:0 (aHR 1.63 [1.26-2.10];P < 0.001) and C18:0 (aHR 1.53 [1.12-2.08];P = 0.01) were associated with increased risk of incident T2DM. CONCLUSIONS In this prospective population-based cohort, ceramides were associated with prevalent T2DM (C16:0,C18:0, C18:0/C16:0 ratio, C18:0/C24:0 ratio) and incident T2DM (C18:0, C18:0/C16:0 ratio) and could suggest targets for the primary and secondary prevention of T2DM.
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Affiliation(s)
- Sagar B Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, United States; Division of Health Care Delivery Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Luke R Christenson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Jeremiah A Aakre
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Hai H Bui
- Eli Lilly and Company, Indianapolis, IN, United States
| | - Adrian Vella
- Division of Endocrinology, Mayo Clinic, Rochester, MN, United States
| | - Michelle M Mielke
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States; Department of Neurology, Mayo Clinic, Rochester, MN, United States.
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