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Kusec A, Milosevich E, Williams OA, Chiu EG, Watson P, Carrick C, Drozdowska BA, Dillon A, Jennings T, Anderson B, Dawes H, Thomas S, Kuppuswamy A, Pendlebury ST, Quinn TJ, Demeyere N. Long-term psychological outcomes following stroke: the OX-CHRONIC study. BMC Neurol 2023; 23:426. [PMID: 38036966 PMCID: PMC10688008 DOI: 10.1186/s12883-023-03463-5] [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: 05/19/2023] [Accepted: 11/10/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Stroke survivors rate longer-term (> 2 years) psychological recovery as their top priority, but data on how frequently psychological consequences occur is lacking. Prevalence of cognitive impairment, depression/anxiety, fatigue, apathy and related psychological outcomes, and whether rates are stable in long-term stroke, is unknown. METHODS N = 105 long-term stroke survivors (M [SD] age = 72.92 [13.01]; M [SD] acute NIH Stroke Severity Score = 7.39 [6.25]; 59.0% Male; M [SD] years post-stroke = 4.57 [2.12]) were recruited (potential N = 208). Participants completed 3 remote assessments, including a comprehensive set of standardized cognitive neuropsychological tests comprising domains of memory, attention, language, and executive function, and questionnaires on emotional distress, fatigue, apathy and other psychological outcomes. Ninety participants were re-assessed one year later. Stability of outcomes was assessed by Cohen's d effect size estimates and percent Minimal Clinically Important Difference changes between time points. RESULTS On the Montreal Cognitive Assessment 65.3% scored < 26. On the Oxford Cognitive Screen 45.9% had at least one cognitive impairment. Attention (27.1%) and executive function (40%) were most frequently impaired. 23.5% and 22.5% had elevated depression/anxiety respectively. Fatigue (51.4%) and apathy (40.5%) rates remained high, comparable to estimates in the first-year post-stroke. Attention (d = -0.12; 85.8% stable) and depression (d = 0.09, 77.1% stable) were the most stable outcomes. Following alpha-adjustments, only perceptuomotor abilities (d = 0.69; 40.4% decline) and fatigue (d = -0.33; 45.3% decline) worsened over one year. Cognitive impairment, depression/anxiety, fatigue and apathy all correlated with worse quality of life. CONCLUSION Nearly half of participants > 2 years post-event exhibited psychological difficulties including domains of cognition, mood, and fatigue, which impact long-term quality of life. Stroke is a chronic condition with highly prevalent psychological needs, which require monitoring and intervention development.
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Affiliation(s)
- Andrea Kusec
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Elise Milosevich
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Owen A Williams
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Evangeline G Chiu
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Pippa Watson
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Chloe Carrick
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Bogna A Drozdowska
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Avril Dillon
- Department of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | | | - Bloo Anderson
- Patient and Public Involvement Representative, Oxford, UK
| | - Helen Dawes
- NIHR Exeter Biomedical Research Centre, University of Exeter, Medical School Building, St Luke's Campus, Magdalen Road, Exeter, UK
| | - Shirley Thomas
- School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Annapoorna Kuppuswamy
- Institute of Neurology Department of Clinical and Movement Neurosciences, University College London, 33 Queen Square, London, UK
- Department of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Sarah T Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Terence J Quinn
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, UK.
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
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Wheeler M, Williams OA, Johns L, Chiu EG, Slavkova ED, Demeyere N. Unravelling the complex interactions between self-awareness, cognitive change, and mood at 6-months post-stroke using the Y-shaped model. Neuropsychol Rehabil 2022; 33:680-702. [PMID: 35257640 DOI: 10.1080/09602011.2022.2042329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We investigated the relationships between cognitive change following stroke, awareness of cognitive impairments, and mood to further understanding of change processes influencing psychological outcomes post-stroke in line with the "Y-shaped" process model. Patients (n = 143; Mage = 73 years, SD = 13.73; 74 males) were assessed at 3-weeks (T1) and 6-months (T2) post-stroke and had completed the Oxford Cognitive Screen (T1 and T2), the Cognitive Failures Questionnaire (CFQ; T2), and the Hospital Anxiety and Depression Scale (HADS; T2). An ANCOVA controlling for disability relating to activities of daily living (ADL) revealed that awareness of cognitive impairment was significantly lower in participants with moderate-severe cognitive impairment. Regression analysis indicated that greater awareness of cognitive impairment and reduced independence in ADL were associated with greater emotional distress at T2. Cognitive improvement was associated with lower emotional distressat T2. Contrary to the awareness hypothesis, moderation analyses suggest that this effect was largest for those most cognitively impaired at T1. Findings emphasize the importance of monitoring stroke patients' capacity to be self-aware when assessing and formulating long-term post-stroke distress and have potential implications for improving long-term emotional status in those most cognitively impaired post-stroke, e.g., through psychoeducation, cognitive rehabilitation, and emotional support.
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Affiliation(s)
- Miranda Wheeler
- The Oxford Institute of Clinical Psychology Training and Research, The Oxford Centre for Psychological Health, University of Oxford, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Owen A Williams
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Louise Johns
- The Oxford Institute of Clinical Psychology Training and Research, The Oxford Centre for Psychological Health, University of Oxford, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Evangeline G Chiu
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Elitsa D Slavkova
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Shafer AT, Williams OA, Perez E, An Y, Landman BA, Ferrucci L, Resnick SM. Accelerated decline in white matter microstructure in subsequently impaired older adults and its relationship with cognitive decline. Brain Commun 2022; 4:fcac051. [PMID: 35356033 PMCID: PMC8963308 DOI: 10.1093/braincomms/fcac051] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/03/2022] [Accepted: 02/25/2022] [Indexed: 11/12/2022] Open
Abstract
Little is known about a longitudinal decline in white matter microstructure and its associations with cognition in preclinical dementia. Longitudinal diffusion tensor imaging and neuropsychological testing were performed in 50 older adults who subsequently developed mild cognitive impairment or dementia (subsequently impaired) and 200 cognitively normal controls. Rates of white matter microstructural decline were compared between groups using voxel-wise linear mixed-effects models. Associations between change in white matter microstructure and cognition were examined. Subsequently impaired individuals had a faster decline in fractional anisotropy in the right inferior fronto-occipital fasciculus and bilateral splenium of the corpus callosum. A decline in right inferior fronto-occipital fasciculus fractional anisotropy was related to a decline in verbal memory, visuospatial ability, processing speed and mini-mental state examination. A decline in bilateral splenium fractional anisotropy was related to a decline in verbal fluency, processing speed and mini-mental state examination. Accelerated regional white matter microstructural decline is evident during the preclinical phase of mild cognitive impairment/dementia and is related to domain-specific cognitive decline.
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Affiliation(s)
- Andrea T. Shafer
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD 21224, USA,Correspondence to: Andrea T. Shafer 251 Bayview Blvd., Baltimore MD 21224, USA E-mail:
| | - Owen A. Williams
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD 21224, USA,Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Evian Perez
- San Juan Bautista School of Medicine, Caguas, Puerto Rico
| | - Yang An
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD 21224, USA
| | | | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, MD 21224, USA
| | - Susan M. Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD 21224, USA,Correspondence may also be addressed to: Susan M. Resnick E-mail:
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Demeyere N, Williams OA, Milosevich E, Chiu EG, Drozdowska BA, Dillon A, Dawes H, Thomas S, Kuppuswamy A, Pendlebury ST, J Quinn T. Long-term psychological consequences of stroke (OX-CHRONIC): A longitudinal study of cognition in relation to mood and fatigue after stroke: Protocol. Eur Stroke J 2021; 6:428-437. [PMID: 35342816 PMCID: PMC8948513 DOI: 10.1177/23969873211046120] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/25/2021] [Indexed: 12/18/2022] Open
Abstract
Background The long-term psychological consequences of stroke and how cognitive problems change over time after the first-year following stroke remain unclear. Particularly, trajectories of domain-specific and domain-general cognitive functions and how cognition interacts with mood, fatigue and quality of life are not well described. Aims To determine the prevalence, trajectories and wider impact of domain-specific cognitive impairment in long-term stroke survivors, in relation to mood, fatigue and quality of life. Methods Participants who previously took part in the Oxford Cognitive Screening study, completed the 6-month follow-up with cognitive, mood, fatigue and quality of life assessments and agreed to be contacted for future research will be recruited into OX-CHRONIC. The eligible cohort is between 2- and 9-years post-stroke. Cognition will be assessed with a detailed neuropsychological battery, alongside questionnaire measures of mood, fatigue, activities of daily life and quality of life measures at two timepoints, 1 year apart. Additionally, medical records will be accessed to extract further clinical information about the stroke and patients may opt-in to wear an activity monitor for 1 week to provide fine-grained measures of sleep and activity. The study protocol and study materials were approved by the national ethics committee (REC Ref: 19/SC/0520). Planned outputs OX-CHRONIC will provide detailed data on the evolving cognitive profiles of stroke survivors over several years post-stroke. Estimates of long-term prevalence as well as the effect of changes in cognitive profiles on mood, fatigue and quality of life will be examined. This study is funded by a Priority Programme Grant from the Stroke Association (SA PPA 18/100032).
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Affiliation(s)
- Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Owen A Williams
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Elise Milosevich
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Evangeline G Chiu
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Bogna A Drozdowska
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Avril Dillon
- Centre for Movement, Occupational and Rehabilitation Sciences, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Helen Dawes
- Centre for Movement, Occupational and Rehabilitation Sciences, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Shirley Thomas
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Annapoorna Kuppuswamy
- Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, UK
| | - Sarah T Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre and Departments of General (Internal) Medicine and Gerantology, John Radcliffe Hospital, Oxford, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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5
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Armstrong NM, Williams OA, Landman BA, Deal JA, Lin FR, Resnick SM. Association of Poorer Hearing With Longitudinal Change in Cerebral White Matter Microstructure. JAMA Otolaryngol Head Neck Surg 2021; 146:1035-1042. [PMID: 32880621 DOI: 10.1001/jamaoto.2020.2497] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance There is a dearth of studies that examine the association between poorer hearing and change in cerebral white matter (WM) microstructure. Objective To examine the association of poorer hearing with baseline and change in WM microstructure among older adults. Design, Setting, and Participants This was a prospective cohort study that evaluated speech-in-noise, pure-tone audiometry, and WM microstructure, as measured by mean diffusivity (MD) and fractional anisotropy (FA), both of which were evaluated by diffusion tensor imaging (DTI) in 17 WM regions. Data were collected between October 2012 and December 2018 and analyzed between March 2019 and August 2019 with a mean follow-up time of 1.7 years. The study evaluated responses to the Baltimore Longitudinal Study of Aging among 356 cognitively normal adults who had at least 1 hearing assessment and DTI session. Excluded were those with baseline cognitive impairment, stroke, head injuries, Parkinson disease, and/or bipolar disorder. Exposures Peripheral auditory function was measured by pure-tone average in the better-hearing ear. Central auditory function was measured by signal-to-noise ratio score from a speech-in-noise task and adjusted by pure-tone average. Main Outcomes and Measures Linear mixed-effects models with random intercepts and slopes were used to examine the association of poorer peripheral and central auditory function with baseline and longitudinal DTI metrics in 17 WM regions, adjusting for baseline characteristics (age, sex, race, hypertension, elevated total cholesterol, and obesity). Results Of 356 cognitively normal adults included in the study, the mean (SD) age was 73.5 (8.8) years, and 204 (57.3%) were women. There were no baseline associations between hearing and DTI measures. Longitudinally, poorer peripheral hearing was associated with increases in MD in the inferior fronto-occipital fasciculus (β = 0.025; 95% CI, 0.008-0.042) and the body (β = 0.050; 95% CI, 0.015-0.085) of the corpus callosum, but there were no associations of peripheral hearing with FA changes in these tracts. Poorer central auditory function was associated with longitudinal MD increases (β = 0.031; 95% CI, 0.010-0.052) and FA declines (β = -1.624; 95% CI, -2.511 to -0.738) in the uncinate fasciculus. Conclusions and Relevance Findings of this cohort study suggest that poorer hearing is related to change in integrity of specific WM regions involved with auditory processing.
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Affiliation(s)
- Nicole M Armstrong
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Maryland.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Owen A Williams
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | | | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Frank R Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
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Williams OA, An Y, Armstrong NM, Kitner-Triolo M, Ferrucci L, Resnick SM. Profiles of Cognitive Change in Preclinical and Prodromal Alzheimer's Disease Using Change-Point Analysis. J Alzheimers Dis 2021; 75:1169-1180. [PMID: 32390623 DOI: 10.3233/jad-191268] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is now understood to have a long preclinical phase in which pathology starts to accumulate in the absence of clinical symptoms. Identifying the temporal stages of accelerated cognitive decline in this phase may help in developing more sensitive neuropsychological tools for early screening of preclinical cognitive decline. Change-point analyses are increasingly used to characterize the temporal stages of accelerated cognitive decline in the preclinical stages of AD. However, statistical comparisons of change-points between specific cognitive measures have not been reported. OBJECTIVE To characterize and compare the temporal stages of accelerated decline in performance on multiple cognitive tests in a sample of participants from the Baltimore Longitudinal Study on Aging (BLSA) who later developed AD. METHODS 165 older adults (baseline age range: 61.1-91.2) from the BLSA developed AD during follow-up. Linear and non-linear mixed models were fit for 11 cognitive measures to determine change-points in rates of decline before AD diagnosis. Bootstrapping was used to compare the timing of change-points across cognitive measures. RESULTS Change-points followed by accelerated decline ranged from 15.5 years (Standard Error (S.E.) = 1.72) for Card Rotations to 1.9 years (S.E. = 0.68) for the Trail-Making Test Part A before AD diagnosis. Accelerated decline in Card Rotations occurred significantly earlier than all other measures, including learning and memory measures. CONCLUSION Results suggest that visuospatial ability, as assessed by Card Rotations, may have the greatest utility as an early predictive tool in identifying preclinical AD.
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Affiliation(s)
- Owen A Williams
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA.,Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Yang An
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA
| | - Nicole M Armstrong
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA
| | - Melissa Kitner-Triolo
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, USA
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA
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Shafer AT, Beason-Held L, An Y, Williams OA, Huo Y, Landman BA, Caffo BS, Resnick SM. Default mode network connectivity and cognition in the aging brain: the effects of age, sex, and APOE genotype. Neurobiol Aging 2021; 104:10-23. [PMID: 33957555 DOI: 10.1016/j.neurobiolaging.2021.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/04/2021] [Accepted: 03/24/2021] [Indexed: 01/18/2023]
Abstract
The default mode network (DMN) overlaps with regions showing early Alzheimer's Disease (AD) pathology. Age, sex, and apolipoprotein E ɛ4 are the predominant risk factors for developing AD. How these risk factors interact to influence DMN connectivity and connectivity-cognition relationships before the onset of impairment remains unknown. Here, we examined these issues in 475 cognitively normal adults, targeting total DMN connectivity, its anticorrelated network (acDMN), and the DMN-hippocampal component. There were four main findings. First, in the ɛ3 homozygous group, lower DMN and acDMN connectivity was observed with age. Second, sex and ɛ4 modified the relationship between age and connectivity for the DMN and hippocampus with ɛ4 vs. ɛ3 males showing sustained or higher connectivity with age. Third, in the ɛ3 group, age and sex modified connectivity-cognition relationships with the oldest participants having the most differential patterns due to sex. Fourth, ɛ4 carriers with lower connectivity had poorer cognitive performance. Taken together, our results show the three predominant risk factors for AD interact to influence brain function and function-cognition relationships.
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Affiliation(s)
- Andrea T Shafer
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD.
| | - Lori Beason-Held
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD
| | - Yang An
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD
| | - Owen A Williams
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD
| | - Yuankai Huo
- Department of Electrical Engineering & Computer Science, Vanderbilt University, Nashville, TN
| | - Bennett A Landman
- Department of Electrical Engineering & Computer Science, Vanderbilt University, Nashville, TN
| | - Brian S Caffo
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD.
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8
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Williams OA, Demeyere N. Association of Depression and Anxiety With Cognitive Impairment 6 Months After Stroke. Neurology 2021; 96:e1966-e1974. [PMID: 33632803 DOI: 10.1212/wnl.0000000000011748] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/13/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To investigate the associations between general cognitive impairment and domain-specific cognitive impairment with depression and anxiety at 6 months poststroke. METHODS Participants were patients with confirmed acute stroke from the OCS-Care Study who were recruited on stroke wards in a multisite study and followed up at a 6-month poststroke assessment. Depression and anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale subscales, with scores greater than 7 indicating possible mood disorders. General cognitive impairment at follow-up was assessed using the Montreal Cognitive Assessment (MoCA); stroke-specific cognitive domain impairments were assessed using the Oxford Cognitive Screen (OCS). Linear regression was used to examine the associations between cognition and depression/anxiety symptoms at 6 months, controlling for acute stroke severity and activities of daily living impairment, age, sex, education, and co-occurring poststroke depression/anxiety. RESULTS A total of 437 participants (mean age, 69.28 years [SD 12.17], 226 male [51.72%]) were included in analyses. Six-month poststroke depression (n = 115, 26%) was associated with 6-month impairment on the MoCA (β = 0.96, standard error [SE] 0.31, p = 0.006) and all individual domains assessed by the OCS: spatial attention (β = 0.67, SE 0.33, p = 0.041), executive function (β = 1.37, SE 0.47, p = 0.004), language processing (β = 0.87, SE 0.38, p = 0.028), memory (β = 0.76, SE 0.37, p = 0.040), number processing (β = 1.13, SE 0.40, p = 0.005), and praxis (β = 1.16, SE 0.49, p = 0.028). Poststroke anxiety (n = 133, 30%) was associated with impairment on the MoCA (β = 1.47, SE 0.42, p = 0.001) and spatial attention (β = 1.25, SE 0.45, p = 0.006); these associations did not remain significant after controlling for co-occurring poststroke depression. CONCLUSION Domain-general and domain-specific poststroke cognitive impairment was found to be highly related to depressive symptomatology but not anxiety symptomatology.
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Affiliation(s)
- Owen A Williams
- From the Department of Experimental Psychology, University of Oxford, UK.
| | - Nele Demeyere
- From the Department of Experimental Psychology, University of Oxford, UK
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Tian Q, Williams OA, Landman BA, Resnick SM, Ferrucci L. Microstructural Neuroimaging of Frailty in Cognitively Normal Older Adults. Front Med (Lausanne) 2020; 7:546344. [PMID: 33195297 PMCID: PMC7645067 DOI: 10.3389/fmed.2020.546344] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 09/21/2020] [Indexed: 11/17/2022] Open
Abstract
Physical frailty is an age-related clinical syndrome that is associated with multiple adverse health outcomes, including cognitive impairment and dementia. Recent studies have shown that frailty is associated with specific volumetric neuroimaging characteristics. Whether brain microstructural characteristics, particularly gray matter, associated with frailty exist and what their spatial distribution is have not been explored. We identified 670 participants of the Baltimore Longitudinal Study of Aging who were aged 60 and older and cognitively normal and who had concurrent data on frailty and regional microstructural neuroimaging markers by diffusion tensor imaging (DTI), including mean diffusivity (MD) of gray matter and fractional anisotropy (FA) of white matter. We identified neuroimaging markers that were associated with frailty status (non-frail, pre-frail, frail) and further examined differences between three groups using multivariate linear regression (non-frail = reference). Models were adjusted for age, sex, race, years of education, body mass index, scanner type, and Apolipoprotein E e4 carrier status. Compared to the non-frail participants, those who were frail had higher MD in the medial frontal cortex, several subcortical regions (putamen, caudate, thalamus), anterior cingulate cortex, and a trend of lower FA in the body of the corpus callosum. Those who were pre-frail also had higher MD in the putamen and a trend of lower FA in the body of the corpus callosum. Our study demonstrates for the first time that the microstructure of both gray and white matter differs by frailty status in cognitively normal older adults. Brain areas were not widespread but mostly localized in frontal and subcortical motor areas and the body of the corpus callosum. Whether changes in brain microstructure precede future frailty development warrants further investigation.
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Affiliation(s)
- Qu Tian
- Longitudinal Studies Section, National Institute on Aging, Baltimore, MD, United States
| | - Owen A Williams
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, United States.,Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Bennett A Landman
- School of Engineering, Vanderbilt University, Nashville, TN, United States
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, United States
| | - Luigi Ferrucci
- Longitudinal Studies Section, National Institute on Aging, Baltimore, MD, United States
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June D, Williams OA, Huang CW, An Y, Landman BA, Davatzikos C, Bilgel M, Resnick SM, Beason-Held LL. Lasting consequences of concussion on the aging brain: Findings from the Baltimore Longitudinal Study of Aging. Neuroimage 2020; 221:117182. [PMID: 32702483 PMCID: PMC7848820 DOI: 10.1016/j.neuroimage.2020.117182] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 04/29/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022] Open
Abstract
Studies suggest that concussions may be related to increased risk of
neurodegenerative diseases, such as Chronic Traumatic Encephalopathy and
Alzheimer’s Disease. Most neuroimaging studies show effects of
concussionsin frontal and temporal lobes of the brain, yet the long-term impacts
of concussions on the aging brain have not been well studied. We examined
neuroimaging data from 51 participants (mean age at first imaging visit =
65.1±11.23) in the Baltimore Longitudinal Study of Aging (BLSA) who
reported a concussion in their medical history an average of 23 years prior to
the first imaging visit, and compared them to 150 participants (mean age at
first imaging visit = 66.6 ± 10.97) with no history of concussion.
Participants underwent serial structural MRI overa mean of 5.17 ± 6.14
years and DTI over a mean of 2.92 ± 2.22 years to measure brain
structure, as well as 15O-water PET over a mean of 5.33 ± 2.19
years to measure brain function. A battery of neuropsychological tests was also
administered over a mean of 11.62 ± 7.41 years. Analyses of frontal and
temporal lobe regions were performed to examine differences in these measures
between the concussion and control groups at first imaging visit and in change
over time. Compared to those without concussion, participants with a prior
concussion had greater brain atrophy in temporal lobe white matter and
hippocampus at first imaging visit, which remained stable throughout the
follow-up visits. Those with prior concussion also showed differences in white
matter microstructure using DTI, including increased radial and axial
diffusivity in the fornix/stria terminalis, anterior corona radiata, and
superior longitudinal fasciculus at first imaging visit. In 15O-water
PET, higher resting cerebral blood flow was seen at first imaging visit in
orbitofrontal and lateral temporal regions, and both increases and decreases
were seen in prefrontal, cingulate, insular, hippocampal, and ventral temporal
regions with longitudinal follow-up. There were no significant differences in
neuropsychological performance between groups. Most of the differences observed
between the concussed and non-concussed groups were seen at the first imaging
visit, suggesting that concussions can produce long-lasting structural and
functional alterations in temporal and frontal regions of the brain in older
individuals. These results also suggest that many of the reported short-term
effects of concussion may still be apparent later in life.
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Affiliation(s)
- Danielle June
- Laboratory of Behavioral Neuroscience, National Institute on Aging, 251 Bayview Blvd., Baltimore, MD, 21224-6825, USA
| | - Owen A Williams
- Laboratory of Behavioral Neuroscience, National Institute on Aging, 251 Bayview Blvd., Baltimore, MD, 21224-6825, USA
| | - Chiung-Wei Huang
- Laboratory of Behavioral Neuroscience, National Institute on Aging, 251 Bayview Blvd., Baltimore, MD, 21224-6825, USA
| | - Yang An
- Laboratory of Behavioral Neuroscience, National Institute on Aging, 251 Bayview Blvd., Baltimore, MD, 21224-6825, USA
| | - Bennett A Landman
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA, USA
| | - Murat Bilgel
- Laboratory of Behavioral Neuroscience, National Institute on Aging, 251 Bayview Blvd., Baltimore, MD, 21224-6825, USA
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, 251 Bayview Blvd., Baltimore, MD, 21224-6825, USA
| | - Lori L Beason-Held
- Laboratory of Behavioral Neuroscience, National Institute on Aging, 251 Bayview Blvd., Baltimore, MD, 21224-6825, USA.
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11
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Williams OA, An Y, Armstrong NM, Shafer AT, Helphrey J, Kitner-Triolo M, Ferrucci L, Resnick SM. Apolipoprotein E ε4 allele effects on longitudinal cognitive trajectories are sex and age dependent. Alzheimers Dement 2019; 15:1558-1567. [PMID: 31561966 DOI: 10.1016/j.jalz.2019.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/08/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Questions remain about whether apolipoprotein E (APOE)-ε4 effects on cognitive decline are similar in men and women and how APOE-ε4 and age interact to influence decline in different cognitive domains. METHODS In sex-stratified analyses, baseline age-dependent associations between APOE-ε4 status and longitudinal cognitive trajectories were examined in cognitively normal Caucasian older adults (631 men, 561 women, baseline age range: 50-93, 6733 assessments). RESULTS In men, older baseline age was associated with greater effects of APOE-ε4 on longitudinal decline in memory and executive function, detectible from baseline age of 64 and 68, respectively. In women, older baseline age was associated with greater APOE-ε4 effects on longitudinal decline in attention, detectible at baseline age of 66. No significant APOE-ε4 effects were found for language, visual-spatial ability, or processing speed. DISCUSSION Results highlight the importance of considering sex and age when assessing APOE-ε4-associated vulnerability to cognitive decline.
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Affiliation(s)
- Owen A Williams
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA
| | - Yang An
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA
| | - Nicole M Armstrong
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA
| | - Andrea T Shafer
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA
| | - Jessica Helphrey
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA
| | - Melissa Kitner-Triolo
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, USA
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA.
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12
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Williams OA, Zeestraten EA, Benjamin P, Lambert C, Lawrence AJ, Mackinnon AD, Morris RG, Markus HS, Barrick TR, Charlton RA. Predicting Dementia in Cerebral Small Vessel Disease Using an Automatic Diffusion Tensor Image Segmentation Technique. Stroke 2019; 50:2775-2782. [PMID: 31510902 PMCID: PMC6756294 DOI: 10.1161/strokeaha.119.025843] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Supplemental Digital Content is available in the text. Cerebral small vessel disease (SVD) is the most common cause of vascular cognitive impairment, with a significant proportion of cases going on to develop dementia. We explore the extent to which diffusion tensor image segmentation technique (DSEG; which characterizes microstructural damage across the cerebrum) predicts both degree of cognitive decline and conversion to dementia, and hence may provide a useful prognostic procedure.
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Affiliation(s)
- Owen A Williams
- From the Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom (O.A.W., E.A.Z., C.L., T.R.B.)
| | - Eva A Zeestraten
- From the Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom (O.A.W., E.A.Z., C.L., T.R.B.)
| | - Philip Benjamin
- Department of Radiology, Charing Cross Hospital campus, Imperial College NHS Trust, United Kingdom (P.B.)
| | - Christian Lambert
- From the Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom (O.A.W., E.A.Z., C.L., T.R.B.).,Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, United Kingdom (C.L.)
| | - Andrew J Lawrence
- Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (A.J.L., H.S.M.)
| | - Andrew D Mackinnon
- Atkinson Morley Regional Neuroscience Centre, St George's NHS Healthcare Trust, London, United Kingdom (A.G.M.)
| | - Robin G Morris
- Department of Psychology, King's College Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom (R.G.M.)
| | - Hugh S Markus
- Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (A.J.L., H.S.M.)
| | - Thomas R Barrick
- From the Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom (O.A.W., E.A.Z., C.L., T.R.B.)
| | - Rebecca A Charlton
- Department of Psychology, Goldsmiths University of London, United Kingdom (R.A.C.)
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13
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June D, Williams OA, Huang CW, An Y, Bilgel M, Resnick SM, Beason-Held LL. P2-340: LASTING CONSEQUENCES OF CONCUSSION: BRAIN FINDINGS FROM THE BALTIMORE LONGITUDINAL STUDY OF AGING. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.2747] [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: 11/17/2022]
Affiliation(s)
| | | | | | - Yang An
- National Institute on Aging; NIH; Baltimore MD USA
| | - Murat Bilgel
- National Institute on Aging; NIH; Baltimore MD USA
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14
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Armstrong N, An Y, Williams OA, Doshi J, Erus G, Davatzikos C, Resnick SM. O3-03-03: CHANGE IN COGNITION IS CORRELATED WITH CHANGE IN BRAIN VOLUMES IN COGNITIVELY NORMAL OLDER ADULTS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Yang An
- National Institute on Aging, NIH; Baltimore MD USA
| | | | - Jimit Doshi
- Center for Biomedical Image Computing and Analytics; University of Pennsylvania; Philadelphia PA USA
| | - Guray Erus
- University of Pennsylvania; Philadelphia PA USA
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15
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Williams OA, Zeestraten EA, Benjamin P, Lambert C, Lawrence AJ, Mackinnon AD, Morris RG, Markus HS, Charlton RA, Barrick TR. Corrigendum to "Diffusion tensor image segmentation of the cerebrum provides a single measure of cerebral small vessel disease severity related to cognitive change" [Neuroimage: Clinical 16 (2017) 330-342]. Neuroimage Clin 2019; 23:101742. [PMID: 31235449 PMCID: PMC6734147 DOI: 10.1016/j.nicl.2019.101742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Owen A Williams
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
| | - Eva A Zeestraten
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Philip Benjamin
- Department of Radiology, Charing Cross Hospital Campus, Imperial College NHS Trust, London, UK
| | - Christian Lambert
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Andrew J Lawrence
- Stroke Research Group, Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Andrew D Mackinnon
- Atkinson Morley Regional Neuroscience Centre, St George's NHS Healthcare Trust, London, UK
| | - Robin G Morris
- Department of Psychology, King's College Institute of Psychiatry, Psychology, and Neuroscience, London, UK
| | - Hugh S Markus
- Stroke Research Group, Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Thomas R Barrick
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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16
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Klemencic GM, Fellows JM, Werrell JM, Mandal S, Giblin SR, Smith RA, Williams OA. Observation of a superconducting glass state in granular superconducting diamond. Sci Rep 2019; 9:4578. [PMID: 30872614 PMCID: PMC6418110 DOI: 10.1038/s41598-019-40306-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/11/2019] [Indexed: 11/13/2022] Open
Abstract
The magnetic field dependence of the superconductivity in nanocrystalline boron doped diamond thin films is reported. Evidence of a superconducting glass state is presented, as demonstrated by the observation of a quasi de Almeida-Thouless line in the phase diagram and a logarithmic time dependence of the magnetism. The position of the phase boundary in the H-T plane is determined from electrical transport data by detailed fitting to quasi-zero-dimensional fluctuation conductivity theory. This allows determination of the boundary between resistive and non-resistive behaviour to be made with greater precision than the standard ad hoc onset/midpoint/offset criterion. We attribute the glassy superconductivity to the morphological granularity of the diamond films.
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Affiliation(s)
- G M Klemencic
- School of Physics and Astronomy, Cardiff University, Queen's Buildings, The Parade, Cardiff, CF24 3AA, UK.
| | - J M Fellows
- School of Physics, HH Wills Physics Laboratory, University of Bristol, Tyndall Avenue, Bristol, BS8 1TL, UK
| | - J M Werrell
- School of Physics and Astronomy, Cardiff University, Queen's Buildings, The Parade, Cardiff, CF24 3AA, UK
| | - S Mandal
- School of Physics and Astronomy, Cardiff University, Queen's Buildings, The Parade, Cardiff, CF24 3AA, UK
| | - S R Giblin
- School of Physics and Astronomy, Cardiff University, Queen's Buildings, The Parade, Cardiff, CF24 3AA, UK
| | - R A Smith
- School of Physics and Astronomy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - O A Williams
- School of Physics and Astronomy, Cardiff University, Queen's Buildings, The Parade, Cardiff, CF24 3AA, UK
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17
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Armstrong NM, Huang CW, Williams OA, Bilgel M, An Y, Doshi J, Erus G, Davatzikos C, Wong DF, Ferrucci L, Resnick SM. Sex differences in the association between amyloid and longitudinal brain volume change in cognitively normal older adults. Neuroimage Clin 2019; 22:101769. [PMID: 30927602 PMCID: PMC6444285 DOI: 10.1016/j.nicl.2019.101769] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/22/2019] [Accepted: 03/10/2019] [Indexed: 01/19/2023]
Abstract
Objective Amyloid positivity is a biomarker of AD pathology, yet the associations between amyloid positivity and brain volumetric changes, especially in the hippocampus, are inconsistent. We hypothesize that sex differences in associations may contribute to inconsistent findings among cognitively normal older adults. Methods Using linear mixed effects models, we examined the association of amyloid positivity with prospective volumetric changes (mean = 3.3 visits) of parahippocampal gyrus (phg), hippocampus, entorhinal cortex (erc), precuneus, and fusiform gyrus among 171 Baltimore Longitudinal Study of Aging participants aged ≥55 years. Amyloid positivity was defined by a mean 11C-Pittsburgh Compound B (PiB) distribution volume ratio (DVR) cut-off of 1.062. All analyses included age, race, sex, education, APOE e4 carrier status, and two-way interactions of these covariates with time. Two-way interaction between sex and PiB+/− status and three-way interaction of sex and PiB+/− status with time were added to assess whether sex modified associations. Results PiB+ status was associated with greater volumetric declines in the phg (β = −0.036, SE = 0.011, p = 0.001) and erc (β = −0.019, SE = 0.009, p = 0.045). Sex modified the association of PiB+ status and rates of volumetric declines in fusiform (β = −0.117, SE = 0.049, p = 0.019). PiB+ males had steeper rates of volumetric declines in phg (β = −0.051, SE = 0.013, p < 0.001) and erc (β = −0.029, SE = 0.012, p = 0.014) than PiB- males, while there was no difference in rates of volumetric change between PiB+ and PiB- females. Conclusions Amyloidosis is a marker of entorhinal and parahippocampal volume loss. Amyloid positivity is a predictor of volume loss in brain regions affected by early AD pathology in men, but not women. Amyloid positivity is related to volume loss in regions of early AD pathology. Sex modified the association of amyloid positivity and brain volumetric changes. Amyloid-positive males were vulnerable to volume loss in regions of early AD. Females with and without amyloid positivity had similar volume changes.
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Affiliation(s)
- Nicole M Armstrong
- Laboratory of Behavioral Neuroscience, National Institutes of Health, National Institute on Aging, Baltimore, MD, United States of America
| | - Chiung-Wei Huang
- Laboratory of Behavioral Neuroscience, National Institutes of Health, National Institute on Aging, Baltimore, MD, United States of America
| | - Owen A Williams
- Laboratory of Behavioral Neuroscience, National Institutes of Health, National Institute on Aging, Baltimore, MD, United States of America
| | - Murat Bilgel
- Laboratory of Behavioral Neuroscience, National Institutes of Health, National Institute on Aging, Baltimore, MD, United States of America
| | - Yang An
- Laboratory of Behavioral Neuroscience, National Institutes of Health, National Institute on Aging, Baltimore, MD, United States of America
| | - Jimit Doshi
- Section of Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Guray Erus
- Section of Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Christos Davatzikos
- Section of Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Dean F Wong
- Section of High Resolution Brain PET, Departments of Neurology, Psychiatry, Neuroscience, and Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Luigi Ferrucci
- Translational Gerontology Branch, Longitudinal Studies Section, National Institutes of Health, National Institute on Aging, Baltimore, MD, United States of America
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, National Institutes of Health, National Institute on Aging, Baltimore, MD, United States of America.
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18
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Williams OA, An Y, Beason-Held L, Huo Y, Ferrucci L, Landman BA, Resnick SM. Vascular burden and APOE ε4 are associated with white matter microstructural decline in cognitively normal older adults. Neuroimage 2019; 188:572-583. [PMID: 30557663 PMCID: PMC6601608 DOI: 10.1016/j.neuroimage.2018.12.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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: 09/18/2018] [Revised: 11/20/2018] [Accepted: 12/04/2018] [Indexed: 11/27/2022] Open
Abstract
White matter microstructure can be measured with diffusion tensor imaging (DTI). While increasing age is a predictor of white matter (WM) microstructure changes, roles of other possible modifiers, such as cardiovascular risk factors, APOE ε4 allele status and biological sex have not been clarified. We investigated 665 cognitively normal participants from the Baltimore Longitudinal Study of Aging (age 50-95, 56.7% female) with a total of 1384 DTI scans. WM microstructure was assessed by fractional anisotropy (FA) and mean diffusivity (MD). A vascular burden score was defined as the sum of five risk factors (hypertension, obesity, elevated cholesterol, diabetes and smoking status). Linear mixed effects models assessed the association of baseline vascular burden on baseline and on rates of change of FA and MD over a mean follow-up of 3.6 years, while controlling for age, race, and scanner type. We also compared DTI trajectories in APOE ε4 carriers vs. non-carriers and men vs. women. At baseline, higher vascular burden was associated with lower FA and higher MD in many WM structures including association, commissural, and projection fibers. Higher baseline vascular burden was also associated with greater longitudinal decline in FA in the hippocampal part of the cingulum and the fornix (crus)/stria terminalis and splenium of the corpus callosum, and with greater increases in MD in the splenium of the corpus callosum. APOE ε4 carriers did not differ from non-carriers in baseline DTI metrics but had greater decline in FA in the genu and splenium of the corpus callosum. Men had higher FA and lower MD in multiple WM regions at baseline but showed greater increase in MD in the genu of the corpus callosum. Women showed greater decreases over time in FA in the gyrus part of the cingulum, compared to men. Our findings show that modifiable vascular risk factors (1) have a negative impact on white matter microstructure and (2) are associated with faster microstructural deterioration of temporal WM regions and the splenium of the corpus callosum in cognitively normal adults. Reducing vascular burden in aging could modify the rate of WM deterioration and could decrease age-related cognitive decline and impairment.
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Affiliation(s)
- Owen A Williams
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD 21224, USA.
| | - Yang An
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD 21224, USA
| | - Lori Beason-Held
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD 21224, USA
| | - Yuankai Huo
- School of Engineering, Vanderbilt University, Nashville, TN 37212, USA
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, MD 21224, USA
| | - Bennett A Landman
- School of Engineering, Vanderbilt University, Nashville, TN 37212, USA
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD 21224, USA.
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19
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Williams OA, An Y, Huo Y, Landman B, Resnick SM. P2‐412: SEX DIFFERENCES IN WHITE MATTER MICROSTRUCTURE AND ITS EFFECTS ON EXECUTIVE FUNCTION: RESULTS FROM THE BALTIMORE LONGITUDINAL STUDY OF AGING. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Yang An
- National Institute on AgingBaltimoreMDUSA
| | | | | | - Susan M. Resnick
- National Institute on Aging/National Institutes of Health (NIA/NIH)BaltimoreMDUSA
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20
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Benjamin P, Trippier S, Lawrence AJ, Lambert C, Zeestraten E, Williams OA, Patel B, Morris RG, Barrick TR, MacKinnon AD, Markus HS. Lacunar Infarcts, but Not Perivascular Spaces, Are Predictors of Cognitive Decline in Cerebral Small-Vessel Disease. Stroke 2018; 49:586-593. [PMID: 29438074 PMCID: PMC5832012 DOI: 10.1161/strokeaha.117.017526] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [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: 03/31/2017] [Revised: 12/11/2017] [Accepted: 12/21/2017] [Indexed: 11/29/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— Cerebral small-vessel disease is a major cause of cognitive impairment. Perivascular spaces (PvS) occur in small-vessel disease, but their relationship to cognitive impairment remains uncertain. One reason may be difficulty in distinguishing between lacunes and PvS. We determined the relationship between baseline PvS score and PvS volume with change in cognition over a 5-year follow-up. We compared this to the relationship between baseline lacune count and total lacune volume with cognition. In addition, we examined change in PvS volume over time. Methods— Data from the prospective SCANS study (St Georges Cognition and Neuroimaging in Stroke) of patients with symptomatic lacunar stroke and confluent leukoaraiosis were used (n=121). Multimodal magnetic resonance imaging was performed annually for 3 years and neuropsychological testing annually for 5 years. Lacunes were manually identified and distinguished from PvS. PvS were rated using a validated visual rating scale, and PvS volumes calculated using T1-weighted images. Linear mixed-effect models were used to determine the impact of PvS and lacunes on cognition. Results— Baseline PvS scores or volumes showed no association with cognitive indices. No change was detectable in PvS volumes over the 3 years. In contrast, baseline lacunes associated with all cognitive indices and predicted cognitive decline over the 5-year follow-up. Conclusions— Although a feature of small-vessel disease, PvS are not a predictor of cognitive decline, in contrast to lacunes. This study highlights the importance of carefully differentiating between lacunes and PvS in studies investigating vascular cognitive impairment.
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Affiliation(s)
- Philip Benjamin
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M).
| | - Sarah Trippier
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Andrew J Lawrence
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Christian Lambert
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Eva Zeestraten
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Owen A Williams
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Bhavini Patel
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Robin G Morris
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Thomas R Barrick
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Andrew D MacKinnon
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Hugh S Markus
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
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Williams OA, Zeestraten EA, Benjamin P, Lambert C, Lawrence AJ, Mackinnon AD, Morris RG, Markus HS, Charlton RA, Barrick TR. Diffusion tensor image segmentation of the cerebrum provides a single measure of cerebral small vessel disease severity related to cognitive change. Neuroimage Clin 2017; 16:330-342. [PMID: 28861335 PMCID: PMC5568143 DOI: 10.1016/j.nicl.2017.08.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 07/05/2017] [Accepted: 08/12/2017] [Indexed: 02/02/2023]
Abstract
Cerebral small vessel disease (SVD) is the primary cause of vascular cognitive impairment and is associated with decline in executive function (EF) and information processing speed (IPS). Imaging biomarkers are needed that can monitor and identify individuals at risk of severe cognitive decline. Recently there has been interest in combining several magnetic resonance imaging (MRI) markers of SVD into a unitary score to describe disease severity. Here we apply a diffusion tensor image (DTI) segmentation technique (DSEG) to describe SVD related changes in a single unitary score across the whole cerebrum, to investigate its relationship with cognitive change over a three-year period. 98 patients (aged 43-89) with SVD underwent annual MRI scanning and cognitive testing for up to three years. DSEG provides a vector of 16 discrete segments describing brain microstructure of healthy and/or damaged tissue. By calculating the scalar product of each DSEG vector in reference to that of a healthy ageing control we generate an angular measure (DSEG θ) describing the patients' brain tissue microstructural similarity to a disease free model of a healthy ageing brain. Conventional MRI markers of SVD brain change were also assessed including white matter hyperintensities, cerebral atrophy, incident lacunes, cerebral-microbleeds, and white matter microstructural damage measured by DTI histogram parameters. The impact of brain change on cognition was explored using linear mixed-effects models. Post-hoc sample size analysis was used to assess the viability of DSEG θ as a tool for clinical trials. Changes in brain structure described by DSEG θ were related to change in EF and IPS (p < 0.001) and remained significant in multivariate models including other MRI markers of SVD as well as age, gender and premorbid IQ. Of the conventional markers, presence of new lacunes was the only marker to remain a significant predictor of change in EF and IPS in the multivariate models (p = 0.002). Change in DSEG θ was also related to change in all other MRI markers (p < 0.017), suggesting it may be used as a surrogate marker of SVD damage across the cerebrum. Sample size estimates indicated that fewer patients would be required to detect treatment effects using DSEG θ compared to conventional MRI and DTI markers of SVD severity. DSEG θ is a powerful tool for characterising subtle brain change in SVD that has a negative impact on cognition and remains a significant predictor of cognitive change when other MRI markers of brain change are accounted for. DSEG provides an automatic segmentation of the whole cerebrum that is sensitive to a range of SVD related structural changes and successfully predicts cognitive change. Power analysis shows DSEG θ has potential as a monitoring tool in clinical trials. As such it may provide a marker of SVD severity from a single imaging modality (i.e. DTIs).
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Affiliation(s)
- Owen A. Williams
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Eva A. Zeestraten
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Philip Benjamin
- Department of Radiology, Charing Cross Hospital Campus, Imperial College NHS Trust, London, UK
| | - Christian Lambert
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Andrew J. Lawrence
- Stroke Research Group, Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Andrew D. Mackinnon
- Atkinson Morley Regional Neuroscience Centre, St George's NHS Healthcare Trust, London, UK
| | - Robin G. Morris
- Department of Psychology, King's College Institute of Psychiatry, Psychology, and Neuroscience, London, UK
| | - Hugh S. Markus
- Stroke Research Group, Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Thomas R. Barrick
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Williams OA, Zeestraten E, Benjamin P, Lambert C, Lawrence AJ, Mackinnon AD, Morris RG, Markus H, Charlton R, Barrick T. [P1–011]: DIFFUSION TENSOR IMAGE SEGMENTATION OF THE CEREBRUM PROVIDES A SINGLE MEASURE OF CEREBRAL SMALL‐VESSEL DISEASE SEVERITY RELATED TO COGNITIVE CHANGE. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.078] [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: 11/15/2022]
Affiliation(s)
| | | | | | | | | | | | - Robin G. Morris
- King's College London, Institute of PsychiatryLondonUnited Kingdom
| | - Hugh Markus
- University of CambridgeCambridgeUnited Kingdom
| | | | - Tom Barrick
- St. George's University of LondonLondonUnited Kingdom
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Benjamin P, Zeestraten E, Lambert C, Chis Ster I, Williams OA, Lawrence AJ, Patel B, MacKinnon AD, Barrick TR, Markus HS. Progression of MRI markers in cerebral small vessel disease: Sample size considerations for clinical trials. J Cereb Blood Flow Metab 2016; 36:228-40. [PMID: 26036939 PMCID: PMC4758545 DOI: 10.1038/jcbfm.2015.113] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/18/2015] [Accepted: 04/30/2015] [Indexed: 11/09/2022]
Abstract
Detecting treatment efficacy using cognitive change in trials of cerebral small vessel disease (SVD) has been challenging, making the use of surrogate markers such as magnetic resonance imaging (MRI) attractive. We determined the sensitivity of MRI to change in SVD and used this information to calculate sample size estimates for a clinical trial. Data from the prospective SCANS (St George’s Cognition and Neuroimaging in Stroke) study of patients with symptomatic lacunar stroke and confluent leukoaraiosis was used (n = 121). Ninety-nine subjects returned at one or more time points. Multimodal MRI and neuropsychologic testing was performed annually over 3 years. We evaluated the change in brain volume, T2 white matter hyperintensity (WMH) volume, lacunes, and white matter damage on diffusion tensor imaging (DTI). Over 3 years, change was detectable in all MRI markers but not in cognitive measures. WMH volume and DTI parameters were most sensitive to change and therefore had the smallest sample size estimates. MRI markers, particularly WMH volume and DTI parameters, are more sensitive to SVD progression over short time periods than cognition. These markers could significantly reduce the size of trials to screen treatments for efficacy in SVD, although further validation from longitudinal and intervention studies is required.
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Affiliation(s)
- Philip Benjamin
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George’s University of London, London, UK
| | - Eva Zeestraten
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George’s University of London, London, UK
| | - Christian Lambert
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George’s University of London, London, UK
| | - Irina Chis Ster
- Institute of Infection and Immunity, St George's University of London, London, UK
| | - Owen A Williams
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George’s University of London, London, UK
| | | | - Bhavini Patel
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George’s University of London, London, UK
| | - Andrew D MacKinnon
- Atkinson Morley Regional Neuroscience Centre, St George’s NHS Healthcare Trust, London, UK
| | - Thomas R Barrick
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George’s University of London, London, UK
| | - Hugh S Markus
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Ajayi CA, Williams OA, Famuyide OO, Adebayo O. Economic Potential Of Moringa Oleifera As A Commercial Tree Species And Its Suitability For Forest Management Intervention In Taungya Farming System. ACTA ACUST UNITED AC 2014. [DOI: 10.4314/agrosh.v13i3.7s] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kummer K, Fondacaro A, Yakhou-Harris F, Sessi V, Pobedinskas P, Janssens SD, Haenen K, Williams OA, Hees J, Brookes NB. Thin conductive diamond films as beam intensity monitors for soft x-ray beamlines. Rev Sci Instrum 2013; 84:035105. [PMID: 23556850 DOI: 10.1063/1.4794439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Quantitative analysis of X-ray absorption and dichroism data requires knowledge of the beamline photon flux during the measurements. We show that thin conductive (B-doped) diamond thin films can be an alternative to the widely used gold meshes for monitoring the beam intensity of soft X-ray beamlines in situ. Limited by the carbon extended x-ray absorption fine structure oscillations, the diamond films become applicable beginning from about 600 eV photon energy, where the important transition metal edges and the rare-earth edges are found. The 100 nm and 250 nm thick free-standing diamond films were grown and tested against standard gold meshes in real-life dichroism experiments performed at beamline ID08 of the European Synchrotron Radiation Facility, Grenoble, France. Quantitative agreement was found between the two experimental data sets. The films feature an extremely high transmission of about 90% and, at the same time, yield a sufficiently strong and clean reference signal. Furthermore, the thin films do not affect the shape of the transmitted beam. X-rays passing mesh-type monitors are subject to diffraction effects, which widen the beam and become particularly disturbing for small beamsizes in the micrometer range.
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Affiliation(s)
- K Kummer
- European Synchrotron Radiation Facility, 6 Rue Jules Horowitz, BP 220, F-38043 Grenoble Cedex, France
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Hees J, Heidrich N, Pletschen W, Sah RE, Wolfer M, Williams OA, Lebedev V, Nebel CE, Ambacher O. Piezoelectric actuated micro-resonators based on the growth of diamond on aluminum nitride thin films. Nanotechnology 2013; 24:025601. [PMID: 23220817 DOI: 10.1088/0957-4484/24/2/025601] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Unimorph heterostructures based on piezoelectric aluminum nitride (AlN) and diamond thin films are highly desirable for applications in micro- and nanoelectromechanical systems. In this paper, we present a new approach to combine thin conductive boron-doped as well as insulating nanocrystalline diamond (NCD) with sputtered AlN films without the need for any buffer layers between AlN and NCD or polishing steps. The zeta potentials of differently treated nanodiamond (ND) particles in aqueous colloids are adjusted to the zeta potential of AlN in water. Thereby, the nucleation density for the initial growth of diamond on AlN can be varied from very low (10(8) cm(-2)), in the case of hydrogen-treated ND seeding particles, to very high values of 10(11) cm(-2) for oxidized ND particles. Our approach yielding high nucleation densities allows the growth of very thin NCD films on AlN with thicknesses as low as 40 nm for applications such as microelectromechanical beam resonators. Fabricated piezo-actuated micro-resonators exhibit enhanced mechanical properties due to the incorporation of boron-doped NCD films. Highly boron-doped NCD thin films which replace the metal top electrode offer Young's moduli of more than 1000 GPa.
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Affiliation(s)
- J Hees
- Fraunhofer Institute for Applied Solid State Physics, Tullastrasse 72, D-79108 Freiburg, Germany.
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Vermeeren V, Wenmackers S, Daenen M, Haenen K, Williams OA, Ameloot M, Vande Ven M, Wagner P, Michiels L. Topographical and functional characterization of the ssDNA probe layer generated through EDC-mediated covalent attachment to nanocrystalline diamond using fluorescence microscopy. Langmuir 2008; 24:9125-9134. [PMID: 18627188 DOI: 10.1021/la800946v] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The covalent attachment method for DNA on nanocrystalline diamond (NCD), involving the introduction of COOH functionalities on the surface by photoattachment of 10-undecenoic acid (10-UDA), followed by the 1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide (EDC)-mediated coupling to NH 2-labeled ssDNA, is evaluated in terms of stability, density, and functionality of the resulting biological interface. This is of crucial importance in DNA biosensor development. The covalent nature of DNA attachment will infer the necessary stability and favorable orientation to the ssDNA probe molecules. Using confocal fluorescence microscopy, the influence of buffer type for the removal of excess 10-UDA and ssDNA, the probe ssDNA length, the probe ssDNA concentration, and the presence of the COOH-linker on the density and functionality of the ssDNA probe layer were investigated. It was determined that the most homogeneously dense and functional DNA layer was obtained when 300 pmol of short ssDNA was applied to COOH-modified NCD samples, while H-terminated NCD was resistant for DNA attachment. Exploiting this surface functionality dependence of the DNA attachment efficiency, a shadow mask was applied during the photochemical introduction of the COOH-functionalities, leaving certain regions on the NCD H-terminated. The subsequent DNA attachment resulted in a fluorescence pattern corresponding to the negative of the shadow mask. Finally, NCD surfaces covered with mixtures of the 10-UDA linker molecule and a similar molecule lacking the COOH functionality, functioning as a lateral spacer, were examined for their suitability in preventing nonspecific adsorption to the surface and in decreasing steric hindrance. However, purely COOH-modified NCD samples, patterned with H-terminated regions and treated with a controlled amount of probe DNA, proved the most efficient in fulfilling these tasks.
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Affiliation(s)
- V Vermeeren
- Biomedical Research Institute, School for Life Sciences, Hasselt University and transnationale Universiteit Limburg, Agoralaan, Diepenbeek, Belgium
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Vermeeren V, Bijnens N, Wenmackers S, Daenen M, Haenen K, Williams OA, Ameloot M, vandeVen M, Wagner P, Michiels L. Towards a real-time, label-free, diamond-based DNA sensor. Langmuir 2007; 23:13193-13202. [PMID: 18004892 DOI: 10.1021/la702143d] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Most challenging in the development of DNA sensors is the ability to distinguish between fully complementary target ssDNA (single-strand DNA) and 1-mismatch ssDNA. To deal with this problem, we performed impedance spectroscopy on DNA-functionalized nanocrystalline diamond (NCD) layers during hybridization and denaturation. In both reactions, a difference in behavior was observed for 1-mismatch target DNA and complementary target DNA in real-time. During real-time hybridization, a decrease of the impedance was observed at lower frequencies when the complementary target DNA was added, while the addition of 1-mismatch target ssDNA caused no significant change. Fitting these results to an electrical circuit demonstrates that this is correlated with a decrease of the depletion zone in the space charge region of the diamond. During real-time denaturation, differentiation between 1-mismatch and complementary target DNA was possible at higher frequencies. Denaturation of complementary DNA showed the longest exponential decay time of the impedance, while the decay time during 1-mismatch denaturation was the shortest. The real-time hybridization and denaturation experiments were carried out on different NCD samples in various buffer solutions at temperatures between 20 and 80 degrees C. It was revealed that the best results were obtained using a Microhyb hybridization buffer at 80 degrees C and 10x PCR buffer at 30 degrees C for hybridization and 0.1 M NaOH at temperatures above 40 degrees C for denaturation. We demonstrate that the combination of real-time hybridization spectra and real-time denaturation spectra yield important information on the type of target. This approach may allow a reliable identification of the mismatch sequence, which is the most biologically relevant.
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Affiliation(s)
- V Vermeeren
- Hasselt University and Transnationale Universiteit Limburg, School for Life Sciences, Biomedical Research Institute, Agoralaan, Building A, B-3590 Diepenbeek, Belgium
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Abstract
Cowpea (Vigna unguiculata) is an important source of protein in Africa, but production is hindered by the parasitic plant Striga gesnerioides. Crop rotation with nonhost cultivars, selected to stimulate parasite seed germination, is being used successfully to control other Striga spp. and may have potential to control S. gesnerioides. Little information has been available on nonhosts of S. gesnerioides that are capable of stimulating germination of parasite seeds. A laboratory procedure was used to evaluate species and cultivars for their ability to stimulate S. gesnerioides seed germination. Genotypes of all Vigna spp. tested stimulated parasite seed germination. Some genotypes of the nonhost species Cajanus cajan, Lablab purpureus, stenocarpa, and Sorghum bicolor also stimulated parasite seed germination. One cultivar of Sorghum bicolor stimulated significantly more germination than any other cultivar or species. Control of S. gesnerioides through rotation with selected nonhost cultivars has potential if selection is done with the parasite isolate(s) from the locality of intended use. When seeds of single-plant isolates of S. gesnerioides were tested against roots of seedlings from Sorghum bicolor landraces and from a susceptible cowpea cultivar, only specific isolate and plant combinations resulted in parasite seed germination. These specific interactions have broader implications for parasite survival.
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Affiliation(s)
- D K Berner
- International Institute of Tropical Agriculture, Ibadan, Nigeria, c/o L. W. Lambourn & Co., Carolyn House, 26 Dingwall Road, Croydon, CR9 3EE, England
| | - O A Williams
- International Institute of Tropical Agriculture, Ibadan, Nigeria, c/o L. W. Lambourn & Co., Carolyn House, 26 Dingwall Road, Croydon, CR9 3EE, England
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Abstract
Gastric emptying was studied indirectly by paracetamol absorption in 20 patients at 8-12 weeks' gestation and also in 20 non-pregnant controls. Subjects received paracetamol 1.5 g in a tablet with 50 ml of water and remained semi-recumbent for 2 h while venous blood samples were obtained at 15-min intervals. The maximum concentration of paracetamol was significantly lower and the time to maximum concentration significantly greater in pregnant patients. In addition, the areas under the time-concentration curves at 60 and 120 min were significantly smaller in the pregnant group. These changes are indicative of a delay in gastric emptying at 8-12 weeks' gestation.
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Affiliation(s)
- D M Levy
- Department of Surgical and Anaesthetic Sciences, University of Sheffield, Royal Hallamshire Hospital
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Abstract
A double-blind trial of the effect of droperidol on the incidence of nausea and vomiting in patients using patient-controlled analgesia was carried out in 60 healthy women undergoing abdominal hysterectomy. After a standard anaesthetic including droperidol 2.5 mg as a prophylactic antiemetic, patients were randomly allocated to receive postoperative patient-controlled analgesia with either morphine alone (2 mg.ml-1) or morphine (2 mg.ml-1) with droperidol (0.2 mg.ml-1) added to the syringe. Verbal scores and visual analogue scores for nausea, vomiting, pain and sedation were made at 4, 12 and 24 h postoperatively, and any requirement for intramuscular prochlorperazine noted. There was no difference between the groups at any time in the amount of morphine consumed or in pain scores. At 12 h, patients receiving droperidol experienced significantly less nausea, and over the first 24 h, 31% required prochlorperazine compared with 59.3% of patients not receiving droperidol. The number of patients with sedation at 24 h was significantly greater in the droperidol group. We conclude that the addition of droperidol to morphine both reduces nausea and the need for further antiemetic treatment.
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Affiliation(s)
- O A Williams
- Department of Anaesthesia, University of Sheffield Medical School
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Abstract
To investigate knowledge of perioperative events, a questionnaire was administered to 111 elective surgical patients. Six topics were covered: The operation, the anaesthetic, time spent in the operating theatre, amount of post-operative pain, duration of hospital admission and time required to return to normal fitness. Apart from evaluating information-sources for each topic, the questionnaire assessed degree of knowledge and satisfaction with this information, and the relationship of these to anxiety. More than 30% of the patients responded that they had received no information about anaesthesia, time in theatre, return to fitness or pain. For each topic more than 40% desired further information. Nursing staff provided most information, although for the anaesthetic, time in theatre, return to fitness and pain, more than 60% of patients responded that nobody had provided explanation. There was no correlation between knowledge relating to the topics per se and anxiety, but there was a significant correlation between satisfaction with information and anxiety. This survey shows a considerable need for improved information provision, especially for patients in whom anxiety is associated with a desire for further explanation of operative care.
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Williams OA. Patient knowledge of operative care. J R Soc Med 1993; 86:328-31. [PMID: 8315625 PMCID: PMC1294481] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
To investigate knowledge of perioperative events, a questionnaire was administered to 111 elective surgical patients. Six topics were covered: the operation, the anaesthetic, time spent in the operating theatre, amount of post-operative pain, duration of hospital admission and time required to return to normal fitness. Apart from evaluating information-sources for each topic, the questionnaire assessed degree of knowledge and satisfaction with this information, and the relationship of these to anxiety. More than 30% of the patients responded that they had received no information about anaesthesia, time in theatre, return to fitness or pain. For each topic more than 40% desired further information. Nursing staff provided most information, although for the anaesthetic, time in theatre, return to fitness and pain, more than 60% of patients responded that nobody had provided explanation. There was no correlation between knowledge relating to the topics per se and anxiety, but there was a significant correlation between satisfaction with information and anxiety. This survey shows a considerable need for improved information provision, especially for patients in whom anxiety is associated with a desire for further explanation of operative care.
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Affiliation(s)
- O A Williams
- Sheffield Hospital Training Scheme, Chesterfield, Derbyshire, UK
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Abstract
Ten percent lignocaine spray is in widespread clinical use as a means of suppressing responses to tracheal intubation. It is sprayed from a multidose container into the glottis and on to the vocal cords through an applicator nozzle, which may be used on successive patients. We have investigated the likelihood of the contamination of these nozzles, with patients' mouth flora. Spray applicators from four of the 20 cases investigated showed contamination with potential bacterial pathogens. We therefore recommend that lignocaine spray should not be applied to successive patients using the same applicator nozzle.
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Affiliation(s)
- O A Williams
- Department of Anaesthesia, University of Sheffield Medical School
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Abstract
A frequent dilemma facing the anaesthetist is the child with respiratory tract symptoms. The risks of anaesthesia and surgery in these patients have not been clearly established. We present three cases which illustrate a potentially serious complication which may arise. Our patients each had symptoms of cough, but were systemically healthy. Two of the children had absent clinical signs, whilst the third had a normal chest X ray. However, during surgery and anaesthesia each child developed significant pulmonary collapse, associated with desaturation on oximetry.
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Williams OA. Local anaesthesia for reduction of neonatal inguinal hernia. Anaesthesia 1992; 47:363. [PMID: 1519709 DOI: 10.1111/j.1365-2044.1992.tb02205.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Williams OA. Intraocular pressure changes during muscular hyperactivity after general anesthesia. Anesthesiology 1987; 67:604. [PMID: 3662093 DOI: 10.1097/00000542-198710000-00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Familusi JB, Aderele WI, Williams OA. Features of neuroblastoma in African children. East Afr Med J 1978; 55:182-90. [PMID: 679869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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