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Cox CG, Salazar CR, Birnbaum AI, Witbracht M, Tam SP, Thai GT, Sajjadi SA, Gillen DL, Grill JD. Alzheimer's Disease Biomarker Decision-Making among Patients with Mild Cognitive Impairment and Their Care Partners. J Prev Alzheimers Dis 2024; 11:285-293. [PMID: 38374734 DOI: 10.14283/jpad.2024.10] [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] [Indexed: 02/21/2024]
Abstract
BACKGROUND Alzheimer's disease (AD) biomarker tests can be ordered as part of the diagnostic workup of patients with mild cognitive impairment (MCI). Little is known about how patients with MCI and their care partners decide whether to pursue testing. OBJECTIVE To examine factors that influence AD biomarker testing decisions among patients with MCI and their care partners. DESIGN We performed structured research interviews with patients with MCI and their study partners to assess the importance of eight factors in the decision whether to undergo AD biomarker testing (6-point Likert scale; 1-extremely unimportant to 6-extremely important): cost, fear of testing procedures, learning if AD is the cause of cognitive problems, concern about health insurance, instructing future planning, informing treatment decisions, family members' opinions, and doctor recommendation. SETTING Two researchers administered interviews with participants in-person (i.e., participant home, research center) or remotely (i.e., telephone, video-conference). PARTICIPANTS We completed interviews with 65 patients with a diagnosis of MCI and 57 study partners, referred by dementia specialist clinicians from the University of California, Irvine health system. MEASUREMENTS We used generalized estimating equations (GEE) to examine the mean importance of each factor among patients and study partners, and the mean difference in importance of each factor within dyads. RESULTS One third of participants reported the patient had previously undergone AD biomarker testing. Fifty-five percent of patients and 65% of study partners who reported no previous testing indicated a desire for the patient to be tested. GEE analyses found that patients and study partners rated the following factors with highest importance: informing treatment decisions (mean score 5.29, 95% CI: 5.06, 5.52 for patients; mean score 5.56, 95% CI: 5.41, 5.72 for partners); doctor recommendation (4.94, 95% CI: 4.73, 5.15 for patients; 5.16, 95% CI: 4.97, 5.34 for partners); and instructing future planning (4.88, 95% CI: 4.59, 5.16 for patients; 5.11, 95% CI: 4.86, 5.35 for partners). High dyadic agreement was observed for all factors except fear of testing, which patients rated with lower importance than their study partners. CONCLUSIONS Biomarker testing for AD in patients with MCI is a rapidly evolving practice and limited data exist on patient perspectives. In this study, most patients and their care partners were interested in testing to help inform treatment decisions and to plan for the future. Participants placed high importance on clinician recommendations for biomarker testing, highlighting the need for clear communication and education on the options, limitations, risks, and benefits of testing.
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Affiliation(s)
- C G Cox
- Chelsea G. Cox, Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA,
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Sordo L, Qian T, Bukhari SA, Nguyen KM, Woodworth DC, Head E, Kawas CH, Corrada MM, Montine TJ, Sajjadi SA. Characterization of hippocampal sclerosis of aging and its association with other neuropathologic changes and cognitive deficits in the oldest-old. Acta Neuropathol 2023; 146:415-432. [PMID: 37382680 PMCID: PMC10412485 DOI: 10.1007/s00401-023-02606-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/16/2023] [Accepted: 06/18/2023] [Indexed: 06/30/2023]
Abstract
Hippocampal sclerosis of aging (HS-A) is a common age-related neuropathological lesion characterized by neuronal loss and astrogliosis in subiculum and CA1 subfield of hippocampus. HS-A is associated with cognitive decline that mimics Alzheimer's disease. Pathological diagnosis of HS-A is traditionally binary based on presence/absence of the lesion. We compared this traditional measure against our novel quantitative measure for studying the relationship between HS-A and other neuropathologies and cognitive impairment. We included 409 participants from The 90+ study with neuropathological examination and longitudinal neuropsychological assessments. In those with HS-A, we examined digitized H&E and LFB stained hippocampal slides. The length of HS-A in each subfield of hippocampus and subiculum, each further divided into three subregions, was measured using Aperio eSlide Manager. For each subregion, the proportion affected by HS-A was calculated. Using regression models, both traditional/binary and quantitative measures were used to study the relationship between HS-A and other neuropathological changes and cognitive outcomes. HS-A was present in 48 (12%) of participants and was always focal, primarily affecting CA1 (73%), followed by subiculum (9%); overlapping pathology (subiculum and CA1) affected 18% of individuals. HS-A was more common in the left (82%) than the right (25%) hemisphere and was bilateral in 7% of participants. HS-A traditional/binary assessment was associated with limbic-predominant age-related TDP-43 encephalopathy (LATE-NC; OR = 3.45, p < 0.001) and aging-related tau astrogliopathy (ARTAG; OR = 2.72, p = 0.008). In contrast, our quantitative approach showed associations between the proportion of HS-A (CA1/subiculum/combined) and LATE-NC (p = 0.001) and arteriolosclerosis (p = 0.005). While traditional binary assessment of HS-A was associated with impaired memory (OR = 2.60, p = 0.007), calculations (OR = 2.16, p = 0.027), and orientation (OR = 3.56, p < 0.001), our quantitative approach revealed additional associations with impairments in language (OR = 1.33, p = 0.018) and visuospatial domains (OR = 1.37, p = 0.006). Our novel quantitative method revealed associations between HS-A and vascular pathologies and impairment in cognitive domains that were not detected using traditional/binary measures.
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Affiliation(s)
- Lorena Sordo
- Department of Neurology, University of California, Irvine, Office 364, Med Surge II Building, Irvine, CA, 92697, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA, USA
| | - Tianchen Qian
- Department of Statistics, University of California, Irvine, CA, USA
| | - Syed A Bukhari
- Department of Pathology, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Katelynn M Nguyen
- Department of Neurology, University of California, Irvine, Office 364, Med Surge II Building, Irvine, CA, 92697, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Davis C Woodworth
- Department of Neurology, University of California, Irvine, Office 364, Med Surge II Building, Irvine, CA, 92697, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Elizabeth Head
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA, USA
| | - Claudia H Kawas
- Department of Neurology, University of California, Irvine, Office 364, Med Surge II Building, Irvine, CA, 92697, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
- Department of Neurobiology and Behavior, University of California, Irvine, CA, USA
| | - María M Corrada
- Department of Neurology, University of California, Irvine, Office 364, Med Surge II Building, Irvine, CA, 92697, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
- Department of Epidemiology and Biostatistics, University of California, Irvine, CA, USA
| | - Thomas J Montine
- Department of Pathology, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - S Ahmad Sajjadi
- Department of Neurology, University of California, Irvine, Office 364, Med Surge II Building, Irvine, CA, 92697, USA.
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA.
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA, USA.
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Li JX, Nguyen HL, Qian T, Woodworth DC, Sajjadi SA. Longitudinal hippocampal atrophy in hippocampal sclerosis of aging. Aging Brain 2023; 4:100092. [PMID: 37635712 PMCID: PMC10448324 DOI: 10.1016/j.nbas.2023.100092] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023] Open
Abstract
Hippocampal sclerosis of aging (HS-A) is a common degenerative neuropathology in older individuals and is associated with dementia. HS-A is characterized by disproportionate hippocampal atrophy at autopsy but cannot be diagnosed during life. Therefore, little is known about the onset and progression of hippocampal atrophy in individuals with HS-A. To better understand the onset and progression of hippocampal atrophy in HS-A, we examined longitudinal hippocampal atrophy using serial MRI in participants with HS-A at autopsy (HS-A+, n = 8) compared to participants with limbic-predominant age-related TDP-43 encephalopathy neuropathological change (LATE-NC) without HS-A (n = 13), Alzheimer's disease neuropathologic change (ADNC) without HS-A or LATE-NC (n = 16), and those without these pathologies (n = 7). We found that participants with HS-A had lower hippocampal volumes compared to the other groups, and this atrophy preceded the onset of dementia. There was also some evidence that rates of hippocampal volume loss were slightly slower in those with HS-A. Together, these results suggest that the disproportionate hippocampal atrophy seen in HS-A may begin early prior to dementia.
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Affiliation(s)
- Janice X. Li
- Department of Neurology, University of California, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Hannah L. Nguyen
- Department of Neurology, University of California, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Tianchen Qian
- Department of Statistics, University of California, Irvine, Irvine, CA, USA
| | - Davis C. Woodworth
- Department of Neurology, University of California, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - S. Ahmad Sajjadi
- Department of Neurology, University of California, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
- Department of Pathology, University of California, Irvine, CA, USA
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Neuville RS, Biswas R, Ho CC, Bukhari S, Sajjadi SA, Paganini-Hill A, Montine TJ, Corrada MM, Kawas CH. Study of neuropathological changes and dementia in 100 centenarians in The 90+ Study. Alzheimers Dement 2023; 19:3417-3425. [PMID: 36795955 PMCID: PMC10427735 DOI: 10.1002/alz.12981] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION The association between neuropathological changes and dementia among centenarians and nonagenarians remains unclear. METHODS We examined brain tissue from 100 centenarians and 297 nonagenarians from The 90+ Study, a community-based longitudinal study of aging. We determined the prevalence of 10 neuropathological changes and compared their associations with dementia and cognitive performance between centenarians and nonagenarians. RESULTS A total of 59% of centenarians and 47% of nonagenarians had at least four neuropathological changes. In centenarians, neuropathological changes were associated with higher odds of dementia and, compared to nonagenarians, the odds were not attenuated. For each additional neuropathological change, the Mini-Mental State Examination score was lower by 2 points for both groups. DISCUSSION Neuropathological changes continue to be strongly related to dementia in centenarians, highlighting the importance of slowing or preventing the development of multiple neuropathological changes in the aging brain to maintain cognitive health. HIGHLIGHTS Individual and multiple neuropathological changes are frequent in centenarians. These neuropathological changes are strongly associated with dementia. There is no attenuation of this association with age.
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Affiliation(s)
- Raumin S. Neuville
- School of Medicine, University of California, Irvine,
Irvine, CA 92617, USA
| | - Roshni Biswas
- Department of Neurology, University of California, Irvine,
Hewitt Hall, Irvine, CA 92697, USA
| | - Chu-Ching Ho
- Institute for Memory Impairments and Neurological
Disorders, University of California, Irvine, Irvine, CA 92697, USA
| | - Syed Bukhari
- Department of Pathology, Stanford University, 300 Pasteur
Drive, Stanford, CA 94305, USA
| | - S. Ahmad Sajjadi
- Department of Neurology, University of California, Irvine,
Hewitt Hall, Irvine, CA 92697, USA
- Institute for Memory Impairments and Neurological
Disorders, University of California, Irvine, Irvine, CA 92697, USA
- Department of Neurobiology & Behavior, University of
California, Irvine, Gillespie NRF, Irvine, CA 92697, USA
| | - Annlia Paganini-Hill
- Department of Neurology, University of California, Irvine,
Hewitt Hall, Irvine, CA 92697, USA
| | - Thomas J. Montine
- Department of Pathology, Stanford University, 300 Pasteur
Drive, Stanford, CA 94305, USA
| | - María M. Corrada
- Department of Neurology, University of California, Irvine,
Hewitt Hall, Irvine, CA 92697, USA
- Institute for Memory Impairments and Neurological
Disorders, University of California, Irvine, Irvine, CA 92697, USA
- Department of Epidemiology, University of California,
Irvine, Anteater Instruction & Research Offices (AIRB), 653 E. Peltason Drive,
Irvine, CA 92697, USA
| | - Claudia H. Kawas
- Department of Neurology, University of California, Irvine,
Hewitt Hall, Irvine, CA 92697, USA
- Institute for Memory Impairments and Neurological
Disorders, University of California, Irvine, Irvine, CA 92697, USA
- Department of Neurobiology & Behavior, University of
California, Irvine, Gillespie NRF, Irvine, CA 92697, USA
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Scambray KA, Nguyen HL, Sajjadi SA. Association of vascular and degenerative brain pathologies and past medical history from the National Alzheimer's Coordinating Center Database. J Neuropathol Exp Neurol 2023; 82:390-401. [PMID: 36947583 PMCID: PMC10117154 DOI: 10.1093/jnen/nlad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
The relationship between past medical histories (PMH) and dementia-related neuropathologies is not well understood. Using the National Alzheimer's Coordinating Center (NACC) database, we explored the relationship between patient-reported PMH and various vascular and degenerative neuropathologies. We examined the following PMH: transient ischemic attack (TIA), stroke, traumatic brain injury, seizures, hypertension, cardiovascular events, hypercholesterolemia, B12 deficiency, diabetes mellitus, and thyroid disease. We dichotomized the following neuropathologies: atherosclerosis, arteriolosclerosis, cerebral amyloid angiopathy (CAA), Alzheimer disease neuropathology (ADNP), Lewy bodies (LB), hippocampal sclerosis, frontotemporal lobar degeneration (FTLD), and TAR DNA-binding protein-43 (TDP-43). Separate logistic regression models assessed the relationship between the outcome of individual neuropathologies and all PMHs. Additional logistic regressions were stratified by sex to further examine these associations. Hypertension history was associated with an increased likelihood of atherosclerosis (OR = 1.7) and arteriolosclerosis (OR = 1.3), but decreased odds of ADNP (OR = 0.81), CAA (OR = 0.79), and LB (OR = 0.78). History of TIA was associated with an increased likelihood of atherosclerosis (OR = 1.3) and arteriolosclerosis (OR = 1.4) and lower odds of ADNP (OR = 0.72). Seizure history was associated with an increased likelihood of ADNP (OR = 1.9) and lower odds of FTLD (OR = 0.49). Hypertension history was associated with a greater likelihood of vascular pathologies yet a lower likelihood of ADNP and other neurodegenerative pathologies.
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Affiliation(s)
- Kiana A Scambray
- Department of Neurology, University of California, Irvine, Irvine, California, USA
| | - Hannah L Nguyen
- Department of Neurology, University of California, Irvine, Irvine, California, USA
| | - S Ahmad Sajjadi
- Department of Neurology, University of California, Irvine, Irvine, California, USA
- Department of Pathology, University of California, Irvine, Irvine, California, USA
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Nelson PT, Lee EB, Cykowski MD, Alafuzoff I, Arfanakis K, Attems J, Brayne C, Corrada MM, Dugger BN, Flanagan ME, Ghetti B, Grinberg LT, Grossman M, Grothe MJ, Halliday GM, Hasegawa M, Hokkanen SRK, Hunter S, Jellinger K, Kawas CH, Keene CD, Kouri N, Kovacs GG, Leverenz JB, Latimer CS, Mackenzie IR, Mao Q, McAleese KE, Merrick R, Montine TJ, Murray ME, Myllykangas L, Nag S, Neltner JH, Newell KL, Rissman RA, Saito Y, Sajjadi SA, Schwetye KE, Teich AF, Thal DR, Tomé SO, Troncoso JC, Wang SHJ, White CL, Wisniewski T, Yang HS, Schneider JA, Dickson DW, Neumann M. LATE-NC staging in routine neuropathologic diagnosis: an update. Acta Neuropathol 2023; 145:159-173. [PMID: 36512061 PMCID: PMC9849315 DOI: 10.1007/s00401-022-02524-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022]
Abstract
An international consensus report in 2019 recommended a classification system for limbic-predominant age-related TDP-43 encephalopathy neuropathologic changes (LATE-NC). The suggested neuropathologic staging system and nomenclature have proven useful for autopsy practice and dementia research. However, some issues remain unresolved, such as cases with unusual features that do not fit with current diagnostic categories. The goal of this report is to update the neuropathologic criteria for the diagnosis and staging of LATE-NC, based primarily on published data. We provide practical suggestions about how to integrate available genetic information and comorbid pathologies [e.g., Alzheimer's disease neuropathologic changes (ADNC) and Lewy body disease]. We also describe recent research findings that have enabled more precise guidance on how to differentiate LATE-NC from other subtypes of TDP-43 pathology [e.g., frontotemporal lobar degeneration (FTLD) and amyotrophic lateral sclerosis (ALS)], and how to render diagnoses in unusual situations in which TDP-43 pathology does not follow the staging scheme proposed in 2019. Specific recommendations are also made on when not to apply this diagnostic term based on current knowledge. Neuroanatomical regions of interest in LATE-NC are described in detail and the implications for TDP-43 immunohistochemical results are specified more precisely. We also highlight questions that remain unresolved and areas needing additional study. In summary, the current work lays out a number of recommendations to improve the precision of LATE-NC staging based on published reports and diagnostic experience.
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Affiliation(s)
- Peter T Nelson
- University of Kentucky, Rm 575 Todd Building, Lexington, KY, USA.
| | - Edward B Lee
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Konstantinos Arfanakis
- Rush University Medical Center, Chicago, IL, USA
- Illinois Institute of Technology, Chicago, IL, USA
| | | | | | | | | | | | | | | | | | - Michel J Grothe
- Unidad de Trastornos del Movimiento, Servicio de Neurología Y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | | | - Masato Hasegawa
- Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | | | | | | | | | | | | | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Laboratory Medicine Program, University Health Network, Toronto, Canada
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Qinwen Mao
- University of Utah, Salt Lake City, UT, USA
| | | | | | | | | | - Liisa Myllykangas
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sukriti Nag
- Rush University Medical Center, Chicago, IL, USA
| | - Janna H Neltner
- University of Kentucky, Rm 575 Todd Building, Lexington, KY, USA
| | | | | | - Yuko Saito
- Tokyo Metropolitan Geriatric Hospital & Institute of Gerontology, Tokyo, Japan
| | | | | | | | - Dietmar R Thal
- Laboratory for Neuropathology, Department of Imaging and Pathoogy, and Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Pathology, University Hospital Leuven, Leuven, Belgium
| | - Sandra O Tomé
- Laboratory for Neuropathology, Department of Imaging and Pathoogy, and Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | | | | | - Charles L White
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Hyun-Sik Yang
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, BostonBoston, MAMA, USA
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Paganini-Hill A, Montine TJ, Bukhari SA, Corrada MM, Kawas CH, Sajjadi SA. LATE and potential estrogen-related risk factors collected 30 years earlier: The 90+ Study. J Neuropathol Exp Neurol 2023; 82:120-126. [PMID: 36562637 PMCID: PMC9852944 DOI: 10.1093/jnen/nlac119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) is a recently described neuropathological construct associated with dementia. This study aimed to investigate in an autopsy study, LATE-NC and its associations with potential estrogen-related risk factors collected about 30 years before death. Participants were part of The 90+ Study and had, as part of the Leisure World Cohort Study, provided information on menstrual and reproductive variables and details of use of estrogen replacement therapy (ERT). No menstrual and reproductive variable showed an association with LATE-NC. Use of ERT, especially long-term use (15+ years) and more recent use (within 1 year of completing the questionnaire), was associated with reduced risk. The odds were significantly lower for long-term (0.39, 95% confidence interval [CI]: 0.16-0.95) and recent use (0.39, 95% CI: 0.16-0.91) compared with no use. In conclusion, we found that women who reported long-term ERT in their 50s and 60s had a significantly reduced odds of harboring LATE-NC when they died in the 10th and 11th decades of their lives. Our study adds to the existing literature reporting seemingly protective effect of peri- and postmenopausal ERT against neurodegenerative dementia.
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Affiliation(s)
| | - Thomas J Montine
- Department of Pathology, Stanford University, Palo Alto, California, USA
| | - Syed A Bukhari
- Department of Pathology, Stanford University, Palo Alto, California, USA
| | - Maria M Corrada
- Department of Neurology, University of California, Irvine, California, USA
- Department of Epidemiology, University of California, Irvine, California, USA
| | - Claudia H Kawas
- Department of Neurology, University of California, Irvine, California, USA
- Department of Neurobiology and Behavior, University of California, Irvine, California, USA
| | - S Ahmad Sajjadi
- Department of Neurology, University of California, Irvine, California, USA
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Leiby AMC, Scambray KA, Nguyen HL, Basith F, Fakhraee S, Melikyan ZA, Bukhari SA, Montine TJ, Corrada MM, Kawas CH, Sajjadi SA. Characterizing Limbic-Predominant Age-Related TDP-43 Encephalopathy Without Alzheimer's Disease and Lewy Body Dementia in the Oldest Old: A Case Series. J Alzheimers Dis 2023; 96:113-124. [PMID: 37742640 PMCID: PMC10615772 DOI: 10.3233/jad-230238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND Limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) is a clinicopathological construct proposed to facilitate studying TDP-43 pathology in older individuals. OBJECTIVE Our aim was to describe clinical and cognitive characteristics of LATE-NC without Alzheimer's disease neuropathologic change (ADNC) and Lewy body (LB) and to compare this with ADNC and primary age related tauopathy (PART). METHODS In 364 autopsies of the oldest old of The 90+ Study, we identified those with LATE-NC without ADNC and LB. Control groups were participants with ADNC and PART. RESULTS Of 31% of participants who had LATE-NC, only 5 (1.4%) had LATE-NC without ADNC and LB, all of whom had tau. These participants had a gradual and progressive cognitive decline. Four (80%) had dementia at death, a rate that was higher than ADNC (50%) and PART (21.7%). Mean duration of cognitive impairment was twice as long in LATE-NC without ADNC and LB (6.2 years) compared to ADNC (2.9 years) and PART (3 years). LATE-NC without ADNC and LB group had a higher prevalence of syncope, depression, and extrapyramidal signs than the ADNC and PART groups. CONCLUSIONS Despite the high prevalence of LATE-NC, LATE-NC without ADNC and LB was rare in this large oldest-old cohort, highlighting the very high prevalence of multiple pathologic changes in the oldest old. Slowly progressive cognitive decline, ubiquitous memory impairment, history of syncope and depression, and extrapyramidal signs were prominent features among our LATE-NC without ADNC and LB group.
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Affiliation(s)
| | | | - Hannah L. Nguyen
- Department of Neurology, University of California, Irvine, CA, USA
| | - Farheen Basith
- Department of Neurology, University of California, Irvine, CA, USA
| | | | - Zarui A. Melikyan
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Syed A. Bukhari
- Department of Pathology, Stanford University, Palo Alto, CA, USA
| | | | - María M. Corrada
- Department of Neurology, University of California, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
- Department of Epidemiology and Biostatistics, University of California, Irvine, CA, USA
| | - Claudia H. Kawas
- Department of Neurology, University of California, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
- Department of Pathology, University of California, Irvine, CA, USA
| | - S. Ahmad Sajjadi
- Department of Neurology, University of California, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
- Department of Neurobiology and Behavior, University of California, Irvine, CA, USA
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Wang J, Ackley SF, Woodworth DC, Sajjadi SA, Fletcher E, DeCarli CS, Glymour MM, Kawas CH, Corrada MM. Associations of Amyloid, White Matter Hyperintensities, and Hippocampal Volume with Cognitive Trajectories in the Oldest‐Old: The 90+ Study. Alzheimers Dement 2022. [DOI: 10.1002/alz.062067] [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)
- Jingxuan Wang
- University of California, San Francisco San Francisco CA USA
| | - Sarah F Ackley
- University of California, San Francisco San Francisco CA USA
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Woodworth DC, Nguyen HL, Li JX, Nguyen KM, Greenia DE, Kawas CH, Corrada MM, Sajjadi SA. Problems using structural MRIs from the oldest‐old, and some solutions: Lessons learned from The 90+ Study and ADNI. Alzheimers Dement 2022. [DOI: 10.1002/alz.067500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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11
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Woodworth DC, Nguyen HL, Li JX, Nguyen KM, Greenia DE, Kawas CH, Corrada MM, Sajjadi SA. Problems using structural MRIs from the oldest‐old, and some solutions: Lessons learned from The 90+ Study and ADNI. Alzheimers Dement 2022. [DOI: 10.1002/alz.067505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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12
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Woodworth DC, Corrada MM, Kawas CH, Sajjadi SA. Differential associations of amyloid and tau (from PET) with brain volumes (from MRI) by cognitive status. Alzheimers Dement 2022. [DOI: 10.1002/alz.067508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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13
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Sajjadi SA, Qian T, Bukhari S, Woodworth DC, Montine TJ, Corrada MM, Kawas CH. Longitudinal clinical and neuropsychological outcomes in limbic predominant age related TDP_43 encephalopathy vs. Alzheimer’s disease from
The 90+ Study. Alzheimers Dement 2022. [DOI: 10.1002/alz.067366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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14
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Woodworth DC, Corrada MM, Kawas CH, Sajjadi SA. Differential associations of amyloid and tau (from PET) with brain volumes (from MRI) by cognitive status. Alzheimers Dement 2022. [DOI: 10.1002/alz.067480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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15
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Woodworth DC, Faramarzi S, Greenia DE, Kawas CH, Sajjadi SA. Amyloid burden is not associated with brain atrophy in the oldest‐old. Alzheimers Dement 2022. [DOI: 10.1002/alz.067491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Korb M, Peck A, Alfano LN, Berger KI, James MK, Ghoshal N, Healzer E, Henchcliffe C, Khan S, Mammen PPA, Patel S, Pfeffer G, Ralston SH, Roy B, Seeley WW, Swenson A, Mozaffar T, Weihl C, Kimonis V, Fanganiello R, Lee G, Mahoney RP, Diaz-Manera J, Evangelista T, Freimer M, Lloyd TE, Keung B, Kushlaf H, Milone M, Needham M, Palmio J, Stojkovic T, Villar-Quiles RN, Wang LH, Wicklund MP, Singer FR, Jones M, Miller BL, Ahmad Sajjadi S, Obenaus A, Geschwind MD, Al-Chalabi A, Wymer J, Chen N, Kompoliti K, Wang SC, Boissoneault CA, Cruz-Coble B, Garand KL, Rinholen AJ, Tabor-Gray L, Rosenfeld J, Guo M, Peck N. Development of a standard of care for patients with valosin-containing protein associated multisystem proteinopathy. Orphanet J Rare Dis 2022; 17:23. [PMID: 35093159 PMCID: PMC8800193 DOI: 10.1186/s13023-022-02172-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/16/2022] [Indexed: 02/08/2023] Open
Abstract
Valosin-containing protein (VCP) associated multisystem proteinopathy (MSP) is a rare inherited disorder that may result in multisystem involvement of varying phenotypes including inclusion body myopathy, Paget’s disease of bone (PDB), frontotemporal dementia (FTD), parkinsonism, and amyotrophic lateral sclerosis (ALS), among others. An international multidisciplinary consortium of 40+ experts in neuromuscular disease, dementia, movement disorders, psychology, cardiology, pulmonology, physical therapy, occupational therapy, speech and language pathology, nutrition, genetics, integrative medicine, and endocrinology were convened by the patient advocacy organization, Cure VCP Disease, in December 2020 to develop a standard of care for this heterogeneous and under-diagnosed disease. To achieve this goal, working groups collaborated to generate expert consensus recommendations in 10 key areas: genetic diagnosis, myopathy, FTD, PDB, ALS, Charcot Marie Tooth disease (CMT), parkinsonism, cardiomyopathy, pulmonology, supportive therapies, nutrition and supplements, and mental health. In April 2021, facilitated discussion of each working group’s conclusions with consensus building techniques enabled final agreement on the proposed standard of care for VCP patients. Timely referral to a specialty neuromuscular center is recommended to aid in efficient diagnosis of VCP MSP via single-gene testing in the case of a known familial VCP variant, or multi-gene panel sequencing in undifferentiated cases. Additionally, regular and ongoing multidisciplinary team follow up is essential for proactive screening and management of secondary complications. The goal of our consortium is to raise awareness of VCP MSP, expedite the time to accurate diagnosis, define gaps and inequities in patient care, initiate appropriate pharmacotherapies and supportive therapies for optimal management, and elevate the recommended best practices guidelines for multidisciplinary care internationally.
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Corrada MM, Melikyan ZA, Dominguez EN, Ho C, Sajjadi SA, Kawas CH. Super‐agers in memory are not necessarily super‐agers in other cognitive domains. Alzheimers Dement 2021. [DOI: 10.1002/alz.055708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | - ChuChing Ho
- University of California, Irvine Irvine CA USA
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Woodworth DC, Nguyen HL, Phelan MJ, Greenia DE, Corrada MM, Kawas CH, Sajjadi SA. Associations of TDP‐43 vs. Alzheimer’s disease neuropathology with brain atrophy in the oldest‐old: Initial imaging‐pathological results from
The 90+ Study. Alzheimers Dement 2021. [DOI: 10.1002/alz.056545] [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: 11/05/2022]
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19
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Li JX, Nguyen HL, Woodworth DC, Sajjadi SA. Longitudinal hippocampal atrophy in hippocampal sclerosis of aging vs. Alzheimer’s disease. Alzheimers Dement 2021. [DOI: 10.1002/alz.052326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
The oldest-old, those 85 years and older, are the fastest growing segment of the population and present with the highest prevalence of dementia. Given the importance of neuroimaging measures to understand aging and dementia, the objective of this study was to review neuroimaging studies performed in oldest-old participants. We used PubMed, Google Scholar, and Web of Science search engines to identify in vivo CT, MRI, and PET neuroimaging studies either performed in the oldest-old or that addressed the oldest-old as a distinct group in analyses. We identified 60 studies and summarized the main group characteristics and findings. Generally, oldest-old participants presented with greater atrophy compared to younger old participants, with most studies reporting a relatively stable constant decline in brain volumes over time. Oldest-old participants with greater global atrophy and atrophy in key brain structures such as the medial temporal lobe were more likely to have dementia or cognitive impairment. The oldest-old presented with a high burden of white matter lesions, which were associated with various lifestyle factors and some cognitive measures. Amyloid burden as assessed by PET, while high in the oldest-old compared to younger age groups, was still predictive of transition from normal to impaired cognition, especially when other adverse neuroimaging measures (atrophy and white matter lesions) were also present. While this review highlights past neuroimaging research in the oldest-old, it also highlights the dearth of studies in this important population. It is imperative to perform more neuroimaging studies in the oldest-old to better understand aging and dementia.
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Affiliation(s)
- Davis C Woodworth
- Department of Neurology, University of California, Irvine, CA, USA.,Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Kiana A Scambray
- Department of Neurology, University of California, Irvine, CA, USA.,Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - María M Corrada
- Department of Neurology, University of California, Irvine, CA, USA.,Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA.,Department of Epidemiology, University of California, Irvine, CA, USA
| | - Claudia H Kawas
- Department of Neurology, University of California, Irvine, CA, USA.,Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA.,Department of Neurobiology and Behavior, University of California, Irvine, CA, USA
| | - S Ahmad Sajjadi
- Department of Neurology, University of California, Irvine, CA, USA.,Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
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Woodworth DC, Nguyen HL, Khan Z, Kawas CH, Corrada MM, Sajjadi SA. Utility of MRI in the identification of hippocampal sclerosis of aging. Alzheimers Dement 2020; 17:847-855. [PMID: 33615673 DOI: 10.1002/alz.12241] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/01/2020] [Accepted: 10/22/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Hippocampal sclerosis of aging (HS) is a common pathology often misdiagnosed as Alzheimer's disease. We tested the hypothesis that participants with HS would have a magnetic resonance imaging (MRI)-detectable hippocampal pattern of atrophy distinct from participants without HS, both with and without Alzheimer's disease neuropathology (ADNP). METHODS Query of the National Alzheimer's Coordinating Center database identified 198 participants with MRI and autopsy. Hippocampal subfields were segmented with FreeSurfer v6. Analysis of covariance for subfield volumes compared HS+ participants to those without HS, both with ADNP (HS-/ADNP+) and without (HS-/ADNP-). RESULTS HS+ participants (N = 27, 14%) showed atrophied cornu ammonis 1 (CA1; left P < .001, ηp 2 = 0.14; right P = .001, ηp 2 = 0.09) and subiculum (left P < .001, ηp 2 = 0.139; right P = .001, ηp 2 = 0.085) compared to HS-/ADNP+ (N = 100, 51%). Compared to HS-/ADNP- (N = 71, 36%), HS+ also had atrophy in subiculum (left P < .001, ηp 2 = 0.235; right P = .002, ηp 2 = 0.137) and CA1 (left P < .001, ηp 2 = 0.137; right P = .006, ηp 2 = 0.070). DISCUSSION Subiculum and CA1 atrophy from clinical MRI may be a promising in vivo biomarker for HS.
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Affiliation(s)
- Davis C Woodworth
- Department of Neurology, University of California, Orange, California, USA.,Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, California, USA
| | - Hannah L Nguyen
- Department of Biological Sciences, University of California, Irvine, California, USA
| | - Zainab Khan
- Department of Biological Sciences, University of California, Irvine, California, USA
| | - Claudia H Kawas
- Department of Neurology, University of California, Orange, California, USA.,Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, California, USA.,Department of Neurobiology and Behavior, University of California, Irvine, California, USA
| | - María M Corrada
- Department of Neurology, University of California, Orange, California, USA.,Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, California, USA.,Department of Neurobiology and Behavior, University of California, Irvine, California, USA.,Department of Epidemiology, University of California, Irvine, California, USA
| | - S Ahmad Sajjadi
- Department of Neurology, University of California, Orange, California, USA.,Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, California, USA
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22
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Woodworth DC, Sheikh‐Bahaei N, Scambray KA, Phelan M, Corrada MM, Kawas CH, Sajjadi SA. Dementia is strongly associated with atrophy of medial temporal lobe structures even after accounting for neuropathologies. Alzheimers Dement 2020. [DOI: 10.1002/alz.046160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Nasim Sheikh‐Bahaei
- Alzheimer’s Disease Research Center Keck School of Medicine University of Southern California Los Angeles CA USA
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23
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Sajjadi SA, Phelan M, Yan R, Scambray KA, Ho C, Woodworth DC, Corrada MM, Kawas CH. Cognitive impairment and risk factors of LATE in the oldest old: The 90+ Study. Alzheimers Dement 2020. [DOI: 10.1002/alz.044652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Rui Yan
- University of California Irvine CA USA
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24
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Woodworth DC, Scambray KA, Phelan M, Corrada MM, Kawas CH, Sajjadi SA. Distinct patterns of gray matter atrophy in hippocampal sclerosis of aging and Alzheimer’s disease neuropathology. Alzheimers Dement 2020. [DOI: 10.1002/alz.046089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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25
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Witbracht MG, Bernstein OM, Lin V, Salazar CR, Sajjadi SA, Hoang D, Cox CG, Gillen DL, Grill JD. Education and Message Framing Increase Willingness to Undergo Research Lumbar Puncture: A Randomized Controlled Trial. Front Med (Lausanne) 2020; 7:493. [PMID: 33043024 PMCID: PMC7530193 DOI: 10.3389/fmed.2020.00493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/20/2020] [Indexed: 12/26/2022] Open
Abstract
Reluctance to undergo lumbar puncture (LP) is a barrier to neurological disease biomarker research. We assessed whether an educational intervention increased willingness to consider research LP and whether message framing modified intervention effectiveness. We randomly assigned 851 recruitment registry enrollees who had previously indicated they were unwilling to be contacted about studies requiring LP to gain or loss framed video educational interventions describing the procedure and the probability of experiencing adverse events. The gain framed intervention emphasized the proportion of individuals free of adverse events; the loss frame emphasized the proportion experiencing adverse events. The primary outcome for the study was the participant's post-intervention agreement to be contacted about studies requiring LP. Participants were mean (SD) age 60.1 years (15.7), 69% female (n = 591), and mostly college educated and white. Among the 699 participants who completed the study, 43% (95% CI: 0.39, 0.47; n = 301) changed their response to agree to be contacted about studies requiring LP. We estimated that participants randomized to the gain framed intervention had 67% higher odds of changing their response compared to those randomized to the loss frame (Odds Ratio = 1.67; 95% CI: 1.24, 2.26; p < 0.001). A classification and regression tree model identified participants' pre-intervention willingness as the strongest predictor of changing response. Education, in particular education that alerts participants to the probability of not experiencing adverse events, may be an effective tool to increase participation rates in research requiring LP.
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Affiliation(s)
- Megan G Witbracht
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
| | - Olivia M Bernstein
- Department of Statistics, University of California, Irvine, Irvine, CA, United States
| | - Vanessa Lin
- Graduate Medical Sciences, Boston University School of Medicine, Boston, MA, United States
| | - Christian R Salazar
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
| | - S Ahmad Sajjadi
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States.,Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Dan Hoang
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
| | - Chelsea G Cox
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
| | - Daniel L Gillen
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States.,Department of Statistics, University of California, Irvine, Irvine, CA, United States
| | - Joshua D Grill
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States.,Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, United States.,Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, United States.,Institute for Clinical and Translational Science, University of California, Irvine, Irvine, CA, United States
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Sheikh-Bahaei N, Sajjadi SA, Manavaki R, Priest A, O'Brien JT, Gillard JH. IC-P-095: THE ASSOCIATION BETWEEN MICROVASCULAR CHANGES AND PET MEASURES OF AMYLOID, PERFUSION AND METABOLISM IN ALZHEIMER'S DISEASE. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Nasim Sheikh-Bahaei
- Keck School of Medicine; University of Southern California; Los Angeles CA USA
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Woodworth DC, Corrada MM, Greenia D, Kawas CH, Sajjadi SA. IC-P-153: THE 90+ STUDY T1W TEMPLATE: IMPROVED REGISTRATION OF OLDEST-OLD MRI TO A STANDARD SPACE. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4268] [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: 11/28/2022]
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28
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Sajjadi SA, Fletcher E, Sheikh-Bahaei N, Greenia D, Woodworth DC, Singh B, Corrada MM, Kawas CH, Decarli C. P3-430: THE RELATION BETWEEN AMYLOID IMAGING AND AMYLOID PATHOLOGY IN THE OLDEST OLD: THE 90+ STUDY. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3464] [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: 10/25/2022]
Affiliation(s)
| | - Evan Fletcher
- IDeA Laboratory, Department of Neurology; UC Davis; Davis CA USA
| | - Nasim Sheikh-Bahaei
- Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | | | | | | | | | | | - Charles Decarli
- IDeA Laboratory, Department of Neurology; UC Davis; Davis CA USA
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Sheikh-Bahaei N, Manavaki R, Sajjadi SA, Priest AN, O’Brien JT, Gillard JH. Correlation of Lobar Cerebral Microbleeds with Amyloid, Perfusion, and Metabolism in Alzheimer’s Disease. J Alzheimers Dis 2019; 68:1489-1497. [DOI: 10.3233/jad-180443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Nasim Sheikh-Bahaei
- Department of Radiology, Keck School of Medicine of USC, University of Southern California, USA
| | - Roido Manavaki
- Department of Radiology, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - S. Ahmad Sajjadi
- Department of Neurology, University of California Irvine, CA, USA
| | - Andrew N. Priest
- Department of Radiology, Cambridge University Hospitals, Cambridge, UK
| | - John T. O’Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jonathan H. Gillard
- Department of Radiology, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Corrada MM, Sajjadi SA, Greenia D, Fletcher E, DeCarli CS, Kawas CH. P3‐367: PET AMYLOID IMAGING WITH FLORBETAPIR AND COGNITION IN THE OLDEST‐OLD: THE 90+ STUDY. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Sheikh-Bahaei N, Sajjadi SA, Manavaki R, McLean M, O'Brien JT, Gillard JH. Positron emission tomography-guided magnetic resonance spectroscopy in Alzheimer disease. Ann Neurol 2018; 83:771-778. [PMID: 29518282 DOI: 10.1002/ana.25202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 03/02/2018] [Accepted: 03/04/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine whether the level of metabolites in magnetic resonance spectroscopy (MRS) is a representative marker of underlying pathological changes identified in positron emission tomographic (PET) images in Alzheimer disease (AD). METHODS We performed PET-guided MRS in cases of probable AD, mild cognitive impairment (MCI), and healthy controls (HC). All participants were imaged by 11 C-Pittsburgh compound B (11 C-PiB) and 18 F-fluorodeoxyglucose (18 F-FDG) PET followed by 3T MRS. PET images were assessed both visually and using standardized uptake value ratios (SUVRs). MRS voxels were placed in regions with maximum abnormality on amyloid (Aβ+) and FDG (hypometabolic) areas on PET scans. Corresponding normal areas were selected in controls. The ratios of total N-acetyl (tNA) group, myoinositol (mI), choline, and glutamate + glutamine over creatine (Cr) were compared between these regions. RESULTS Aβ + regions had significantly higher (p = 0.02) mI/Cr and lower tNA/Cr (p = 0.02), whereas in hypometabolic areas only tNA/Cr was reduced (p = 0.003). Multiple regression analysis adjusting for sex, age, and education showed mI/Cr was only associated with 11 C-PiB SUVR (p < 0.0001). tNA/Cr, however, was associated with both PiB (p = 0.0003) and 18 F-FDG SUVR (p = 0.006). The level of mI/Cr was not significantly different between MCI and AD (p = 0.28), but tNA/Cr showed significant decline from HC to MCI to AD (p = 0.001, p = 0.04). INTERPRETATION mI/Cr has significant temporal and spatial associations with Aβ and could potentially be considered as a disease state biomarker. tNA is an indicator of early neurodegenerative changes and might have a role as disease stage biomarker and also as a valuable surrogate marker for treatment response. Ann Neurol 2018;83:771-778.
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Affiliation(s)
- Nasim Sheikh-Bahaei
- Department of Radiology, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - S Ahmad Sajjadi
- Department of Neurology, University of California, Irvine, Irvine, CA
| | - Roido Manavaki
- Department of Radiology, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Mary McLean
- Cancer Research UK, University of Cambridge, Cambridge, United Kingdom
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Jonathan H Gillard
- Department of Radiology, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
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Sajjadi SA, Nestor PJ. Reply. AJNR Am J Neuroradiol 2017; 38:E64. [PMID: 28546245 DOI: 10.3174/ajnr.a5261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- S A Sajjadi
- Department of Neurology University of California, Irvine Irvine, California
| | - P J Nestor
- German Center for Neurodegenerative diseases Magdeburg, Germany
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Bennett IJ, Greenia DE, Maillard P, Sajjadi SA, DeCarli C, Corrada MM, Kawas CH. Age-related white matter integrity differences in oldest-old without dementia. Neurobiol Aging 2017; 56:108-114. [PMID: 28527525 PMCID: PMC5647141 DOI: 10.1016/j.neurobiolaging.2017.04.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 04/07/2017] [Accepted: 04/15/2017] [Indexed: 12/30/2022]
Abstract
Aging is known to have deleterious effects on cerebral white matter, yet little is known about these white matter alterations in advanced age. In this study, 94 oldest-old adults without dementia (90-103 years) underwent diffusion tensor imaging to assess relationships between chronological age and multiple measures of integrity in 18 white matter regions across the brain. Results revealed significant age-related declines in integrity in regions previously identified as being sensitive to aging in younger-old adults (corpus callosum, fornix, cingulum, external capsule). For the corpus callosum, the effect of age on genu fractional anisotropy was significantly weaker than the relationship between age and splenium fractional anisotropy. Importantly, age-related declines in white matter integrity did not differ in cognitively normal and cognitively impaired not demented oldest-old, suggesting that they were not solely driven by cognitive dysfunction or preclinical dementia in this advanced age group. Instead, white matter in these regions appears to remain vulnerable to normal aging processes through the 10th decade of life.
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Affiliation(s)
- Ilana J Bennett
- Department of Psychology, University of California, Riverside, CA, USA.
| | - Dana E Greenia
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Pauline Maillard
- Department of Neurology, University of California, Davis, CA, USA
| | - S Ahmad Sajjadi
- Department of Neurology, University of California, Irvine, CA, USA
| | - Charles DeCarli
- Department of Neurology, University of California, Davis, CA, USA; Alzheimer's Disease Center, University of California, Davis, CA, USA
| | - Maria M Corrada
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA; Department of Neurology, University of California, Irvine, CA, USA; Department of Epidemiology, University of California, Irvine, CA, USA
| | - Claudia H Kawas
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA; Department of Neurology, University of California, Irvine, CA, USA; Department of Epidemiology, University of California, Irvine, CA, USA; Department of Neurobiology and Behavior, University of California, Irvine, CA, USA
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Sheikh‐Bahaei N, Sajjadi SA, Manavaki R, McLean M, Gillard JH, O'Brien JT. [P1–419]: PET‐GUIDED MR SPECTROSCOPY REVEALS DISTINCT RELATIONS BETWEEN BRAIN METABOLITES, AMYLOID AND HYPOMETABOLISM IN ALZHEIMER'S DISEASE. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.435] [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: 10/18/2022]
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Sajjadi SA, Corrada MM, Greenia D, Fletcher E, DeCarli CS, Kawas CH. [P4–199]: THE ASSOCIATION BETWEEN AMYLOID IMAGING AND COGNITION IN THE OLDEST‐OLD WITHOUT DEMENTIA. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.2066] [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: 11/16/2022]
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Sajjadi SA, Corrada MM, Greenia D, Fletcher E, DeCarli CS, Kawas CH. [O2–10–01]: HIGHER EDUCATION CONFERS RESILIENCE IN THE OLDEST‐OLD WITH POSITIVE AMYLOID PET SCAN. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.07.198] [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: 10/18/2022]
Affiliation(s)
- S. Ahmad Sajjadi
- University of California, IrvineIrvineCAUSA
- University of California at IrvineIrvineCAUSA
- University of California, DavisDavisCAUSA
- Department of NeurologyUniversity of California at DavisDavisCAUSA
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Sajjadi SA, Sheikh-Bahaei N, Cross J, Gillard JH, Scoffings D, Nestor PJ. Can MRI Visual Assessment Differentiate the Variants of Primary-Progressive Aphasia? AJNR Am J Neuroradiol 2017; 38:954-960. [PMID: 28341715 DOI: 10.3174/ajnr.a5126] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 08/24/2016] [Accepted: 01/02/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Primary-progressive aphasia is a clinically and pathologically heterogeneous condition. Nonfluent, semantic, and logopenic are the currently recognized clinical variants. The recommendations for the classification of primary-progressive aphasia have advocated variant-specific patterns of atrophy. The aims of the present study were to evaluate the sensitivity and specificity of the proposed imaging criteria and to assess the intra- and interrater reporting agreements. MATERIALS AND METHODS The cohort comprised 51 patients with a root diagnosis of primary-progressive aphasia, 25 patients with typical Alzheimer disease, and 26 matched control participants. Group-level analysis (voxel-based morphometry) confirmed the proposed atrophy patterns for the 3 syndromes. The individual T1-weighted anatomic images were reported by 3 senior neuroradiologists. RESULTS We observed a dichotomized pattern of high sensitivity (92%) and specificity (93%) for the proposed atrophy pattern of semantic-variant primary-progressive aphasia and low sensitivity (21% for nonfluent-variant primary-progressive aphasia and 43% for logopenic-variant primary-progressive aphasia) but high specificity (91% for nonfluent-variant primary-progressive aphasia and 95% for logopenic-variant primary-progressive aphasia) in other primary-progressive aphasia variants and Alzheimer disease (sensitivity 43%, specificity 92%). MR imaging was least sensitive for the diagnosis of nonfluent-variant primary-progressive aphasia. Intrarater agreement analysis showed mean κ values above the widely accepted threshold of 0.6 (mean, 0.63 ± 0.16). Pair-wise interobserver agreement outcomes, however, were well below this threshold in 5 of the 6 possible interrater contrasts (mean, 0.41 ± 0.09). CONCLUSIONS While the group-level results were in precise agreement with the recommendations, semantic-variant primary-progressive aphasia was the only subtype for which the proposed recommendations were both sensitive and specific at an individual level.
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Affiliation(s)
- S A Sajjadi
- From the Department of Neurology (S.A.S.), University of California, Irvine, Irvine, California
| | - N Sheikh-Bahaei
- Department of Radiology (N.S.-B., J.H.G.), University of Cambridge, Cambridge, UK
- Department of Radiology (N.S.-.B., J.C., J.H.G., D.S.), Cambridge University Hospitals, Cambridge, UK
| | - J Cross
- Department of Radiology (N.S.-.B., J.C., J.H.G., D.S.), Cambridge University Hospitals, Cambridge, UK
| | - J H Gillard
- Department of Radiology (N.S.-B., J.H.G.), University of Cambridge, Cambridge, UK
- Department of Radiology (N.S.-.B., J.C., J.H.G., D.S.), Cambridge University Hospitals, Cambridge, UK
| | - D Scoffings
- Department of Radiology (N.S.-.B., J.C., J.H.G., D.S.), Cambridge University Hospitals, Cambridge, UK
| | - P J Nestor
- German Center for Neurodegenerative Diseases (P.J.N.), Magdeburg, Germany
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Abstract
OBJECTIVE Primary progressive aphasia (PPA) has been proposed to comprise 3 discrete clinical subtypes: semantic, agrammatic/nonfluent, and logopenic. Recent consensus recommendations suggest a diagnostic framework based primarily on clinical and neuropsychological findings to classify these variants. Our objective was to evaluate the extent to which patients with PPA would conform to the proposed tripartite system and whether the clustering pattern of elements of the linguistic profile suggests discrete clinical syndromes. METHODS A total of 46 patients with PPA were prospectively recruited to the Cambridge Longitudinal Study of PPA. Sufficient data were collected to assess all consensus-proposed diagnostic domains. By comparing patients' performances against those of 30 age- and education-matched healthy volunteers, z scores were calculated, and values of 1.5 SDs outside control participants' means were considered abnormal. Raw test scores were used to undertake a principal factor analysis to identify the clustering pattern of individual measures. RESULTS Of the patients, 28.3%, 26.1%, and 4.3% fitted semantic, nonfluent/agrammatic, and logopenic categories respectively, and 41.3% did not fulfill the diagnostic recommendations for any of the 3 proposed variants. There was no significant between-group difference in age, education, or disease duration. Furthermore, the outcome of the factor analysis was in keeping with discrete semantic and nonfluent/agrammatic syndromes but did not support a logopenic variant. CONCLUSION Taken together, the results of this prospective data-driven study suggest that although a substantial proportion of patients with PPA have neither the semantic nor the nonfluent variants, they do not necessarily conform to a discrete logopenic variant.
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Sajjadi SA, Patterson K, Tomek M, Arnold RJ, Nestor PJ. 037 A data-driven assessment of the proposed criteria for classification of primary progressive aphasia. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2011-301993.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sajjadi SA, Bridgman HA. Respiratory Hospital Admissions before and after Closure of a Major Industry in the Lower Hunter Region, Australia. Iran J Public Health 2011; 40:41-54. [PMID: 23113085 PMCID: PMC3481643] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 07/13/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND Many epidemiological studies reported significant associations between air pollution and respiratory hospital admissions. Proximity of industries to the residential areas may have considerable impacts on air quality and subsequently public health. This paper describes the indirect impacts of closing a large steel industry, Broken Hill Proprietary (BHP), in the Lower Hunter region, Australia. METHODS The number of hospital admissions for a group of respiratory diseases including all respiratory disease, Chronic Obstructive Pulmonary Disease (COPD) and asthma were incorporated in this study. The study location comprised the entire Lower Hunter, Newcastle, as the closest location, and Port Stephens, as the most distant area to the industry. Two series of data set for 3.5 years before and after industry closure allowed a comparison of daily hospital admissions. Mixed Model was employed to calculate significant changes in the time series by month. RESULTS While the rest of the disease categories decreased, COPD 65+ increased after BHP closure. All-age asthma in Newcastle showed the highest decrease whereas the least difference was observed for respiratory disease in Port Stephens. The decrease of admission rates was generally more significant in Newcastle, where the industry was operating, than in the other areas. CONCLUSION Inconsistent results challenged the publically viewed significant role of BHP closure on public health. The study expected consistent decreases of respiratory admissions after industry closure; however, the district results suggested some impacts on community health. Incompatible findings could be attributable to other factors that dominated the possible impacts of BHP closure.
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Affiliation(s)
- SA Sajjadi
- Dept. of Environmental Health Engineering, Gonabad University of Medical Sciences, Iran,Corresponding Author: Tel: +98 533 7223028, Fax: +98 533 7223814, E-mail:
| | - HA Bridgman
- School of Environmental and Life Science, University of Newcastle, NSW, Australia
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Bagheri HR, Shafiei R, Shafiei F, Sajjadi SA. Isolation of acanthamoeba spp. From drinking waters in several hospitals of iran. Iran J Parasitol 2010; 5:19-25. [PMID: 22347240 PMCID: PMC3279834] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 05/08/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Acanthamoeba is an opportunistic amphizoic protozoan found in different water sources including swimming pool as well as in sewage. The aim of this study was to investigate the prevalence of Acanthamoeba in tap-water samples in Iran. METHOD In this descriptive cross-sectional study, 94 samples of cold and warm tap-water were collected from different wards of hospitals in 13 cities of Iran in 2007-2008. Free residual chlorine, pH, and temperature of samples were measured. After filtration through multipore nylon membrane, samples were cultured on non-nutrient agar. Then we investigated existence of Acanthamoeba by reverse contrast phase microscope. RESULTS Acanthamoeba was found in 45 samples (48%). Thirty-four and 11 positive samples were collected from cold and warm tap water, respectively. The samples belonged to the category of 20-30°C temperature with 0-2 ppm free residual chlorine and pH 6-7.4 showed the most coincidence to the positive cases. The greatest proportion of positive samples was obtained from Mashhad hospitals, while all samples collected from Arak and Semnan hospitals were negative. CONCLUSION considering the results of this study and the pathogenic role of this protozoan on patients with immunodeficiency, as well as capability of this microorganism in carrying other pathogens such as Legionella, further studies are needed. What is more important, potable water in hospitals should follow the procedure of treatment and sanitation, in order to prevent the relevant nosocomial infections.
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Affiliation(s)
- HR Bagheri
- Dept. of Microbiology, Center of Research Cellular and Molecular Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - R Shafiei
- Dept. of Medical Parasitology and Mycology, Shiraz University of Medical Sciences, Iran,Corresponding author: Tel: 09157029331, Email address:
| | - F Shafiei
- Health Center of Khorasan Razavi Province, Iran
| | - SA Sajjadi
- Dept. of Environmental Health, Gonabad University of Medical Sciences, Iran
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