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Kong SDX, Espinosa N, McKinnon AC, Gordon CJ, Wassing R, Hoyos CM, Hickie IB, Naismith SL. Different heart rate variability profile during sleep in mid-later life adults with remitted early-onset versus late-onset depression. J Affect Disord 2024:S0165-0327(24)00658-X. [PMID: 38701901 DOI: 10.1016/j.jad.2024.04.054] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND In mid-later life adults, early-onset and late-onset (i.e., onset ≥50 years) depression appear to be underpinned by different pathophysiology yet have not been examined in relation to autonomic function. Sleep provides an opportunity to examine the autonomic nervous system as the physiology changes across the night. Hence, we aimed to explore if autonomic profile is altered in mid-later life adults with remitted early-onset, late-onset and no history of lifetime depression. METHODS Participants aged 50-90 years (n = 188) from a specialised clinic underwent a comprehensive clinical assessment and completed an overnight polysomnography study. General Linear Models were used to examine the heart rate variability differences among the three groups for four distinct sleep stages and the wake after sleep onset. All analyses controlled for potential confounders - age, sex, current depressive symptoms and antidepressant usage. RESULTS For the wake after sleep onset, mid-later life adults with remitted early-onset depression had reduced standard deviation of Normal to Normal intervals (SDNN; p = .014, d = -0.64) and Shannon Entropy (p = .004, d = -0.46,) than those with no history of lifetime depression. Further, the late-onset group showed a reduction in high-frequency heart rate variability (HFn.u.) during non-rapid eye movement sleep stage 2 (N2; p = .005, d = -0.53) and non-rapid eye movement sleep stage 3 (N3; p = .009, d = -0.55) when compared to those with no lifetime history. LIMITATIONS Causality between heart rate variability and depression cannot be derived in this cross-sectional study. Longitudinal studies are needed to examine the effects remitted depressive episodes on autonomic function. CONCLUSION The findings suggest differential autonomic profile for remitted early-onset and late-onset mid-later life adults during sleep stages and wake periods. The differences could potentially serve as peripheral biomarkers in conjunction with more disease-specific markers of depression to improve diagnosis and prognosis.
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Affiliation(s)
- Shawn D X Kong
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia; Charles Perkins Centre, University of Sydney, Camperdown, NSW 2050, Australia; CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia.
| | - Nicole Espinosa
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
| | - Andrew C McKinnon
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia; Charles Perkins Centre, University of Sydney, Camperdown, NSW 2050, Australia; Race Against Dementia, Dementia Australia Research Foundation Initiative, Dementia Australia, Australia
| | - Christopher J Gordon
- CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia; Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Glebe, NSW 2037, Australia; Faculty of Medicine and Health, Royal North Shore Hospital, Sydney 2050, Australia
| | - Rick Wassing
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Glebe, NSW 2037, Australia; School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Sydney Local Health District, Sydney, NSW, Australia
| | - Camilla M Hoyos
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Glebe, NSW 2037, Australia; School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Ian B Hickie
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Sharon L Naismith
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia; Charles Perkins Centre, University of Sydney, Camperdown, NSW 2050, Australia; CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia
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Gardener SL, Fuller SJ, Naismith SL, Baker L, Kivipelto M, Villemagne VL, Grieve SM, Yates P, Rainey‐Smith SR, Chen J, Thompson B, Armstrong NJ, Fernando MG, Blagojevic Castro C, Meghwar S, Raman R, Gleason A, Ireland C, Clarnette R, Anstey KJ, Taddei K, Garg M, Sohrabi HR, Martins RN. The AUstralian multidomain Approach to Reduce dementia Risk by prOtecting brain health With lifestyle intervention study (AU-ARROW): A study protocol for a single-blind, multi-site, randomized controlled trial. Alzheimers Dement (N Y) 2024; 10:e12466. [PMID: 38596483 PMCID: PMC11002765 DOI: 10.1002/trc2.12466] [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] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/07/2024] [Accepted: 03/09/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION The Finnish Geriatric Intervention Study (FINGER) led to the global dementia risk reduction initiative: World-Wide FINGERS (WW-FINGERS). As part of WW-FINGERS, the Australian AU-ARROW study mirrors aspects of FINGER, as well as US-POINTER. METHOD AU-ARROW is a randomized, single-blind, multisite, 2-year clinical trial (n = 600; aged 55-79). The multimodal lifestyle intervention group will engage in aerobic exercise, resistance training and stretching, dietary advice to encourage MIND diet adherence, BrainHQ cognitive training, and medical monitoring and health education. The Health Education and Coaching group will receive occasional health education sessions. The primary outcome measure is the change in a global composite cognitive score. Extra value will emanate from blood biomarker analysis, positron emission tomography (PET) imaging, brain magnetic resonance imaging (MRI), and retinal biomarker tests. DISCUSSION The finalized AU-ARROW protocol is expected to allow development of an evidence-based innovative treatment plan to reduce cognitive decline and dementia risk, and effective transfer of research outcomes into Australian health policy. Highlights Study protocol for a single-blind, randomized controlled trial, the AU-ARROW Study.The AU-ARROW Study is a member of the World-Wide FINGERS (WW-FINGERS) initiative.AU-ARROW's primary outcome measure is change in a global composite cognitive score.Extra significance from amyloid PET imaging, brain MRI, and retinal biomarker tests.Leading to development of an innovative treatment plan to reduce cognitive decline.
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Affiliation(s)
- Samantha L. Gardener
- Centre of Excellence for Alzheimer's Disease Research and CareSchool of Medical and Health SciencesEdith Cowan UniversityJoondalupWestern AustraliaAustralia
- Alzheimer's Research AustraliaRalph and Patricia Sarich Neuroscience Research InstituteNedlandsWestern AustraliaAustralia
- Lifestyle Approaches Towards Cognitive Health Research GroupMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Stephanie J. Fuller
- Department of Biomedical SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | | | - Laura Baker
- Wake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Miia Kivipelto
- Karolinska InstitutetSolnaStockholmSweden
- FINGERS Brain Health InstituteStockholmSweden
| | - Victor L. Villemagne
- Centre of Excellence for Alzheimer's Disease Research and CareSchool of Medical and Health SciencesEdith Cowan UniversityJoondalupWestern AustraliaAustralia
- University of PittsburghPittsburghPennsylvaniaUSA
- Austin Health, Department of Nuclear Medicine and Centre for Positron Emission TomographyHeidelbergVictoriaAustralia
| | - Stuart M. Grieve
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
| | - Paul Yates
- Austin Health, Department of Nuclear Medicine and Centre for Positron Emission TomographyHeidelbergVictoriaAustralia
| | - Stephanie R. Rainey‐Smith
- Centre of Excellence for Alzheimer's Disease Research and CareSchool of Medical and Health SciencesEdith Cowan UniversityJoondalupWestern AustraliaAustralia
- Alzheimer's Research AustraliaRalph and Patricia Sarich Neuroscience Research InstituteNedlandsWestern AustraliaAustralia
- Lifestyle Approaches Towards Cognitive Health Research GroupMurdoch UniversityMurdochWestern AustraliaAustralia
- The University of Western AustraliaPerthWestern AustraliaAustralia
- Centre for Healthy AgeingMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Juliana Chen
- Department of Biomedical SciencesMacquarie UniversitySydneyNew South WalesAustralia
- Discipline of Nutrition and DieteticsSusan Wakil School of Nursing and MidwiferyCharles Perkins CentreThe University of SydneySydneyNew South WalesAustralia
| | - Belinda Thompson
- Department of Health SciencesAustralian Lymphoedema EducationResearch and TreatmentMacquarie UniversitySydneyNew South WalesAustralia
| | | | - Malika G. Fernando
- Department of Biomedical SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Carolina Blagojevic Castro
- Alzheimer's Research AustraliaRalph and Patricia Sarich Neuroscience Research InstituteNedlandsWestern AustraliaAustralia
- Centre for Healthy AgeingMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Silochna Meghwar
- Department of Biomedical SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Rema Raman
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Andrew Gleason
- Department of Biomedical SciencesMacquarie UniversitySydneyNew South WalesAustralia
- Florey Institute of Neuroscience and Mental HealthUniversity of MelbourneParkvilleVictoriaAustralia
- Department of NeuroscienceCentral Clinical SchoolThe Alfred CentreMonash UniversityVictoriaAustralia
| | | | - Roger Clarnette
- The University of Western AustraliaPerthWestern AustraliaAustralia
| | | | - Kevin Taddei
- Centre of Excellence for Alzheimer's Disease Research and CareSchool of Medical and Health SciencesEdith Cowan UniversityJoondalupWestern AustraliaAustralia
| | - Manohar Garg
- Department of Biomedical SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Hamid R. Sohrabi
- Centre of Excellence for Alzheimer's Disease Research and CareSchool of Medical and Health SciencesEdith Cowan UniversityJoondalupWestern AustraliaAustralia
- Alzheimer's Research AustraliaRalph and Patricia Sarich Neuroscience Research InstituteNedlandsWestern AustraliaAustralia
- Department of Biomedical SciencesMacquarie UniversitySydneyNew South WalesAustralia
- Centre for Healthy AgeingMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Ralph N. Martins
- Centre of Excellence for Alzheimer's Disease Research and CareSchool of Medical and Health SciencesEdith Cowan UniversityJoondalupWestern AustraliaAustralia
- Alzheimer's Research AustraliaRalph and Patricia Sarich Neuroscience Research InstituteNedlandsWestern AustraliaAustralia
- Department of Biomedical SciencesMacquarie UniversitySydneyNew South WalesAustralia
- Centre for Healthy AgeingMurdoch UniversityMurdochWestern AustraliaAustralia
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Woolf C, Kaplan L, Norrie LM, Burke D, Cunich M, Mowszowski L, Naismith SL. A feasibility, randomised controlled trial of Club Connect: a group-based healthy brain ageing cognitive training program for older adults with major depression within an older people's mental health service. BMC Psychiatry 2024; 24:208. [PMID: 38500095 PMCID: PMC10946102 DOI: 10.1186/s12888-023-05391-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/21/2023] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, we outline steps taken to implement an evidence-based cognitive training program, Club Connect, in older adults with major depressive disorder in an Older People's Mental Health Service in Sydney, Australia. The primary aim was to explore feasibility (or 'reach'), tolerability (or 'implementation'), and acceptability (or 'adoption'). The secondary aim was to explore the most sensitive clinical outcomes and measurement tools (i.e. 'effectiveness') to inform a formal randomised controlled trial, and to explore the healthcare resources used (i.e. costs) to assist decision-making by health care managers and policy-makers in relation to future resource allocation. METHODS Using a single blinded feasibility design, 40 participants (mean age: 76.13 years, SD: 7.45, range: 65-95 years) were randomised to either (a) Club Connect, a 10-week group-based multifaceted program, comprising psychoeducation and computer-based cognitive training, or (b) a waitlist control group. RESULTS Implementing group-based cognitive training within a clinical setting was feasible, well tolerated and accepted by participants. Further, cognitive training, in comparison to the waiting list control, was associated with moderate to very large effect size improvements in depression, stress and inhibition (ηp2 = 0.115-0.209). We also found moderate effect size improvements on measures of daily functioning, wellbeing and cognitive flexibility. Small effect size improvements for other cognitive and psychosocial outcomes were also observed. The average cost per person participating in in the intervention was AU$607.50. CONCLUSIONS Our findings support the feasibility of implementing group-based cognitive training into a specialised clinical (public health) setting. This trial was registered on the Australian and New Zealand Clinical Trial Registry (ACTRN12619000195156, 12/02/2019).
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Affiliation(s)
- Claudia Woolf
- Older People's Mental Health Service, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia.
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia.
- Faculty of Science, School of Psychology, The University of Sydney, Camperdown, NSW, Australia.
| | - L Kaplan
- Older People's Mental Health Service, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
| | - L M Norrie
- Older People's Mental Health Service, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
- School of Psychiatry, University of New South Wales, Randwick, NSW, Australia
| | - D Burke
- Older People's Mental Health Service, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
- Discipline of Psychiatry, University of Notre Dame, Sydney, NSW, Australia
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - M Cunich
- Charles Perkins Centre, The Faculty of Medicine and Health (Central Clinical School), The University of Sydney, Camperdown, NSW, Australia
- Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, NSW, Australia
| | - L Mowszowski
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, The Faculty of Medicine and Health (Central Clinical School), The University of Sydney, Camperdown, NSW, Australia
| | - S L Naismith
- Older People's Mental Health Service, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
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Sun Z, Naismith SL, Meikle S, Calamante F. A novel method for PET connectomics guided by fibre-tracking MRI: Application to Alzheimer's disease. Hum Brain Mapp 2024; 45:e26659. [PMID: 38491564 PMCID: PMC10943179 DOI: 10.1002/hbm.26659] [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: 11/14/2023] [Revised: 02/20/2024] [Accepted: 02/29/2024] [Indexed: 03/18/2024] Open
Abstract
This study introduces a novel brain connectome matrix, track-weighted PET connectivity (twPC) matrix, which combines positron emission tomography (PET) and diffusion magnetic resonance imaging data to compute a PET-weighted connectome at the individual subject level. The new method is applied to characterise connectivity changes in the Alzheimer's disease (AD) continuum. The proposed twPC samples PET tracer uptake guided by the underlying white matter fibre-tracking streamline point-to-point connectivity calculated from diffusion MRI (dMRI). Using tau-PET, dMRI and T1-weighted MRI from the Alzheimer's Disease Neuroimaging Initiative database, structural connectivity (SC) and twPC matrices were computed and analysed using the network-based statistic (NBS) technique to examine topological alterations in early mild cognitive impairment (MCI), late MCI and AD participants. Correlation analysis was also performed to explore the coupling between SC and twPC. The NBS analysis revealed progressive topological alterations in both SC and twPC as cognitive decline progressed along the continuum. Compared to healthy controls, networks with decreased SC were identified in late MCI and AD, and networks with increased twPC were identified in early MCI, late MCI and AD. The altered network topologies were mostly different between twPC and SC, although with several common edges largely involving the bilateral hippocampus, fusiform gyrus and entorhinal cortex. Negative correlations were observed between twPC and SC across all subject groups, although displaying an overall reduction in the strength of anti-correlation with disease progression. twPC provides a new means for analysing subject-specific PET and MRI-derived information within a hybrid connectome using established network analysis methods, providing valuable insights into the relationship between structural connections and molecular distributions. PRACTITIONER POINTS: New method is proposed to compute patient-specific PET connectome guided by MRI fibre-tracking. Track-weighted PET connectivity (twPC) matrix allows to leverage PET and structural connectivity information. twPC was applied to dementia, to characterise the PET nework abnormalities in Alzheimer's disease and mild cognitive impairment.
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Affiliation(s)
- Zhuopin Sun
- School of Biomedical EngineeringThe University of SydneySydneyNew South WalesAustralia
| | - Sharon L. Naismith
- Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Faculty of Science, School of PsychologyThe University of SydneySydneyNew South WalesAustralia
- Charles Perkins CenterThe University of SydneySydneyNew South WalesAustralia
| | - Steven Meikle
- Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Sydney ImagingThe University of SydneySydneyNew South WalesAustralia
- School of Health SciencesThe University of SydneySydneyNew South WalesAustralia
| | - Fernando Calamante
- School of Biomedical EngineeringThe University of SydneySydneyNew South WalesAustralia
- Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Sydney ImagingThe University of SydneySydneyNew South WalesAustralia
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Lam A, Kong S, Naismith SL. Recent advances in understanding of sleep disorders and disturbances for dementia risk and prevention. Curr Opin Psychiatry 2024; 37:94-100. [PMID: 38226546 DOI: 10.1097/yco.0000000000000921] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
PURPOSE OF REVIEW To synthesise the recent work examining the relationship between sleep disturbances and dementia, emphasising studies involving individuals with mild cognitive impairment (MCI) or Alzheimer's disease (AD) and/or those investigating AD biomarkers. Additionally, we provide an update on recent interventions targeting sleep-related issues in older adults with MCI or AD. RECENT FINDINGS Various studies have examined obstructive sleep apnoea, sleep duration, and circadian alterations in relation to Alzheimer's pathology and dementia risk, with an emerging body of evidence suggesting that cardiovascular disease, hypertension, glymphatic function, and inflammation might serve as plausible pathophysiological mechanisms contributing to dementia during critical brain periods. Conversely, recent studies investigating insomnia have produced disparate results. Regarding intervention studies, the scarcity of prospective randomised control trials poses a challenge in establishing the benefits of addressing sleep disorders and disturbances. SUMMARY Recent work examining the pathophysiological links between sleep and dementia is strongest for obstructive sleep apnoea and sleep duration, while findings in insomnia studies exhibit inconsistency, possibly due to varied associations with dementia among different insomnia subtypes. It is apparent that more longitudinal studies examining the underlying pathophysiological mechanisms are necessary, alongside more rigorous clinical trials. Although some trials are underway in this field, there is still scarcity in trials examining interventions for circadian disturbances.
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Affiliation(s)
- Aaron Lam
- Healthy Brain Ageing Program, Brain and Mind Centre
- School of Psychology, Faculty of Science
- Charles Perkins Centre, The University of Sydney, Camperdown
- The Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - Shawn Kong
- Healthy Brain Ageing Program, Brain and Mind Centre
- School of Psychology, Faculty of Science
- Charles Perkins Centre, The University of Sydney, Camperdown
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre
- School of Psychology, Faculty of Science
- Charles Perkins Centre, The University of Sydney, Camperdown
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Ricciardiello A, McKinnon AC, Mowszowski L, LaMonica HM, Schrire ZM, Haroutonian C, Lam A, Hickie IB, D'Rozario A, Naismith SL. Assessing sleep architecture and cognition in older adults with depressive symptoms attending a memory clinic. J Affect Disord 2024; 348:35-43. [PMID: 38123073 DOI: 10.1016/j.jad.2023.12.032] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/28/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND While depression is intrinsically and bidirectionally linked with both sleep disturbance and cognition, the inter-relationships between sleep, cognition, and brain integrity in older people with depression, especially those with late-onset depression are undefined. METHODS One hundred and seventy-two older adults (mean age 64.3 ± 6.9 years, Depression: n = 66, Control: n = 106) attending a memory clinic underwent a neuropsychological battery of declarative memory, executive function tasks, cerebral magnetic resonance imaging and overnight polysomnography with quantitative electroencephalography. RESULTS The time spent in slow-wave sleep (SWS) and rapid eye movement (REM) sleep, slow-wave activity, sleep spindles, hippocampal volume and prefrontal cortex thickness did not differ between depression and control and depression onset groups. However, sleep onset latency (p = 0.005) and REM onset latency (p = 0.02) were later in the Depression group compared to controls. Less SWS was associated with poorer memory (r = 0.31, p = 0.023) in the depression group, and less SWS was related to better memory in the control group (r = -0.20, p = 0.043; Fishers r-to-z = -3.19). LIMITATIONS Longitudinal studies are needed to determine if changes in sleep in those with depressive symptoms predict cognitive decline and illness trajectory. CONCLUSION Older participants with depressive symptoms had delayed sleep initiation, suggestive of delayed sleep phase. The association between SWS and memory suggests SWS may be a useful target for cognitive intervention in older adults with depression symptoms. Reduced hippocampal volumes did not mediate this relationship, indicating a broader distributed neural network may underpin these associations.
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Affiliation(s)
- Andrea Ricciardiello
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Camperdown, NSW, Australia.
| | - Andrew C McKinnon
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia
| | - Loren Mowszowski
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia
| | - Haley M LaMonica
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Zoe Menczel Schrire
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Camperdown, NSW, Australia; CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia
| | - Carla Haroutonian
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Camperdown, NSW, Australia
| | - Aaron Lam
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Camperdown, NSW, Australia; School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Ian B Hickie
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Angela D'Rozario
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Camperdown, NSW, Australia; CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia; School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Sharon L Naismith
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW, Australia; Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia; Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia; CogSleep, Australian National Health and Medical Research Council Centre of Research Excellence, Australia
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Lam AKF, Carrick J, Kao CH, Phillips CL, Zheng YZ, Yee BJ, Kim JW, Grunstein RR, Naismith SL, D'Rozario AL. EEG slowing during REM sleep in older adults with subjective cognitive impairment and mild cognitive impairment. Sleep 2024:zsae051. [PMID: 38394454 DOI: 10.1093/sleep/zsae051] [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: 09/19/2023] [Indexed: 02/25/2024] Open
Abstract
STUDY OBJECTIVES In older adults with Alzheimer's disease, slowing of electroencephalographic (EEG) activity during REM sleep has been observed. Few studies have examined EEG slowing during REM in those with mild cognitive impairment (MCI) and none have examined its relationship with cognition in this at-risk population. METHODS 210 older adults (mean age = 67.0, sd = 8.2 years) underwent comprehensive neuropsychological, medical, and psychiatric assessment and overnight polysomnography. Participants were classified as subjective cognitive impairment (SCI; n=75), non-amnestic MCI (naMCI, n=85), and amnestic MCI (aMCI, n=50). REM EEG slowing was defined as (delta + theta) / (alpha + sigma + beta) power and calculated for frontal, central, parietal, and occipital regions. Analysis of variance compared REM EEG slowing between groups. Correlations between REM EEG slowing and cognition, including learning and memory, visuospatial and executive functions, were examined within each subgroup. RESULTS The aMCI group had significantly greater REM EEG slowing in the parietal and occipital regions compared to the naMCI and SCI groups (partial η2 = 0.06, p<0.05 and 0.06, p<0.05, respectively), and greater EEG slowing in the central region compared to SCI group (partial η2 = 0.03, p<0.05). Greater REM EEG slowing in parietal (r = -0.49) and occipital regions (r = -0.38 (O1/M2) and -0.33 (O2/M1) were associated with poorer visuospatial performance in naMCI. CONCLUSION REM EEG slowing may differentiate older adults with memory impairment from those without. Longitudinal studies are now warranted to examine the prognostic utility of REM EEG slowing for cognitive and dementia trajectories.
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Affiliation(s)
- Aaron Kin Fu Lam
- The University of Sydney, School of Psychology, Camperdown, NSW, AU
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Glebe, NSW, AU
- Macquarie University, School of Psychological Sciences, Faculty of Medicine, Sydney, NSW, AU
| | - James Carrick
- The University of Sydney, School of Psychology, Camperdown, NSW, AU
| | - Chien-Hui Kao
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Glebe, NSW, AU
- Macquarie University, School of Psychological Sciences, Faculty of Medicine, Sydney, NSW, AU
| | - Craig L Phillips
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Glebe, NSW, AU
- Macquarie University, School of Psychological Sciences, Faculty of Medicine, Sydney, NSW, AU
| | - Yi Zhong Zheng
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Glebe, NSW, AU
| | - Brendon J Yee
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Glebe, NSW, AU
- Royal Prince Alfred Hospital, Sydney Medical School, Faculty of Medicine and Health Camperdown, AU
- Central Clinical School, University of Sydney, NSW, AU
| | - Jong Won Kim
- Inje University, Department of Healthcare IT, Gimhae, Gyeongsangnam-do, KR
| | - Ronald R Grunstein
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Glebe, NSW, AU
- Royal Prince Alfred Hospital, Sydney Medical School, Faculty of Medicine and Health Camperdown, AU
| | - Sharon L Naismith
- The University of Sydney, School of Psychology, Camperdown, NSW, AU
- The University of Sydney, Charles Perkins Centre, Sydney, NSW, AU
| | - Angela L D'Rozario
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, Glebe, NSW, AU
- Macquarie University, School of Psychological Sciences, Faculty of Medicine, Sydney, NSW, AU
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Hoyos CM, Phillips CL, Marshall NS, Yaffe K, Martins R, Lagopoulos J, Jackson ML, Mowszowski L, Grunstein RR, Naismith SL. REducing Sleep Apnoea for the PrEvention of Dementia (REShAPED): Protocol for a multi-site feasibility randomised controlled trial. Contemp Clin Trials 2024; 137:107424. [PMID: 38145713 DOI: 10.1016/j.cct.2023.107424] [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: 08/29/2023] [Revised: 12/07/2023] [Accepted: 12/22/2023] [Indexed: 12/27/2023]
Abstract
There is accumulating evidence that has linked OSA with increased risk of cognitive decline and dementia. Here we present the protocol for an Australian, multi-site randomised controlled, parallel open-label trial which will evaluate the feasibility for a full-scale trial investigating the effects of treating OSA on cognitive decline in older adults at risk of dementia within memory clinic settings. We will randomise 180 older adults to either the treatment intervention group or control group for 2 years. Inclusion criteria include: 50-85 years; mild-severe OSA (defined average ODI ≥ 10 with 3% oxygen desaturation determined by wrist oximetry over two nights); and subjective cognitive complaints or mild cognitive impairment. The treatment intervention arm aims to achieve an optimal treatment response based on reducing hypoxic burden with either CPAP, mandibular advancement splint, positional therapy, or oxygen therapy. Furthermore, participants will receive up to 8 sessions which involve motivational interviewing, collaborative goal setting, and behavioural sleep management. The control arm will not receive OSA treatment as part of this trial, however there will be no OSA treatment restrictions, and any treatment will be documented. Primary outcomes are 1) acceptability based upon willingness of participants to be randomised; 2) alleviating hypoxic burden by reducing OSA severity; 3) tolerability of the trial burden based upon collection of outcomes over the 2-year follow-up. Secondary outcomes include safety and cognitive function. Outcomes will be collected at 0, 6 and 24-months. This feasibility study aims to will provide the basis for a larger longer-term trial of dementia prevention.
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Affiliation(s)
- Camilla M Hoyos
- Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Macquarie University, Sydney, Australia; Faculty of Medicine and Human Health Sciences, Macquarie University, North Ryde, Sydney, Australia.
| | - Craig L Phillips
- Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Macquarie University, Sydney, Australia; Faculty of Medicine and Human Health Sciences, Macquarie University, North Ryde, Sydney, Australia; Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Nathaniel S Marshall
- Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Macquarie University, Sydney, Australia; Faculty of Medicine and Human Health Sciences, Macquarie University, North Ryde, Sydney, Australia
| | - Kristine Yaffe
- UCSF Weill Institute for Neurosciences, San Francisco, CA, USA
| | - Ralph Martins
- Faculty of Medicine and Human Health Sciences, Macquarie University, North Ryde, Sydney, Australia; Centre for Ageing, Cognition and Wellbeing, Macquarie University, North Ryde, Sydney, Australia
| | - Jim Lagopoulos
- Thompson Institute, University of Sunshine Coast, Queensland, Australia
| | - Melinda L Jackson
- Turner Institute of Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Loren Mowszowski
- Healthy Brain Ageing Program, School of Psychology, The University of Sydney, Camperdown, Sydney, Australia
| | - Ronald R Grunstein
- Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Macquarie University, Sydney, Australia; CPC-RPA Clinic, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, School of Psychology, The University of Sydney, Camperdown, Sydney, Australia; Brain and Mind Centre, The University of Sydney, Camperdown, Sydney, Australia; Charles Perkins Centre, The University of Sydney, Camperdown, Sydney, Australia
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9
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Yang Y, Kim WS, Michaelian JC, Lewis SJG, Phillips CL, D'Rozario AL, Chatterjee P, Martins RN, Grunstein R, Halliday GM, Naismith SL. Predicting neurodegeneration from sleep related biofluid changes. Neurobiol Dis 2024; 190:106369. [PMID: 38049012 DOI: 10.1016/j.nbd.2023.106369] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/06/2023] Open
Abstract
Sleep-wake disturbances are common in neurodegenerative diseases and may occur years before the clinical diagnosis, potentially either representing an early stage of the disease itself or acting as a pathophysiological driver. Therefore, discovering biomarkers that identify individuals with sleep-wake disturbances who are at risk of developing neurodegenerative diseases will allow early diagnosis and intervention. Given the association between sleep and neurodegeneration, the most frequently analyzed fluid biomarkers in people with sleep-wake disturbances to date include those directly associated with neurodegeneration itself, such as neurofilament light chain, phosphorylated tau, amyloid-beta and alpha-synuclein. Abnormalities in these biomarkers in patients with sleep-wake disturbances are considered as evidence of an underlying neurodegenerative process. Levels of hormonal sleep-related biomarkers such as melatonin, cortisol and orexin are often abnormal in patients with clinical neurodegenerative diseases, but their relationships with the more standard neurodegenerative biomarkers remain unclear. Similarly, it is unclear whether other chronobiological/circadian biomarkers, such as disrupted clock gene expression, are causal factors or a consequence of neurodegeneration. Current data would suggest that a combination of fluid biomarkers may identify sleep-wake disturbances that are most predictive for the risk of developing neurodegenerative disease with more optimal sensitivity and specificity.
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Affiliation(s)
- Yue Yang
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia.
| | - Woojin Scott Kim
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia; School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Johannes C Michaelian
- Healthy Brain Ageing Program, School of Psychology, Brain and Mind Centre & The Charles Perkins Centre, The University of Sydney, Sydney, NSW 2050, Australia.
| | - Simon J G Lewis
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia; School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia; Parkinson's Disease Research Clinic, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia.
| | - Craig L Phillips
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW 2109, Australia; Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia.
| | - Angela L D'Rozario
- Healthy Brain Ageing Program, School of Psychology, Brain and Mind Centre & The Charles Perkins Centre, The University of Sydney, Sydney, NSW 2050, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW 2109, Australia.
| | - Pratishtha Chatterjee
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, WA 6027, Australia.
| | - Ralph N Martins
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, WA 6027, Australia; School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA 6009, Australia.
| | - Ron Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW 2109, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Glenda M Halliday
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia; School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Sharon L Naismith
- Healthy Brain Ageing Program, School of Psychology, Brain and Mind Centre & The Charles Perkins Centre, The University of Sydney, Sydney, NSW 2050, Australia.
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10
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D'Rozario AL, Kao CH, Phillips CL, Mullins AE, Memarian N, Yee BJ, Duffy SL, Cho G, Wong KKH, Kremerskothen K, Chapman J, Haroutonian C, Bartlett DJ, Naismith SL, Grunstein RR. Region-specific changes in brain activity and memory after continuous positive airway pressure therapy in obstructive sleep apnea: a pilot high-density electroencephalography study. Sleep 2023; 46:zsad255. [PMID: 37777337 DOI: 10.1093/sleep/zsad255] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 08/24/2023] [Indexed: 10/02/2023] Open
Abstract
STUDY OBJECTIVES Limited channel electroencephalography (EEG) investigations in obstructive sleep apnea (OSA) have revealed deficits in slow wave activity (SWA) and spindles during sleep and increased EEG slowing during resting wakefulness. High-density EEG (Hd-EEG) has also detected local parietal deficits in SWA (delta power) during NREM. It is unclear whether effective continuous positive airway pressure (CPAP) treatment reverses regional SWA deficits, and other regional sleep and wake EEG abnormalities, and whether any recovery relates to improved overnight memory consolidation. METHODS A clinical sample of men with moderate-severe OSA underwent sleep and resting wake recordings with 256-channel Hd-EEG before and after 3 months of CPAP. Declarative and procedural memory tasks were administered pre- and post-sleep. Topographical spectral power maps and differences between baseline and treatment were compared using t-tests and statistical nonparametric mapping (SnPM). RESULTS In 11 compliant CPAP users (5.2 ± 1.1 hours/night), total sleep time did not differ after CPAP but N1 and N2 sleep were lower and N3 was higher. Centro-parietal gamma power during N3 increased and fronto-central slow spindle activity during N2 decreased (SnPM < 0.05). No other significant differences in EEG power were observed. When averaged specifically within the parietal region, N3 delta power increased after CPAP (p = 0.0029) and was correlated with the change in overnight procedural memory consolidation (rho = 0.79, p = 0.03). During resting wakefulness, there were trends for reduced delta and theta power. CONCLUSIONS Effective CPAP treatment of OSA may correct regional EEG abnormalities, and regional recovery of SWA may relate to procedural memory improvements in the short term.
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Affiliation(s)
- Angela L D'Rozario
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Chien-Hui Kao
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Craig L Phillips
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Anna E Mullins
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine, New York City, NY, USA
| | - Negar Memarian
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Brendon J Yee
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health University of Sydney, Sydney, NSW, Australia
| | - Shantel L Duffy
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Garry Cho
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Keith K H Wong
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health University of Sydney, Sydney, NSW, Australia
| | - Kyle Kremerskothen
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Julia Chapman
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Carla Haroutonian
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Delwyn J Bartlett
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health University of Sydney, Sydney, NSW, Australia
| | - Sharon L Naismith
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Ron R Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health University of Sydney, Sydney, NSW, Australia
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11
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Orlando IF, O'Callaghan C, Lam A, McKinnon AC, Tan JBC, Michaelian JC, Kong SDX, D'Rozario AL, Naismith SL. Sleep spindle architecture associated with distinct clinical phenotypes in older adults at risk for dementia. Mol Psychiatry 2023:10.1038/s41380-023-02335-1. [PMID: 38052981 DOI: 10.1038/s41380-023-02335-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 12/07/2023]
Abstract
Sleep spindles are a hallmark of non-REM sleep and play a fundamental role in memory consolidation. Alterations in these spindles are emerging as sensitive biomarkers for neurodegenerative diseases of ageing. Understanding the clinical presentations associated with spindle alterations may help to elucidate the functional role of these distinct electroencephalographic oscillations and the pathophysiology of sleep and neurodegenerative disorders. Here, we use a data-driven approach to examine the sleep, memory and default mode network connectivity phenotypes associated with sleep spindle architecture in older adults (mean age = 66 years). Participants were recruited from a specialist clinic for early diagnosis and intervention for cognitive decline, with a proportion showing mild cognitive deficits on neuropsychological testing. In a sample of 88 people who underwent memory assessment, overnight polysomnography and resting-state fMRI, a k-means cluster analysis was applied to spindle measures of interest: fast spindle density, spindle duration and spindle amplitude. This resulted in three clusters, characterised by preserved spindle architecture with higher fast spindle density and longer spindle duration (Cluster 1), and alterations in spindle architecture (Clusters 2 and 3). These clusters were further characterised by reduced memory (Clusters 2 and 3) and nocturnal hypoxemia, associated with sleep apnea (Cluster 3). Resting-state fMRI analysis confirmed that default mode connectivity was related to spindle architecture, although directionality of this relationship differed across the cluster groups. Together, these results confirm a diversity in spindle architecture in older adults, associated with clinically meaningful phenotypes, including memory function and sleep apnea. They suggest that resting-state default mode connectivity during the awake state can be associated with sleep spindle architecture; however, this is highly dependent on clinical phenotype. Establishing relationships between clinical and neuroimaging features and sleep spindle alterations will advance our understanding of the bidirectional relationships between sleep changes and neurodegenerative diseases of ageing.
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Affiliation(s)
- Isabella F Orlando
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Claire O'Callaghan
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Aaron Lam
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia
| | - Andrew C McKinnon
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia
| | - Joshua B C Tan
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Johannes C Michaelian
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia
| | - Shawn D X Kong
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia
| | - Angela L D'Rozario
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia.
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia.
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia.
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia.
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12
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Turner A, LaMonica HM, Moroney C, O'Leary F, Naismith SL, Flood VM. Knowledge, Attitudes, and Behaviours Concerning the Mediterranean Diet Among Older Adults in Australia. J Community Health 2023; 48:951-962. [PMID: 37289354 PMCID: PMC10248335 DOI: 10.1007/s10900-023-01237-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/09/2023]
Abstract
Despite the growing body of evidence demonstrating the positive health effects of the Mediterranean diet, it is not routinely recommended in practice and adherence is low in the general population in Australia. The knowledge-attitude-behaviour model explains how health behaviours are supported through a process of acquiring knowledge, developing attitudes, and forming behaviours. Evidence has suggested that having a high level of nutrition-related knowledge is associated with more positive attitudes, which is directly linked to positive dietary behaviours. However, reports of knowledge and attitudes towards the Mediterranean diet, and how these directly relate to behaviours in older adults, are lacking. This study explored Mediterranean diet-related knowledge, attitudes, and behaviours among community-dwelling older adults in Australia. Participants were adults aged 55 years and older who completed an online survey that contained three parts: (a) knowledge - Mediterranean Diet Nutrition Knowledge Questionnaire (Med-NKQ); (b) nutrition-related attitudes and behaviours, and barriers and enablers to dietary change; (c) demographics. The sample included 61 adults who ranged in age from 55 to 89 years. The overall knowledge score was 30.5 out of a possible 40 points, with 60.7% classified as having a high level of knowledge. Knowledge was lowest for nutrient content and label reading. Attitudes and behaviours were generally positive and were not associated with level of knowledge. The most common barriers to dietary change were perceived cost and lack of knowledge, and motivational factors. There are a number of key gaps in knowledge that should be addressed through targeted educational programs. Strategies and tools to overcome perceived barriers and improve self-efficacy are needed to facilitate positive dietary behaviours.
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Affiliation(s)
- Ashlee Turner
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Haley M LaMonica
- Faculty of Medicine and Health, Translational Research Collective, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Carissa Moroney
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Fiona O'Leary
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Discipline of Nutrition and Dietetics, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Sharon L Naismith
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
- Brain and Mind Centre, Healthy Brain Ageing Program, The University of Sydney, Sydney, NSW, 2006, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Victoria M Flood
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia.
- Faculty of Medicine and Health, The University of Sydney, University Centre for Rural Health, Northern Rivers, NSW, 2480, Australia.
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13
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Bramich S, Noyce AJ, King AE, Naismith SL, Kuruvilla MV, Lewis SJG, Roccati E, Bindoff AD, Barnham KJ, Beauchamp LC, Vickers JC, Pérez-Carbonell L, Alty J. Isolated rapid eye movement sleep behaviour disorder (iRBD) in the Island Study Linking Ageing and Neurodegenerative Disease (ISLAND) Sleep Study: protocol and baseline characteristics. J Sleep Res 2023:e14109. [PMID: 38014898 DOI: 10.1111/jsr.14109] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Abstract
Isolated rapid eye movement (REM) sleep behaviour disorder (iRBD) is a sleep disorder that is characterised by dream enactment episodes during REM sleep. It is the strongest known predictor of α-synuclein-related neurodegenerative disease (αNDD), such that >80% of people with iRBD will eventually develop Parkinson's disease, dementia with Lewy bodies, or multiple system atrophy in later life. More research is needed to understand the trajectory of phenoconversion to each αNDD. Only five 'gold standard' prevalence studies of iRBD in older adults have been undertaken previously, with estimates ranging from 0.74% to 2.01%. The diagnostic recommendations for video-polysomnography (vPSG) to confirm iRBD makes prevalence studies challenging, as vPSG is often unavailable to large cohorts. In Australia, there have been no iRBD prevalence studies, and little is known about the cognitive and motor profiles of Australian people with iRBD. The Island Study Linking Ageing and Neurodegenerative Disease (ISLAND) Sleep Study will investigate the prevalence of iRBD in Tasmania, an island state of Australia, using validated questionnaires and home-based vPSG. It will also explore several cognitive, motor, olfactory, autonomic, visual, tactile, and sleep profiles in people with iRBD to better understand which characteristics influence the progression of iRBD to αNDD. This paper details the ISLAND Sleep Study protocol and presents preliminary baseline results.
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Affiliation(s)
- Samantha Bramich
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Alastair J Noyce
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University, London, UK
| | - Anna E King
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Sharon L Naismith
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | | | - Simon J G Lewis
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Eddy Roccati
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Aidan D Bindoff
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Kevin J Barnham
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
| | - Leah C Beauchamp
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - James C Vickers
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Laura Pérez-Carbonell
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University, London, UK
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jane Alty
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
- School of Medicine, University of Tasmania, Hobart, Australia
- Department of Neurology, Royal Hobart Hospital, Hobart, Australia
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14
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Harding IH, Ryan J, Heritier S, Spark S, Flanagan Z, McIntyre R, Anderson CS, Naismith SL, Chong TTJ, O'Sullivan M, Egan G, Law M, Zoungas S. STAREE-Mind Imaging Study: a randomised placebo-controlled trial of atorvastatin for prevention of cerebrovascular decline and neurodegeneration in older individuals. BMJ Neurol Open 2023; 5:e000541. [PMID: 37920607 PMCID: PMC10619122 DOI: 10.1136/bmjno-2023-000541] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/08/2023] [Indexed: 11/04/2023] Open
Abstract
Introduction Cerebrovascular disease and neurodegeneration are causes of cognitive decline and dementia, for which primary prevention options are currently lacking. Statins are well-tolerated and widely available medications that potentially have neuroprotective effects. The STAREE-Mind Imaging Study is a randomised, double-blind, placebo-controlled clinical trial that will investigate the impact of atorvastatin on markers of neurovascular health and brain atrophy in a healthy, older population using MRI. This is a nested substudy of the 'Statins for Reducing Events in the Elderly' (STAREE) primary prevention trial. Methods Participants aged 70 years or older (n=340) will be randomised to atorvastatin or placebo. Comprehensive brain MRI assessment will be undertaken at baseline and up to 4 years follow-up, including structural, diffusion, perfusion and susceptibility imaging. The primary outcome measures will be change in brain free water fraction (a composite marker of vascular leakage, neuroinflammation and neurodegeneration) and white matter hyperintensity volume (small vessel disease). Secondary outcomes will include change in perivascular space volume (glymphatic drainage), cortical thickness, hippocampal volume, microbleeds and lacunae, prefrontal cerebral perfusion and white matter microstructure. Ethics and dissemination Academic publications from this work will address the current uncertainty regarding the impact of statins on brain structure and vascular integrity. This study will inform the utility of repurposing these well-tolerated, inexpensive and widely available drugs for primary prevention of neurological outcomes in older individuals. Ethics approval was given by Monash University Human Research Ethics Committee, Protocol 12206. Trial registration number ClinicalTrials.gov Identifier: NCT05586750.
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Affiliation(s)
- Ian H Harding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stephane Heritier
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Simone Spark
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zachary Flanagan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Richard McIntyre
- Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
| | - Craig S Anderson
- Global Brain Health Program, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sharon L Naismith
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Trevor T-J Chong
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael O'Sullivan
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia
| | - Gary Egan
- Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
| | - Meng Law
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Munn BR, Müller EJ, Medel V, Naismith SL, Lizier JT, Sanders RD, Shine JM. Neuronal connected burst cascades bridge macroscale adaptive signatures across arousal states. Nat Commun 2023; 14:6846. [PMID: 37891167 PMCID: PMC10611774 DOI: 10.1038/s41467-023-42465-2] [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: 11/29/2022] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
The human brain displays a rich repertoire of states that emerge from the microscopic interactions of cortical and subcortical neurons. Difficulties inherent within large-scale simultaneous neuronal recording limit our ability to link biophysical processes at the microscale to emergent macroscopic brain states. Here we introduce a microscale biophysical network model of layer-5 pyramidal neurons that display graded coarse-sampled dynamics matching those observed in macroscale electrophysiological recordings from macaques and humans. We invert our model to identify the neuronal spike and burst dynamics that differentiate unconscious, dreaming, and awake arousal states and provide insights into their functional signatures. We further show that neuromodulatory arousal can mediate different modes of neuronal dynamics around a low-dimensional energy landscape, which in turn changes the response of the model to external stimuli. Our results highlight the promise of multiscale modelling to bridge theories of consciousness across spatiotemporal scales.
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Affiliation(s)
- Brandon R Munn
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.
- Complex Systems, School of Physics, University of Sydney, Sydney, NSW, Australia.
- Centre for Complex Systems, The University of Sydney, Sydney, NSW, Australia.
| | - Eli J Müller
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Complex Systems, School of Physics, University of Sydney, Sydney, NSW, Australia
- Centre for Complex Systems, The University of Sydney, Sydney, NSW, Australia
| | - Vicente Medel
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago, Chile
| | - Sharon L Naismith
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- School of Psychology, Faculty of Science & Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Joseph T Lizier
- Centre for Complex Systems, The University of Sydney, Sydney, NSW, Australia
- School of Computer Science, The University of Sydney, Sydney, NSW, Australia
| | - Robert D Sanders
- Department of Anaesthetics & Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
- Central Clinical School & NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - James M Shine
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Complex Systems, School of Physics, University of Sydney, Sydney, NSW, Australia
- Centre for Complex Systems, The University of Sydney, Sydney, NSW, Australia
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16
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Chong MK, Hickie IB, Cross SP, McKenna S, Varidel M, Capon W, Davenport TA, LaMonica HM, Sawrikar V, Guastella A, Naismith SL, Scott EM, Iorfino F. Digital Application of Clinical Staging to Support Stratification in Youth Mental Health Services: Validity and Reliability Study. JMIR Form Res 2023; 7:e45161. [PMID: 37682588 PMCID: PMC10517388 DOI: 10.2196/45161] [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: 12/18/2022] [Revised: 05/31/2023] [Accepted: 06/26/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND As the demand for youth mental health care continues to rise, managing wait times and reducing treatment delays are key challenges to delivering timely and quality care. Clinical staging is a heuristic model for youth mental health that can stratify care allocation according to individuals' risk of illness progression. The application of staging has been traditionally limited to trained clinicians yet leveraging digital technologies to apply clinical staging could increase the scalability and usability of this model in services. OBJECTIVE The aim of this study was to validate a digital algorithm to accurately differentiate young people at lower and higher risk of developing mental disorders. METHODS We conducted a study with a cohort comprising 131 young people, aged between 16 and 25 years, who presented to youth mental health services in Australia between November 2018 and March 2021. Expert psychiatrists independently assigned clinical stages (either stage 1a or stage 1b+), which were then compared to the digital algorithm's allocation based on a multidimensional self-report questionnaire. RESULTS Of the 131 participants, the mean age was 20.3 (SD 2.4) years, and 72% (94/131) of them were female. Ninety-one percent of clinical stage ratings were concordant between the digital algorithm and the experts' ratings, with a substantial interrater agreement (κ=0.67; P<.001). The algorithm demonstrated an accuracy of 91% (95% CI 86%-95%; P=.03), a sensitivity of 80%, a specificity of 93%, and an F1-score of 73%. Of the concordant ratings, 16 young people were allocated to stage 1a, while 103 were assigned to stage 1b+. Among the 12 discordant cases, the digital algorithm allocated a lower stage (stage 1a) to 8 participants compared to the experts. These individuals had significantly milder symptoms of depression (P<.001) and anxiety (P<.001) compared to those with concordant stage 1b+ ratings. CONCLUSIONS This novel digital algorithm is sufficiently robust to be used as an adjunctive decision support tool to stratify care and assist with demand management in youth mental health services. This work could transform care pathways and expedite care allocation for those in the early stages of common anxiety and depressive disorders. Between 11% and 27% of young people seeking care may benefit from low-intensity, self-directed, or brief interventions. Findings from this study suggest the possibility of redirecting clinical capacity to focus on individuals in stage 1b+ for further assessment and intervention.
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Affiliation(s)
- Min K Chong
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | | | - Sarah McKenna
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Mathew Varidel
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - William Capon
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Tracey A Davenport
- Design and Strategy Division, Australian Digital Health Agency, Sydney, Australia
| | - Haley M LaMonica
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Vilas Sawrikar
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Adam Guastella
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sharon L Naismith
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- Healthy Brain Ageing Program, University of Sydney, Sydney, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- St Vincent's and Mater Clinical School, The University of Notre Dame, Sydney, Australia
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
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Vujic A, Mowszowski L, Meares S, Batchelor J, Naismith SL. Not all mentally stimulating activities are alike: insights from a 4-factor model and implications for late-life cognition. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2023; 30:822-836. [PMID: 35775824 DOI: 10.1080/13825585.2022.2094878] [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] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/23/2022] [Indexed: 06/15/2023]
Abstract
It is not yet known which specific qualities of cognitively stimulating activities are most likely to enhance cognitive reserve in older adults. Taking an inductive approach to this problem, we asked 504 older adults with subjective and/or cognitive impairment to complete the Cognitively Stimulating Activities Questionnaire (CSA-Q). Exploratory factor analysis identified a 4-factor structure within a split-half sample, after which confirmatory factor analysis cross-validated the model. Retaining 12 CSA-Q items, the 4 factors were dubbed CSA-Processing, CSA-Challenging, CSA-Connecting and CSA-Socializing. Resulting factor weights were analyzed relative to cognitive reserve proxies and neuropsychological domains. All factors except CSA-Challenging were positively linked to cognitive reserve. Neuropsychologically, CSA-Challenging was modestly and positively correlated with processing speed and executive function, while CSA-Processing was positively correlated with executive function. CSA-Socializing had a small positive correlation with processing speed. Our findings offer new insights into late-life stimulating activities, laying the groundwork for longitudinal and intervention studies.
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Affiliation(s)
- Adam Vujic
- Department of Psychology, Faculty of Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Loren Mowszowski
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| | - Susanne Meares
- Department of Psychology, Faculty of Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jennifer Batchelor
- Department of Psychology, Faculty of Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
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18
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Weddell J, Naismith SL, Bauman A, Tofler G, Zhao E, Redfern J, Buckley T, Gallagher R. Age and Marital Status Predict Mild Cognitive Impairment During Acute Coronary Syndrome Admission: An Observational Study of Acute Coronary Syndrome Inpatients. J Cardiovasc Nurs 2023; 38:462-471. [PMID: 36729065 DOI: 10.1097/jcn.0000000000000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Mild cognitive impairment (MCI) has been reported after acute coronary syndrome (ACS), but it is uncertain who is at risk, particularly during inpatient admission. OBJECTIVE In this study, we aimed to explore the prevalence and cognitive domains affected in MCI during ACS admission and determine factors that identify patients most at risk of MCI. METHODS Inpatients with ACS were consecutively recruited from 2 tertiary hospital cardiac wards and screened with the Montreal Cognitive Assessment and the Hopkins Verbal Learning Test. Screening included health literacy (Newest Vital Sign), depressive symptoms (Patient Health Questionnaire-9), and physical activity (Physical Activity Scale for the Elderly). Factors associated with MCI were determined using logistic regression. RESULTS Participants (n = 81) had a mean (SD) age of 63.5 (10.9) years, and 82.7% were male. In total, MCI was identified in 52.5%, 42.5% with 1 screen and 10% with both. Individually, the Montreal Cognitive Assessment identified MCI in 48.1%, and the Hopkins Verbal Learning Test identified MCI in 13.8%. In Montreal Cognitive Assessment screening, the cognitive domains in which participants most frequently did not achieve the maximum points available were delayed recall (81.5%), visuospatial executive function (48.1%), and attention (30.9%). Accounting for education, depression, physical activity, and ACS diagnosis, the likelihood of an MCI positive screen increased by 11% per year of age (odds ratio, 1.11; 95% confidence interval, 1.04-1.18) and by 3.6 times for those who are unmarried/unpartnered (odds ratio, 3.61; 95% confidence interval, 1.09-11.89). CONCLUSION An estimated half of patients with ACS screen positive for MCI during admission, with single and older patients most at risk. Multiple areas of thinking were affected with potential impact on capacity for learning heart disease management.
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19
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Michaelian JC, McCade D, Hoyos CM, Brodaty H, Harrison F, Henry JD, Guastella AJ, Naismith SL. Pilot Randomized, Double-Blind, Placebo-Controlled Crossover Trial Evaluating the Feasibility of an Intranasal Oxytocin in Improving Social Cognition in Individuals Living with Alzheimer's Disease. J Alzheimers Dis Rep 2023; 7:715-729. [PMID: 37483320 PMCID: PMC10357119 DOI: 10.3233/adr-230013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/10/2023] [Indexed: 07/25/2023] Open
Abstract
Background Individuals living with Alzheimer's disease (AD) demonstrate extensive deficits in social cognition. To date, no studies have investigated the feasibility of an intranasal oxytocin (INOT) treatment to improve social cognition in individuals living with AD. Objective We conducted a pilot trial to determine recruitment feasibility, enrolment acceptability, and adherence to an INOT treatment to inform on the subsequent design of a future randomized controlled trial (RCT). We also estimated the effect sizes of potential social cognitive function outcome measures related to participants and their caregivers. Methods Four individuals with AD were enrolled in a single-center, randomized, double-blind, placebo-controlled crossover trial involving a one-week treatment period with both INOT (72 IU twice daily) and placebo. Results All participants reported no treatment-causative or serious adverse events following repeated INOT administration. While enrolment acceptability (100%) and INOT adherence (placebo, 95%; INOT, 98%) were excellent, feasibility of recruitment was not acceptable (i.e., n = 4/58 individuals screened met inclusion criteria). However, positive/large effects were associated with secondary outcomes of self-reported health and wellbeing, caregiver 'burden', intimacy and interpersonal-bonding, following repeated INOT administration. No positive effects were associated with participant outcomes of social cognition. Conclusion This pilot RCT provides first evidence that INOT administration in individuals living with AD is safe and well-tolerated. Despite limitations in sample size, moderate-to-large effect size improvements were identified in participant health outcomes as well as core social cognitive functions and 'burden' as reported by a caregiver. This suggests potential broad-ranging beneficial effects of INOT which should be assessed in future RCTs.
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Affiliation(s)
- Johannes C. Michaelian
- School of Psychology, University of Sydney, Sydney, NSW, Australia
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Donna McCade
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Camilla M. Hoyos
- School of Psychology, University of Sydney, Sydney, NSW, Australia
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Fleur Harrison
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Adam J. Guastella
- Brain and Mind Centre, Children’s Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Sharon L. Naismith
- School of Psychology, University of Sydney, Sydney, NSW, Australia
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
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20
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Lin P, LaMonica HM, Naismith SL, Mowszowski L. Identifying subtle functional change in individuals with mild cognitive impairment: development and validation of the Healthy Brain Ageing - Functional Assessment Questionnaire. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2023; 30:536-554. [PMID: 35345965 DOI: 10.1080/13825585.2022.2057910] [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: 04/21/2021] [Accepted: 03/21/2022] [Indexed: 05/10/2023]
Abstract
Accumulating research suggests that individuals with Mild Cognitive Impairment (MCI) experience subtle functional changes, but that available functional assessment tools are insensitive to this. To address this gap, we describe the development and validation of the self-report, "Healthy Brain Ageing Functional Assessment Questionnaire" (HBA-FAQ). We examined the factor structure and psychometric properties of the HBA-FAQ in 503 participants with normal cognition, subjective cognitive decline (SCD), MCI or dementia. Our results found the HBA-FAQ to have good reliability, validity and stronger discriminative ability between healthy control participants and those with SCD (0.734, p = .001), MCI (0.666, p = .012) and dementia (0.798, p < .001) compared to a widely-used instrumental activities of daily living screener. In conclusion, the HBA-FAQ is a valid, reliable self-report tool, providing an efficient and sensitive approach to identifying subtle changes in daily functioning in older people at risk of dementia.
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Affiliation(s)
- Pinghsiu Lin
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Sydney, Nsw, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Nsw, Australia
| | - Haley M LaMonica
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Sydney, Nsw, Australia
- Translational Research Collective, The University of Sydney, Nsw, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Sydney, Nsw, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Nsw, Australia
- Charles Perkins Centre, the University of Sydney, Sydney, Nsw, Australia
| | - Loren Mowszowski
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Sydney, Nsw, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Nsw, Australia
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21
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Teh JZ, Grummitt L, Haroutonian C, Cross NE, Skinner B, Bartlett DJ, Yee B, Grunstein RR, Naismith SL, D’Rozario AL. Overnight declarative memory consolidation and non-rapid eye movement sleep electroencephalographic oscillations in older adults with obstructive sleep apnea. Sleep 2023; 46:zsad087. [PMID: 37052122 PMCID: PMC10666962 DOI: 10.1093/sleep/zsad087] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 03/01/2023] [Indexed: 04/14/2023] Open
Abstract
STUDY OBJECTIVES To compare overnight declarative memory consolidation and non-rapid eye movement (NREM) sleep electroencephalogram (EEG) oscillations in older adults with obstructive sleep apnea (OSA) to a control group and assess slow-wave activity (SWA) and sleep spindles as correlates of memory consolidation. METHODS Forty-six older adults (24 without OSA and 22 with OSA) completed a word-pair associate's declarative memory task before and after polysomnography. Recall and recognition were expressed as a percentage of the morning relative to evening scores. Power spectral analysis was performed on EEG recorded at frontal (F3-M2, F4-M1) and central (C3-M2, C4-M1) sites. We calculated NREM absolute slow oscillation (0.25-1 Hz) and delta (0.5-4.5 Hz) EEG power, and slow (11-13 Hz) spindle density (number of events per minute of N2 sleep) and fast (13-16 Hz) spindle density. RESULTS There were no significant differences in overnight recall and recognition between OSA (mean age 58.7 ± 7.1 years, apnea-hypopnea index (AHI) 41.9 ± 29.7 events/hour) and non-OSA (age 61.1 ± 10.3 years, AHI 6.6 ± 4.2 events/hour) groups. The OSA group had lower fast spindle density in the frontal region (p = 0.007). No between-group differences in SWA were observed. In the Control group, overnight recognition positively correlated with slow spindle density in frontal (rho = 0.555, p = 0.020) and central regions (rho = 0.490, p = 0.046). Overnight recall was not related to SWA or spindle measures in either group. CONCLUSIONS Older adults with OSA had deficits in fast sleep spindles but showed preserved overnight declarative memory consolidation. It is possible that compensatory mechanisms are being recruited by OSA patients to preserve declarative memory consolidation despite the presence of sleep spindle deficits.
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Affiliation(s)
- Jun Z Teh
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia
| | - Lucinda Grummitt
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Carla Haroutonian
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Nathan E Cross
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Bradley Skinner
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Delwyn J Bartlett
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia
| | - Brendon Yee
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia
| | - Ronald R Grunstein
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia
| | - Sharon L Naismith
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia
| | - Angela L D’Rozario
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
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Ellison TS, Cappa SF, Garrett D, Georges J, Iwatsubo T, Kramer JH, Lehmann M, Lyketsos C, Maier AB, Merrilees J, Morris JC, Naismith SL, Nobili F, Pahor M, Pond D, Robinson L, Soysal P, Vandenbulcke M, Weber CJ, Visser PJ, Weiner M, Frisoni GB. Outcome measures for Alzheimer's disease: A global inter-societal Delphi consensus. Alzheimers Dement 2023; 19:2707-2729. [PMID: 36749854 PMCID: PMC11010236 DOI: 10.1002/alz.12945] [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: 11/22/2022] [Accepted: 12/20/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION We aim to provide guidance on outcomes and measures for use in patients with Alzheimer's clinical syndrome. METHODS A consensus group of 20 voting members nominated by 10 professional societies, and a non-voting chair, used a Delphi approach and modified GRADE criteria. RESULTS Consensus was reached on priority outcomes (n = 66), measures (n = 49) and statements (n = 37) across nine domains. A number of outcomes and measurement instruments were ranked for: Cognitive abilities; Functional abilities/dependency; Behavioural and neuropsychiatric symptoms; Patient quality of life (QoL); Caregiver QoL; Healthcare and treatment-related outcomes; Medical investigations; Disease-related life events; and Global outcomes. DISCUSSION This work provides indications on the domains and ideal pertinent measurement instruments that clinicians may wish to use to follow patients with cognitive impairment. More work is needed to develop instruments that are more feasible in the context of the constraints of clinical routine.
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Affiliation(s)
| | - Stefano F. Cappa
- Scuola Universitaria Superiore IUSS Pavia, Pavia, Italy
- Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | | | | | - Takeshi Iwatsubo
- Unit for Early and Exploratory Clinical Development, The University of Tokyo Hospital, Tokyo, Japan
- Department of Neuropathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Joel H. Kramer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | | | - Constantine Lyketsos
- Richman Family Precision Medicine Center of Excellence in Alzheimer’s Disease, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University and Medicine, Baltimore, USA
| | - Andrea B. Maier
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Centre for Healthy Longevity, National University Health System, Singapore, Singapore
| | - Jennifer Merrilees
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - John C. Morris
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Sharon L. Naismith
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Flavio Nobili
- UO Clinica Neurologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Child and Mother Health, University of Genoa, Genova, Italy
| | - Marco Pahor
- Department of Aging and Geriatric Research, Institute on Aging, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Dimity Pond
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
- European Society of Geriatric Medicine, Dementia Special Interest Group
| | - Mathieu Vandenbulcke
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Geriatric Psychiatry, University Psychiatric Centre KU Leuven, Leuven, Belgium
| | | | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
- Alzheimer Center, Department of Neurology, Neuroscience Campus Amsterdam, Amsterdam University Medical Center, VU Medical Center, Amsterdam, Netherlands
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institute, Stockholm, Sweden
| | - Michael Weiner
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Giovanni B. Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Memory Clinic, Department of Readaptation and Geriatrics, Geneva University and University Hospitals, Geneva, Switzerland
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23
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Kong SDX, Gordon CJ, Hoyos CM, Wassing R, D’Rozario A, Mowszowski L, Ireland C, Palmer JR, Grunstein RR, Shine JM, McKinnon AC, Naismith SL. Heart rate variability during slow wave sleep is linked to functional connectivity in the central autonomic network. Brain Commun 2023; 5:fcad129. [PMID: 37234683 PMCID: PMC10208252 DOI: 10.1093/braincomms/fcad129] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/20/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Reduced heart rate variability can be an early sign of autonomic dysfunction in neurodegenerative diseases and may be related to brain dysfunction in the central autonomic network. As yet, such autonomic dysfunction has not been examined during sleep-which is an ideal physiological state to study brain-heart interaction as both the central and peripheral nervous systems behave differently compared to during wakefulness. Therefore, the primary aim of the current study was to examine whether heart rate variability during nocturnal sleep, specifically slow wave (deep) sleep, is associated with central autonomic network functional connectivity in older adults 'at-risk' of dementia. Older adults (n = 78; age range = 50-88 years; 64% female) attending a memory clinic for cognitive concerns underwent resting-state functional magnetic resonance imaging and an overnight polysomnography. From these, central autonomic network functional connectivity strength and heart rate variability data during sleep were derived, respectively. High-frequency heart rate variability was extracted to index parasympathetic activity during distinct periods of sleep, including slow wave sleep as well as secondary outcomes of non-rapid eye movement sleep, wake after sleep onset, and rapid eye movement sleep. General linear models were used to examine associations between central autonomic network functional connectivity and high-frequency heart rate variability. Analyses revealed that increased high-frequency heart rate variability during slow wave sleep was associated with stronger functional connectivity (F = 3.98, P = 0.022) in two core brain regions within the central autonomic network, the right anterior insular and posterior midcingulate cortex, as well as stronger functional connectivity (F = 6.21, P = 0.005) between broader central autonomic network brain regions-the right amygdala with three sub-nuclei of the thalamus. There were no significant associations between high-frequency heart rate variability and central autonomic network connectivity during wake after sleep onset or rapid eye movement sleep. These findings show that in older adults 'at-risk' of dementia, parasympathetic regulation during slow wave sleep is uniquely linked to differential functional connectivity within both core and broader central autonomic network brain regions. It is possible that dysfunctional brain-heart interactions manifest primarily during this specific period of sleep known for its role in memory and metabolic clearance. Further studies elucidating the pathophysiology and directionality of this relationship should be conducted to determine if heart rate variability drives neurodegeneration, or if brain degeneration within the central autonomic network promotes aberrant heart rate variability.
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Affiliation(s)
- Shawn D X Kong
- Correspondence to: Shawn Dexiao KongHealthy Brain Ageing ProgramBrain and Mind Centre, University of Sydney100 Mallett St, Camperdown, NSW 2050, Australia E-mail:
| | - Christopher J Gordon
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW 2037, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
| | - Camilla M Hoyos
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW 2050, Australia
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW 2050, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW 2037, Australia
| | - Rick Wassing
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW 2037, Australia
| | - Angela D’Rozario
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW 2050, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW 2037, Australia
| | - Loren Mowszowski
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW 2050, Australia
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW 2050, Australia
| | - Catriona Ireland
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
| | - Jake R Palmer
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
| | - Ronald R Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW 2037, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
- Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW 2050, Australia
| | - James M Shine
- Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW 2050, Australia
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24
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Gallagher R, Ouyang ML, Tofler G, Bauman A, Zhao E, Weddell J, Naismith SL. Sensitivity and specificity of 5 min cognitive screening tests in patients with acute coronary syndrome. Eur J Cardiovasc Nurs 2023; 22:166-174. [PMID: 35714164 DOI: 10.1093/eurjcn/zvac026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 11/12/2022]
Abstract
AIMS This study aimed to determine the sensitivity and specificity of the National Institute of Neurological Disorders and Stroke (NINDS) and the Canadian Stroke Network (CSN) brief (5 min) screen composed of three items of the Montreal Cognitive Assessment (MoCA), in acute coronary syndrome (ACS) patients during hospital admission, relative to the full MoCA and potential alternative combinations of other items. METHODS AND RESULTS Participants were consecutively recruited during ACS admission and administered the MoCA before discharge. The three NINDS-CSN screen items were extracted, collated and compared to the full MoCA. Receiver operator characteristic (ROC) curves were created to determine the sensitivity, specificity, and appropriate cut-off scores of the screens. The mean age of the sample (n = 81) was 63.49 [standard deviation (SD) 10.85] years and 49.4% screened positive for cognitive impairment. The NINDS-CSN mean score was 9.22 (SD 2.09 of the potential range 0-12). Area under the ROC (AUC) indicated high accuracy levels for screening for cognitive impairment (AUC = 0.89, P < 0.01, 95% confidence interval 0.82, 0.96) with none of the alternative combination screens performing better on both sensitivity and specificity. A cut-off score of ≤10 on the NINDS-CSN protocol provided 83% sensitivity and 80% specificity for classifying cognitive impairment. CONCLUSION The NINDS-CSN protocol presents an accurate, feasible screen for cognitive impairment in patients following ACS for use at the bedside and potentially also for telephone screens. Diagnostic accuracy should be confirmed using a neurocognitive battery.
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Affiliation(s)
- Robyn Gallagher
- Faculty of Medicine and Health, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia.,Charles Perkins Centre, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia
| | - Meng-Lu Ouyang
- Neurological Program, The George Institute for Global Health, City Road, Darlington, Sydney, NSW 2008, Australia
| | - Geoffrey Tofler
- Faculty of Medicine and Health, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia.,Department of Cardiology, Royal North Shore Hospital, Reserve Road St Leonards, Sydney, NSW 2065, Australia
| | - Adrian Bauman
- Faculty of Medicine and Health, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia.,Charles Perkins Centre, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia
| | - Emma Zhao
- Faculty of Medicine and Health, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia.,Charles Perkins Centre, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia
| | - Joseph Weddell
- Faculty of Medicine and Health, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia.,Charles Perkins Centre, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia
| | - Sharon L Naismith
- Charles Perkins Centre, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia.,Faculty of Science, The University of Sydney, Camperdown Campus, Sydney, NSW 2006, Australia.,Brain & Mind Centre, The University of Sydney, Mallet Street Campus, Sydney, NSW 2006, Australia
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25
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Wee J, Sukudom S, Bhat S, Marklund M, Peiris NJ, Hoyos CM, Patel S, Naismith SL, Dwivedi G, Misra A. The relationship between midlife dyslipidemia and lifetime incidence of dementia: A systematic review and meta-analysis of cohort studies. Alzheimers Dement (Amst) 2023; 15:e12395. [PMID: 36911359 PMCID: PMC9993469 DOI: 10.1002/dad2.12395] [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: 08/19/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 03/14/2023]
Abstract
Introduction We conducted a systematic review and meta-analysis to review the relationship between midlife dyslipidemia and lifetime incident dementia. Methods The databases Medline, Embase, Scopus, Web of Science, and Cochrane were searched from inception to February 20, 2022. Longitudinal studies examining the relationship between midlife lipid levels on dementia, dementia subtypes, and/or cognitive impairment were pooled using inverse-variance weighted random-effects meta-analysis. Results Seventeen studies (1.2 million participants) were included. Midlife hypercholesterolemia was associated with increased incidence of mild cognitive impairment (effect size [ES] = 2.01; 95% confidence interval [CI] 1.19 to 2.84; I2 = 0.0%) and all-cause dementia (ES = 1.14; 95% CI: 1.07 to 1.21; I2 = 0.0%). Each 1 mmol/L increase in low-density lipoprotein was associated with an 8% increase (ES = 1.08, 95% CI: 1.03 to 1.14; I2 = 0.3%) in incidence of all-cause dementia. Discussion Midlife dyslipidemia is associated with an increased risk of cognitive impairment in later life.
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Affiliation(s)
- Jason Wee
- Fiona Stanley Hospital South Metropolitan Health Service Perth Western Australia Australia
| | - Sara Sukudom
- University of Western Australia Perth Western Australia Australia.,Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Saiuj Bhat
- Royal Perth Hospital Perth Western Australia Australia
| | - Matti Marklund
- The George Institute for Global Health University of New South Wales Sydney New South Wales Australia.,Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA.,Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden
| | - Niridu Jude Peiris
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Camilla M Hoyos
- Faculty of Science and School of Psychology and Centre for Sleep and Chronobiology Woolcock Institute of Medical Research The University of Sydney Sydney New South Wales Australia
| | - Sanjay Patel
- Heart Research Institute Sydney New South Wales Australia
| | - Sharon L Naismith
- Faculty of Science and School of Psychology Charles Perkins Centre University of Sydney Sydney New South Wales Australia
| | - Girish Dwivedi
- University of Western Australia Perth Western Australia Australia
| | - Ashish Misra
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia.,Heart Research Institute Sydney New South Wales Australia
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26
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Naismith SL, Michaelian JC, Santos C, Mehrani I, Robertson J, Wallis K, Lin X, Ward SA, Martins R, Masters CL, Breakspear M, Ahern S, Fripp J, Schofield PR, Sachdev PS, Rowe CC. Tackling Dementia Together via The Australian Dementia Network (ADNeT): A Summary of Initiatives, Progress and Plans. J Alzheimers Dis 2023; 96:913-925. [PMID: 37927266 PMCID: PMC10741334 DOI: 10.3233/jad-230854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 11/07/2023]
Abstract
In 2018, the Australian Dementia Network (ADNeT) was established to bring together Australia's leading dementia researchers, people with living experience and clinicians to transform research and clinical care in the field. To address dementia diagnosis, treatment, and care, ADNeT has established three core initiatives: the Clinical Quality Registry (CQR), Memory Clinics, and Screening for Trials. Collectively, the initiatives have developed an integrated clinical and research community, driving practice excellence in this field, leading to novel innovations in diagnostics, clinical care, professional development, quality and harmonization of healthcare, clinical trials, and translation of research into practice. Australia now has a national Registry for Mild Cognitive Impairment and dementia with 55 participating clinical sites, an extensive map of memory clinic services, national Memory and Cognition Clinic Guidelines and specialized screening for trials sites in five states. This paper provides an overview of ADNeT's achievements to date and future directions. With the increase in dementia cases expected over coming decades, and with recent advances in plasma biomarkers and amyloid lowering therapies, the nationally coordinated initiatives and partnerships ADNeT has established are critical for increased national prevention efforts, co-ordinated implementation of emerging treatments for Alzheimer's disease, innovation of early and accurate diagnosis, driving continuous improvements in clinical care and patient outcome and access to post-diagnostic support and clinical trials. For a heterogenous disorder such as dementia, which is now the second leading cause of death in Australia following cardiovascular disease, the case for adequate investment into research and development has grown even more compelling.
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Affiliation(s)
- Sharon L. Naismith
- Healthy Brain Ageing Program, School of Psychology, Charles Perkins Centre and the Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Johannes C. Michaelian
- Healthy Brain Ageing Program, School of Psychology, Charles Perkins Centre and the Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Cherry Santos
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Inga Mehrani
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Joanne Robertson
- The Florey Institute, The University of Melbourne, Parkville, Victoria, Australia
| | - Kasey Wallis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Xiaoping Lin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stephanie A. Ward
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Geriatric Medicine, The Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Ralph Martins
- School of Medical Sciences, Edith Cowan University, Perth, Western Australia, Australia and Department of Biomedical Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Colin L. Masters
- The Florey Institute, The University of Melbourne, Parkville, Victoria, Australia
| | - Michael Breakspear
- School of Psychology, College of Engineering, Science and the Environment, University of Newcastle, New South Wales, Australia and School of Medicine and Public Health, College of Health and Medicine, University of Newcastle, New South Wales, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jurgen Fripp
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Queensland, Australia
| | - Peter R. Schofield
- Neuroscience Research Australia, Sydney, Australia and School of Biomedical Sciences, University of New South Wales, Sydney, Australia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Christopher C. Rowe
- The University of Melbourne, Melbourne, Victoria, Australia
- The Florey Institute, The University of Melbourne, Parkville, Victoria, Australia
- Department of Molecular Imaging and Therapy, Austin Health, The University of Melbourne, Victoria, Australia
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27
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DeMayo MM, Lv J, Duffy SL, D'Souza A, Mowszowski L, Naismith SL, Calamante F. Hippocampal Neuronal Integrity and Functional Connectivity Within the Default Mode Network in Mild Cognitive Impairment: A Multimodal Investigation. Brain Connect 2022; 13:143-153. [PMID: 36367166 DOI: 10.1089/brain.2022.0050] [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: 11/13/2022] Open
Abstract
Background: In older people with mild cognitive impairment (MCI), the relationship between early changes in functional connectivity and in vivo changes in key neurometabolites is not known. Two established correlates of MCI diagnosis are decreased N-acetylaspartate (NAA) in the hippocampus, indicative of decreased neuronal integrity, and changes in the default mode network (DMN) functional network. If and how these measures interrelate is yet to be established, and such understanding may provide insight into the processes underpinning observed cognitive decline. Objectives: To determine the relationship between NAA levels in the left hippocampus and functional connectivity within the DMN in an aging cohort. Methods: In a sample of 51 participants with MCI and 30 controls, hippocampal NAA was determined using magnetic resonance spectroscopy, and DMN connectivity was quantified using resting-state functional MRI. The association between hippocampal NAA and the DMN functional connectivity was tested within the MCI group and separately within the control group. Results: In the DMN, we showed a significant inverse association between functional connectivity and hippocampal NAA in 20 specific brain connections for patients with MCI. This was despite no evidence of any associations in the healthy control group or group differences in either of these measures alone. Conclusions: This study suggests that decreased neuronal integrity in the hippocampus is associated with functional change within the DMN for those with MCI, in contrast to healthy older adults. These results highlight the potential of multimodal investigations to better understand the processes associated with cognitive decline. Impact statement This study measured activity within the default mode network (DMN) and quantified N-acetylaspartate (NAA), a measure of neuronal integrity, within the hippocampus in participants with mild cognitive impairment (MCI) and healthy controls. In participants with MCI, NAA levels were inversely associated with connectivity between specific regions of the DMN, a relationship not evident in healthy controls. This association was present even in the absence of group differences in DMN connectivity or NAA levels. This research illustrates the possibility of using multiple magnetic resonance modalities for more sensitive measures of early cognitive decline to identify and intervene earlier.
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Affiliation(s)
- Marilena M DeMayo
- School of Biomedical Engineering, The University of Sydney, Sydney, Australia.,Brain and Mind Center, The University of Sydney, Sydney, Australia
| | - Jinglei Lv
- School of Biomedical Engineering, The University of Sydney, Sydney, Australia.,Brain and Mind Center, The University of Sydney, Sydney, Australia
| | - Shantel L Duffy
- Healthy Brain Aging Program, Brain and Mind Center, The University of Sydney, Sydney, Australia
| | - Arkiev D'Souza
- Brain and Mind Center, The University of Sydney, Sydney, Australia.,Sydney Imaging, The University of Sydney, Sydney, Australia
| | - Loren Mowszowski
- Healthy Brain Aging Program, Brain and Mind Center, The University of Sydney, Sydney, Australia.,School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Sharon L Naismith
- Healthy Brain Aging Program, Brain and Mind Center, The University of Sydney, Sydney, Australia.,School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia.,Charles Perkins Center, The University of Sydney, Sydney, Australia
| | - Fernando Calamante
- School of Biomedical Engineering, The University of Sydney, Sydney, Australia.,Brain and Mind Center, The University of Sydney, Sydney, Australia.,Sydney Imaging, The University of Sydney, Sydney, Australia
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28
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Michaelian JC, McCade D, Hoyos CM, Brodaty H, Harrison F, Henry JD, Guastella AJ, Naismith SL. Pilot Randomised, Double‐Blind, Placebo‐Controlled Crossover Trial Evaluating the Feasibility of an Intranasal Oxytocin in Improving Social Cognition in Individuals Living with Alzheimer’s Disease. Alzheimers Dement 2022. [DOI: 10.1002/alz.064386] [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)
- Johannes C Michaelian
- Charles Perkins Centre, University of Sydney Sydney NSW Australia
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney Sydney NSW Australia
- School of Psychology, University of Sydney Sydney NSW Australia
| | - Donna McCade
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney Sydney NSW Australia
| | - Camilla M Hoyos
- Charles Perkins Centre, University of Sydney Sydney NSW Australia
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney Sydney NSW Australia
- Woolcock Institute of Medical Research, University of Sydney Sydney NSW Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), UNSW Sydney Sydney NSW Australia
- UNSW Sydney Sydney NSW Australia
| | | | | | | | - Sharon L Naismith
- Charles Perkins Centre, University of Sydney Sydney NSW Australia
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney Sydney NSW Australia
- University of Sydney Sydney NSW Australia
- School of Psychology, Faculty of Science, University of Sydney Sydney NSW Australia
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29
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Naismith SL, Leng Y, Palmer JR, Lucey BP. Age differences in the association between sleep and Alzheimer's disease biomarkers in the EPAD cohort. Alzheimers Dement (Amst) 2022; 14:e12380. [PMID: 36447477 PMCID: PMC9695753 DOI: 10.1002/dad2.12380] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 11/26/2022]
Abstract
Introduction We aimed to determine the independent association between sleep quality and Alzheimer's disease (AD) biomarkers, and whether the associations differ with age. Methods We included 1240 individuals aged ≥50, without dementia from the European Prevention of Alzheimer's Disease v1500.0 dataset. Linear regression was used to examine Pittsburgh Sleep Quality Index (PSQI) scores against cerebrospinal fluid (CSF) phosphorylated tau/β-amyloid ratio (p-tau/Aβ42) for the entire sample and via age tertiles. Models controlled for demographic, clinical, genetic, vascular, and neuroimaging variables. Results For the youngest age tertile, shorter sleep duration and higher sleep efficiency were associated with greater p-tau/Aβ42 ratio. For the oldest tertile, longer sleep latency was associated with greater p-tau/Aβ42. Discussion Differential relationships between sleep and AD pathology depend on age. Short sleep duration and sleep efficiency are relevant in middle age whereas time taken to fall asleep is more closely linked to AD biomarkers in later life. Highlights This study shows age differences in the link between sleep and AD biomarkers.Shorter sleep was associated with greater p-tau/Aβ42 ratio in middle age.The association was independent of genetic, vascular, and neuroimaging markers of AD.
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Affiliation(s)
- Sharon L. Naismith
- School of PsychologyFaculty of ScienceThe University of SydneySydneyNew South WalesAustralia,CogSleep NHMRC Centre of Research ExcellenceThe University of SydneySydneyNew South WalesAustralia,Brain and Mind Centre and Charles Perkins CentreThe University of SydneySydneyNew South WalesAustralia
| | - Yue Leng
- Department of Psychiatry and Behavioural SciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Jake R. Palmer
- School of PsychologyFaculty of ScienceThe University of SydneySydneyNew South WalesAustralia,CogSleep NHMRC Centre of Research ExcellenceThe University of SydneySydneyNew South WalesAustralia,Brain and Mind Centre and Charles Perkins CentreThe University of SydneySydneyNew South WalesAustralia
| | - Brendan P. Lucey
- Department of NeurologyWashington University School of MedicineSt LouisMissouriUSA
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30
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Menczel Schrire Z, Gordon CJ, Palmer JR, Murray J, Hickie I, Rogers NL, Lewis SJG, Terpening Z, Pye JE, Naismith SL, Hoyos CM. Actigraphic and melatonin alignment in older adults with varying dementia risk. Chronobiol Int 2022; 40:91-102. [PMID: 36408793 DOI: 10.1080/07420528.2022.2144744] [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: 11/22/2022]
Abstract
Circadian rhythms alter with ageing and may be aetiologically linked to neurodegeneration. This study explored the association between clinical markers and 1) dim light melatonin onset (DLMO) time and 2) phase angle derived from sleep midpoint, in older adults with varying dementia risks. Participants completed 14 days of actigraphy followed by in-lab measurement of salivary melatonin, from which DLMO time and phase angle were computed. Eighty participants (age = 65.5, SD = 9.6), 44 males (55%), MMSE (28.6, SD = 1.5) were included in the analysis. Sex (t = 2.15, p = .04), sleep onset (r = 0.49, p < .001) and midpoint (r = 0.44, p < .001) also correlated with DLMO time. Multiple linear regression showed chronotype, average actigraphy-derived light exposure during the DLMO window (window 2 h prior to DLMO to 2 h post), early biological day (6-10 h post DLMO time) and late biological day (10-14 h post DLMO time) were predictive of DLMO time (adjusted R2 = 0.75). Sleep offset, depression severity, average light exposure during the early biological night and early and late biological day were shown to be predictive variables in the estimation of phase angle (adjusted R2 = 0.78). The current study highlights the potential use of clinical variables, such as actigraphy-derived light, as circadian markers in ageing which could be easily implemented into existing clinical practice and could yield potential targets focusing on chronotherapeutic interventions.
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Affiliation(s)
- Zoe Menczel Schrire
- School of Psychology, Faculty of Science, Healthy Brain Ageing Program, the University of Sydney, Sydney, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, the University of Sydney, Sydney, Australia
- Brain & Mind Centre, the University of Sydney, Sydney, Australia
| | - Christopher J Gordon
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, the University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, the University of Sydney, Sydney, Australia
| | - Jake R Palmer
- School of Psychology, Faculty of Science, Healthy Brain Ageing Program, the University of Sydney, Sydney, Australia
- Brain & Mind Centre, the University of Sydney, Sydney, Australia
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Jade Murray
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia
| | - Ian Hickie
- School of Psychology, Faculty of Science, Healthy Brain Ageing Program, the University of Sydney, Sydney, Australia
- Brain & Mind Centre, the University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, the University of Sydney, Sydney, Australia
| | - Naomi L. Rogers
- Brain & Mind Centre, the University of Sydney, Sydney, Australia
| | - Simon JG Lewis
- Brain & Mind Centre, the University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, the University of Sydney, Sydney, Australia
| | - Zoe Terpening
- School of Psychology, Faculty of Science, Healthy Brain Ageing Program, the University of Sydney, Sydney, Australia
| | - Jonathon E Pye
- Faculty of Medicine and Health, the University of Sydney, Sydney, Australia
| | - Sharon L Naismith
- School of Psychology, Faculty of Science, Healthy Brain Ageing Program, the University of Sydney, Sydney, Australia
- Brain & Mind Centre, the University of Sydney, Sydney, Australia
| | - Camilla M Hoyos
- School of Psychology, Faculty of Science, Healthy Brain Ageing Program, the University of Sydney, Sydney, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, the University of Sydney, Sydney, Australia
- Brain & Mind Centre, the University of Sydney, Sydney, Australia
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31
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Del Pozo Cruz B, Ahmadi M, Naismith SL, Stamatakis E. Association of Daily Step Count and Intensity With Incident Dementia in 78 430 Adults Living in the UK. JAMA Neurol 2022; 79:1059-1063. [PMID: 36066874 PMCID: PMC9449869 DOI: 10.1001/jamaneurol.2022.2672] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Step-based recommendations may be appropriate for dementia-prevention guidelines. However, the association of step count and intensity with dementia incidence is unknown. Objective To examine the dose-response association between daily step count and intensity and incidence of all-cause dementia among adults in the UK. Design, Setting, and Participants UK Biobank prospective population-based cohort study (February 2013 to December 2015) with 6.9 years of follow-up (data analysis conducted May 2022). A total of 78 430 of 103 684 eligible adults aged 40 to 79 years with valid wrist accelerometer data were included. Registry-based dementia was ascertained through October 2021. Exposures Accelerometer-derived daily step count, incidental steps (less than 40 steps per minute), purposeful steps (40 steps per minute or more), and peak 30-minute cadence (ie, mean steps per minute recorded for the 30 highest, not necessarily consecutive, minutes in a day). Main Outcomes and Measures Incident dementia (fatal and nonfatal), obtained through linkage with inpatient hospitalization or primary care records or recorded as the underlying or contributory cause of death in death registers. Spline Cox regressions were used to assess dose-response associations. Results The study monitored 78 430 adults (mean [SD] age, 61.1 [7.9] years; 35 040 [44.7%] male and 43 390 [55.3%] female; 881 [1.1%] were Asian, 641 [0.8%] were Black, 427 [0.5%] were of mixed race, 75 852 [96.7%] were White, and 629 [0.8%] were of another, unspecified race) over a median (IQR) follow-up of 6.9 (6.4-7.5) years, 866 of whom developed dementia (mean [SD] age, 68.3 [5.6] years; 480 [55.4%] male and 386 [54.6%] female; 5 [0.6%] Asian, 6 [0.7%] Black, 4 [0.4%] mixed race, 821 [97.6%] White, and 6 [0.7%] other). Analyses revealed nonlinear associations between daily steps. The optimal dose (ie, exposure value at which the maximum risk reduction was observed) was 9826 steps (hazard ratio [HR], 0.49; 95% CI, 0.39-0.62) and the minimal dose (ie, exposure value at which the risk reduction was 50% of the observed maximum risk reduction) was 3826 steps (HR, 0.75; 95% CI, 0.67-0.83). The incidental cadence optimal dose was 3677 steps (HR, 0.58; 95% CI, 0.44-0.72); purposeful cadence optimal dose was 6315 steps (HR, 0.43; 95% CI, 0.32-0.58); and peak 30-minute cadence optimal dose was 112 steps per minute (HR, 0.38; 95% CI, 0.24-0.60). Conclusions and Relevance In this cohort study, a higher number of steps was associated with lower risk of all-cause dementia. The findings suggest that a dose of just under 10 000 steps per day may be optimally associated with a lower risk of dementia. Steps performed at higher intensity resulted in stronger associations.
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Affiliation(s)
- Borja Del Pozo Cruz
- Department of Sports Science and Clinical Biomechanics, Centre for Active and Healthy Ageing, University of Southern Denmark, Odense, Denmark
| | - Matthew Ahmadi
- Charles Perkins Centre, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sharon L Naismith
- Charles Perkins Centre, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
| | - Emmanuel Stamatakis
- Charles Perkins Centre, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia
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Pun TB, Phillips CL, Marshall NS, Comas M, Hoyos CM, D’Rozario AL, Bartlett DJ, Davis W, Hu W, Naismith SL, Cain S, Postnova S, Grunstein RR, Gordon CJ. The Effect of Light Therapy on Electroencephalographic Sleep in Sleep and Circadian Rhythm Disorders: A Scoping Review. Clocks Sleep 2022; 4:358-373. [PMID: 35997384 PMCID: PMC9397048 DOI: 10.3390/clockssleep4030030] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/21/2022] [Accepted: 08/02/2022] [Indexed: 01/27/2023] Open
Abstract
Light therapy is used to treat sleep and circadian rhythm disorders, yet there are limited studies on whether light therapy impacts electroencephalographic (EEG) activity during sleep. Therefore, we aimed to provide an overview of research studies that examined the effects of light therapy on sleep macro- and micro-architecture in populations with sleep and circadian rhythm disorders. We searched for randomized controlled trials that used light therapy and included EEG sleep measures using MEDLINE, PubMed, CINAHL, PsycINFO and Cochrane Central Register of Controlled Trials databases. Five articles met the inclusion criteria of patients with either insomnia or delayed sleep−wake phase disorder (DSWPD). These trials reported sleep macro-architecture outcomes using EEG or polysomnography. Three insomnia trials showed no effect of the timing or intensity of light therapy on total sleep time, wake after sleep onset, sleep efficiency and sleep stage duration compared to controls. Only one insomnia trial reported significantly higher sleep efficiency after evening light therapy (>4000 lx between 21:00−23:00 h) compared with afternoon light therapy (>4000 lx between 15:00−17:00 h). In the only DSWPD trial, six multiple sleep latency tests were conducted across the day (09:00 and 19:00 h) and bright light (2500 lx) significantly lengthened sleep latency in the morning (09:00 and 11:00 h) compared to control light (300 lx). None of the five trials reported any sleep micro-architecture measures. Overall, there was limited research about the effect of light therapy on EEG sleep measures, and studies were confined to patients with insomnia and DSWPD only. More research is needed to better understand whether lighting interventions in clinical populations affect sleep macro- and micro-architecture and objective sleep timing and quality.
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Affiliation(s)
- Teha B. Pun
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
| | - Craig L. Phillips
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Nathaniel S. Marshall
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
| | - Maria Comas
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
| | - Camilla M. Hoyos
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW 2050, Australia
| | - Angela L. D’Rozario
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW 2050, Australia
| | - Delwyn J. Bartlett
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
| | - Wendy Davis
- School of Architecture, Design and Planning, The University of Sydney, Sydney, NSW 2008, Australia
| | - Wenye Hu
- School of Architecture, Design and Planning, The University of Sydney, Sydney, NSW 2008, Australia
| | - Sharon L. Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW 2050, Australia
| | - Sean Cain
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC 3800, Australia
| | - Svetlana Postnova
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
- School of Physics, Faculty of Science, The University of Sydney, Sydney, NSW 2006, Australia
| | - Ron R. Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
- Sleep and Severe Mental Illness Clinic, CPC-RPA Clinic, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Christopher J. Gordon
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
- Correspondence: ; Tel.: +61-2-9351-0586
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Woodward M, Brodaty H, McCabe M, Masters CL, Naismith SL, Morris P, Rowe CC, Walker P, Yates M. Nationally Informed Recommendations on Approaching the Detection, Assessment, and Management of Mild Cognitive Impairment. J Alzheimers Dis 2022; 89:803-809. [PMID: 35964184 PMCID: PMC9535556 DOI: 10.3233/jad-220288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prior to the usual clinical symptoms of dementia, there can be subtle changes in cognitive function that differ from the normal age-related cognitive decline, which has been termed mild cognitive impairment (MCI). The increase in the numbers of individuals with possible MCI presenting to health care professionals, notably, General Practitioners (GPs), is going to rise dramatically in the coming years. With ever increasing demands on GPs, it is therefore timely to provide information that can be accessed by health care professionals to assist them in making appropriate diagnoses and to provide the most relevant, evidence-based treatment options. We have provided a comprehensive list of recommendations that aim to address key aspects of MCI in primary care. Specifically, these relate to detection and diagnosis; sharing the diagnosis, monitoring, and follow up; practical interventions to potentially delay progression; and personalizing care—planning, engagement, and patient motivation for the long term.
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Affiliation(s)
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia
| | - Maree McCabe
- Dementia Australia, Parkville, Victoria, Australia
| | - Colin L Masters
- Florey Institute and The University of Melbourne, Victoria, Australia
| | - Sharon L Naismith
- School of Psychology, The University of Sydney, New South Wales, Australia
| | - Philip Morris
- Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - Christopher C Rowe
- Austin Health, University of Melbourne, Victoria, Australia.,Florey Institute and The University of Melbourne, Victoria, Australia
| | | | - Mark Yates
- Grampians Health, Deakin University, Victoria, Australia
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Alty J, Bai Q, Li R, Lawler K, St George RJ, Hill E, Bindoff A, Garg S, Wang X, Huang G, Zhang K, Rudd KD, Bartlett L, Goldberg LR, Collins JM, Hinder MR, Naismith SL, Hogg DC, King AE, Vickers JC. The TAS Test project: a prospective longitudinal validation of new online motor-cognitive tests to detect preclinical Alzheimer's disease and estimate 5-year risks of cognitive decline and dementia. BMC Neurol 2022; 22:266. [PMID: 35850660 PMCID: PMC9289357 DOI: 10.1186/s12883-022-02772-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The worldwide prevalence of dementia is rapidly rising. Alzheimer's disease (AD), accounts for 70% of cases and has a 10-20-year preclinical period, when brain pathology covertly progresses before cognitive symptoms appear. The 2020 Lancet Commission estimates that 40% of dementia cases could be prevented by modifying lifestyle/medical risk factors. To optimise dementia prevention effectiveness, there is urgent need to identify individuals with preclinical AD for targeted risk reduction. Current preclinical AD tests are too invasive, specialist or costly for population-level assessments. We have developed a new online test, TAS Test, that assesses a range of motor-cognitive functions and has capacity to be delivered at significant scale. TAS Test combines two innovations: using hand movement analysis to detect preclinical AD, and computer-human interface technologies to enable robust 'self-testing' data collection. The aims are to validate TAS Test to [1] identify preclinical AD, and [2] predict risk of cognitive decline and AD dementia. METHODS Aim 1 will be addressed through a cross-sectional study of 500 cognitively healthy older adults, who will complete TAS Test items comprising measures of motor control, processing speed, attention, visuospatial ability, memory and language. TAS Test measures will be compared to a blood-based AD biomarker, phosphorylated tau 181 (p-tau181). Aim 2 will be addressed through a 5-year prospective cohort study of 10,000 older adults. Participants will complete TAS Test annually and subtests of the Cambridge Neuropsychological Test Battery (CANTAB) biennially. 300 participants will undergo in-person clinical assessments. We will use machine learning of motor-cognitive performance on TAS Test to develop an algorithm that classifies preclinical AD risk (p-tau181-defined) and determine the precision to prospectively estimate 5-year risks of cognitive decline and AD. DISCUSSION This study will establish the precision of TAS Test to identify preclinical AD and estimate risk of cognitive decline and AD. If accurate, TAS Test will provide a low-cost, accessible enrichment strategy to pre-screen individuals for their likelihood of AD pathology prior to more expensive tests such as blood or imaging biomarkers. This would have wide applications in public health initiatives and clinical trials. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05194787 , 18 January 2022. Retrospectively registered.
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Affiliation(s)
- Jane Alty
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia. .,School of Medicine, University of Tasmania, Hobart, Australia. .,Royal Hobart Hospital, Hobart, Tasmania, Australia.
| | - Quan Bai
- School of Information and Communication Technologies, University of Tasmania, Hobart, Australia
| | - Renjie Li
- School of Information and Communication Technologies, University of Tasmania, Hobart, Australia
| | - Katherine Lawler
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia.,Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Rebecca J St George
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia.,School of Psychological Sciences, University of Tasmania, Hobart, Australia
| | - Edward Hill
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Aidan Bindoff
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Saurabh Garg
- School of Information and Communication Technologies, University of Tasmania, Hobart, Australia
| | - Xinyi Wang
- School of Information and Communication Technologies, University of Tasmania, Hobart, Australia
| | - Guan Huang
- School of Information and Communication Technologies, University of Tasmania, Hobart, Australia
| | - Kaining Zhang
- School of Information and Communication Technologies, University of Tasmania, Hobart, Australia
| | - Kaylee D Rudd
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Larissa Bartlett
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Lynette R Goldberg
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Jessica M Collins
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Mark R Hinder
- School of Psychological Sciences, University of Tasmania, Hobart, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, University of Sydney, Sydney, Australia
| | - David C Hogg
- School of Computing, University of Leeds, Leeds, UK
| | - Anna E King
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - James C Vickers
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
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Naismith SL, Michaelian JC, Low LF, Arsenova V, Mehrani I, Fyfe K, Kochan NA, Kurrle SE, Rowe C, Sachdev PS. Characterising Australian memory clinics: current practice and service needs informing national service guidelines. BMC Geriatr 2022; 22:578. [PMID: 35836238 PMCID: PMC9281346 DOI: 10.1186/s12877-022-03253-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 06/03/2022] [Indexed: 11/22/2022] Open
Abstract
Background Memory clinics (MCs) play a key role in accurate and timely diagnoses and treatment of dementia and mild cognitive impairment. However, within Australia, there are little data available on current practices in MCs, which hinder international comparisons for best practice, harmonisation efforts and national coordination. Here, we aimed to characterise current service profiles of Australian MCs. Methods The ‘Australian Dementia Network Survey of Expert Opinion on Best Practice and the Current Clinical Landscape’ was conducted between August-September 2020 as part of a larger-scale Delphi process deployed to develop national MC guidelines. In this study, we report on the subset of questions pertaining to current practice including wait-times and post-diagnostic care. Results Responses were received from 100 health professionals representing 60 separate clinics (45 public, 11 private, and 4 university/research clinics). The majority of participants were from clinics in metropolitan areas (79%) and in general were from high socioeconomic areas. While wait-times varied, only 28.3% of clinics were able to offer an appointment within 1-2 weeks for urgent referrals, with significantly more private clinics (58.3%) compared to public clinics (19.5%) being able to do so. Wait-times were less than 8 weeks for 34.5% of non-urgent referrals. Only 20.0 and 30.9% of clinics provided cognitive interventions or post-diagnostic support respectively, with 7.3% offering home-based reablement programs, and only 12.7% offering access to group-based education. Metropolitan clinics utilised neuropsychological assessments for a broader range of cases and were more likely to offer clinical trials and access to research opportunities. Conclusions In comparison to similar countries with comprehensive government-funded public healthcare systems (i.e., United Kingdom, Ireland and Canada), wait-times for Australian MCs are long, and post-diagnostic support or evidence-based strategies targeting cognition are not common practice. The timely and important results of this study highlight a need for Australian MCs to adopt a more holistic service of multidisciplinary assessment and post-diagnostic support, as well as the need for the number of Australian MCs to be increased to match the rising number of dementia cases. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03253-7.
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Affiliation(s)
- Sharon L Naismith
- School of Psychology, Charles Perkins Centre and the Brain and Mind Centre, University of Sydney, Sydney, Australia. .,Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
| | - Johannes C Michaelian
- School of Psychology, Charles Perkins Centre and the Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Lee-Fay Low
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Valerie Arsenova
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Inga Mehrani
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Katrina Fyfe
- School of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Susan E Kurrle
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Christopher Rowe
- Department of Molecular Imaging and Therapy, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, Australia
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Carpenter JS, Scott J, Iorfino F, Crouse JJ, Ho N, Hermens DF, Cross SPM, Naismith SL, Guastella AJ, Scott EM, Hickie IB. Predicting the emergence of full-threshold bipolar I, bipolar II and psychotic disorders in young people presenting to early intervention mental health services. Psychol Med 2022; 52:1990-2000. [PMID: 33121545 DOI: 10.1017/s0033291720003840] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Predictors of new-onset bipolar disorder (BD) or psychotic disorder (PD) have been proposed on the basis of retrospective or prospective studies of 'at-risk' cohorts. Few studies have compared concurrently or longitudinally factors associated with the onset of BD or PDs in youth presenting to early intervention services. We aimed to identify clinical predictors of the onset of full-threshold (FT) BD or PD in this population. METHOD Multi-state Markov modelling was used to assess the relationships between baseline characteristics and the likelihood of the onset of FT BD or PD in youth (aged 12-30) presenting to mental health services. RESULTS Of 2330 individuals assessed longitudinally, 4.3% (n = 100) met criteria for new-onset FT BD and 2.2% (n = 51) met criteria for a new-onset FT PD. The emergence of FT BD was associated with older age, lower social and occupational functioning, mania-like experiences (MLE), suicide attempts, reduced incidence of physical illness, childhood-onset depression, and childhood-onset anxiety. The emergence of a PD was associated with older age, male sex, psychosis-like experiences (PLE), suicide attempts, stimulant use, and childhood-onset depression. CONCLUSIONS Identifying risk factors for the onset of either BD or PDs in young people presenting to early intervention services is assisted not only by the increased focus on MLE and PLE, but also by recognising the predictive significance of poorer social function, childhood-onset anxiety and mood disorders, and suicide attempts prior to the time of entry to services. Secondary prevention may be enhanced by greater attention to those risk factors that are modifiable or shared by both illness trajectories.
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Affiliation(s)
- Joanne S Carpenter
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
| | - Jan Scott
- Department of Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, England
- Diderot University, Sorbonne City, Paris, France
| | - Frank Iorfino
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
| | - Jacob J Crouse
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
| | - Nicholas Ho
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
| | - Daniel F Hermens
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
- Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Shane P M Cross
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
- School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sharon L Naismith
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
- School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Adam J Guastella
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
| | - Elizabeth M Scott
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
- School of Medicine, University of Notre Dame, Sydney, Australia
| | - Ian B Hickie
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
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D'Rozario AL, Hoyos CM, Wong KKH, Unger G, Kim JW, Vakulin A, Kao CH, Naismith SL, Bartlett DJ, Grunstein RR. Improvements in cognitive function and quantitative sleep electroencephalogram in obstructive sleep apnea after six months of continuous positive airway pressure treatment. Sleep 2022; 45:6507350. [PMID: 35029691 PMCID: PMC9189957 DOI: 10.1093/sleep/zsac013] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Untreated obstructive sleep apnea (OSA) is associated with cognitive deficits and altered brain electrophysiology. We evaluated the effect of continuous positive airway pressure (CPAP) treatment on quantitative sleep electroencephalogram (EEG) measures and cognitive function. METHODS We studied 167 patients with OSA (age 50 ± 13, AHI 35.0 ± 26.8) before and after 6 months of CPAP. Cognitive tests assessed working memory, sustained attention, visuospatial scanning, and executive function. All participants underwent overnight polysomnography at baseline and after CPAP. Power spectral analysis was performed on EEG data (C3-M2) in a sub-set of 90 participants. Relative delta EEG power and sigma power in NREM and EEG slowing in REM were calculated. Spindle densities (events/min) in N2 were also derived using automated spindle event detection. All outcomes were analysed as change from baseline. RESULTS Cognitive function across all cognitive domains improved after six months of CPAP. In our sub-set, increased relative delta power (p < .0001) and reduced sigma power (p = .001) during NREM were observed after the 6-month treatment period. Overall, fast and slow sleep spindle densities during N2 were increased after treatment. CONCLUSIONS Cognitive performance was improved and sleep EEG features were enhanced when assessing the effects of CPAP. These findings suggest the reversibility of cognitive deficits and altered brain electrophysiology observed in untreated OSA following six months of treatment.
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Affiliation(s)
- Angela L D'Rozario
- Faculty of Science, School of Psychology, University of Sydney, Sydney, New South Wales, Australia.,Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.,Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Camilla M Hoyos
- Faculty of Science, School of Psychology, University of Sydney, Sydney, New South Wales, Australia.,Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.,Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Keith K H Wong
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Gunnar Unger
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Jong Won Kim
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,Department of Healthcare IT, Inje University, Inje-ro 197, Kimhae, Kyunsangnam-do, 50834,South Korea
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health/FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Chien-Hui Kao
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Sharon L Naismith
- Faculty of Science, School of Psychology, University of Sydney, Sydney, New South Wales, Australia.,Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.,Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Delwyn J Bartlett
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ronald R Grunstein
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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38
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Hoyos CM, Cross NE, Terpening Z, D'Rozario AL, Yee BJ, LaMonica H, Marshall NS, Grunstein RR, Naismith SL. CPAP for Cognition in Sleep Apnea and Mild Cognitive Impairment: A Pilot Randomised Cross-Over Trial. Am J Respir Crit Care Med 2022; 205:1479-1482. [PMID: 35584294 DOI: 10.1164/rccm.202111-2646le] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Camilla M Hoyos
- The University of Sydney, 4334, Faculty of Science, School of Psychology, Sydney NSW, Australia, Sydney, New South Wales, Australia.,The University of Sydney, 4334, Healthy Brain Ageing Program, Brain and Mind Centre, Sydney, New South Wales, Australia.,Woolcock Institute of Medical Research, 104349, Centre for Sleep and Chronobiology, Glebe, New South Wales, Australia;
| | - Nathan E Cross
- The University of Sydney, 4334, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia.,The University of Sydney, 4334, Healthy Brain Ageing Program, Brain and Mind Centre, Sydney, New South Wales, Australia.,Woolcock Institute of Medical Research, 104349, Centre for Sleep and Chronobiology, Glebe, New South Wales, Australia.,Concordia University, 5618, Center for Studies in Behavioural Neurobiology; Department of Health, Kinesiology and Applied Physiology, Montreal, Quebec, Canada
| | - Zoe Terpening
- The University of Sydney, 4334, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia.,University of New South Wales, 7800, Faculty of Medicine, Sydney, New South Wales, Australia
| | - Angela L D'Rozario
- The University of Sydney, 4334, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia.,The University of Sydney, 4334, Healthy Brain Ageing Program, Brain and Mind Centre, Sydney, New South Wales, Australia.,Woolcock Institute of Medical Research, 104349, Centre for Sleep and Chronobiology, Glebe, New South Wales, Australia
| | - Brendon J Yee
- Woolcock Institute of Medical Research, 104349, Centre for Sleep and Chronobiology, Glebe, New South Wales, Australia.,Royal Prince Alfred Hospital, 2205, Department of Respiratory and Sleep Medicine, Camperdown, New South Wales, Australia
| | - Haley LaMonica
- The University of Sydney, 4334, Healthy Brain Ageing Program, Brain and Mind Centre, Sydney, New South Wales, Australia.,The University of Sydney, 4334, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Nathaniel S Marshall
- The University of Sydney, 4334, Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia.,Woolcock Institute of Medical Research, 104349, Centre for Sleep and Chronobiology, Glebe, New South Wales, Australia
| | - Ronald R Grunstein
- Woolcock Institute of Medical Research, 104349, Centre for Sleep and Chronobiology, Glebe, New South Wales, Australia.,Royal Prince Alfred Hospital, 2205, Department of Respiratory and Sleep Medicine, Camperdown, New South Wales, Australia.,The University of Sydney, 4334, Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
| | - Sharon L Naismith
- The University of Sydney, 4334, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia.,The University of Sydney, 4334, Healthy Brain Ageing Program, Brain and Mind Centre, Sydney, New South Wales, Australia
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Boel JA, Bie RM, Schmand BA, Dalrymple‐Alford JC, Marras C, Adler CH, Goldman JG, Tröster AI, Burn DJ, Litvan I, Geurtsen GJ, Bernard B, Stebbins G, Filoteo JV, Weintraub D, Caviness JN, Belden C, Zabetian CP, Cholerton BA, Huang X, Eslinger PJ, Leverenz JB, Duff‐Canning S, Farrer M, Anderson TJ, Myall DJ, Naismith SL, Lewis SJ, Halliday GM, Wu R, Williams‐Gray CH, Breen DP, Barker RA, Yarnall AJ, Klein M, Mollenhauer B, Trenkwalder C, Kulisevsky J, Pagonabarraga J, Gasca‐Salas C, Rodriguez‐Oroz MC, Junque C, Segura B, Barone P, Santangelo G, Cammisuli DM, Biundo R, Antonini A, Weis L, Pedersen KF, Alves G. Level I
PD‐MCI
using global cognitive tests and the risk for Parkinson's disease dementia. Mov Disord Clin Pract 2022; 9:479-483. [PMID: 35582313 PMCID: PMC9092740 DOI: 10.1002/mdc3.13451] [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] [Received: 12/27/2021] [Revised: 03/07/2022] [Accepted: 03/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background The criteria for PD‐MCI allow the use of global cognitive tests. Their predictive value for conversion from PD‐MCI to PDD, especially compared to comprehensive neuropsychological assessment, is unknown. Methods The MDS PD‐MCI Study Group combined four datasets containing global cognitive tests as well as a comprehensive neuropsychological assessment to define PD‐MCI (n = 467). Risk for developing PDD was examined using a Cox model. Global cognitive tests were compared to neuropsychological test batteries (Level I&II) in determining risk for PDD. Results PD‐MCI based on a global cognitive test (MMSE or MoCA) increases the hazard for developing PDD (respectively HR = 2.57, P = 0.001; HR = 4.14, P = <0.001). The C‐statistics for MMSE (0.72) and MoCA (0.70) were lower than those based on neuropsychological tests (Level I = 0.82; Level II = 0.81). Sensitivity, specificity and diagnostic accuracy balance was best in Level II. Conclusion MMSE and MoCA predict conversion to PDD. However, Level II neuropsychological assessment seems the preferred assessment for PD‐MCI.
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Affiliation(s)
- Judith A. Boel
- Amsterdam UMC location University of Amsterdam Department of Neurology The Netherlands
- Department of Psychology University of Amsterdam The Netherlands
| | - Rob M.A. Bie
- Amsterdam UMC location University of Amsterdam Department of Neurology The Netherlands
- Amsterdam Neuroscience The Netherlands
| | - Ben A. Schmand
- Department of Psychology University of Amsterdam The Netherlands
- Amsterdam UMC location University of Amsterdam Department of Medical Psychology The Netherlands
| | - John C. Dalrymple‐Alford
- New Zealand Brain Research Institute and School of Psychology, Speech and Hearing University of Canterbury Christchurch New Zealand
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's disease, Toronto Western Hospital University of Toronto Canada
| | - Charles H. Adler
- Arizona Study of Aging and Neurodegenerative Disorders, Mayo Clinic Arizona, Scottsdale, Arizona, USA and Banner Sun Health Research Institute Sun City Arizona USA
| | - Jennifer G. Goldman
- Shirley Ryan AbilityLab and Northwestern University Departments of Physical Medicine and Rehabilitation and Neurology Chicago Illinois USA
| | - Alexander I. Tröster
- Department of Clinical Neuropsychology and Center for Neuromodulation Barrow Neurological Institute Phoenix Arizona USA
| | - David J. Burn
- Institute of Neuroscience Newcastle University Newcastle upon Tyne UK
| | - Irene Litvan
- Parkinson and Other Movement Disorder Center, Department of Neurosciences University of California San Diego California
| | - Gert J. Geurtsen
- Amsterdam UMC location University of Amsterdam Department of Medical Psychology The Netherlands
- Amsterdam Neuroscience The Netherlands
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40
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Menczel Schrire Z, Phillips CL, Chapman JL, Duffy SL, Wong G, D'Rozario AL, Comas M, Raisin I, Saini B, Gordon CJ, McKinnon AC, Naismith SL, Marshall NS, Grunstein RR, Hoyos CM. Safety of higher doses of melatonin in adults: A systematic review and meta-analysis. J Pineal Res 2022; 72:e12782. [PMID: 34923676 DOI: 10.1111/jpi.12782] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 12/13/2022]
Abstract
Melatonin is commonly used for sleep and jetlag at low doses. However, there is less documentation on the safety of higher doses, which are being increasingly used for a wide variety of conditions, including more recently COVID-19 prevention and treatment. The aim of this review was to investigate the safety of higher doses of melatonin in adults. Medline, Scopus, Embase and PsycINFO databases from inception until December 2019 with convenience searches until October 2020. Randomised controlled trials investigating high-dose melatonin (≥10 mg) in human adults over 30 years of age were included. Two investigators independently abstracted articles using PRISMA guidelines. Risk of bias was assessed by a committee of three investigators. 79 studies were identified with a total of 3861 participants. Studies included a large range of medical conditions. The meta-analysis was pooled data using a random effects model. The outcomes examined were the number of adverse events (AEs), serious adverse events (SAEs) and withdrawals due to AEs. A total of 29 studies (37%) made no mention of the presence or absence of AEs. Overall, only four studies met the pre-specified low risk of bias criteria for meta-analysis. In that small subset, melatonin did not cause a detectable increase in SAEs (Rate Ratio = 0.88 [0.52, 1.50], p = .64) or withdrawals due to AEs (0.93 [0.24, 3.56], p = .92), but did appear to increase the risk of AEs such as drowsiness, headache and dizziness (1.40 [1.15, 1.69], p < .001). Overall, there has been limited AE reporting from high-dose melatonin studies. Based on this limited evidence, melatonin appears to have a good safety profile. Better safety reporting in future long-term trials is needed to confirm this as our confidence limits were very wide due to the paucity of suitable data.
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Affiliation(s)
- Zoe Menczel Schrire
- Healthy Brain Ageing Program, Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
| | - Craig L Phillips
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Julia L Chapman
- Healthy Brain Ageing Program, Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
| | - Shantel L Duffy
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Grace Wong
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
| | - Angela L D'Rozario
- Healthy Brain Ageing Program, Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
| | - Maria Comas
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
| | - Isabelle Raisin
- University Library, The University of Sydney, Sydney, New South Wales, Australia
| | - Bandana Saini
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher J Gordon
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew C McKinnon
- Healthy Brain Ageing Program, Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Nathaniel S Marshall
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ronald R Grunstein
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Camilla M Hoyos
- Healthy Brain Ageing Program, Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
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Sesel AL, Sharpe L, Beadnall HN, Barnett MH, Szabo M, Naismith SL. A randomized controlled trial of a web-based mindfulness programme for people with MS with and without a history of recurrent depression. Mult Scler 2022; 28:1392-1401. [PMID: 35130768 DOI: 10.1177/13524585211068002] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Evidence shows small positive effects associated with psychological treatments for people with multiple sclerosis (PwMS). In a recent meta-analysis, the treatment with the largest effect size was a mindfulness-based intervention (MBI). OBJECTIVES We aimed to determine whether an Internet-delivered MBI was beneficial for PwMS. Furthermore, we aimed to investigate history of recurrent depression as a moderator of treatment outcome. METHODS Participants (N = 132) were assessed based on whether they had a history of recurrent depression, then stratified and randomized to MBI or waitlist. Outcomes were assessed at baseline, post-intervention, and 3 and 6 months. RESULTS The MBI group reported significantly improved depressive symptoms (primary outcome) compared with the waitlist (p = 0.046, Cohen's d = 0.39). Those with a history of recurrent depression benefitted significantly more than those without (p = 0.034, d = 0.66). There were benefits for health-related quality of life (HRQoL) in the MBI, irrespective of depression history (p = 0.009, d = 0.5). Pain interference was less overall in the MBI group (p < 0.001, d = 0.2), but change over time did not differ from waitlist. There were no treatment effects for anxiety, pain severity or fatigue. CONCLUSION The Internet-delivered MBI significantly improved depressive symptoms and HRQoL in PwMS. For depression, the benefits were greater for those with a history of recurrent depression. TRIAL REGISTRATION ACTRN12618001260213, available at: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375598.
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Affiliation(s)
- Amy-Lee Sesel
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Louise Sharpe
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Heidi N Beadnall
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia/Neurology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Michael H Barnett
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia/Neurology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Marianna Szabo
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Sharon L Naismith
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
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Leong CWY, Leow JWS, Grunstein RR, Naismith SL, Teh JZ, D’Rozario AL, Saini B. A systematic scoping review of the effects of central nervous system active drugs on sleep spindles and sleep-dependent memory consolidation. Sleep Med Rev 2022; 62:101605. [DOI: 10.1016/j.smrv.2022.101605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/15/2022] [Accepted: 01/26/2022] [Indexed: 11/26/2022]
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43
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Hoyos CM, Turner A, Ireland C, Naismith SL, Duffy SL. Brain oxidative stress and cognitive function in older adults with diabetes and pre-diabetes who are at risk for dementia. Diabetes Res Clin Pract 2022; 184:109178. [PMID: 34958845 DOI: 10.1016/j.diabres.2021.109178] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/08/2021] [Accepted: 12/11/2021] [Indexed: 01/04/2023]
Abstract
AIMS Diabetes is an established risk factor for dementia. This study aimed to examine the relationship between various cognitive domains, brain oxidative stress and markers of diabetes in older adults at risk for dementia. METHODS Older adults at risk for dementia underwent comprehensive neuropsychological and medical assessment. At risk was defined as those with subjective and/or objective cognitive impairment. Pre-diabetes and type 2 diabetes were defined using American Diabetes Association definitions for fasting blood glucose and HbA1c. Brain oxidative stress as indicated by glutathione (GSH) was assessed via magnetic resonance spectroscopy in the anterior cingulate cortex. RESULTS One-hundred and forty-seven older adults completed a neuropsychological assessment and fasting blood sample with 63 also undergoing magnetic resonance spectroscopy. Those with pre-diabetes/diabetes according to FBG had impaired memory retention, set-shifting and response inhibition, compared to those with normal blood glucose. In contrast, there were no significant differences in any cognitive outcome using the HbA1c definition. Increasing glucose and HbA1c levels were associated with reduced GSH concentration in the anterior cingulate. CONCLUSIONS This study demonstrates that in older adults at risk for dementia, having pre-diabetes or diabetes is associated with impaired memory and executive dysfunction. It also highlights the potential role of oxidative stress as a pathophysiological mechanism that may underpin the link between diabetes and cognitive dysfunction.
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Affiliation(s)
- Camilla M Hoyos
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia; The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, The University of Sydney, Sydney, New South Wales, Australia.
| | - Ashlee Turner
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia; The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Catriona Ireland
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia; The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Sharon L Naismith
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, New South Wales, Australia; The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Shantel L Duffy
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, Charles Perkins Centre, Sydney, New South Wales, Australia; The University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
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Palmer JR, Wang C, Kong D, Cespedes M, Pye J, Hickie IB, Barnett M, Naismith SL. Rest-activity rhythms and tract specific white matter lesions in older adults at risk for cognitive decline. Mol Psychiatry 2022; 27:3410-3416. [PMID: 35764707 PMCID: PMC9708592 DOI: 10.1038/s41380-022-01641-4] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/04/2022] [Accepted: 05/23/2022] [Indexed: 11/09/2022]
Abstract
White matter lesions (WMLs) are common in older adults and represent an important predictor of negative long-term outcomes. Rest-activity rhythm disturbance is also common, however, few studies have investigated associations between these factors. We employed a novel AI-based automatic WML segmentation tool and diffusion-weighted tractography to investigate associations between tract specific WML volumes and non-parametric actigraphy measures in older adults at risk for cognitive decline. The primary non-parametric measures of interest were inter-daily stability (IS), intra-daily variability and relative amplitude, with the anterior thalamic radiation (ATR), superior longitudinal fasciculus (SLF) and inferior longitudinal fasciculus (ILF) selected as tracts of interest. One hundred and eight participants at risk for cognitive decline (classified as experiencing subjective or objective cognitive decline) were included (mean age = 68.85 years, SD = 8.91). Of the primary non-parametric measures of interest, results showed that lower IS was associated with a greater likelihood of higher WML burden in the ATR (OR = 1.82, 95% CI [1.12,3.15]). Analysis of secondary non-parametric measures revealed later onset of the least active period to be associated with greater likelihood of high WML burden in the SLF (OR = 1.55, 95% CI [1.00,2.53]) and increased activity during the least active 5-h period to be associated with a greater likelihood of high whole-brain WML burden (OR = 1.83, 95% CI [1.06,3.47]). This study shows integrity of the ATR and SLF, and overall WML burden is linked to altered rest-activity rhythms in older adults at risk for cognitive decline, with those demonstrating altered rest-activity rhythms showing 50%-80% higher odds of having high WML burden.
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Affiliation(s)
- Jake R. Palmer
- grid.1013.30000 0004 1936 834XSchool of Psychology, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XBrain and Mind Centre, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XCharles Perkins Centre, The University of Sydney, Sydney, NSW Australia ,grid.1004.50000 0001 2158 5405Department of Psychology, Macquarie University, Sydney, NSW Australia
| | - Chenyu Wang
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, The University of Sydney, Sydney, NSW Australia ,Sydney Neuroimaging Analysis Centre, Sydney, NSW Australia
| | - Dexiao Kong
- grid.1013.30000 0004 1936 834XSchool of Psychology, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XBrain and Mind Centre, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XCharles Perkins Centre, The University of Sydney, Sydney, NSW Australia
| | - Marcela Cespedes
- grid.467740.60000 0004 0466 9684Australian e-Health Research Centre, CSIRO Health and Biosecurity, Herston, QLD Australia
| | - Jonathon Pye
- grid.1013.30000 0004 1936 834XSchool of Psychology, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XSusan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW Australia
| | - Ian B. Hickie
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, The University of Sydney, Sydney, NSW Australia
| | - Michael Barnett
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, The University of Sydney, Sydney, NSW Australia ,Sydney Neuroimaging Analysis Centre, Sydney, NSW Australia
| | - Sharon L. Naismith
- grid.1013.30000 0004 1936 834XSchool of Psychology, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XBrain and Mind Centre, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XCharles Perkins Centre, The University of Sydney, Sydney, NSW Australia ,NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration, Sydney, NSW Australia
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Choi I, La Monica H, Naismith SL, Rahmanovic A, Mowszowski L, Glozier N. Communicating Personal Risk Profiles of Alzheimer's Disease to Older Adults: A Pilot Trial. J Prev Alzheimers Dis 2022; 9:144-150. [PMID: 35098985 DOI: 10.14283/jpad.2021.34] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Communicating personal Alzheimer's disease risk profiles based on validated risk algorithms may improve public knowledge about risk reduction, and initiate action. This proof of concept pilot trial aimed to test whether this is feasible and potentially effective and/or harmful. Older at-risk adults (N=24) were provided with their personal Alzheimer's disease risk profile online, which contained information on their personal risk level, scores and tailored recommendations to manage modifiable risk factors. After receiving the risk profile, participants were significantly more accurate in identifying risk and protective factors, and revised their perceived risk to be lower than their initial estimate. There was no apparent harm seen in psychological distress or dementia-related worry. This shows preliminary support for the feasibility of delivering personal dementia risk profiles to low risk, help-seeking older adults in an online format. A definitive trial examining behavioural outcomes and testing in groups with higher risk profiles is now warranted.
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Affiliation(s)
- I Choi
- Dr Isabella Choi, 94 Mallett Street, Camperdown, NSW 2050, Australia, , +612 8627 7240
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Mehrani I, Kochan NA, Crawford JD, Naismith SL, Sachdev PS. Harmonisation of assessments in Australian Memory Clinics: Challenges and opportunities. Alzheimers Dement 2021. [DOI: 10.1002/alz.051211] [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)
- Inga Mehrani
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales (UNSW) Sydney Sydney NSW Australia
| | - Nicole A. Kochan
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales (UNSW) Sydney Sydney NSW Australia
| | - John D. Crawford
- Centre for Healthy Brain Ageing (CHeBA), UNSW Sydney Sydney NSW Australia
| | - Sharon L Naismith
- School of Psychology, Faculty of Science, University of Sydney Sydney NSW Australia
- Charles Perkins Centre, University of Sydney Sydney NSW Australia
| | - Perminder S. Sachdev
- University of New South Wales Sydney NSW Australia
- Neuropsychiatric Institute (NPI), Euroa Centre, Prince of Wales Hospital Sydney NSW Australia
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47
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Lin P, LaMonica H, Naismith SL, Mowszowski L. Clinical factors contributing to functional change over time in individuals with subjective cognitive concerns and mild cognitive impairment. Alzheimers Dement 2021. [DOI: 10.1002/alz.053233] [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)
- Pinghsiu Lin
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney Sydney NSW Australia
- School of Psychology, Faculty of Science, University of Sydney Sydney NSW Australia
| | - Haley LaMonica
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney Sydney NSW Australia
- Central Clinical School, University of Sydney, Australia Sydney NSW Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney Sydney NSW Australia
- School of Psychology, Faculty of Science, University of Sydney Sydney NSW Australia
- Charles Perkins Centre, University of Sydney Sydney NSW Australia
| | - Loren Mowszowski
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney Sydney NSW Australia
- School of Psychology, Faculty of Science, University of Sydney Sydney NSW Australia
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48
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Naismith SL, Palmer JR, Leng Y, Lucey BP. Associations between sleep and Alzheimer’s disease biomarkers within the EPAD cohort. Alzheimers Dement 2021. [DOI: 10.1002/alz.053208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Sharon L. Naismith
- Brain and Mind Centre and Charles Perkins Centre, University of Sydney Sydney NSW Australia
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration Sydney NSW Australia
- University of Sydney Sydney NSW Australia
| | - Jake R. Palmer
- Brain and Mind Centre and Charles Perkins Centre, University of Sydney Sydney NSW Australia
- University of Sydney Sydney NSW Australia
- Macquarie University Sydney NSW Australia
| | - Yue Leng
- University of California, San Francisco San Francisco CA USA
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Espinosa N, Duffy SL, LaMonica H, Mowszowski L, Hickie IB, Palmer JR, McKinnon AC, Naismith SL. Thalamic abnormalities in older adults with early‐onset depression using structural magnetic resonance imaging. Alzheimers Dement 2021. [DOI: 10.1002/alz.053670] [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)
| | - Shantel L Duffy
- Brain & Mind Research Centre, University of Sydney Sydney NSW Australia
| | - Haley LaMonica
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney Sydney NSW Australia
| | - Loren Mowszowski
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney Sydney NSW Australia
| | - Ian B Hickie
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney Sydney Australia
| | | | | | - Sharon L Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney Sydney NSW Australia
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Crouse JJ, Carpenter JS, Song YJC, Hockey SJ, Naismith SL, Grunstein RR, Scott EM, Merikangas KR, Scott J, Hickie IB. Circadian rhythm sleep-wake disturbances and depression in young people: implications for prevention and early intervention. Lancet Psychiatry 2021; 8:813-823. [PMID: 34419186 DOI: 10.1016/s2215-0366(21)00034-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/19/2022]
Abstract
A rate-limiting step in the prevention and early intervention of depressive disorders in young people is our insufficient understanding of causal mechanisms. One plausible pathophysiological pathway is disturbance in the 24 h sleep-wake cycle and the underlying circadian system. Abnormalities in circadian rhythms are well documented in adults with various depressive disorders and have been linked to core clinical features, including unstable mood, daytime fatigue, non-restorative sleep, reduced motor activity, somatic symptoms, and appetite and weight change. In this Review, we summarise four areas of research: basic circadian biology and animal models of circadian disturbances; developmental changes in circadian rhythms during adolescence and implications for the emergence of adolescent-onset depressive syndromes; community and clinical studies linking 24 h sleep-wake cycle disturbances and depressive disorders; and clinical trials of circadian-based treatments. We present recommendations based on a highly personalised, early intervention model for circadian-linked depression in young people.
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Affiliation(s)
- Jacob J Crouse
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.
| | - Joanne S Carpenter
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Yun Ju C Song
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Samuel J Hockey
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Ronald R Grunstein
- Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, NSW, Australia
| | - Elizabeth M Scott
- St Vincent's and Mater Clinical School, The University of Notre Dame, Sydney, NSW, Australia
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, Division of Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Ian B Hickie
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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