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Royall DR, Palmer RF. INFLAMMATION's cognitive impact revealed by a novel "Line of Identity" approach. PLoS One 2024; 19:e0295386. [PMID: 38517924 PMCID: PMC10959355 DOI: 10.1371/journal.pone.0295386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 11/22/2023] [Indexed: 03/24/2024] Open
Abstract
IMPORTANCE Dementia is an "overdetermined" syndrome. Few individuals are demented by any single biomarker, while several may independently explain small fractions of dementia severity. It may be advantageous to identify individuals afflicted by a specific biomarker to guide individualized treatment. OBJECTIVE We aim to validate a psychometric classifier to identify persons adversely impacted by inflammation and replicate it in a second cohort. DESIGN Secondary analyses of data collected by the Texas Alzheimer's Research and Care Consortium (TARCC) (N = 3497) and the Alzheimer's Disease Neuroimaging Initiative (ADNI) (N = 1737). SETTING Two large, well-characterized multi-center convenience samples. PARTICIPANTS Volunteers with normal cognition (NC), Mild Cognitive Impairment (MCI) or clinical "Alzheimer's Disease (AD)". EXPOSURE Participants were assigned to "Afflicted" or "Resilient" classes on the basis of a psychometric classifier derived by confirmatory factor analysis. MAIN OUTCOME(S) AND MEASURE(S) The groups were contrasted on multiple assessments and biomarkers. The groups were also contrasted regarding 4-year prospective conversions to "AD" from non-demented baseline diagnoses (controls and MCI). The Afflicted groups were predicted to have adverse levels of inflammation-related blood-based biomarkers, greater dementia severity and greater risk of prospective conversion. RESULTS In ADNI /plasma, 47.1% of subjects were assigned to the Afflicted class. 44.6% of TARCC's subjects were afflicted, 49.5% of non-Hispanic Whites (NHW) and 37.2% of Mexican Americans (MA). There was greater dementia severity in the Afflicted class [by ANOVA: ADNI /F(1) = 686.99, p <0.001; TARCC /F(1) = 1544.01, p <0.001]. "INFLAMMATION" factor composite scores were significantly higher (adverse) in Afflicted subjects [by ANOVA in ADNI /plasma F(1) = 1642.64, p <0.001 and in TARCC /serum F(1) = 3059.96, p <0.001]. Afflicted cases were more likely to convert to AD in the next four years [by Cox's F, ADNI /plasma: F (252, 268) = 3.74 p < 0.001; TARCC /serum: F (160, 134) = 3.03, p < 0.001 (in TARCC's entire sample), F (110, 90) = 4.92, p <0.001 in NHW, and F(50, 44) = 2.13, p = 0.006 in MA]. The proportions converting were similar among afflicted NHW in both cohorts /biofluids but MA exhibited a lower risk (7% in TARCC /serum at 48 months). CONCLUSIONS AND RELEVANCE Our inflammation-specific psychometric classifier selects individuals with pre-specified biomarker profiles and predicts conversion to "AD" across cohorts, biofluids, and ethnicities. This algorithm might be applied to any dementia-related biomarker making the psychometric estimation of individual biomarker effects feasible without biomarker assessment. Our approach also distinguishes individuals resilient to individual biomarker effects allowing for more accurate prediction and precision intervention.
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Affiliation(s)
- Donald R. Royall
- Department of Psychiatry and Behavioral Science, The University of Texas Health Science Center, San Antonio, Texas, United States of America
- Department of Medicine, The University of Texas Health Science Center, San Antonio, Texas, United States of America
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, Texas, United States of America
- The Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Disease, The University of Texas Health Science Center, San Antonio, Texas, United States of America
| | - Raymond F. Palmer
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, Texas, United States of America
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Royall DR, Palmer RF. Statin use moderates APOE's and CRP's associations with dementia and is associated with lesser dementia severity in ε4 carriers. Alzheimers Dement 2024; 20:1627-1636. [PMID: 38055626 PMCID: PMC10984456 DOI: 10.1002/alz.13543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/21/2023] [Accepted: 10/01/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION We tested the effect of statins on C-reactive protein (CRP) and apolipoprotein E (APOE)'s associations with dementia severity. METHODS A total of 1725 participants of the Alzheimer's Disease Neuroimaging Initiative (ADNI) were assigned from 12-month follow-up data into the following groups: (1) ε4 (-)/statin (-), (2) ε4 (-)/statin (+), (3) ε4 (+)/statin (-), and (4) ε4 (+)/statin (+). Dementia severity was assessed by a δ homolog: "dHABS." A mediation model was stratified on statin use and moderation effects tested by a chi-square difference. RESULTS Plasma CRP level decreased with ε4 allelic dose. Statins had no effect on the dHABS d-score in non-carriers but were associated with better scores in carriers. Treated carriers did not have more severe dementia than non-carriers. Statin use moderated the mutual adjusted effects of APOE and CRP. CRP was not a mediator of APOE's effect. DISCUSSION Statins may provide a protective effect on the dementia severity of ε4 carriers. HIGHLIGHTS δ is a dementia-specific phenotype related to general intelligence "g" and is assessed via a "d-score." Apolipoprotein E (APOE) and plasma C-reactive protein (CRP) are independently associated with δ. Plasma CRP decreases with ε4 allelic dose. Statins were associated with better (less demented) d-scores in ε4 carriers but had no effect in non-ε4 carriers. Treated ε4 carriers did not have more severe dementia than non-carriers. Statin use moderated the effects of APOE and CRP on δ. CRP was not a mediator of APOE's effect on δ.
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Affiliation(s)
- Donald R Royall
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, Texas, USA
- Department of Medicine, University of Texas Health Science Center, San Antonio, Texas, USA
- Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, Texas, USA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Disorders, San Antonio, USA
| | - Raymond F Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, Texas, USA
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Fowler SP, Gimeno Ruiz de Porras D, Swartz MD, Granados PS, Heilbrun LP, Palmer RF. Reply to Ayoub-Charette et al. Lack of Biological Plausibility and Major Methodological Issues Cast Doubt on the Association between Aspartame and Autism. Comment on "Fowler et al. Daily Early-Life Exposures to Diet Soda and Aspartame Are Associated with Autism in Males: A Case-Control Study. Nutrients 2023, 15, 3772". Nutrients 2024; 16:676. [PMID: 38474804 DOI: 10.3390/nu16050676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Thank you for the opportunity to respond to the concerns raised by Ayoub-Charette et al [...].
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Affiliation(s)
- Sharon Parten Fowler
- Department of Medicine, Joe R. & Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - David Gimeno Ruiz de Porras
- Center for Research in Occupational Health (CiSAL), Universitat Pompeu Fabra, 08003 Barcelona, Spain
- Center for Biomedical Research in Epidemiology and Public Health Network (CIBER) of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Department of Environmental and Occupational Health, UT School of Public Health San Antonio, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Michael D Swartz
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Paula Stigler Granados
- Division of Environmental Health, San Diego State University School of Public Health, San Diego, CA 92182, USA
| | - Lynne Parsons Heilbrun
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health in San Antonio, The University of Texas Health Science Center at Houston, San Antonio, TX 78229, USA
| | - Raymond F Palmer
- Department of Family Practice and Community Medicine, Joe R. & Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
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Palmer RF, Dempsey TT, Afrin LB. Chemical Intolerance and Mast Cell Activation: A Suspicious Synchronicity. J Xenobiot 2023; 13:704-718. [PMID: 37987446 PMCID: PMC10660865 DOI: 10.3390/jox13040045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/19/2023] [Accepted: 11/10/2023] [Indexed: 11/22/2023] Open
Abstract
Background: Chemical Intolerance (CI) is characterized by intolerances for chemicals, foods, and drugs with multi-system symptoms. As yet, the biomechanism remains unclear. One study reported converging lines of evidence supporting a substantive association between mast cell activation syndrome (MCAS) and CI. The purpose of this study is to (1) confirm a previous report demonstrating that 60% of MCAS patients report CI and (2) examine the parallels between symptoms and intolerances in CI and MCAS. Methods: Five hundred forty-four MCAS patients were assigned a clinical MCAS score using a validated assessment instrument and were assessed for CI using the validated Quick Environmental Exposure Sensitivity Index. Results: Our outcomes confirm the previously published study where the majority of MCAS patients also have CI. There was a clear overlap between various ICD-10 diagnostic categories and CI symptoms, providing further support for a potential shared mechanism. Conclusions: Exposures to pesticides, volatile organic compounds, combustion products, and mold have previously been reported as initiators of CI. However, until recently, little was known about the biological mechanism involved that could explain the multisystem symptoms associated with CI. This paper addresses a newly identified biomechanism for disease, which may underlie a host of "medically unexplained symptoms" triggered by xenobiotics.
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Affiliation(s)
- Raymond F Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA
| | - Tania T Dempsey
- AIM Center for Personalized Medicine, Purchase, NY 10577, USA
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Muir T, Michalek JE, Palmer RF. Determination of safe levels of persistent organic pollutants in toxicology and epidemiology. Rev Environ Health 2023; 38:401-408. [PMID: 35506713 DOI: 10.1515/reveh-2021-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/30/2022] [Indexed: 06/14/2023]
Abstract
We reviewed published manuscripts from toxicology and epidemiology reporting harmful health effects and doses of persistent organic pollutants (POPs), published between 2000 and 2021. We found 42 in vitro, 32 in vivo, and 74 epidemiological studies and abstracted the dose associated with harm in a common Molar unit. We hypothesized that the dose associated with harm would vary between animal and human studies. To test this hypothesis, for each of several POPs, we assessed the significance of variation in the dose associated with a harmful effect [categorized as non-thyroid endocrine (NTE), developmental neurotoxicity (DNT), and Thyroid] with study type (in vitro, in vivo, and Epidemiology) using a linear model after adjustment for basis (lipid weight, wet weight). We created a Calculated Safety Factor (CSF) defined as the toxicology dose divided by epidemiology dose needed to exhibit significant harm. Significant differences were found between study types ranging from <1 to 5.0 orders of magnitude in the dose associated with harm. Our CSFs in lipid weight varied from 12.4 (95% confidence interval (CI) 3.3, 47) for NTE effects in Epidemiology relative to in vivo studies to 6,244 (95% CI 2510, 15530) for DNT effects in Epidemiology relative to in vitro in wet weight representing 12.4 to 6.2 thousand-fold more sensitivity in people relative to animals, and mechanistic models, respectively. In lipid weight, all CSF 95% CI lower bounds across effect categories were less than 6.5. CIs for CSFs ranged from less than one to four orders of magnitude for in vivo, and two to five orders of magnitude for in vitro vs. Epidemiology. A global CSF for all Epidemiology vs. all Toxicology was 104.6 (95% CI 72 to 152), significant at p<0.001.
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Affiliation(s)
- Tom Muir
- Environment Canada, 70 Townsend Ave, Burlington, ON, Canada
| | - Joel E Michalek
- Department of Population Health Sciences, UT Health San Antonio, San Antonio TX, USA
| | - Raymond F Palmer
- Department of Family and Community Medicine, UT Health San Antonio, San Antonio TX, USA
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Royall DR, Palmer RF. The effects of CNS atrophy and ICVD on tests of executive function and functional status are mediated by intelligence. Cereb Circ Cogn Behav 2023; 5:100184. [PMID: 37811522 PMCID: PMC10550593 DOI: 10.1016/j.cccb.2023.100184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 09/05/2023] [Accepted: 09/13/2023] [Indexed: 10/10/2023]
Abstract
Background Impairments in executive function (EF) are often attributed to ischemic cerebrovascular disease (ICVD) and frontal circuit pathology. However, EF can be distinguished from general intelligence and the latter is likely to manifest in "executive" measures. We aimed to distinguish the effects of imaging biomarkers on these constructs. Methods We tested neuroimaging biomarkers as independent predictors of observed 12 month-prospective cognitive performance by a Multiple Indicators Multiple Causes (MIMIC) model in the Alzheimer's Disease Neuroimaging Initiative (ADNI) (N ≅ 1750). Results ICVD was associated with ''Organization" (ORG) and "Planning" (PLAN) domain scores from the test of Every Day Cognition. Left anterior cingulate (LAC) atrophy was independently associated with Trail-Making part B and Animal Naming. The MIMIC model had excellent fit and tests additional latent variables i.e., EF and dEF (a latent δ homolog derived from Spearman's general intelligence factor, g). Only dEF was associated with instrumental activities of daily living (IADL). ICVD and LAC were both associated with observed executive measures through dEF. ICVD was independently associated with those same measures through EF. Conclusions Observed EF is independently determined by multiple factors. The effects of EF-associated MRI biomarkers can be related to disability and dementia only via their effects on g. Because g /δ are unlikely to be located within the frontal lobes, the dementia-specific variance in executive measures may have little to do with either frontal structure or function. Conversely, domain-specific variance in EF may have little to do with either IADL-impairment or dementia.
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Affiliation(s)
- Donald R. Royall
- Department of Psychiatry, the University of Texas Health Science Center, San Antonio, TX, United States of America
- Department of Medicine, the University of Texas Health Science Center, San Antonio, TX, United States of America
- Department of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, TX, United States of America
- The Glenn Biggs Institute for Alzheimer's and Neurodegenerative Disease, the University of Texas Health Science Center, San Antonio, TX, United States of America
| | - Raymond F. Palmer
- Department of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, TX, United States of America
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Fowler SP, Gimeno Ruiz de Porras D, Swartz MD, Stigler Granados P, Heilbrun LP, Palmer RF. Daily Early-Life Exposures to Diet Soda and Aspartame Are Associated with Autism in Males: A Case-Control Study. Nutrients 2023; 15:3772. [PMID: 37686804 PMCID: PMC10490529 DOI: 10.3390/nu15173772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Since its introduction, aspartame-the leading sweetener in U.S. diet sodas (DS)-has been reported to cause neurological problems in some users. In prospective studies, the offspring of mothers who consumed diet sodas/beverages (DSB) daily during pregnancy experienced increased health problems. We hypothesized that gestational/early-life exposure to ≥1 DS/day (DSearly) or equivalent aspartame (ASPearly: ≥177 mg/day) increases autism risk. The case-control Autism Tooth Fairy Study obtained retrospective dietary recalls for DSB and aspartame consumption during pregnancy/breastfeeding from the mothers of 235 offspring with autism spectrum disorder (ASD: cases) and 121 neurotypically developing offspring (controls). The exposure odds ratios (ORs) for DSearly and ASPearly were computed for autism, ASD, and the non-regressive conditions of each. Among males, the DSearly odds were tripled for autism (OR = 3.1; 95% CI: 1.02, 9.7) and non-regressive autism (OR = 3.5; 95% CI: 1.1, 11.1); the ASPearly odds were even higher: OR = 3.4 (95% CI: 1.1, 10.4) and 3.7 (95% CI: 1.2, 11.8), respectively (p < 0.05 for each). The ORs for non-regressive ASD in males were almost tripled but were not statistically significant: DSearly OR = 2.7 (95% CI: 0.9, 8.4); ASPearly OR = 2.9 (95% CI: 0.9, 8.8). No statistically significant associations were found in females. Our findings contribute to the growing literature raising concerns about potential offspring harm from maternal DSB/aspartame intake in pregnancy.
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Affiliation(s)
- Sharon Parten Fowler
- Department of Medicine, Joe R. & Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - David Gimeno Ruiz de Porras
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health in San Antonio, The University of Texas Health Science Center at Houston, 7411 John Smith Drive, San Antonio, TX 78229, USA;
- Center for Research in Occupational Health, Universitat Pompeu Fabra, 08003 Barcelona, Spain
- CIBER of Epidemiology and Public Health, 28029 Madrid, Spain
| | - Michael D. Swartz
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX 77030, USA;
| | - Paula Stigler Granados
- Divisions of Environmental Health and Global Health, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA;
| | - Lynne Parsons Heilbrun
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health in San Antonio, The University of Texas Health Science Center at Houston, 7411 John Smith Drive, San Antonio, TX 78229, USA;
| | - Raymond F. Palmer
- Department of Family Practice and Community Medicine, Joe R. & Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA;
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Royall DR, Palmer RF. Multiple Adipokines Predict Dementia Severity as Measured by δ: Replication Across Biofluids and Cohorts. J Alzheimers Dis 2023; 92:639-652. [PMID: 36776066 DOI: 10.3233/jad-221052] [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: 02/12/2023]
Abstract
BACKGROUND We have explored dementia's blood-based protein biomarkers in the Texas Alzheimer's Research and Care Consortium (TARCC) study. Among them are adipokines, i.e., proteins secreted by adipose tissue some of which have been associated with cognitive impairment. OBJECTIVE To associate adipokines with dementia severity and replicate their association across cohorts and biofluids (serum /plasma). METHODS We used eight rationally chosen blood-based protein biomarkers as indicators of a latent variable, i.e., "Adipokines". We then associated that construct with dementia severity as measured by the latent dementia-specific phenotype "δ" in structural equation models (SEM). Significant factor loadings and Adipokines' association with δ were replicated across biofluids in the Alzheimer's Disease Neuroimaging Initiative (ADNI). RESULTS Eight adipokine proteins loaded significantly on the Adipokines construct. Adipokines measured in plasma (ADNI) or serum (TARCC) explained 24 and 70% of δ's variance, respectively. An Adipokine composite score, derived from the latent variables, rose significantly across clinical diagnoses and achieved high areas under the receiver operating characteristic curve (ROC/AUC) for discrimination of Alzheimer's disease from normal controls (NC) or cases of mild cognitive impairment (MCI) and between NC and MCI. CONCLUSION These results again suggest that SEM can be used to create latent biomarker classifiers that replicate across samples and biofluids, and that a substantial fraction of dementia's variance is attributable to peripheral blood-based protein levels via the patterns codified in those latent constructs.
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Affiliation(s)
- Donald R Royall
- Department of Psychiatry, the University of Texas Health Science Center, San Antonio, TX, USA.,Department of Medicine, the University of Texas Health Science Center, San Antonio, TX, USA.,Department of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, TX, USA.,The Glenn Biggs Institute for Alzheimer's and Neurodegenerative Disease, the University of Texas Health ScienceCenter, San Antonio, TX, USA
| | - Raymond F Palmer
- Department of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, TX, USA
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Braskie MN, Hazra N, Kothapalli D, Cho H, Lester J, Rogers JN, Palmer RF, Vintimilla R, Johnson L, Yaffe K, Toga AW, O'Bryant SE. Type 2 diabetes and cortical thickness in older Mexican Americans and non‐Hispanic Whites. Alzheimers Dement 2022. [DOI: 10.1002/alz.065815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Meredith N Braskie
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California Marina del Rey CA USA
| | - Nalini Hazra
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California Marina del Rey CA USA
| | - Deydeep Kothapalli
- University of Southern California, Stevens Neuroimaging and Informatics Institute, Imaging Genetics Center Marina del Rey CA USA
| | - HyungJin Cho
- University of Southern California Marina del Rey CA USA
| | - Jacob Lester
- University of Southern California Marina del Rey CA USA
| | | | - Raymond F. Palmer
- University of Texas Health Science Center at San Antonio San Antonio TX USA
| | - Raul Vintimilla
- University of North Texas Health Science Center Fort Worth TX USA
| | - Leigh Johnson
- University of North Texas Health Science Center Fort Worth TX USA
| | - Kristine Yaffe
- University of California, San Francisco San Francisco CA USA
| | - Arthur W. Toga
- Stevens Neuroimaging and Informatics Institute, University of Southern California Los Angeles CA USA
| | - Sid E. O'Bryant
- University of North Texas Health Science Center Fort Worth TX USA
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Ferrer RL, Schlenker CG, Cruz I, Noël PH, Palmer RF, Poursani R, Jaén CR. Community Health Workers as Trust Builders and Healers: A Cohort Study in Primary Care. Ann Fam Med 2022; 20:438-445. [PMID: 36228078 PMCID: PMC9512562 DOI: 10.1370/afm.2848] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/08/2022] [Accepted: 05/10/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Improving patients' self-care for chronic disease is often elusive in the context of social deprivation. We evaluated whether a practice-integrated community health worker (CHW) intervention could encourage effective long-term self-management of type 2 diabetes mellitus (T2DM). METHODS This cohort study, in a safety-net primary care practice, enrolled patients with uncontrolled T2DM and psychosocial risk factors. Patients were identified through a practice diabetes registry or by clinicians' referrals. The CHWs engaged patients in trust building and sensemaking to understand their social context, identify goals, navigate health care, and connect to community resources. Primary outcome was progress through 3 prospectively defined stages of self-care: outreach (meeting face-to-face); stabilization (collaborating to address patients' life circumstances); and self-care generativity (achieving self-care competencies). Secondary outcomes were change in hemoglobin A1c (HbA1c) and need for urgent care, emergency department, or hospital visits. RESULTS Of 986 participating patients, 27% remained in outreach, 41% progressed to stabilization, and 33% achieved self-care generativity. Repeated measures ANOVA demonstrates an overall decline in HbA1c, without group differences, through the 4th HbA1c measurement (mean follow-up 703 days). Beginning at the 5th HbA1c measurement (mean 859 days), the self-care generativity group achieved greater declines in HbA1c, which widened through the 10th measurement (mean 1,365 days) to an average of 8.5% compared with an average of 8.8% in the outreach group and 9.0% in the stabilization group (P = .003). Rates of emergency department and hospital visits were lower in the self-care generativity group. CONCLUSIONS Practice-linked CHWs can sustainably engage vulnerable patients, helping them advance self-management goals in the context of formidable social disadvantage.
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Affiliation(s)
- Robert L Ferrer
- Department of Family and Community Medicine, Long School of Medicine, UT Health San Antonio, San Antonio, Texas
| | - Carolina Gonzalez Schlenker
- Department of Family and Community Medicine, Long School of Medicine, UT Health San Antonio, San Antonio, Texas
| | - Inez Cruz
- Department of Family and Community Medicine, Long School of Medicine, UT Health San Antonio, San Antonio, Texas
| | - Polly Hitchcock Noël
- Department of Family and Community Medicine, Long School of Medicine, UT Health San Antonio, San Antonio, Texas
| | - Raymond F Palmer
- Department of Family and Community Medicine, Long School of Medicine, UT Health San Antonio, San Antonio, Texas
| | - Ramin Poursani
- Department of Family and Community Medicine, Long School of Medicine, UT Health San Antonio, San Antonio, Texas
| | - Carlos Roberto Jaén
- Department of Family and Community Medicine, Long School of Medicine, UT Health San Antonio, San Antonio, Texas
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Palmer RF, Walker T, Kattari D, Rincon R, Perales RB, Jaén CR, Grimes C, Sundblad DR, Miller CS. Validation of a Brief Screening Instrument for Chemical Intolerance in a Large U.S. National Sample. Int J Environ Res Public Health 2021; 18:ijerph18168714. [PMID: 34444461 PMCID: PMC8391803 DOI: 10.3390/ijerph18168714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 12/12/2022]
Abstract
Background: Chemical intolerance (CI) is characterized by multisystem symptoms triggered by low levels of exposure to xenobiotics including chemicals, foods/food additives, and drugs/medications. Prior prevalence estimates vary from 8–33% worldwide. Clinicians and researchers need a brief, practical screening tool for identifying possible chemical intolerance. This large, population-based study describes the validation of a three-item screening questionnaire, the Brief Environmental Exposure and Sensitivity Inventory (BREESI), against the international reference standard used for assessing chemical intolerance, the Quick Environmental Exposure and Sensitivity Inventory (QEESI). Methods: More than 10,000 people in the U.S. responded to the BREESI and the QEESI in a population-based survey. We calculated the overall prevalence of CI in this sample, as well as by gender, age, and income. Common statistical metrics were used to evaluate the BREESI as a screener for CI against the QEESI. Results: The prevalence estimate for QEESI-defined chemical intolerance in the U.S. was 20.39% (95% CI 19.63–21.15%). The BREESI had 91.26% sensitivity (95% CI: 89.20–93.04%) and 92.89% specificity (95% CI: 91.77–93.90%). The positive likelihood ratio was 12.83 (95% CI: 11.07–14.88), and the negative likelihood ratio was 0.09 (95% CI: 0.08–0.12). Logistic regression demonstrates that the predicted probability of CI increased sharply with each increase in the number of BREESI items endorsed (Odds Ratio: 5.3, 95% CI: 4.90–5.75). Conclusions: Chemical intolerance may affect one in five people in the U.S. The BREESI is a new, practical instrument for researchers, clinicians, and epidemiologists. As a screening tool, the BREESI offers a high degree of confidence in case ascertainment. We recommend: screen with the BREESI, confirm with the QEESI.
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Affiliation(s)
- Raymond F. Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; (T.W.); (R.R.); (R.B.P.); (C.R.J.); (C.S.M.)
- Correspondence: ; Tel.: +1-210-827-7681
| | - Tatjana Walker
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; (T.W.); (R.R.); (R.B.P.); (C.R.J.); (C.S.M.)
| | - David Kattari
- Hayward Score, Carmel, CA 93921, USA; (D.K.); (C.G.); (D.R.S.)
| | - Rudy Rincon
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; (T.W.); (R.R.); (R.B.P.); (C.R.J.); (C.S.M.)
| | - Roger B. Perales
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; (T.W.); (R.R.); (R.B.P.); (C.R.J.); (C.S.M.)
| | - Carlos R. Jaén
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; (T.W.); (R.R.); (R.B.P.); (C.R.J.); (C.S.M.)
| | - Carl Grimes
- Hayward Score, Carmel, CA 93921, USA; (D.K.); (C.G.); (D.R.S.)
| | | | - Claudia S. Miller
- Department of Family and Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; (T.W.); (R.R.); (R.B.P.); (C.R.J.); (C.S.M.)
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12
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Frye RE, Cakir J, Rose S, Palmer RF, Austin C, Curtin P. Physiological mediators of prenatal environmental influences in autism spectrum disorder. Bioessays 2021; 43:e2000307. [PMID: 34260745 DOI: 10.1002/bies.202000307] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 12/27/2022]
Abstract
Recent research has pointed to the importance of the prenatal environment in the etiology of autism spectrum disorder (ASD) but the biological mechanisms which mitigate these environmental factors are not clear. Mitochondrial metabolism abnormalities, inflammation and oxidative stress as common physiological disturbances associated with ASD. Network analysis of the scientific literature identified several leading prenatal environmental factors associated with ASD, particularly air pollution, pesticides, the microbiome and epigenetics. These leading prenatal environmental factors were found to be most associated with inflammation, followed by oxidative stress and mitochondrial dysfunction. Other prenatal factors associated with ASD not identified by the network analysis were also found to be significantly associated with these common physiological disturbances. A better understanding of the biological mechanism which mediate the effect of prenatal environmental factors can lead to insights of how ASD develops and the development of targeted therapeutics to prevent ASD from occuring.
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Affiliation(s)
- Richard E Frye
- Section on Neurodevelopmental Disorders, Division of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, Arizona, 85016, USA.,Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, 85004, USA
| | - Janet Cakir
- Department of Applied Ecology, North Carolina State University, Raleigh, North Carolina, 27695, USA
| | - Shannon Rose
- Arkansas Children's Research Institute, Little Rock, Arkansas, 72202, USA.,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, 72205, USA
| | - Raymond F Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, Texas, 78229, USA
| | - Christine Austin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
| | - Paul Curtin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
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Frye RE, Cakir J, Rose S, Delhey L, Bennuri SC, Tippett M, Melnyk S, James SJ, Palmer RF, Austin C, Curtin P, Arora M. Prenatal air pollution influences neurodevelopment and behavior in autism spectrum disorder by modulating mitochondrial physiology. Mol Psychiatry 2021; 26:1561-1577. [PMID: 32963337 PMCID: PMC8159748 DOI: 10.1038/s41380-020-00885-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/03/2020] [Accepted: 09/08/2020] [Indexed: 02/07/2023]
Abstract
We investigate the role of the mitochondrion, an organelle highly sensitive to environmental agents, in the influence of prenatal air pollution exposure on neurodevelopment and behavior in 96 children with autism spectrum disorder (ASD) [45 with neurodevelopmental regression (NDR); 76% Male; mean (SD) age 10 y 9 m (3 y 9 m)]. Mitochondrial function was assessed using the Seahorse XFe96 in fresh peripheral blood mononuclear cells. Second and third trimester average and maximal daily exposure to fine air particulate matter of diameter ≤2.5 µm (PM2.5) was obtained from the Environmental Protection Agency's Air Quality System. Neurodevelopment was measured using the Vineland Adaptive Behavior Scale 2nd edition and behavior was assessed using the Aberrant Behavior Checklist and Social Responsiveness Scale. Prenatal PM2.5 exposure influenced mitochondrial respiration during childhood, but this relationship was different for those with (r = 0.25-0.40) and without (r = -0.07 to -0.19) NDR. Mediation analysis found that mitochondrial respiration linked to energy production accounted for 25% (SD = 2%) and 10% (SD = 2%) of the effect of average prenatal PM2.5 exposure on neurodevelopment and behavioral symptoms, respectively. Structural equation models estimated that PM2.5 and mitochondrial respiration accounted for 34% (SD = 4%) and 36% (SD = 3%) of the effect on neurodevelopment, respectively, and that behavior was indirectly influenced by mitochondrial respiration through neurodevelopment but directly influenced by prenatal PM2.5. Our results suggest that prenatal exposure to PM2.5 disrupts neurodevelopment and behavior through complex mechanisms, including long-term changes in mitochondrial respiration and that patterns of early development need to be considered when studying the influence of environmental agents on neurodevelopmental outcomes.
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Affiliation(s)
- Richard E Frye
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA.
| | - Janet Cakir
- North Carolina State University, Raleigh, NC, USA
| | - Shannon Rose
- Arkansas Children's Research Institute, Little Rock, AR, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Leanna Delhey
- Arkansas Children's Research Institute, Little Rock, AR, USA
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sirish C Bennuri
- Arkansas Children's Research Institute, Little Rock, AR, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Marie Tippett
- Arkansas Children's Research Institute, Little Rock, AR, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stepan Melnyk
- Arkansas Children's Research Institute, Little Rock, AR, USA
| | - S Jill James
- Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Raymond F Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Christine Austin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul Curtin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Manish Arora
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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14
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Frye RE, Cakir J, Rose S, Palmer RF, Austin C, Curtin P, Arora M. Mitochondria May Mediate Prenatal Environmental Influences in Autism Spectrum Disorder. J Pers Med 2021; 11:218. [PMID: 33803789 PMCID: PMC8003154 DOI: 10.3390/jpm11030218] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 12/13/2022] Open
Abstract
We propose that the mitochondrion, an essential cellular organelle, mediates the long-term prenatal environmental effects of disease in autism spectrum disorder (ASD). Many prenatal environmental factors which increase the risk of developing ASD influence mitochondria physiology, including toxicant exposures, immune activation, and nutritional factors. Unique types of mitochondrial dysfunction have been associated with ASD and recent studies have linked prenatal environmental exposures to long-term changes in mitochondrial physiology in children with ASD. A better understanding of the role of the mitochondria in the etiology of ASD can lead to targeted therapeutics and strategies to potentially prevent the development of ASD.
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Affiliation(s)
- Richard E. Frye
- Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
| | - Janet Cakir
- Department of Applied Ecology, North Carolina State University, Raleigh, NC 27695, USA;
| | - Shannon Rose
- Department of Pediatrics, Arkansas Children’s Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA;
| | - Raymond F. Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, TX 78229, USA;
| | - Christine Austin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.A.); (P.C.); (M.A.)
| | - Paul Curtin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.A.); (P.C.); (M.A.)
| | - Manish Arora
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.A.); (P.C.); (M.A.)
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15
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Colmenarez M, Silzer T, Royall DR, Palmer RF, Barber R, Phillips N. ‘δ’ is for dementia: Genomic architecture of the latent variable δ homolog (dEQ) in Mexican Americans and non‐Hispanic Whites. Alzheimers Dement 2020. [DOI: 10.1002/alz.044205] [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: 11/11/2022]
Affiliation(s)
| | - Talisa Silzer
- University of North Texas, Health Science Center Fort Worth TX USA
| | - Donald R. Royall
- University of Texas Health Science Center at San Antonio San Antonio TX USA
| | - Raymond F. Palmer
- University of Texas Health Science Center at San Antonio San Antonio TX USA
| | - Robert Barber
- University of North Texas, Health Science Center Fort Worth TX USA
| | - Nicole Phillips
- University of North Texas, Health Science Center Fort Worth TX USA
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16
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Royall DR, Palmer RF. δ scores predict multiple neuropsychiatric symptoms. Int J Geriatr Psychiatry 2020; 35:1341-1348. [PMID: 32584472 DOI: 10.1002/gps.5371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/03/2020] [Accepted: 06/21/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Dementia severity is strongly related to Spearman's general intelligence factor "g", via the latent dementia phenotype "δ" and is distinct from domain-specific cognitive impairments arising from disease-specific regional pathologies. It is an empiric question whether behavioral and psychological symptoms of dementia (BPSD) are associated with δ or with domain-specific constructs. METHODS A recently developed δ homolog ("dDx") was tested as a predictor of 1 year prospective BPSD in n = 723 Mexican-American and non-Hispanic White participants in the Texas Alzheimer's Research and Care Consortium (TARCC). The informant-rated frequencies of 12 BPSD were rated by the neuropsychiatric inventory (NPI-Q). Baseline BPSD, demographic features, selected biomarkers, and treatment exposure to acetylcholinesterase inhibitors were used as covariates. Composite scores derived from orthogonal latent measures of domain-specific memory (MEM) and executive function (EF) were also tested as predictors. RESULTS "Functionally salient cognitive impairment (FSCI)" that is, categorical "dementia" as diagnosed by dDx was associated with increased prospective frequency of 11/12 BPSD, independently of baseline behavior and covariates. Age, depressive symptoms, and EF were associated with individual BPSD. MEM was not associated with any. Dementia severity, as measured by dDx, was also associated with a prospective increase in total NPI-Q scores. CONCLUSION δ is associated non-specifically with multiple BPSD. This suggests the existence of a dementia-specific behavioral profile, arising from insults to general intelligence, and unrelated to disease-specific regional pathology(ies).
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Affiliation(s)
- Donald R Royall
- Departments of Psychiatry, Medicine, Family and Community Medicine, and the Glenn Biggs Institute for Alzheimer's and Neurodegenerative Disease, The University of Texas Health Science Center, San Antonio, Texas, USA
| | - Raymond F Palmer
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, Texas, USA
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17
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Palmer RF, Palavecino E, McLemore JL. Naegleria Fowleri Diagnosed with Hospital Autopsy in a Toddler: A Case Study. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Casestudy
Naegleria fowleri, an amoeba, is typically found in warm freshwater lakes, ponds, rivers and hot springs. It is responsible for causing the incredibly rare and lethal central nervous system infection called Primary Amoebic Meningoencephalitis (PAM). In the United States, 145 confirmed cases have been documented since 1962. Most cases are associated with freshwater lakes, ponds and reservoirs, while only a handful have been linked to artificial recreational venues such as pools, interactive water play-grounds, and spas. In addition to highlighting a rare amoebic disease, this case illustrates the continued importance of hospital autopsies especially given recent ruling to eliminate the autopsy requirement by the Centers for Medicare and Medicaid Services.
Results
An otherwise healthy toddler had upper respiratory symptoms and otitis media days after returning from an artificial recreational water venue, becoming increasingly lethargic and febrile over the next few days. At the hospital, cerebrospinal fluid (CSF) abnormalities were suggestive but not consistent with bacterial meningitis. A meningoencephalitis panel, a Computed Tomograph (CT) scan of the head, and chest-x-ray were negative for abnormalities. Appropriate antimicrobial therapy was initiated. Three days after hospital admission, his symptoms worsened including development of dysconjugate gaze and signs of cerebellitis. He became increasingly hemodynamically unstable, suffered an arrest, and passed away days later.
Conclusion
Since this death did not fall under the state’s statutes mandating medicolegal autopsy, a hospital- requested autopsy was performed. Cerebral edema and a light gray to light green exudate was along the inferior and lateral left temporal lobe, brain stem, and cerebellum. An exuberant lymphoplasmacytic infiltrate with scattered polymorphonuclear leukocytes expanded the meninges. Small histiocyte-like cells with distinct eccentric nuclei and granular, vacuolated cytoplasm, confirmed by Centers for Disease Control and Prevention (CDC) to be Naegleria fowleri, were best visualized in the Virchow-Robin spaces and deeper parenchyma.
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Affiliation(s)
- R F Palmer
- Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, UNITED STATES
| | - E Palavecino
- Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, UNITED STATES
| | - J L McLemore
- Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, UNITED STATES
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18
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Royall DR, Palmer RF. δ-Related Biomarkers Attenuate Multiple Alzheimer's Disease Conversion Risks and Offer Targets for Intervention. J Gerontol A Biol Sci Med Sci 2020; 75:2177-2183. [PMID: 31665233 DOI: 10.1093/gerona/glz253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We tested certain serum proteins' ability to mediate the effects of demographic variables on prospective 5-year conversion to clinical "Alzheimer's disease" from non-demented states (i.e. normal control and mild cognitive impairment). The proteins were rationally selected from previously published mediators of those same variables' (plural posessive) association with the latent variable "δ," a novel omnibus dementia severity metric. METHODS Each protein's attenuation of its risk factor's independent association with conversion was performed using logistic regression, adjusted for education, ethnicity, self-reported diabetes mellitus, and hypertension, among initially non-demented Mexican American and non-Hispanic white (N = 772) participants in the Texas Alzheimer's Research and Care Consortium. RESULTS A total of 70 (9.1%) non-demented participants at baseline converted to "Alzheimer's disease", with a mean follow-up of 5.4 years. Age >80 years (odds ratio = 3.1), 30-item Geriatric Depression Scale >10/30 (odds ratio = 2.3), female gender (odds ratio = 2.2), and the presence of an apolipoprotein E ε4 allele (odds ratio = 2.4) were independently associated with prospective conversion. These effects were fully attenuated by five serum proteins: age: insulin-like growth factor-binding protein 2 and epidermal growth factor receptor 1; depression: resistin; gender: thrombopoietin; and apolipoprotein E: C-reactive protein. CONCLUSION Clinical dementia arises from the sum of independent δ-related processes. This analysis provides proof of concept for the rational selection of antidementia targets and offers a foundation for precision antidementia therapy.
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Affiliation(s)
- Donald R Royall
- Department of Psychiatry, The University of Texas Health Science Center, San Antonio, Texas
- Department of Medicine, The University of Texas Health Science Center, San Antonio, Texas
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, Texas
- The Glenn Biggs Institute for Alzheimer's and Neurodegenerative Disease, The University of Texas Health Science Center, San Antonio, Texas
| | - Raymond F Palmer
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, Texas
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Palmer RF, Jaén CR, Perales RB, Rincon R, Forster JN, Miller CS. Three questions for identifying chemically intolerant individuals in clinical and epidemiological populations: The Brief Environmental Exposure and Sensitivity Inventory (BREESI). PLoS One 2020; 15:e0238296. [PMID: 32936802 PMCID: PMC7494077 DOI: 10.1371/journal.pone.0238296] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 08/14/2020] [Indexed: 12/12/2022] Open
Abstract
The Quick Environmental Exposure and Sensitivity Inventory (QEESI) is a validated questionnaire used worldwide to assess intolerances to chemicals, foods, and drugs, and has emerged as the gold standard for assessing chemical intolerance (CI). Despite a reported prevalence of 8–33%, epidemiological studies and routine primary care clinics rarely assess CI. To help address this gap, we developed the Brief Environmental Exposure and Sensitivity Inventory (BREESI)—a 3-item CI screening tool. We tested the BREESI’s potential to predict whether an individual is likely to be classified as chemically intolerant if administered the 50-item QEESI. We recruited 293 participants from a university-based primary care clinic and through online participation. The statistical sensitivity, specificity, and positive and negative predictive values of the BREESI were calculated against the validated QEESI. Ninety percent (90%) of participants answering “yes” to all three items on the BREESI fit the QEESI criteria for being very suggestive of CI based upon their chemical intolerance and symptom scores (positive predictive value = 90%). For participants endorsing two items, 93% were classified as either very suggestive (39%) or suggestive (54%) of CI (positive predictive value = 87%). Of those endorsing only one item, 13% were classified as very suggestive of CI, and 70% as suggestive. Of those answering “No” to all of the BREESI items, 95% were classified as not suggestive of CI (i.e., negative predictive value = 95%). The BREESI is a versatile screening tool for assessing potential CI useful for clinical and epidemiological applications, based upon individuals’ past adverse responses in a variety of settings. Just as health care professionals routinely inquire about latex allergy to prevent adverse reactions, the BREESI provides an essential screen for CI. Together, the BREESI and QEESI provide new diagnostic tools that may help predict and prevent future adverse reactions to chemicals, foods, and drugs.
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Affiliation(s)
- Raymond F. Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
- * E-mail:
| | - Carlos R. Jaén
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Roger B. Perales
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Rodolfo Rincon
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Jacqueline N. Forster
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Claudia S. Miller
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
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Frye RE, Cakir J, Rose S, Delhey L, Bennuri SC, Tippett M, Palmer RF, Austin C, Curtin P, Arora M. Early life metal exposure dysregulates cellular bioenergetics in children with regressive autism spectrum disorder. Transl Psychiatry 2020; 10:223. [PMID: 32636364 PMCID: PMC7341836 DOI: 10.1038/s41398-020-00905-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/11/2020] [Accepted: 06/16/2020] [Indexed: 12/21/2022] Open
Abstract
Neurodevelopmental regression (NDR) is a subtype of autism spectrum disorder (ASD) that manifests as loss of previously acquired developmental milestones. Early life dysregulation of nutritional metals and/or exposure to toxic metals have been associated with ASD, but the underlying biological mechanisms by which metals influence neurodevelopment remain unclear. We hypothesize that metals influences neurodevelopment through dysregulation of bioenergetics. Prenatal and early postnatal metal exposures were measured using validated tooth-matrix biomarkers in 27 ASD cases (13 with NDR) and 7 typically-developing (TD) controls. Mitochondrial respiration and glycolysis were measured in peripheral blood mononuclear cells using the Seahorse XF96. Children with ASD demonstrated lower prenatal and postnatal Copper (Cu) and prenatal Nickel concentrations and Copper-to-Zinc (Cu/Zn) ratio as compared with TD children. Children with ASD and NDR showed greater metal-related disruption of cellular bioenergetics than children with ASD without NDR. For children with ASD and NDR mitochondrial respiration decreased as prenatal Manganese concentration increased and increased as prenatal Zinc concentration increased; glycolysis decreased with increased exposure to prenatal Manganese and Lead and postnatal Manganese. For children with ASD without a history of NDR, glycolysis increased with increased postnatal exposure to Tin. Language and communication scores in children with ASD were positively related to prenatal Cu exposure and Cu/Zn ratio. This study suggests that prenatal nutritional metals may be important for neurodevelopment in children with ASD, and that exposure to toxic metals and differences in nutritional metal exposures is associated with dysregulation of cellular bioenergetics, particularly in the NDR subtype of ASD.
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Affiliation(s)
- Richard E. Frye
- grid.427785.b0000 0001 0664 3531Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ USA ,grid.134563.60000 0001 2168 186XUniversity of Arizona College of Medicine – Phoenix, Phoenix, AZ USA
| | - Janet Cakir
- grid.40803.3f0000 0001 2173 6074North Carolina State University, Raleigh, NC USA
| | - Shannon Rose
- grid.488749.eArkansas Children’s Research Institute, Little Rock, AR USA ,grid.241054.60000 0004 4687 1637Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Leanna Delhey
- grid.488749.eArkansas Children’s Research Institute, Little Rock, AR USA ,grid.241054.60000 0004 4687 1637Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Sirish C. Bennuri
- grid.488749.eArkansas Children’s Research Institute, Little Rock, AR USA ,grid.241054.60000 0004 4687 1637Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Marie Tippett
- grid.488749.eArkansas Children’s Research Institute, Little Rock, AR USA ,grid.241054.60000 0004 4687 1637Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Raymond F. Palmer
- grid.267309.90000 0001 0629 5880Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, TX USA
| | - Christine Austin
- grid.59734.3c0000 0001 0670 2351Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Paul Curtin
- grid.59734.3c0000 0001 0670 2351Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Manish Arora
- grid.59734.3c0000 0001 0670 2351Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
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Abstract
BACKGROUND The adipokine adiponectin (APN)'s role in Alzheimer's disease (AD) is controversial. Some studies suggest APN is neuroprotective while others propose it has harmful effects. We have used Multiple Indicators Multiple Causes (MIMIC) models to evaluate the effects of serum protein biomarkers on cognitive performance in the Texas Alzheimer's Research and Care Consortium (TARCC) (Royall DR, Bishnoi RJ, Palmer RF. Serum IGF-BP2 strongly moderates age's effect on cognition: a MIMIC analysis. Neurobiol Aging. 2015;36:2232-2240; Bishnoi RJ, Palmer RF, Royall DR. Vitamin D binding protein as a serum biomarker of Alzheimer's disease. J Alzheimers Dis. 2015;43:37-45; Bishnoi RJ, Palmer RF, Royall DR. Serum interleukin (IL)-15 as a biomarker of Alzheimer's disease. PLoS One. 2015;10:e0117282). METHODS MIMIC models were constructed and replicated in randomly selected 50% splits of TARCC's data (Group 1 N = 1,691; Group 2 N = 1,690) and used to evaluate the relationship between serum APN levels and cognition. Our approach has been to divide general intelligence (Spearman's g) (Spearman C. The Abilities of Man: Their Nature and Measurement. 1932) into two latent variables, δ (ie, a dementia-specific phenotype representing the disabling fraction of cognitive variance) and g prime (g') (ie, the residual non-disabling fraction). Only effects on δ are likely to be dementing. RESULTS Serum APN was significantly related to δ scores (r = .10, p = .015). APN had no significant effect on g' (r = -.25, p = .66), nor did it have any independent direct effects on cognitive performance. These results were replicated across random subsets (ΔCHISQ = 2.8(7), p > .90). CONCLUSIONS APN's effect on cognition is mediated through intelligence (ie, δ), likely to be disabling, and therefore to mediate one or more dementing processes. We have previously shown APN to partially mediate age's-specific effect on δ (Royall DR, Al-Rubaye S, Bishnoi R, Palmer RF. Serum protein mediators of dementia and aging proper. Aging (Albany NY). 2016;8:3241-3254). However, because the current model is age adjusted, APN must mediate one or more additional age-independent dementing process(es), possibly AD.
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Affiliation(s)
| | - Raymond F Palmer
- Family and Community Medicine, UT Health San Antonio, San Antonio, Texas
| | - Donald R Royall
- Department of Psychiatry, UT Health San Antonio, San Antonio, Texas
- Family and Community Medicine, UT Health San Antonio, San Antonio, Texas
- Audie L. Murphy Division GRECC, The South Texas Veterans' Health System, San Antonio, Texas
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Royall DR, Bishnoi RJ, Palmer RF. Blood-based protein predictors of dementia severity as measured by δ: Replication across biofluids and cohorts. Alzheimers Dement (Amst) 2019; 11:763-774. [PMID: 31909176 PMCID: PMC6939046 DOI: 10.1016/j.dadm.2019.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Dementia severity can be empirically described by the latent dementia phenotype "δ" and its various composite "homologs". We have explored δ's blood-based protein biomarkers in the Texas Alzheimer's Research and Care Consortium (TARCC) study. However, it would be convenient to replicate those associations in the Alzheimer's Disease Neuroimaging Initiative (ADNI). To this end, we recently engineered a δ homolog from observed cognitive performance measures common to both projects (i.e., "dT2A"). METHODS We used nine rationally chosen peripheral blood-based protein biomarkers as indicators of a latent variable "INFLAMMATION". We then associated that construct with dT2A in structural equation models adjusted for age, gender, depressive symptoms, and apolipoprotein E (APOE) ε4 allelic burden. Significant factor loadings and INFLAMMATION's association with dT2A were confirmed in random splits of TARCC's relatively large sample, and across biofluids in the ADNI. RESULTS Nine proteins measured in serum (TARCC) or plasma (ADNI) explained ≅10% of dT2A's variance in both samples, independently of age, APOE, education, and gender. All loaded significantly on INFLAMMATION, and positively or negatively, depending on their known roles are PRO- or ANTI-inflammatory proteins, respectively. The parameters of interest were confirmed across random 50% splits of the TARCC's sample, and replicated across biofluids in the ADNI. DISCUSSION These results suggest that SEM can be used to replicate biomarker findings across samples and biofluids, and that a substantial fraction of dementia's variance is attributable to peripheral blood-based protein levels.
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Affiliation(s)
- Donald R. Royall
- Department of Psychiatry, The University of Texas Health Science Center, San Antonio, TX, USA
- Department of Medicine, the University of Texas Health Science Center, San Antonio, TX, USA
- Family and Community Medicine, the University of Texas Health Science Center, San Antonio, TX, USA
- The Biggs Institute for Alzheimer's and Neurodegenerative Disease, the University of Texas Health Science Center, San Antonio, TX, USA
| | - Ram J. Bishnoi
- The Department of Psychiatry, The Medical College of Georgia, Augusta, GA, USA
| | - Raymond F. Palmer
- Family and Community Medicine, the University of Texas Health Science Center, San Antonio, TX, USA
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Royall DR, Palmer RF. Blood-based protein mediators of senility with replications across biofluids and cohorts. Brain Commun 2019; 2:fcz036. [PMID: 32954311 PMCID: PMC7425523 DOI: 10.1093/braincomms/fcz036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/25/2019] [Accepted: 10/07/2019] [Indexed: 01/08/2023] Open
Abstract
Dementia severity can be quantitatively described by the latent dementia phenotype 'δ' and its various composite 'homologues'. We have explored δ's blood-based protein biomarkers in the Texas Alzheimer's Research and Care Consortium. However, it would be convenient to replicate them in the Alzheimer's Disease Neuroimaging Initiative. To that end, we have engineered a δ homologue from the observed cognitive performance measures common to both projects [i.e. 'd:Texas Alzheimer's Research and Care Consortium to Alzheimer's Disease Neuroimaging Initiative' (dT2A)]. In this analysis, we confirm 13/22 serum proteins as partial mediators of age's effect on dementia severity as measured by dT2A in the Texas Alzheimer's Research and Care Consortium and then replicate 4/13 in the Alzheimer's Disease Neuroimaging Initiative's plasma data. The replicated mediators of age-specific effects on dementia severity are adiponectin, follicle-stimulating hormone, pancreatic polypeptide and resistin. In their aggregate, the 13 confirmed age-specific mediators suggest that 'cognitive frailty' pays a role in dementia severity as measured by δ. We provide both discriminant and concordant support for that hypothesis. Weight, calculated low-density lipoprotein and body mass index are partial mediators of age's effect in the Texas Alzheimer's Research and Care Consortium. Biomarkers related to other disease processes (e.g. cerebrospinal fluid Alzheimer's disease-specific biomarkers in the Alzheimer's Disease Neuroimaging Initiative) are not. It now appears that dementia severity is the sum of multiple independent processes impacting δ. Each may have a unique set of mediating biomarkers. Age's unique effect appears to be at least partially mediated through proteins related to frailty. Age-specific mediation effects can be replicated across cohorts and biofluids. These proteins may offer targets for the remediation of age-specific cognitive decline (aka 'senility'), help distinguish it from other determinants of dementia severity and/or provide clues to the biology of Aging Proper.
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Affiliation(s)
- Donald R Royall
- Department of Psychiatry, The University of Texas Health Science Center, San Antonio, TX 78229-3900, USA
- Department of Medicine, The University of Texas Health Science Center, San Antonio, TX 78229-3900, USA
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX 78229-3900, USA
- The Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, The University of Texas Health Science Center, San Antonio, TX 78229-3900, USA
| | - Raymond F Palmer
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX 78229-3900, USA
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Royall DR, Palmer RF. δ PREDICTS GENERAL PSYCHOPATHOLOGY. Innov Aging 2019. [PMCID: PMC6841133 DOI: 10.1093/geroni/igz038.2378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
“δ” is a transdiagnostic omnibus dementia severity measure derived from general intelligence (i.e., Spearman’s “g”). It can be estimated in any cognitive battery that contains a measure of Instrumental Activities of Daily Living (IADL). As dementia’s essential cognitive impairment, δ may also explain the appearance of Behavioral and Psychological Symptoms of Dementia (BPSD). Alternatively, the latter may be associated with orthogonal domain-specific cognitive impairments, unrelated to δ and therefore to dementia. The δ homolog ”dDx” was tested as a predictor of one year prospective BPSD among n = 723 participants in the Texas Alzheimer’s Research and Care Consortium (TARCC). Twelve Neuropsychiatric Inventory (NPI-Q)-rated BPSD were themselves submitted to confirmatory factor analysis resulting in a well-fit bifactor model rating general psychopathology (p), positive (+) and negative (-) symptoms. dDx and orthogonal cognitive factors rating memory (MEM) and executive function (EF) were regressed onto prospective p, (+) and (-). dDx was strongly associated with p (r = -0.59, p <0.001). MEM was associated only with (+) (r = 0.14, p <0.001). EF was associated only with (-) (r = -0.23, p <0.001). This is the first demonstration of p in the geriatric literature. p’s strong association with δ suggests that general psychopathology arises from dementia itself. In contrast, (+) and (-) symptoms may arise from regional insults, e.g., to temporo-limbic and frontal circuits (respectively). No such regional pathology is likely to impact δ or p, as they are “indifferent” to their indicators and must derive from global Central Nervous System (CNS) features.
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Affiliation(s)
- Donald R Royall
- Departments of Psychiatry, Medicine and Family & Community Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
| | - Raymond F Palmer
- Department of Family & Community Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
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Palmer RF, Royall DR, Downer B, Markides K. FRAILTY MEDIATES SENILITY IN MEXICAN AMERICANS. Innov Aging 2019. [PMCID: PMC6840891 DOI: 10.1093/geroni/igz038.1073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The latent construct “d” (for “dementia”) offers a continuously distributed transdiagnostic dementia severity metric. Age is significantly associated with “d”. We test whether frailty mediates age’s effect on 6 year prospective change in dementia severity in Mexican-Americans (MA), using data from the Hispanic Established Population for Epidemiological Studies in the Elderly (HEPESE). Age was regressed onto the 6yr prospective slope of change in “d” in N = 880 [mean age = 77.4 (6.1) at wave 3]. Change in “d” was estimated by a latent growth curve (LGC) indicated by latent cognitive measures across three HEPESE waves (i.e., 3, 5 and 6). “Frailty” was assessed by a modified version of Fried et al.’s construct observed at wave 5, and was tested as a mediator of age’s association with change in “d”. The mediation effect was estimated by MacKinnon’s method. “d” at each wave, and the LGC of change in “d” all had acceptable model fit (e.g. RMSEA <.05). Age was significantly associated with change in “d”. 51% of their association was explained by frailty. Frailty mediates the majority of age’s association with dementia severity. Not only does this support the existence of a cognitive “frailty” syndrome in MA, it also implicates an effect of frailty on intelligence (as “d” is derived from Spearman’s general intelligence factor “g”). Their association may be mediated by blood-based serum biomarkers, including somatomedins, which may offer targets for the treatment and /or prevention of senility in frail elderly persons.
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Affiliation(s)
- Raymond F Palmer
- Department of Family & Community Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
| | - Donald R Royall
- Departments of Psychiatry, Medicine and Family & Community Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
| | - Brian Downer
- University of Texas Medical Branch, Galveston, TX, Galveston, Texas, United States
| | - Kyriakos Markides
- University of Texas Medical Branch, Galveston, TX, Galveston, Texas, United States
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Mungia R, Taverna MV, de La Rosa E, Heilbrun LP, Mody P, Oates TW, Tran HA, Castillo M, Reyes SC, Suttle MG, Palmer RF. Tooth Fairy Study- The South Texas Oral Health Network Collaboration. Tex Dent J 2019; 136:687-694. [PMID: 34083843 PMCID: PMC8171277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE This study's purpose was to examine the processes and the potential for dental practitioners to address environmental health exposure risks to their patients through dental practice-based research participation. To explore this, the South Texas Oral Health Network (STOHN) initiated a collaboration with The Tooth Fairy National Study investigating toxicants stored in deciduous teeth as a potential neurodevelopmental risk factor. BACKGROUND Neurodevelopmental disorders (ND), like Autism Spectrum Disorder (ASD), affect 1 in 68 live births. Evidence suggests that environmental chemicals may play a role in ASD risk and/or etiology by acting independently or through interactions with genetic vulnerabilities. Provider awareness of environmental exposure risk during pregnancy and early childhood in South Texas is low. Therefore, it is important to increase provider knowledge and awareness to enable greater communication with patients. STOHN serves as a conduit reaching large numbers of patients. This study also engaged practitioners in an ongoing national study with minimal impact on their practice. METHODS The goal was to enroll twenty parents with children via ten dental practitioners. STOHN pediatric and general practitioners were recruited for the study. Practitioners were contacted by phone and in person. Upon completion of Human Subject Protection training, each practitioner participated in a study training taught by a public health educator in the department of Family and Community Medicine at University of Texas Health Science Center in San Antonio (UTHSCSA). Training topics included NDs, environmental health exposures, patient engagement, survey administration, and how to collect donated teeth. This collaboration allowed STOHN to gather control teeth as well as demographic and health information for the Tooth Fairy Study repository for future analyses. Participants received a thank you card from the Tooth Fairy and participating providers were highlighted in the monthly STOHN newsletter. EVALUATION RESULTS Evaluation was threefold: Practitioner enrollment and retention; practitioner confidence in educating their patients about potential environmental risk exposures and completed surveys with donated teeth. CONCLUSION The interdisciplinary collaboration between dental practitioners and medical researchers through STOHN provided an opportunity to increase practitioner knowledge and awareness of a novel health concern, while also raising their confidence and willingness to educate their patients about potential environmental exposure risks. UTHSCSA IRB Protocol # HSC20170132E.
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Affiliation(s)
- Rahma Mungia
- Department of Periodontics- University of Texas Health Science Center at San Antonio
| | - Melanie V Taverna
- Department of Periodontics- University of Texas Health Science Center at San Antonio
| | - Elisabeth de La Rosa
- Manager of Research Operations, Institute for Integration of Medicine & Science - University of Texas Health Science Center at San Antonio
| | - Lynne P Heilbrun
- Department of Family & Community Medicine - University of Texas Health Science Center at San Antonio
| | - Pooja Mody
- Department of Periodontics- University of Texas Health Science Center at San Antonio
| | - Thomas W Oates
- Department of Advanced Oral Sciences and Therapeutics - University of Maryland
| | - Huyen A Tran
- South Texas Oral Health Network and Private Practitioner, San Antonio, Texas
| | - Monica Castillo
- Research Coordinator, Institute for Integration of Medicine & Science - University of Texas Health Science Center at San Antonio Health Science Center at San Antonio
| | - Stephanie C Reyes
- Research Coordinator, Southwest Region National Dental PBRN - University of Texas Health Science Center at San Antonio
| | - Marsha G Suttle
- Intern, Department of Sociology - University of Texas at San Antonio
| | - Raymond F Palmer
- Department of Family & Community Medicine - University of Texas Health Science Center at San Antonio
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Affiliation(s)
- Donald R. Royall
- Departments of Psychiatry, The University of Texas Health Science Center, San Antonio, TX, USA
- Departments of Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
- Departments of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, TX, USA
- South Texas Veterans’ Health System Audie L. Murphy Division GRECC, San Antonio, TX, USA
| | - Raymond F. Palmer
- Departments of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, TX, USA
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Abstract
The latent variable "δ" (for "dementia") provides an etiologically "agnostic" omnibus dementia severity metric capable of recognizing the dementing potential of any condition. Depressive symptoms are independent predictors of δ and are thereby implicated as "dementing". Serum resistin levels partially mediate the association between depressive symptoms and δ. We use a novel "off-diagonal" CHI SQ algorithm to demonstrate our ability to select individuals demented solely by depression's effect in both the Texas Alzheimer's Research and Care Consortium (TARCC) (N ≌ 3,500), and the Alzheimer's Disease Neuroimaging Initiative (ADNI (N ≌ 1,750), and demonstrate the higher resistin levels of such cases in TARCC. This approach can be adapted to any δ-related dementia risk factor or biomarker and used identify individuals who might revert back to non-demented states after its successful treatment.
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Affiliation(s)
- Donald R. Royall
- Department of Psychiatry, the University of Texas Health Science Center, San Antonio, Texas, United States of America
- Department of Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
- Department of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
- South Texas Veterans’ Health System Audie L. Murphy Division Geriatric Research Education and Clinical Care Center, San Antonio, Texas, United States of America
| | - Raymond F. Palmer
- Department of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
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Abstract
Dementia can be empirically described by the latent dementia phenotype "δ" and its various composite "homologs". We have explored δ's blood-based protein biomarkers in the Texas Alzheimer's Research and Care Consortium (TARCC) study. However, it would be convenient to replicate those associations in the Alzheimer's Disease Neuroimaging Initiative (ADNI). To this end, we have engineered a δ homolog from observed cognitive performance measures common to both projects. Our findings were replicated in randomly selected 50% splits of TARCC data (Group 1, N = 1,747; Group 2, N = 1,755), and then independently in ADNI (N = 1,737). The new δ homolog, i.e., "dT2A" (d-TARCC to ADNI), fit the data of both studies well, and was strongly correlated with dementia severity, as rated by the Clinical Dementia Rating Scale "sum of boxes" (TARCC: r = 0.99, p < 0.001; ADNI: r = 0.96, p < 0.001). dT2A achieved an area under the receiver operating characteristic curve of 0.981 (0.976-0.985) for the discrimination of Alzheimer's disease from normal controls in TARCC, and 0.988 (0.983-0.993) in ADNI. dT2A is the 12th δ homolog published to date, and opens the door to independent replications across these and similar studies.
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Affiliation(s)
- Donald R Royall
- Department of Psychiatry, The University of Texas Health Science Center, San Antonio, TX, USA.,Department of Medicine, The University of Texas Health Science Center, San Antonio, TX, USA.,Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX, USA.,South Texas Veterans' Health System Audie L. Murphy Division GRECC, San Antonio, TX, USA
| | - Raymond F Palmer
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
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Abstract
The "δ" (for "dementia") is a latent dementia phenotype that can be constructed by a unique confirmatory bifactor model in a structural equation model framework. Because it is derived from Spearman's general intelligence factor, "g," δ can be constructed from any cognitive battery. This may allow for accurate dementia case-finding by telephone and in the absence of expert clinical evaluation or review. The authors constructed a new δ homolog in a large ethnically diverse convenience sample: the Texas Alzheimer's Research and Care Consortium, comprising 2,016 participants (Alzheimer's disease [AD], N=920; mild cognitive impairment, N=277; normal controls, N=819). A δ composite ("dTEL") was extracted from informant-rated Instrumental Activities of Daily Living and a brief battery of verbal cognitive measures. The entire battery was engineered to be administered over the telephone. dTEL's model had excellent fit. dTEL correlated strongly with dementia severity, as measured by the Clinical Dementia Rating "sum of boxes" scale (r=0.78, p<0.001). The dTEL composite's area under the receiver operating characteristic curve for the discrimination between control subjects and AD patients was 0.97 (95% CI=0.964-0.975). This was superior to all dTEL indicators. Therefore, the authors have demonstrated that a δ homolog composite constructed entirely from verbal measures is strongly associated with dementia severity, can accurately diagnose dementia, and outperforms all observed measures from which it is constructed. Future studies are required to assess dTEL's performance relative to evaluation by expert clinicians when obtained by lay psychometricians over the telephone.
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Affiliation(s)
- Donald R Royall
- From the Departments of Psychiatry, Medicine, and Family and Community Medicine, the University of Texas Health Science Center, San Antonio, Tex., (DRR, RFP); and the South Texas Veterans' Health System Audie L. Murphy Division GRECC (DRR)
| | - Raymond F Palmer
- From the Departments of Psychiatry, Medicine, and Family and Community Medicine, the University of Texas Health Science Center, San Antonio, Tex., (DRR, RFP); and the South Texas Veterans' Health System Audie L. Murphy Division GRECC (DRR)
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Royall DR, Bishnoi RJ, Palmer RF. O2‐11‐06: BLOOD‐BASED PROTEIN PREDICTORS OF DEMENTIA SEVERITY AS MEASURED BY δ: REPLICATION ACROSS BIOFLUIDS AND COHORTS. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2705] [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)
- Donald R. Royall
- University of Texas Health Science Center at San AntonioSan AntonioTXUSA
- South Texas Veterans Health Administration Geriatric Research Education and Clinical CenterSan AntonioTXUSA
| | | | - Raymond F. Palmer
- University of Texas Health Science Center at San AntonioSan AntonioTXUSA
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Royall DR, Palmer RF. P4‐294: AMYLOID BURDEN PREDICTED BY COGNITIVE ASSESSMENT. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.07.116] [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)
- Donald R. Royall
- University of Texas Health Science Center at San AntonioSan AntonioTXUSA
- South Texas Veterans Health Administration Geriatric Research Education and Clinical CenterSan AntonioTXUSA
| | - Raymond F. Palmer
- University of Texas Health Science Center at San AntonioSan AntonioTXUSA
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Royall DR, Bishnoi RJ, Palmer RF. P2‐287: A δ HOMOLOG FOR DEMENTIA CASE FINDING WITH REPLICATION IN ADNI. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Donald R. Royall
- University of Texas Health Science Center at San AntonioSan AntonioTXUSA
- South Texas Veterans Health Administration Geriatric Research Education and Clinical CenterSan AntonioTXUSA
| | | | - Raymond F. Palmer
- University of Texas Health Science Center at San AntonioSan AntonioTXUSA
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Curtin P, Austin C, Curtin A, Gennings C, Arora M, Tammimies K, Willfors C, Berggren S, Siper P, Rai D, Meyering K, Kolevzon A, Mollon J, David AS, Lewis G, Zammit S, Heilbrun L, Palmer RF, Wright RO, Bölte S, Reichenberg A. Dynamical features in fetal and postnatal zinc-copper metabolic cycles predict the emergence of autism spectrum disorder. Sci Adv 2018; 4:eaat1293. [PMID: 29854952 PMCID: PMC5976276 DOI: 10.1126/sciadv.aat1293] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/20/2018] [Indexed: 05/13/2023]
Abstract
Metals are critical to neurodevelopment, and dysregulation in early life has been documented in autism spectrum disorder (ASD). However, underlying mechanisms and biochemical assays to distinguish ASD cases from controls remain elusive. In a nationwide study of twins in Sweden, we tested whether zinc-copper cycles, which regulate metal metabolism, are disrupted in ASD. Using novel tooth-matrix biomarkers that provide direct measures of fetal elemental uptake, we developed a predictive model to distinguish participants who would be diagnosed with ASD in childhood from those who did not develop the disorder. We replicated our findings in three independent studies in the United States and the UK. We show that three quantifiable characteristics of fetal and postnatal zinc-copper rhythmicity are altered in ASD: the average duration of zinc-copper cycles, regularity with which the cycles recur, and the number of complex features within a cycle. In all independent study sets and in the pooled analysis, zinc-copper rhythmicity was disrupted in ASD cases. In contrast to controls, in ASD cases, the cycle duration was shorter (F = 52.25, P < 0.001), regularity was reduced (F = 47.99, P < 0.001), and complexity diminished (F = 57.30, P < 0.001). With two distinct classification models that used metal rhythmicity data, we achieved 90% accuracy in classifying cases and controls, with sensitivity to ASD diagnosis ranging from 85 to 100% and specificity ranging from 90 to 100%. These findings suggest that altered zinc-copper rhythmicity precedes the emergence of ASD, and quantitative biochemical measures of metal rhythmicity distinguish ASD cases from controls.
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Affiliation(s)
- Paul Curtin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY 10029, USA
| | - Christine Austin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY 10029, USA
| | - Austen Curtin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY 10029, USA
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY 10029, USA
| | - Manish Arora
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY 10029, USA
| | - (for the Emergent Dynamical Systems Group)
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY 10029, USA
- Center of Neurodevelopmental Disorders, Division of Neuropsychiatry, Department of Women’s and Children’s Health, Karolinska Institutet, Floor 8, Gävlegatan 22, SE-11330 Stockholm, Sweden
- Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Norra Stationsgatan 69, Plan 7, SE-11364 Stockholm, Sweden
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, England
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, England
- Division of Psychiatry, Faculty of Brain Sciences, University College London, Maple House, London, England
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, Wales
- Family and Community Medicine, School of Medicine, University of Texas Health Sciences Center, San Antonio, TX 78229, USA
| | - Kristiina Tammimies
- Center of Neurodevelopmental Disorders, Division of Neuropsychiatry, Department of Women’s and Children’s Health, Karolinska Institutet, Floor 8, Gävlegatan 22, SE-11330 Stockholm, Sweden
- Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Norra Stationsgatan 69, Plan 7, SE-11364 Stockholm, Sweden
| | - Charlotte Willfors
- Center of Neurodevelopmental Disorders, Division of Neuropsychiatry, Department of Women’s and Children’s Health, Karolinska Institutet, Floor 8, Gävlegatan 22, SE-11330 Stockholm, Sweden
- Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Norra Stationsgatan 69, Plan 7, SE-11364 Stockholm, Sweden
| | - Steve Berggren
- Center of Neurodevelopmental Disorders, Division of Neuropsychiatry, Department of Women’s and Children’s Health, Karolinska Institutet, Floor 8, Gävlegatan 22, SE-11330 Stockholm, Sweden
- Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Norra Stationsgatan 69, Plan 7, SE-11364 Stockholm, Sweden
| | - Paige Siper
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Dheeraj Rai
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, England
| | - Kristin Meyering
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Alexander Kolevzon
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Josephine Mollon
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, England
| | - Anthony S. David
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, England
| | - Glyn Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, Maple House, London, England
| | - Stanley Zammit
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, England
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, Wales
| | - Lynne Heilbrun
- Family and Community Medicine, School of Medicine, University of Texas Health Sciences Center, San Antonio, TX 78229, USA
| | - Raymond F. Palmer
- Family and Community Medicine, School of Medicine, University of Texas Health Sciences Center, San Antonio, TX 78229, USA
| | - Robert O. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY 10029, USA
| | - Sven Bölte
- Center of Neurodevelopmental Disorders, Division of Neuropsychiatry, Department of Women’s and Children’s Health, Karolinska Institutet, Floor 8, Gävlegatan 22, SE-11330 Stockholm, Sweden
- Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Norra Stationsgatan 69, Plan 7, SE-11364 Stockholm, Sweden
| | - Abraham Reichenberg
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY 10029, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, England
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Ratcliffe TA, Crabtree MA, Palmer RF, Pugh JA, Lanham HJ, Leykum LK. Service and Education: The Association Between Workload, Patient Complexity, and Teaching on Internal Medicine Inpatient Services. J Gen Intern Med 2018; 33:449-454. [PMID: 29392597 PMCID: PMC5880780 DOI: 10.1007/s11606-017-4302-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/31/2017] [Accepted: 12/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Attending rounds remain the primary venue for formal teaching and learning at academic medical centers. Little is known about the effect of increasing clinical demands on teaching during attending rounds. OBJECTIVE To explore the relationships among teaching time, teaching topics, clinical workload, and patient complexity variables. DESIGN Observational study of medicine teaching teams from September 2008 through August 2014. Teams at two large teaching hospitals associated with a single medical school were observed for periods of 2 to 4 weeks. PARTICIPANTS Twelve medicine teaching teams consisting of one attending, one second- or third-year resident, two to three interns, and two to three medical students. MAIN MEASURES The study examined relationships between patient complexity (comorbidities, complications) and clinical workload variables (census, turnover) with educational measures. Teams were clustered based on clinical workload and patient complexity. Educational measures of interest were time spent teaching and number of teaching topics. Data were analyzed both at the daily observation level and across a given patient's admission. KEY RESULTS We observed 12 teams, 1994 discussions (approximately 373 h of rounds) of 563 patients over 244 observation days. Teams clustered into three groups: low patient complexity/high clinical workload, average patient complexity/low clinical workload, and high patient complexity/high clinical workload. Modest associations for team, patient complexity, and clinical workload variables were noted with total time spent teaching (9.1% of the variance in time spent teaching during a patient's admission; F[8,549] = 6.90, p < 0.001) and number of teaching topics (16% of the variance in the total number of teaching topics during a patient's admission; F[8,548] = 14.18, p < 0.001). CONCLUSIONS Clinical workload and patient complexity characteristics among teams were only modestly associated with total teaching time and teaching topics.
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Affiliation(s)
- Temple A Ratcliffe
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA. .,South Texas Veterans Health Care System, San Antonio, TX, USA.
| | | | - Raymond F Palmer
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA
| | - Jacqueline A Pugh
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.,South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Holly J Lanham
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.,South Texas Veterans Health Care System, San Antonio, TX, USA.,University of Texas at Austin, Austin, TX, USA
| | - Luci K Leykum
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.,South Texas Veterans Health Care System, San Antonio, TX, USA.,University of Texas at Austin, Austin, TX, USA
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Royall DR, Palmer RF, Markides KS. Exportation and Validation of Latent Constructs for Dementia Case Finding in a Mexican American Population-based Cohort. J Gerontol B Psychol Sci Soc Sci 2017; 72:947-955. [PMID: 26968639 PMCID: PMC5927021 DOI: 10.1093/geronb/gbw004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 08/06/2015] [Accepted: 01/11/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The latent variable "δ" has been validated as a dementia phenotype. δ can be extracted from Spearman's general intelligence factor "g" in any data set that contains measures of cognition and instrumental activities of daily living (IADL). We used δ composites ("d-scores") to estimate the prevalence of dementia in the Hispanic Established Population for Epidemiological Studies in the Elderly (H-EPESE). METHOD δ was constructed from Mini-Mental State Examination, a clock-drawing task (CLOX), and IADL. δ's H-EPESE factor weights were validated in the well-characterized Texas Alzheimer's Research and Care Consortium (TARCC). Optimal thresholds for the discrimination between "Alzheimer's disease" (AD) versus normal controls (NCs) were determined by receiver operating characteristic curve. Those thresholds were used to estimate the prevalence of dementia in H-EPESE. RESULTS Each δ homolog fits its source's data well. d-scores were strongly associated with Clinical Dementia Rating scale Sum of Boxes (r = .74-.85, all p < .001], and accurately distinguished AD cases from NCs, in both Mexican Americans (MAs) and non-Hispanic Whites (NHWs) [c = 0.94-0.96]. The TARCC MA threshold estimated the prevalence of dementia at 21.4% in H-EPESE. The NHW threshold estimated the prevalence of dementia at 21.0%. CONCLUSIONS It is possible to export δ composites from populations to well-characterized cohorts for validation.
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Affiliation(s)
- Donald R Royall
- Department of Psychiatry, University of Texas Health Science Center, San Antonio
- Audie L. Murphy Division GRECC, South Texas Veterans’ Health System, San Antonio
- Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio
| | - Raymond F Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio
| | - Kyriakos S Markides
- Division of Social and Behavioral Sciences, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston
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Rubaye S, Royall DR, Palmer RF. [P3–246]: SERUM S100B MEDIATES DEPRESSION's EFFECT ON COGNITION. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.1459] [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)
- Safa Rubaye
- University of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Donald R. Royall
- University of Texas Health Science Center at San AntonioSan AntonioTXUSA
- South Texas Veterans Health Administration Geriatric Research Education and Clinical Center (GRECC)San AntonioTXUSA
| | - Raymond F. Palmer
- University of Texas Health Science Center at San AntonioSan AntonioTXUSA
- The University of Texas Health Science Center at San AntonioSan AntonioTXUSA
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Frye RE, Rose S, Wynne R, Bennuri SC, Blossom S, Gilbert KM, Heilbrun L, Palmer RF. Oxidative Stress Challenge Uncovers Trichloroacetaldehyde Hydrate-Induced Mitoplasticity in Autistic and Control Lymphoblastoid Cell Lines. Sci Rep 2017; 7:4478. [PMID: 28667285 PMCID: PMC5493637 DOI: 10.1038/s41598-017-04821-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/19/2017] [Indexed: 12/11/2022] Open
Abstract
Mitoplasticity occurs when mitochondria adapt to tolerate stressors. Previously we hypothesized that a subset of lymphoblastoid cell lines (LCLs) from children with autistic disorder (AD) show mitoplasticity (AD-A), presumably due to previous environmental exposures; another subset of AD LCLs demonstrated normal mitochondrial activity (AD-N). To better understand mitoplasticity in the AD-A LCLs we examined changes in mitochondrial function using the Seahorse XF96 analyzer in AD and Control LCLs after exposure to trichloroacetaldehyde hydrate (TCAH), an in vivo metabolite of the environmental toxicant and common environmental pollutant trichloroethylene. To better understand the role of reactive oxygen species (ROS) in mitoplasticity, TCAH exposure was followed by acute exposure to 2,3-dimethoxy-1,4-napthoquinone (DMNQ), an agent that increases ROS. TCAH exposure by itself resulted in a decline in mitochondrial respiration in all LCL groups. This effect was mitigated when TCAH was followed by acute DMNQ exposure but this varied across LCL groups. DMNQ did not affect AD-N LCLs, while it neutralized the detrimental effect of TCAH in Control LCLs and resulted in a increase in mitochondrial respiration in AD-A LCLs. These data suggest that acute increases in ROS can activate mitochondrial protective pathways and that AD-A LCLs are better able to activate these protective pathways.
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Affiliation(s)
- Richard Eugene Frye
- Arkansas Children's Research Institute, Little Rock, AR, USA. .,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Shannon Rose
- Arkansas Children's Research Institute, Little Rock, AR, USA.,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rebecca Wynne
- Arkansas Children's Research Institute, Little Rock, AR, USA.,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sirish C Bennuri
- Arkansas Children's Research Institute, Little Rock, AR, USA.,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sarah Blossom
- Arkansas Children's Research Institute, Little Rock, AR, USA.,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kathleen M Gilbert
- Arkansas Children's Research Institute, Little Rock, AR, USA.,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lynne Heilbrun
- Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Raymond F Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, TX, USA
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Abstract
The latent variable "δ" (for "dementia") uniquely explains dementia severity. Depressive symptoms are independent predictors of δ. We explored 115 serum proteins as potential causal mediators of the effect of depressive symptoms on δ in a large, ethnically diverse, longitudinal cohort. All models were adjusted for age, apolipoprotein E, education, ethnicity, gender, hemoglobin A1c, and homocysteine, and replicated in randomly selected 50% subsets. Alpha1-antitrypsin (A1AT), FAS, Heparin-binding EGF-like Growth Factor (HB-EGF), Insulin-like Growth Factor-1 (IGF-1), Luteinizing Hormone (LH), Macrophage Inflammatory Protein type 1 alpha (MIP-1α), Resitin, S100b, Tissue Inhibitor of Metalloproteinase type 1 (TIMP-1), and Vascular Cell Adhesion Molecule type 1 (VCAM-1) each were partial mediators of depression's association with δ. These proteins may offer targets for the treatment of depression's specific effect on dementia severity and Alzheimer's Disease (AD) conversion risk.
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Affiliation(s)
- Donald R. Royall
- Department of Psychiatry, the University of Texas Health Science Center, San Antonio, Texas, United States of America
- Department of Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
- Department of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
- South Texas Veterans’ Health System Audie L. Murphy Division Geriatric Research Education and Clinical Care Center, San Antonio, Texas, United States of America
| | - Safa Al-Rubaye
- Department of Psychiatry, the University of Texas Health Science Center, San Antonio, Texas, United States of America
| | - Ram Bishnoi
- Department of Psychiatry, the Medical College of Georgia, Augusta, Georgia, United States of America
| | - Raymond F. Palmer
- Department of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
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Abstract
The latent variable "δ" (for "dementia") appears to be uniquely responsible for the dementing aspects of cognitive impairment. Age, depression, gender and the apolipoprotein E (APOE) e4 allele are independently associated with δ. In this analysis, we explore serum proteins as potential mediators of APOE's specific association with δ in a large, ethnically diverse longitudinal cohort, the Texas Alzheimer's Research and Care Consortium (TARCC). APOE was associated only with C-Reactive Protein (CRP), Adiponectin (APN) and Amphiregulin (AREG), although the latter two's associations did not survive Bonferroni correction for multiple comparisons. All three proteins were associated with δ and had weak potential mediation effects on APOE's association with that construct. Our findings suggest that APOE's association with cognitive performance is specific to δ and partially mediated by serum inflammatory proteins. The majority of APOE's significant unadjusted effect on δ is unexplained. It may instead arise from direct central nervous system effects, possibly on native intelligence. If so, then APOE may exert a life-long influence over δ and therefore all-cause dementia risk.
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Affiliation(s)
- Donald R. Royall
- Department of Psychiatry, the University of Texas Health Science Center, San Antonio, Texas, United States of America
- Department of Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
- Department of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
- South Texas Veterans’ Health System Audie L. Murphy Division Geriatric Research Education and Clinical Care Center, San Antonio, Texas, United States of America
| | - Safa Al-Rubaye
- Department of Psychiatry, the University of Texas Health Science Center, San Antonio, Texas, United States of America
| | - Ram Bishnoi
- Department of Psychiatry, the Medical College of Georgia, Augusta, Georgia, United States of America
| | - Raymond F. Palmer
- Department of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
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Abstract
INTRODUCTION We tested the latent variable "δ" (for "dementia")'s ability to predict conversion to "mild cognitive impairment" (MCI) and Alzheimer's disease (AD). METHODS An ethnicity equivalent d homolog ("dEQ") was constructed in n = 1113 Mexican- American (MA) and n = 1958 non-Hispanic white (NHW) participants in the Texas Alzheimer's Research and Care Consortium. "Normal Controls" (NC) (n = 1276) and MCI cases (n = 611) were followed annually for up to 6 years [m = 4.7(0.6)]. RESULTS 22.0% (n = 281) of NC converted to "MCI" or "AD". 17.3%( n = 106) of MCI converted to "AD." Independently of covariates, each quintile increase in the dEQ scores of NC increased the odds of conversion by 52%. Each quintile increase in the dEQ scores of MCI cases increased the odds of conversion to AD almost three-fold. DISCUSSION Baseline δ scores predict MCI and AD conversions from nondemented states in MA and NHW.
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Affiliation(s)
- Donald R. Royall
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
- Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
- Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, TX, USA
- South Texas Veterans' Health System Audie L. Murphy Division GRECC, San Antonio, TX, USA
| | - Raymond F. Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, TX, USA
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Abstract
Although interactions within veterans' families may support or inhibit resilient coping to stress and trauma across the deployment cycle, research on family resilience has been hampered by the lack of a brief assessment. Using a three-stage mixed-method study, we developed and conducted preliminary validation of a measure of family resilience tailored for Iraq and Afghanistan veterans (IAV), the Family Resilience Scale for Veterans (FRS-V), which was field-tested using a survey of 151 IAV. Our findings indicate the resulting 6-item measure shows strong initial reliability and validity and support the application of existing models of family resilience in this population.
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Affiliation(s)
- Erin P Finley
- South Texas Veterans Health Care System, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Mary Jo Pugh
- South Texas Veterans Health Care System, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Raymond F Palmer
- Department of Family and Community Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Abstract
The latent variable "δ" (for "dementia") appears to be uniquely responsible for the dementing aspects of cognitive impairment. Age, depressive symptoms, gender and the apolipoprotein E (APOE) ε4 allele are independently associated with δ. In this analysis, we explore serum proteins as potential mediators of age's specific association with δ in a large, ethnically diverse longitudinal cohort, the Texas Alzheimer's Research and Care Consortium (TARCC). 22 serum proteins were recognized as partial mediators of age's association with δ. These include Insulin-like Growth Factor-Binding Protein 2 (IGF-BP2), which we had previously associated with age-specific cognitive change, and both Pancreatic Polypeptide (PP) and von Willebrand Factor (vWF), previously associated with δ. Nine other δ-related proteins were not confirmed by this ethnicity adjusted analysis. Our findings suggest that age's association with the disabling fraction of cognitive performance is partially mediated by serum proteins, somatomedins and hormones. Those proteins may offer targets for the specific treatment of age-related effects on dementia severity and conversion risk.
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Affiliation(s)
- Donald R. Royall
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
- South Texas Veterans’ Health System Audie L. Murphy Division GRECC, San Antonio, TX 78229, USA
| | - Safa Al-Rubaye
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Ram Bishnoi
- Department of Psychiatry, The Medical College of Georgia, Augusta, GA 30912, USA
| | - Raymond F. Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
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Abstract
Structural Equation Models (SEM) can explicitly distinguish "dementia-relevant" variance in cognitive task performance (i.e., "δ" for dementia). In prior work, δ appears to uniquely account for dementia severity regardless of the cognitive measures used to construct it. In this study, we test δ as a mediator of age's prospective association with future cognitive performance and dementia severity in a large, ethnically diverse longitudinal cohort, the Texas Alzheimer's Research and Care Consortium (TARCC). Age had adverse effects on future cognition, and these were largely mediated through δ, independently of education, ethnicity, gender, depression ratings, serum homo-cysteine levels, hemoglobin A1c, and apolipoprotein e4 status. Age explained 4% of variance in δ, and through it, 11-18% of variance in future cognitive performance. Our findings suggest that normative aging is a dementing condition (i.e., a "senility"). While the majority of variance in dementia severity must be independent of age, age's specific effect is likely to accumulate over the lifespan. Our findings also constrain age's dementing effects on cognition to the age-related fraction of "general intelligence" (Spearman's "g"). That has broad biological and pathophysiological implications.
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Affiliation(s)
- Donald R. Royall
- Department of Psychiatry, The University of Texas Health Science Center, San Antonio, TX, USA
- Department of Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
- The South Texas Veterans' Health System, Audie L. Murphy Division GRECC, San Antonio, TX, USA
| | - Raymond F. Palmer
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
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Ferrer RL, Burge SK, Palmer RF, Cruz I. Practical Opportunities for Healthy Diet and Physical Activity: Relationship to Intentions, Behaviors, and Body Mass Index. Ann Fam Med 2016; 14:109-16. [PMID: 26951585 PMCID: PMC4781513 DOI: 10.1370/afm.1886] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Current strategies for improving diet and activity patterns focus on encouraging patients to make better choices, but they meet with limited success. Because the choices people make depend on the choices they have, we examined how practical opportunities for diet and physical activity shape behavioral intentions and achieved behaviors. METHODS Participants included 746 adults who visited 8 large primary care practices in the Residency Research Network of Texas in 2012. We used structural equation models to confirm factor structures for a previously validated measure of practical opportunities, and then modeled achieved diet (Starting the Conversation - Diet questionnaire), physical activity (International Physical Activity Questionnaire), and BMI as a function of opportunities (classified as either resources or conversion factors that influence use of resources), behavioral intentions, and demographic covariates. RESULTS In path models, resources (P <.001) and conversion factors (P = .005) predicted behavioral intentions for activity. Conversion factors (P <.001), but not resources, predicted diet intentions. Both activity resources (P = .01) and conversion factors (P <.001) were positively associated with weekly activity minutes. Diet conversion factors (P <.001), but not diet resources (P = .08), were positively associated with diet quality. The same patterns were observed for body mass index (BMI). Socioeconomic gradients in resources and conversion factors were evident. CONCLUSIONS Individuals' feasible opportunities for healthy diet and activity have clinically meaningful associations with intentions, achieved behaviors, and BMI. Assessing opportunities as part of health behavior management could lead to more effective, efficient, and compassionate interventions.
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Affiliation(s)
- Robert L Ferrer
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Sandra K Burge
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Raymond F Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Inez Cruz
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Abstract
Introduction Serum thrombopoietin (THPO) is a biomarker of Alzheimer's disease (AD) and the latent dementia phenotype, “δ”. Both associations may be specific to non-Hispanic whites (NHW), not Mexican-Americans (MA). In this analysis, we examine ethnicity's effect on THPO's association with change in δ scores, in the Texas Alzheimer's Research and Care Consortium (TARCC). Methods We constructed an ethnicity equivalent δ homolog (“dEQ”) among n = 1113 MA and n = 1958 NHW. dEQ was output as a composite “dEQ-score” for each of five annual TARCC waves. Those composites were used as indicators of a latent growth curve (LGC). The mean dEQ intercept (idEQ) and slope (ΔdEQ) were estimated in a random subset of N = 1528 participants and replicated in the remainder (n = 1544). THPO was regressed onto idEQ and ΔdEQ. Those associations were tested separately in MA and NHW. Results dEQ correlated strongly with CDR-SB (r = 0.99, P < .001) and achieved high AUCs for AD diagnosis at each wave (range = 0.95–0.99). THPO was significantly associated with idEQ but not ΔdEQ. That effect was observed in NHW only. In MA, THPO had no associations with either idEQ or ΔdEQ. Discussion We confirm THPO's ethnicity-specific association with δ in NHW. It is further clarified that this association is specific to δ's intercept and not its slope. This analysis provides a model for how dementia's specific serum biomarkers can be characterized.
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Affiliation(s)
- Donald R Royall
- Department of Psychiatry, The University of Texas Health Science Center, San Antonio, TX, USA; Department of Medicine, The University of Texas Health Science Center, San Antonio, TX, USA; Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX, USA; South Texas Veterans' Health System, Audie L. Murphy Division GRECC, San Antonio, TX, USA
| | - Raymond F Palmer
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
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Abstract
Vitamin D binding protein (VDBP), a multifunctional protein, has been found to be elevated in the cerebrospinal fluid (CSF) of neurodegenerative disorder cases, implicating it in the pathogenesis of Alzheimer's disease (AD). However, the contribution of VDBP to AD has not been fully explored. We used a Multiple Indicators Multiple Causes (MIMIC) approach to examine the relationship between serum VDBP levels and cognitive performance in a well characterized AD cohort, the Texas Alzheimer's Research and Care Consortium (TARCC). Instead of categorical diagnoses, we used a latent dementia phenotype (d), which has been validated in several prior studies using this dataset. We found that serum VDBP levels are significantly positively associated with d scores, which in turn are inversely related to cognitive performance. This suggests that d mediates the adverse effects of serum VDB on cognition and therefore that its effects are specifically dementing. d scores are also specifically related to default mode network (DMN) structure. VDBP acts as an amyloid-β (Aβ) scavenger, and Aβ deposition in the DMN is seen in the pre-clinical stages of AD. We speculate then that serum effects of VDBP are mediated through changes in DMN structure or function, most probably via Aβ. Aβ affects the DMN early in the course of AD. Therefore, raised serum VDBP levels may be a useful indicator of future dementia and/or dementia conversion. This might be confirmed through longitudinal analysis of TARCC data.
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Affiliation(s)
- Ram J Bishnoi
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
| | - Raymond F Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Donald R Royall
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, TX, USA Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA Audie L. Murphy Division, South Texas Veterans' Health System, GRECC, TX, USA
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Lanham HJ, Palmer RF, Leykum LK, McDaniel RR, Nutting PA, Stange KC, Crabtree BF, Miller WL, Jaén CR. Trust and Reflection in Primary Care Practice Redesign. Health Serv Res 2015; 51:1489-514. [PMID: 26611650 DOI: 10.1111/1475-6773.12415] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 01/17/2023] Open
Abstract
OBJECTIVE To test a conceptual model of relationships, reflection, sensemaking, and learning in primary care practices transitioning to patient-centered medical homes (PCMH). DATA SOURCES/STUDY SETTING Primary data were collected as part of the American Academy of Family Physicians' National Demonstration Project of the PCMH. STUDY DESIGN We conducted a cross-sectional survey of clinicians and staff from 36 family medicine practices across the United States. Surveys measured seven characteristics of practice relationships (trust, diversity, mindfulness, heedful interrelation, respectful interaction, social/task relatedness, and rich and lean communication) and three organizational attributes (reflection, sensemaking, and learning) of practices. DATA COLLECTION/EXTRACTION METHODS We surveyed 396 clinicians and practice staff. We performed a multigroup path analysis of the data. Parameter estimates were calculated using a Bayesian estimation method. PRINCIPAL FINDINGS Trust and reflection were important in explaining the characteristics of practice relationships and their associations with sensemaking and learning. The strongest associations between relationships, sensemaking, and learning were found under conditions of high trust and reflection. The weakest associations were found under conditions of low trust and reflection. CONCLUSIONS Trust and reflection appear to play a key role in moderating relationships, sensemaking, and learning in practices undergoing practice redesign.
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Affiliation(s)
- Holly Jordan Lanham
- Department of Medicine/Hospital Medicine & Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX.,South Texas Veterans Health Care System, San Antonio, TX.,Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, San Antonio, TX
| | - Raymond F Palmer
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX
| | - Luci K Leykum
- South Texas Veterans Health Care System, San Antonio, TX.,Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, San Antonio, TX.,Department of Medicine/Hospital Medicine, The University of Texas Health Science Center, San Antonio, TX
| | - Reuben R McDaniel
- Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, San Antonio, TX
| | | | - Kurt C Stange
- Departments of Family Medicine, Epidemiology and Biostatistics, and Sociology, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Benjamin F Crabtree
- Department of Family Medicine & Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - William L Miller
- Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA
| | - Carlos Roberto Jaén
- Departments of Family & Community Medicine, and Epidemiology and Biostatistics, Research to Advance Community Health Center, The University of Texas Health Sciences Center, San Antonio, TX
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49
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Royall DR, Palmer RF, Matsuoka T, Kato Y, Taniguchi S, Ogawa M, Fujimoto H, Okamura A, Shibata K, Nakamura K, Nakaaki S, Koumi H, Mimura M, Fukui K, Narumoto J. Greater than the Sum of Its Parts: δ can be Constructed from Item Level Data. J Alzheimers Dis 2015; 49:571-9. [DOI: 10.3233/jad-150250] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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)
- Donald R. Royall
- Department of Psychiatry, The University of Texas Health Science Center, San Antonio, TX, USA
- Department of Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
- South Texas Veterans’ Health System, Audie L. Murphy Division GRECC, San Antonio, TX, USA
| | - Raymond F. Palmer
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
| | - Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Yuka Kato
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | | | - Mayu Ogawa
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Hiroshi Fujimoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | | | | | - Kaeko Nakamura
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Shutaro Nakaaki
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hiroyuki Koumi
- Department of Clinical Psychology, Faculty of Social Welfare, Hanazono University, Nishinokyo, Nakagyo-ku, Kyoto, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kenji Fukui
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
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50
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Royall DR, Palmer RF, Matsuoka T, Kato Y, Taniguchi S, Ogawa M, Fujimoto H, Okamura A, Shibata K, Nakamura K, Nakaaki S, Koumi H, Mimura M, Fukui K, Narumoto J. δ Scores are Exportable Across Cultural and Linguistic Boundaries. J Alzheimers Dis 2015; 49:561-70. [DOI: 10.3233/jad-150261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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)
- Donald R. Royall
- Department of Psychiatry, The University of Texas Health Science Center, San Antonio, TX, USA
- Department of Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
- South Texas Veterans’ Health System, Audie L. Murphy Division GRECC, San Antonio, TX, USA
| | - Raymond F. Palmer
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
| | - Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Yuka Kato
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | | | - Mayu Ogawa
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Hiroshi Fujimoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | | | | | - Kaeko Nakamura
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Shutaro Nakaaki
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hiroyuki Koumi
- Department of Clinical Psychology, Faculty of Social Welfare, Hanazono University, Nishinokyo, Nakagyo-ku, Kyoto, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kenji Fukui
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
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