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Young CB, Smith V, Karjadi C, Grogan S, Ang TFA, Insel PS, Henderson VW, Sumner M, Poston KL, Au R, Mormino EC. Speech patterns during memory recall relates to early tau burden across adulthood. Alzheimers Dement 2024; 20:2552-2563. [PMID: 38348772 PMCID: PMC11032578 DOI: 10.1002/alz.13731] [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: 10/24/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Early cognitive decline may manifest in subtle differences in speech. METHODS We examined 238 cognitively unimpaired adults from the Framingham Heart Study (32-75 years) who completed amyloid and tau PET imaging. Speech patterns during delayed recall of a story memory task were quantified via five speech markers, and their associations with global amyloid status and regional tau signal were examined. RESULTS Total utterance time, number of between-utterance pauses, speech rate, and percentage of unique words significantly correlated with delayed recall score although the shared variance was low (2%-15%). Delayed recall score was not significantly different between β-amyoid-positive (Aβ+) and -negative (Aβ-) groups and was not associated with regional tau signal. However, longer and more between-utterance pauses, and slower speech rate were associated with increased tau signal across medial temporal and early neocortical regions. DISCUSSION Subtle speech changes during memory recall may reflect cognitive impairment associated with early Alzheimer's disease pathology. HIGHLIGHTS Speech during delayed memory recall relates to tau PET signal across adulthood. Delayed memory recall score was not associated with tau PET signal. Speech shows greater sensitivity to detecting subtle cognitive changes associated with early tau accumulation. Our cohort spans adulthood, while most PET imaging studies focus on older adults.
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Affiliation(s)
- Christina B. Young
- Department of Neurology and Neurological SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - Viktorija Smith
- Department of Neurology and Neurological SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - Cody Karjadi
- Department of Anatomy & Neurobiology and Framingham Heart StudyBoston University Chobanian and Avedisian School of MedicineBostonMassachusettsUSA
| | - Selah‐Marie Grogan
- Department of Neurology and Neurological SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - Ting Fang Alvin Ang
- Department of Anatomy & Neurobiology and Framingham Heart StudyBoston University Chobanian and Avedisian School of MedicineBostonMassachusettsUSA
| | - Philip S. Insel
- Department of PsychiatryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Victor W. Henderson
- Department of Neurology and Neurological SciencesStanford University School of MedicineStanfordCaliforniaUSA
- Department of Epidemiology and Population HealthStanford UniversityStanfordCaliforniaUSA
| | - Meghan Sumner
- Department of LinguisticsStanford UniversityStanfordCaliforniaUSA
| | - Kathleen L. Poston
- Department of Neurology and Neurological SciencesStanford University School of MedicineStanfordCaliforniaUSA
- Wu Tsai Neuroscience InstituteStanford UniversityStanfordCaliforniaUSA
| | - Rhoda Au
- Department of Anatomy & Neurobiology and Framingham Heart StudyBoston University Chobanian and Avedisian School of MedicineBostonMassachusettsUSA
| | - Elizabeth C. Mormino
- Department of Neurology and Neurological SciencesStanford University School of MedicineStanfordCaliforniaUSA
- Wu Tsai Neuroscience InstituteStanford UniversityStanfordCaliforniaUSA
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Xue C, Kowshik SS, Lteif D, Puducheri S, Jasodanand VH, Zhou OT, Walia AS, Guney OB, Zhang JD, Pham ST, Kaliaev A, Andreu-Arasa VC, Dwyer BC, Farris CW, Hao H, Kedar S, Mian AZ, Murman DL, O’Shea SA, Paul AB, Rohatgi S, Saint-Hilaire MH, Sartor EA, Setty BN, Small JE, Swaminathan A, Taraschenko O, Yuan J, Zhou Y, Zhu S, Karjadi C, Ang TFA, Bargal SA, Plummer BA, Poston KL, Ahangaran M, Au R, Kolachalama VB. AI-based differential diagnosis of dementia etiologies on multimodal data. medRxiv 2024:2024.02.08.24302531. [PMID: 38585870 PMCID: PMC10996713 DOI: 10.1101/2024.02.08.24302531] [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] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Differential diagnosis of dementia remains a challenge in neurology due to symptom overlap across etiologies, yet it is crucial for formulating early, personalized management strategies. Here, we present an AI model that harnesses a broad array of data, including demographics, individual and family medical history, medication use, neuropsychological assessments, functional evaluations, and multimodal neuroimaging, to identify the etiologies contributing to dementia in individuals. The study, drawing on 51,269 participants across 9 independent, geographically diverse datasets, facilitated the identification of 10 distinct dementia etiologies. It aligns diagnoses with similar management strategies, ensuring robust predictions even with incomplete data. Our model achieved a micro-averaged area under the receiver operating characteristic curve (AUROC) of 0.94 in classifying individuals with normal cognition, mild cognitive impairment and dementia. Also, the micro-averaged AUROC was 0.96 in differentiating the dementia etiologies. Our model demonstrated proficiency in addressing mixed dementia cases, with a mean AUROC of 0.78 for two co-occurring pathologies. In a randomly selected subset of 100 cases, the AUROC of neurologist assessments augmented by our AI model exceeded neurologist-only evaluations by 26.25%. Furthermore, our model predictions aligned with biomarker evidence and its associations with different proteinopathies were substantiated through postmortem findings. Our framework has the potential to be integrated as a screening tool for dementia in various clinical settings and drug trials, with promising implications for person-level management.
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Affiliation(s)
- Chonghua Xue
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Electrical & Computer Engineering, Boston University, MA, USA
| | - Sahana S. Kowshik
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Faculty of Computing & Data Sciences, Boston University, MA, USA
| | - Diala Lteif
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Computer Science, Boston University, MA, USA
| | - Shreyas Puducheri
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Varuna H. Jasodanand
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Olivia T. Zhou
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Anika S. Walia
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Osman B. Guney
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Electrical & Computer Engineering, Boston University, MA, USA
| | - J. Diana Zhang
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- School of Chemistry, University of New South Wales, Sydney, Australia
| | - Serena T. Pham
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Artem Kaliaev
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - V. Carlota Andreu-Arasa
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Brigid C. Dwyer
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Chad W. Farris
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Honglin Hao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Sachin Kedar
- Departments of Neurology & Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Asim Z. Mian
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Daniel L. Murman
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sarah A. O’Shea
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Aaron B. Paul
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Saurabh Rohatgi
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Emmett A. Sartor
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Bindu N. Setty
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Juan E. Small
- Department of Radiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | | | - Olga Taraschenko
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jing Yuan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Zhou
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuhan Zhu
- Department of Neurology, Brigham & Women’s Hospital, Boston, MA, USA
| | - Cody Karjadi
- The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Ting Fang Alvin Ang
- The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Sarah A. Bargal
- Department of Computer Science, Georgetown University, Washington DC, USA
| | | | | | - Meysam Ahangaran
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Rhoda Au
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University Alzheimer’s Disease Research Center, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Vijaya B. Kolachalama
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Faculty of Computing & Data Sciences, Boston University, MA, USA
- Department of Computer Science, Boston University, MA, USA
- Boston University Alzheimer’s Disease Research Center, Boston, MA, USA
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Ferretti MT, Ding H, Au R, Liu C, Devine S, Auerbach S, Mez J, Gurnani A, Liu Y, Santuccione A, Ang TFA. Maximizing utility of neuropsychological measures in sex-specific predictive models of incident Alzheimer's disease in the Framingham Heart Study. Alzheimers Dement 2024; 20:1112-1122. [PMID: 37882354 PMCID: PMC10917035 DOI: 10.1002/alz.13500] [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: 02/21/2023] [Revised: 08/23/2023] [Accepted: 09/17/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Sex differences in neuropsychological (NP) test performance might have important implications for the diagnosis of Alzheimer's disease (AD). This study investigates sex differences in neuropsychological performance among individuals without dementia at baseline. METHODS Neuropsychological assessment data, both standard test scores and process coded responses, from Framingham Heart Study participants were analyzed for sex differences using regression model and Cox proportional hazards model. Optimal NP profiles were identified by machine learning methods for men and women. RESULTS Sex differences were observed in both summary scores and composite process scores of NP tests in terms of adjusted means and their associations with AD incidence. The optimal NP profiles for men and women have 10 and 8 measures, respectively, and achieve 0.76 mean area under the curve for AD prediction. DISCUSSION These results suggest that NP tests can be leveraged for developing more sensitive, sex-specific indices for the diagnosis of AD.
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Affiliation(s)
- Maria Teresa Ferretti
- Institute for Regenerative Medicine (IREM)University of ZurichZurichSwitzerland
- Women's Brain ProjectGuntershausenSwitzerland
| | - Huitong Ding
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- The Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Rhoda Au
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- The Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
- Slone Epidemiology CenterBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Department of NeurologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Chunyu Liu
- The Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusettsUSA
| | - Sherral Devine
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- The Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Sanford Auerbach
- Department of NeurologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Jesse Mez
- Department of NeurologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Ashita Gurnani
- Department of NeurologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Yulin Liu
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- The Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | | | - Ting Fang Alvin Ang
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- The Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Slone Epidemiology CenterBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
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Rehman H, Ang TFA, Tao Q, Espenilla AL, Au R, Farrer LA, Zhang X, Qiu WQ. Comparison of Commonly Measured Plasma and Cerebrospinal Fluid Proteins and Their Significance for the Characterization of Cognitive Impairment Status. J Alzheimers Dis 2024; 97:621-633. [PMID: 38143358 DOI: 10.3233/jad-230837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND Although cerebrospinal fluid (CSF) amyloid-β42 peptide (Aβ42) and phosphorylated tau (p-tau) and blood p-tau are valuable for differential diagnosis of Alzheimer's disease (AD) from cognitively normal (CN) there is a lack of validated biomarkers for mild cognitive impairment (MCI). OBJECTIVE This study sought to determine how plasma and CSF protein markers compared in the characterization of MCI and AD status. METHODS This cohort study included Alzheimer's Disease Neuroimaging Initiative (ADNI) participants who had baseline levels of 75 proteins measured commonly in plasma and CSF (257 total, 46 CN, 143 MCI, and 68 AD). Logistic regression, least absolute shrinkage and selection operator (LASSO) and Random Forest (RF) methods were used to identify the protein candidates for the disease classification. RESULTS We observed that six plasma proteins panel (APOE, AMBP, C3, IL16, IGFBP2, APOD) outperformed the seven CSF proteins panel (VEGFA, HGF, PRL, FABP3, FGF4, CD40, RETN) as well as AD markers (CSF p-tau and Aβ42) to distinguish the MCI from AD [area under the curve (AUC) = 0.75 (plasma proteins), AUC = 0.60 (CSF proteins) and AUC = 0.56 (CSF p-tau and Aβ42)]. Also, these six plasma proteins performed better than the CSF proteins and were in line with CSF p-tau and Aβ42 in differentiating CN versus MCI subjects [AUC = 0.89 (plasma proteins), AUC = 0.85 (CSF proteins) and AUC = 0.89 (CSF p-tau and Aβ42)]. These results were adjusted for age, sex, education, and APOEϵ4 genotype. CONCLUSIONS This study suggests that the combination of 6 plasma proteins can serve as an effective marker for differentiating MCI from AD and CN.
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Affiliation(s)
- Habbiburr Rehman
- Department of Medicine (Biomedical Genetics), Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Ting Fang Alvin Ang
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Qiushan Tao
- Department of Pharmacology & Experimental Therapeutics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Arielle Lauren Espenilla
- Department of Biostatistics and Boston University School of Public Health, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Rhoda Au
- Department of Medicine (Biomedical Genetics), Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Framingham Heart Study, Boston University School of Medicine, Framingham, MA, USA
- Alzheimer's Disease Research Center, Boston University School of Medicine, Boston, MA, USA
| | - Lindsay A Farrer
- Department of Medicine (Biomedical Genetics), Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Ophthalmology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics and Boston University School of Public Health, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Framingham Heart Study, Boston University School of Medicine, Framingham, MA, USA
- Alzheimer's Disease Research Center, Boston University School of Medicine, Boston, MA, USA
| | - Xiaoling Zhang
- Department of Medicine (Biomedical Genetics), Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics and Boston University School of Public Health, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Framingham Heart Study, Boston University School of Medicine, Framingham, MA, USA
- Alzheimer's Disease Research Center, Boston University School of Medicine, Boston, MA, USA
| | - Wei Qiao Qiu
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Pharmacology & Experimental Therapeutics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Alzheimer's Disease Research Center, Boston University School of Medicine, Boston, MA, USA
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Tao Q, Zhang C, Mercier G, Lunetta K, Ang TFA, Akhter‐Khan S, Zhang Z, Taylor A, Killiany RJ, Alosco M, Mez J, Au R, Zhang X, Farrer LA, Qiu WWQ. Identification of an APOE ε4-specific blood-based molecular pathway for Alzheimer's disease risk. Alzheimers Dement (Amst) 2023; 15:e12490. [PMID: 37854772 PMCID: PMC10579631 DOI: 10.1002/dad2.12490] [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: 09/11/2023] [Accepted: 09/25/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION The precise apolipoprotein E (APOE) ε4-specific molecular pathway(s) for Alzheimer's disease (AD) risk are unclear. METHODS Plasma protein modules/cascades were analyzed using weighted gene co-expression network analysis (WGCNA) in the Alzheimer's Disease Neuroimaging Initiative study. Multivariable regression analyses were used to examine the associations among protein modules, AD diagnoses, cerebrospinal fluid (CSF) phosphorylated tau (p-tau), and brain glucose metabolism, stratified by APOE genotype. RESULTS The Green Module was associated with AD diagnosis in APOE ε4 homozygotes. Three proteins from this module, C-reactive protein (CRP), complement C3, and complement factor H (CFH), had dose-dependent associations with CSF p-tau and cognitive impairment only in APOE ε4 homozygotes. The link among these three proteins and glucose hypometabolism was observed in brain regions of the default mode network (DMN) in APOE ε4 homozygotes. A Framingham Heart Study validation study supported the findings for AD. DISCUSSION The study identifies the APOE ε4-specific CRP-C3-CFH inflammation pathway for AD, suggesting potential drug targets for the disease.Highlights: Identification of an APOE ε4 specific molecular pathway involving blood CRP, C3, and CFH for the risk of AD.CRP, C3, and CFH had dose-dependent associations with CSF p-Tau and brain glucose hypometabolism as well as with cognitive impairment only in APOE ε4 homozygotes.Targeting CRP, C3, and CFH may be protective and therapeutic for AD onset in APOE ε4 carriers.
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Affiliation(s)
- Qiushan Tao
- Department of Pharmacology, Physiology & BiophysicsBoston University School of MedicineBostonMassachusettsUSA
- Slone Epidemiology CenterSchool of Public HealthBoston University Medical Campus (BUMC)BostonMassachusettsUSA
| | - Chao Zhang
- Section of Computational BiomedicineDepartment of MedicineBoston University School of MedicineBostonMassachusettsUSA
| | - Gustavo Mercier
- Section of Molecular Imaging and Nuclear MedicineDepartment of RadiologyBoston University School of MedicineBostonMassachusettsUSA
| | - Kathryn Lunetta
- Slone Epidemiology CenterSchool of Public HealthBoston University Medical Campus (BUMC)BostonMassachusettsUSA
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusettsUSA
| | - Ting Fang Alvin Ang
- Slone Epidemiology CenterSchool of Public HealthBoston University Medical Campus (BUMC)BostonMassachusettsUSA
- Department of Anatomy & NeurobiologyBoston University School of MedicineBostonMassachusettsUSA
| | - Samia Akhter‐Khan
- Department of Health Service & Population ResearchKing's College London, LondonDavid Goldberg CentreLondonUK
| | - Zhengrong Zhang
- Department of Pharmacology, Physiology & BiophysicsBoston University School of MedicineBostonMassachusettsUSA
| | - Andrew Taylor
- Department of OphthalmologyBoston University School of MedicineBostonMassachusettsUSA
| | - Ronald J. Killiany
- Department of Anatomy & NeurobiologyBoston University School of MedicineBostonMassachusettsUSA
| | - Michael Alosco
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
| | - Jesse Mez
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
- Alzheimer's Disease and CTE CentersBoston University School of MedicineBostonMassachusettsUSA
| | - Rhoda Au
- Slone Epidemiology CenterSchool of Public HealthBoston University Medical Campus (BUMC)BostonMassachusettsUSA
- Department of Anatomy & NeurobiologyBoston University School of MedicineBostonMassachusettsUSA
| | - Xiaoling Zhang
- Department of MedicineBoston University School of MedicineBostonMassachusettsUSA
| | - Lindsay A. Farrer
- Alzheimer's Disease and CTE CentersBoston University School of MedicineBostonMassachusettsUSA
- Department of MedicineBoston University School of MedicineBostonMassachusettsUSA
| | - Wendy Wei Qiao Qiu
- Department of Pharmacology, Physiology & BiophysicsBoston University School of MedicineBostonMassachusettsUSA
- Alzheimer's Disease and CTE CentersBoston University School of MedicineBostonMassachusettsUSA
- Department of PsychiatryBoston University School of MedicineBostonMassachusettsUSA
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Kim H, Alvin Ang TF, Thomas RJ, Lyons MJ, Au R. Long-term blood pressure patterns in midlife and dementia in later life: Findings from the Framingham Heart Study. Alzheimers Dement 2023; 19:4357-4366. [PMID: 37394941 PMCID: PMC10597747 DOI: 10.1002/alz.13356] [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: 03/06/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Long-term blood pressure (BP) measures, such as visit-to-visit BP variability (BPV) and cumulative BP, are strong indicators of cardiovascular risks. This study modeled up to 20 years of BP patterns representative of midlife by using BPV and cumulative BP, then examined their associations with development of dementia in later life. METHODS For 3201 individuals from the Framingham Heart Study, multivariate logistic regression analyses were performed to examine the association between long-term BP patterns during midlife and the development of dementia (ages ≥ 65). RESULTS After adjusting for covariates, every quartile increase in midlife cumulative BP was associated with a sequential increase in the risk of developing dementia (e.g., highest quartile of cumulative systolic blood pressure had approximately 2.5-fold increased risk of all-cause dementia). BPV was not significantly associated with dementia. DISCUSSION Findings suggest that cumulative BP over the course of midlife predicts risk of dementia in later life. HIGHLIGHTS Long-term blood pressure (BP) patterns are strong indicators of vascular risks. Cumulative BP and BP variability (BPV) were used to reflect BP patterns across midlife. High cumulative BP in midlife is associated with increased dementia risk. Visit-to-visit BPV was not associated with the onset of dementia.
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Affiliation(s)
- Hyun Kim
- Dept. of Psychological & Brain Sciences, Boston University, 900 Commonwealth Ave # 2, Boston, MA 02215, USA
- Framingham Heart Study, Boston University School of Medicine, 72 E. Concord St Housman (R), Boston MA 02118
| | - Ting Fang Alvin Ang
- Framingham Heart Study, Boston University School of Medicine, 72 E. Concord St Housman (R), Boston MA 02118
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 72 E. Concord St Housman (R), Boston MA 02118
| | - Robert J. Thomas
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue Shapiro 7 Boston, MA 02215
| | - Michael J. Lyons
- Dept. of Psychological & Brain Sciences, Boston University, 900 Commonwealth Ave # 2, Boston, MA 02215, USA
| | - Rhoda Au
- Framingham Heart Study, Boston University School of Medicine, 72 E. Concord St Housman (R), Boston MA 02118
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 72 E. Concord St Housman (R), Boston MA 02118
- Dept. of Neurology, Medicine and Alzheimer’s Disease Research Center, Boston University School of Medicine, 72 E. Concord St, Boston MA 02118
- Dept. of Epidemiology, Boston University School of Public Health, 715 Albany St.Boston, MA 02118
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Huang J, Wang Y, Stein TD, Ang TFA, Zhu Y, Tao Q, Lunetta KL, Mez J, Au R, Farrer LA, Qiu WQ, Zhang X. The impact of blood MCP-1 levels on Alzheimer's disease with genetic variation of UNC5C and NAV3 loci. Res Sq 2023:rs.3.rs-3376348. [PMID: 37841863 PMCID: PMC10571626 DOI: 10.21203/rs.3.rs-3376348/v1] [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] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background Previous study shows that monocyte chemoattractant protein-1 (MCP-1), which is implicated in the peripheral proinflammatory cascade and blood-brain barrier (BBB) disruption, modulates the genetic risks of AD in established AD loci. Methods In this study, we hypothesized that blood MCP-1 impacts the AD risk of genetic variants beyond known AD loci. We thus performed a genome-wide association study (GWAS) using the logistic regression via generalized estimating equations (GEE) and the Cox proportional-hazards models to examine the interactive effects between single nucleotide polymorphisms (SNPs) and blood MCP-1 level on AD in three cohorts: the Framingham Heart Study (FHS), Alzheimer's Disease Neuroimaging Initiative (ADNI) and Religious Orders Study/Memory and Aging Project (ROSMAP). Results We identified SNPs in two genes, neuron navigator 3 (NAV3, also named Unc-53 Homolog 3, rs696468) (p < 7.55×10- 9) and Unc-5 Netrin Receptor C (UNC5C rs72659964) (p < 1.07×10- 8) that showed an association between increasing levels of blood MCP-1 and AD. Elevating blood MCP-1 concentrations increased AD risk and AD pathology in genotypes of NAV3 (rs696468-CC) and UNC5C (rs72659964-AT + TT), but did not influence the other counterpart genotypes of these variants. Conclusions NAV3 and UNC5C are homologs and may increase AD risk through dysregulating the functions of neurite outgrowth and guidance. Overall, the association of risk alleles of NAV3 and UNC5C with AD is enhanced by peripheral MCP-1 level, suggesting that lowering the level of blood MCP-1 may reduce the risk of developing AD for people with these genotypes.
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Affiliation(s)
- Jinghan Huang
- Boston University Chobanian & Avedisian School of Medicine
| | - Yixuan Wang
- Boston University Chobanian & Avedisian School of Medicine
| | - Thor D Stein
- Boston University Chobanian & Avedisian School of Medicine
| | | | - Yibo Zhu
- Boston University Chobanian & Avedisian School of Medicine
| | - Qiushan Tao
- Boston University Chobanian & Avedisian School of Medicine
| | | | - Jesse Mez
- Boston University Chobanian & Avedisian School of Medicine
| | - Rhoda Au
- Boston University Chobanian & Avedisian School of Medicine
| | | | - Wei Qiao Qiu
- Boston University Chobanian & Avedisian School of Medicine
| | - Xiaoling Zhang
- Boston University Chobanian & Avedisian School of Medicine
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Hwang PH, Ang TFA, De Anda-Duran I, Liu X, Liu Y, Gurnani A, Mez J, Auerbach S, Joshi P, Yuan J, Devine S, Au R, Liu C. Examination of potentially modifiable dementia risk factors across the adult life course: The Framingham Heart Study. Alzheimers Dement 2023; 19:2975-2983. [PMID: 36656649 PMCID: PMC10354206 DOI: 10.1002/alz.12940] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION We examined for associations between potentially modifiable risk factors across the adult life course and incident dementia. METHODS Participants from the Framingham Heart Study were included (n = 4015). Potential modifiable risk factors included education, alcohol intake, smoking, body mass index (BMI), physical activity, social network, diabetes, and hypertension. Cox models were used to examine associations between each factor and incident dementia, stratified by early adult life (33-44 years), midlife (45-65 years), and late life (66-80 years). RESULTS Increased dementia risk was associated with diabetes (hazard ratio [HR] = 1.62; 95% confidence interval [CI] = 1.07-2.46) and physical inactivity (HR = 1.57; 95% CI = 1.12-2.20) in midlife, and with obesity (HR = 1.76; 95% CI = 1.08-2.87) in late life. Having multiple potential modifiable risk factors in midlife and late life was associated with greater risk. DISCUSSION Potentially modifiable risk factors individually have limited impact on dementia risk in this population across the adult life course, although in combination they may have a synergistic effect. HIGHLIGHTS Diabetes and physical inactivity in midlife is associated with increased dementia risk. Obesity in late life is associated with increased dementia risk. Having more potentially modifiable risk factors in midlife and late life is associated with greater dementia risk.
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Affiliation(s)
- Phillip H. Hwang
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Ting Fang Alvin Ang
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Slone Epidemiology Center, Boston, MA, USA
| | - Ileana De Anda-Duran
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Xue Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Yulin Liu
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Ashita Gurnani
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Jesse Mez
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Alzheimer’s Disease Research Center, Boston University School of Medicine, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Sanford Auerbach
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Prajakta Joshi
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Department of General Dentistry, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Jing Yuan
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Sherral Devine
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Rhoda Au
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Slone Epidemiology Center, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Alzheimer’s Disease Research Center, Boston University School of Medicine, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Chunyu Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
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Kang M, Ang TFA, Devine SA, Sherva R, Mukherjee S, Trittschuh EH, Gibbons LE, Scollard P, Lee M, Choi SE, Klinedinst B, Nakano C, Dumitrescu LC, Durant A, Hohman TJ, Cuccaro ML, Saykin AJ, Kukull WA, Bennett DA, Wang LS, Mayeux RP, Haines JL, Pericak-Vance MA, Schellenberg GD, Crane PK, Au R, Lunetta KL, Mez JB, Farrer LA. A genome-wide search for pleiotropy in more than 100,000 harmonized longitudinal cognitive domain scores. Mol Neurodegener 2023; 18:40. [PMID: 37349795 PMCID: PMC10286470 DOI: 10.1186/s13024-023-00633-4] [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: 02/17/2023] [Accepted: 06/06/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND More than 75 common variant loci account for only a portion of the heritability for Alzheimer's disease (AD). A more complete understanding of the genetic basis of AD can be deduced by exploring associations with AD-related endophenotypes. METHODS We conducted genome-wide scans for cognitive domain performance using harmonized and co-calibrated scores derived by confirmatory factor analyses for executive function, language, and memory. We analyzed 103,796 longitudinal observations from 23,066 members of community-based (FHS, ACT, and ROSMAP) and clinic-based (ADRCs and ADNI) cohorts using generalized linear mixed models including terms for SNP, age, SNP × age interaction, sex, education, and five ancestry principal components. Significance was determined based on a joint test of the SNP's main effect and interaction with age. Results across datasets were combined using inverse-variance meta-analysis. Genome-wide tests of pleiotropy for each domain pair as the outcome were performed using PLACO software. RESULTS Individual domain and pleiotropy analyses revealed genome-wide significant (GWS) associations with five established loci for AD and AD-related disorders (BIN1, CR1, GRN, MS4A6A, and APOE) and eight novel loci. ULK2 was associated with executive function in the community-based cohorts (rs157405, P = 2.19 × 10-9). GWS associations for language were identified with CDK14 in the clinic-based cohorts (rs705353, P = 1.73 × 10-8) and LINC02712 in the total sample (rs145012974, P = 3.66 × 10-8). GRN (rs5848, P = 4.21 × 10-8) and PURG (rs117523305, P = 1.73 × 10-8) were associated with memory in the total and community-based cohorts, respectively. GWS pleiotropy was observed for language and memory with LOC107984373 (rs73005629, P = 3.12 × 10-8) in the clinic-based cohorts, and with NCALD (rs56162098, P = 1.23 × 10-9) and PTPRD (rs145989094, P = 8.34 × 10-9) in the community-based cohorts. GWS pleiotropy was also found for executive function and memory with OSGIN1 (rs12447050, P = 4.09 × 10-8) and PTPRD (rs145989094, P = 3.85 × 10-8) in the community-based cohorts. Functional studies have previously linked AD to ULK2, NCALD, and PTPRD. CONCLUSION Our results provide some insight into biological pathways underlying processes leading to domain-specific cognitive impairment and AD, as well as a conduit toward a syndrome-specific precision medicine approach to AD. Increasing the number of participants with harmonized cognitive domain scores will enhance the discovery of additional genetic factors of cognitive decline leading to AD and related dementias.
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Affiliation(s)
- Moonil Kang
- Department of Medicine (Biomedical Genetics), Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street E200, Boston, MA 02118 USA
| | - Ting Fang Alvin Ang
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA USA
- Slone Epidemiology Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA USA
| | - Sherral A. Devine
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA USA
| | - Richard Sherva
- Department of Medicine (Biomedical Genetics), Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street E200, Boston, MA 02118 USA
| | - Shubhabrata Mukherjee
- Department of Medicine, University of Washington School of Medicine, Seattle, WA USA
| | - Emily H. Trittschuh
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA USA
| | - Laura E. Gibbons
- Department of Medicine, University of Washington School of Medicine, Seattle, WA USA
| | - Phoebe Scollard
- Department of Medicine, University of Washington School of Medicine, Seattle, WA USA
| | - Michael Lee
- Department of Medicine, University of Washington School of Medicine, Seattle, WA USA
| | - Seo-Eun Choi
- Department of Medicine, University of Washington School of Medicine, Seattle, WA USA
| | - Brandon Klinedinst
- Department of Medicine, University of Washington School of Medicine, Seattle, WA USA
| | - Connie Nakano
- Department of Medicine, University of Washington School of Medicine, Seattle, WA USA
| | - Logan C. Dumitrescu
- Vanderbilt Memory & Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, TN USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN USA
| | - Alaina Durant
- Vanderbilt Memory & Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, TN USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN USA
| | - Timothy J. Hohman
- Vanderbilt Memory & Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, TN USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN USA
| | - Michael L. Cuccaro
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, Miami, FL USA
| | - Andrew J. Saykin
- Indiana Alzheimer’s Disease Research Center, Indiana University School of Medicine, Indianapolis, IN USA
- Department of Radiology and Imaging Services, Indiana University School of Medicine, Indianapolis, IN USA
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN USA
| | - Walter A. Kukull
- Department of Epidemiology, University of Washington, Seattle, WA USA
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL USA
| | - Li-San Wang
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Richard P. Mayeux
- Department of Neurology, Columbia University School of Medicine, New York, NY USA
| | - Jonathan L. Haines
- Cleveland Institute for Computational Biology, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH USA
| | | | - Gerard D. Schellenberg
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Paul K. Crane
- Department of Medicine, University of Washington School of Medicine, Seattle, WA USA
| | - Rhoda Au
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA USA
- Slone Epidemiology Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA USA
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA USA
| | - Kathryn L. Lunetta
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA USA
| | - Jesse B. Mez
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA USA
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA USA
| | - Lindsay A. Farrer
- Department of Medicine (Biomedical Genetics), Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street E200, Boston, MA 02118 USA
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA USA
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA USA
- Department of Ophthalmology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA USA
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Huang J, Stein TD, Wang Y, Ang TFA, Tao Q, Lunetta KL, Massaro J, Akhter-Khan SC, Mez J, Au R, Farrer LA, Zhang X, Qiu WQ. Blood levels of MCP-1 modulate the genetic risks of Alzheimer's disease mediated by HLA-DRB1 and APOE for Alzheimer's disease. Alzheimers Dement 2023; 19:1925-1937. [PMID: 36396603 PMCID: PMC10182187 DOI: 10.1002/alz.12851] [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: 07/26/2022] [Revised: 09/13/2022] [Accepted: 10/05/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION C-Reactive protein (CRP) and monocyte chemoattractant protein-1 (MCP-1) are both implicated in the peripheral proinflammatory cascade and blood-brain barrier (BBB) disruption. Since the blood CRP level increases Alzheimer's disease (AD) risk depending on the apolipoprotein E (APOE) genotype, we hypothesized that the blood MCP-1 level exerts different effects on the AD risk depending on the genotypes. METHODS Using multiple regression analyses, data from the Framingham Heart Study (n = 2884) and Alzheimer's Disease Neuroimaging Initiative study (n = 231) were analyzed. RESULTS An elevated blood MCP-1 level was associated with AD risk in major histocompatibility complex, Class II, DR beta 1 (HLA-DRB1) rs9271192-AC/CC (hazard ratio [HR] = 3.07, 95% confidence interval [CI] = 1.50-6.28, p = 0.002) and in APOE ε4 carriers (HR = 3.22, 95% CI = 1.59-6.53, p = 0.001). In contrast, among HLA-DRB1 rs9271192-AA and APOE ε4 noncarriers, blood MCP-1 levels were not associated with these phenotypes. DISCUSSION Since HLA-DRB1 and APOE are expressed in the BBB, blood MCP-1 released in the peripheral inflammatory cascade may function as a mediator of the effects of HLA-DRB1 rs9271192-AC/CC and APOE ε4 genotypes on AD pathogenesis in the brain via the BBB pathways.
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Affiliation(s)
- Jinghan Huang
- Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA, USA
| | - Thor D. Stein
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
- Alzheimer’s Disease Research Center, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Yixuan Wang
- Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA, USA
| | - Ting Fang Alvin Ang
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Qiushan Tao
- Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, Boston, MA, USA
| | - Kathryn L. Lunetta
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Joseph Massaro
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Framingham Heart Study, Boston University School of Medicine, Framingham, MA, USA
| | - Samia C. Akhter-Khan
- Framingham Heart Study, Boston University School of Medicine, Framingham, MA, USA
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Jesse Mez
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Framingham Heart Study, Boston University School of Medicine, Framingham, MA, USA
- Alzheimer’s Disease Research Center, Boston University School of Medicine, Boston, MA, USA
| | - Rhoda Au
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Framingham Heart Study, Boston University School of Medicine, Framingham, MA, USA
- Alzheimer’s Disease Research Center, Boston University School of Medicine, Boston, MA, USA
| | - Lindsay A. Farrer
- Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Framingham Heart Study, Boston University School of Medicine, Framingham, MA, USA
- Alzheimer’s Disease Research Center, Boston University School of Medicine, Boston, MA, USA
| | - Xiaoling Zhang
- Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Wei Qiao Qiu
- Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- Alzheimer’s Disease Research Center, Boston University School of Medicine, Boston, MA, USA
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Yang J, Ang TFA, Lu S, Liu X, Devine S, Au R, Liu C. Establishing cognitive baseline in three generations: Framingham Heart Study. Alzheimers Dement (Amst) 2023; 15:e12416. [PMID: 36968621 PMCID: PMC10038074 DOI: 10.1002/dad2.12416] [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] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/10/2022] [Accepted: 02/15/2023] [Indexed: 03/26/2023]
Abstract
Introduction Generational changes warrant recalibrating normative cognitive measures to detect changes indicative of dementia risk within each generation. Methods We performed linear regressions to compare eight neuropsychological (NP) tests among three‐generation cohorts at baseline in Framingham Heart Study (FHS, n = 4787) and conducted Cox regressions to investigate the relationships of NP tests with generation‐specific dementia risk. Results The FHS second and third generations performed better than the first generation for seven NP tests (0.14–0.81 standard deviation improvement, P ≤ .001) while the second and third generations performed similarly for six of eight NP tests (P > .05). One standard deviation better performance was associated with a higher reduction in incident dementia risk in the second than the first generation (35% vs. 24%, Pinteraction = .02) for the similarities test. Discussion Our findings suggest cohort‐based norms are needed for cognitive assessment for the diagnosis of cognitive impairment and dementia.
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Affiliation(s)
- Jin Yang
- Department for Endemic Disease Control and PreventionHenan Provincial Center for Disease Control and PreventionZhengzhouChina
| | - Ting Fang Alvin Ang
- Department of Anatomy and NeurobiologyBoston University School of MedicineBostonMassachusettsUSA
- Framingham Heart StudyBoston University School of MedicineBostonMassachusettsUSA
| | - Sophia Lu
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusettsUSA
| | - Xue Liu
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusettsUSA
| | - Sherral Devine
- Department of Anatomy and NeurobiologyBoston University School of MedicineBostonMassachusettsUSA
- Framingham Heart StudyBoston University School of MedicineBostonMassachusettsUSA
| | - Rhoda Au
- Department of Anatomy and NeurobiologyBoston University School of MedicineBostonMassachusettsUSA
- Framingham Heart StudyBoston University School of MedicineBostonMassachusettsUSA
| | - Chunyu Liu
- Framingham Heart StudyBoston University School of MedicineBostonMassachusettsUSA
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusettsUSA
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12
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Wang Y, Huang J, Ang TFA, Zhu Y, Tao Q, Mez J, Alosco M, Denis GV, Belkina A, Gurnani A, Ross M, Gong B, Han J, Lunetta KL, Stein TD, Au R, Farrer LA, Zhang X, Qiu WQ. Circulating Endothelial Progenitor Cells Reduce the Risk of Alzheimer's Disease. medRxiv 2023:2023.01.16.23284571. [PMID: 36711847 PMCID: PMC9882408 DOI: 10.1101/2023.01.16.23284571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Cerebrovascular damage coexists with Alzheimer's disease (AD) pathology and increases AD risk. However, it is unclear whether endothelial progenitor cells reduce AD risk via cerebrovascular repair. By using the Framingham Heart Study (FHS) offspring cohort, which includes data on different progenitor cells, the incidence of AD dementia, peripheral and cerebrovascular pathologies, and genetic data (n = 1,566), we found that elevated numbers of circulating endothelial progenitor cells with CD34+CD133+ co-expressions had a dose-dependent association with decreased AD risk (HR = 0.67, 95% CI: 0.46-0.96, p = 0.03) after adjusting for age, sex, years of education, and APOE ε4. With stratification, this relationship was only significant among those individuals who had vascular pathologies, especially hypertension (HTN) and cerebral microbleeds (CMB), but not among those individuals who had neither peripheral nor central vascular pathologies. We applied a genome-wide association study (GWAS) and found that the number of CD34+CD133+ cells impacted AD risk depending on the homozygous genotypes of two genes: KIRREL3 rs580382 CC carriers (HR = 0.31, 95% CI: 0.17-0.57, p<0.001), KIRREL3 rs4144611 TT carriers (HR = 0.29, 95% CI: 0.15-0.57, p<0.001), and EXOC6B rs61619102 CC carriers (HR = 0.49, 95% CI: 0.31-0.75, p<0.001) after adjusting for confounders. In contrast, the relationship did not exist in their counterpart genotypes, e.g. KIRREL3 TT/CT or GG/GT carriers and EXOC6B GG/GC carriers. Our findings suggest that circulating CD34+CD133+ endothelial progenitor cells can be therapeutic in reducing AD risk in the presence of cerebrovascular pathology, especially in KIRREL3 and EXOC6B genotype carriers.
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Zhang X, Tong T, Chang A, Ang TFA, Tao Q, Auerbach S, Devine S, Qiu WQ, Mez J, Massaro J, Lunetta KL, Au R, Farrer LA. Midlife lipid and glucose levels are associated with Alzheimer's disease. Alzheimers Dement 2023; 19:181-193. [PMID: 35319157 PMCID: PMC10078665 DOI: 10.1002/alz.12641] [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: 07/23/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION It is unknown whether vascular and metabolic diseases assessed in early adulthood are associated with Alzheimer's disease (AD) later in life. METHODS Association of AD with lipid fractions, glucose, blood pressure, body mass index (BMI), and smoking obtained prospectively from 4932 Framingham Heart Study (FHS) participants across nine quadrennial examinations was evaluated using Cox proportional hazard and Kaplan-Meier models. Age-, sex-, and education-adjusted models were tested for each factor measured at each exam and within three adult age groups (early = 35-50, middle = 51-60, and late = 61-70). RESULTS A 15 mg/dL increase in high density lipoprotein (HDL) cholesterol was associated with decreased AD risk during early (15.4%, P = 0.041) and middle (17.9%, P = 0.014) adulthood. A 15 mg/dL increase in glucose measured during middle adulthood was associated with 14.5% increased AD risk (P = 0.00029). These findings remained significant after adjusting for treatment. DISCUSSION Our findings suggest that careful management of cholesterol and glucose beginning in early adulthood can lower AD risk.
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Affiliation(s)
- Xiaoling Zhang
- Department of Medicine (Biomedical Genetics)Boston University School of MedicineBostonMassachusettsUSA
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusettsUSA
| | - Tong Tong
- Department of Medicine (Biomedical Genetics)Boston University School of MedicineBostonMassachusettsUSA
| | - Andrew Chang
- Department of Physiology & BiophysicsBoston University School of MedicineBostonMassachusettsUSA
| | - Ting Fang Alvin Ang
- Department of Anatomy & NeurobiologyBoston University School of MedicineBostonMassachusettsUSA
- Framingham Heart StudyBoston University School of MedicineFraminghamMassachusettsUSA
| | - Qiushan Tao
- Department of Pharmacology & Experimental TherapeuticsBoston University School of MedicineBostonMassachusettsUSA
| | - Sanford Auerbach
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
| | - Sherral Devine
- Department of Anatomy & NeurobiologyBoston University School of MedicineBostonMassachusettsUSA
- Framingham Heart StudyBoston University School of MedicineFraminghamMassachusettsUSA
| | - Wei Qiao Qiu
- Department of Pharmacology & Experimental TherapeuticsBoston University School of MedicineBostonMassachusettsUSA
- Department of PsychiatryBoston University School of MedicineBostonMassachusettsUSA
- Alzheimer's Disease Research CenterBoston University School of MedicineBostonMassachusettsUSA
| | - Jesse Mez
- Framingham Heart StudyBoston University School of MedicineFraminghamMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
- Alzheimer's Disease Research CenterBoston University School of MedicineBostonMassachusettsUSA
| | - Joseph Massaro
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusettsUSA
- Framingham Heart StudyBoston University School of MedicineFraminghamMassachusettsUSA
| | - Kathryn L. Lunetta
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusettsUSA
| | - Rhoda Au
- Department of Anatomy & NeurobiologyBoston University School of MedicineBostonMassachusettsUSA
- Framingham Heart StudyBoston University School of MedicineFraminghamMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
- Alzheimer's Disease Research CenterBoston University School of MedicineBostonMassachusettsUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
| | - Lindsay A. Farrer
- Department of Medicine (Biomedical Genetics)Boston University School of MedicineBostonMassachusettsUSA
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusettsUSA
- Framingham Heart StudyBoston University School of MedicineFraminghamMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
- Alzheimer's Disease Research CenterBoston University School of MedicineBostonMassachusettsUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
- Department of OphthalmologyBoston University School of MedicineBostonMassachusettsUSA
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14
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Ding H, Mandapati A, Karjadi C, Ang TFA, Lu S, Miao X, Glass J, Au R, Lin H. Association Between Acoustic Features and Neuropsychological Test Performance in the Framingham Heart Study: Observational Study. J Med Internet Res 2022; 24:e42886. [PMID: 36548029 PMCID: PMC9816957 DOI: 10.2196/42886] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/29/2022] [Accepted: 12/03/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Human voice has increasingly been recognized as an effective indicator for the detection of cognitive disorders. However, the association of acoustic features with specific cognitive functions and mild cognitive impairment (MCI) has yet to be evaluated in a large community-based population. OBJECTIVE This study aimed to investigate the association between acoustic features and neuropsychological (NP) tests across multiple cognitive domains and evaluate the added predictive power of acoustic composite scores for the classification of MCI. METHODS This study included participants without dementia from the Framingham Heart Study, a large community-based cohort with longitudinal surveillance for incident dementia. For each participant, 65 low-level acoustic descriptors were derived from voice recordings of NP test administration. The associations between individual acoustic descriptors and 18 NP tests were assessed with linear mixed-effect models adjusted for age, sex, and education. Acoustic composite scores were then built by combining acoustic features significantly associated with NP tests. The added prediction power of acoustic composite scores for prevalent and incident MCI was also evaluated. RESULTS The study included 7874 voice recordings from 4950 participants (age: mean 62, SD 14 years; 4336/7874, 55.07% women), of whom 453 were diagnosed with MCI. In all, 8 NP tests were associated with more than 15 acoustic features after adjusting for multiple testing. Additionally, 4 of the acoustic composite scores were significantly associated with prevalent MCI and 7 were associated with incident MCI. The acoustic composite scores can increase the area under the curve of the baseline model for MCI prediction from 0.712 to 0.755. CONCLUSIONS Multiple acoustic features are significantly associated with NP test performance and MCI, which can potentially be used as digital biomarkers for early cognitive impairment monitoring.
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Affiliation(s)
- Huitong Ding
- Department of Anatomy and Neurobiology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, United States
| | - Amiya Mandapati
- Department of Religious Studies, Brown University, Providence, RI, United States
- The Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Cody Karjadi
- Department of Anatomy and Neurobiology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, United States
- The Framingham Heart Study, Chobanian & Avedisian School of Medicine, Boston University, Framingham, MA, United States
| | - Ting Fang Alvin Ang
- Department of Anatomy and Neurobiology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, United States
- The Framingham Heart Study, Chobanian & Avedisian School of Medicine, Boston University, Framingham, MA, United States
- Slone Epidemiology Center, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, United States
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, United States
| | - Sophia Lu
- Slone Epidemiology Center, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, United States
| | - Xiao Miao
- Innovation Research Institute of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - James Glass
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Rhoda Au
- Department of Anatomy and Neurobiology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, United States
- The Framingham Heart Study, Chobanian & Avedisian School of Medicine, Boston University, Framingham, MA, United States
- Slone Epidemiology Center, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, United States
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, United States
- Department of Neurology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, United States
| | - Honghuang Lin
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
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15
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Huang J, Tao Q, Ang TFA, Farrell J, Zhu C, Wang Y, Stein TD, Lunetta KL, Massaro J, Mez J, Au R, Farrer LA, Qiu WQ, Zhang X. The impact of increasing levels of blood C-reactive protein on the inflammatory loci SPI1 and CD33 in Alzheimer's disease. Transl Psychiatry 2022; 12:523. [PMID: 36550123 PMCID: PMC9780312 DOI: 10.1038/s41398-022-02281-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/19/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Apolipoprotein ε4 (APOE ε4) is the most significant genetic risk factor for late-onset Alzheimer's disease (AD). Elevated blood C-reactive protein (CRP) further increases the risk of AD for people carrying the APOE ε4 allele. We hypothesized that CRP, as a key inflammatory element, could modulate the impact of other genetic variants on AD risk. We selected ten single nucleotide polymorphisms (SNPs) in reported AD risk loci encoding proteins related to inflammation. We then tested the interaction effects between these SNPs and blood CRP levels on AD incidence using the Cox proportional hazards model in UK Biobank (n = 279,176 white participants with 803 incident AD cases). The five top SNPs were tested for their interaction with different CRP cutoffs for AD incidence in the Framingham Heart Study (FHS) Generation 2 cohort (n = 3009, incident AD = 156). We found that for higher concentrations of serum CRP, the AD risk increased for SNP genotypes in 3 AD-associated genes (SPI1, CD33, and CLU). Using the Cox model in stratified genotype analysis, the hazard ratios (HRs) for the association between a higher CRP level (≥10 vs. <10 mg/L) and the risk of incident AD were 1.94 (95% CI: 1.33-2.84, p < 0.001) for the SPI1 rs1057233-AA genotype, 1.75 (95% CI: 1.20-2.55, p = 0.004) for the CD33 rs3865444-CC genotype, and 1.76 (95% CI: 1.25-2.48, p = 0.001) for the CLU rs9331896-C genotype. In contrast, these associations were not observed in the other genotypes of these genes. Finally, two SNPs were validated in 321 Alzheimer's Disease Neuroimaging (ADNI) Mild Cognitive Impairment (MCI) patients. We observed that the SPI1 and CD33 genotype effects were enhanced by elevated CRP levels for the risk of MCI to AD conversion. Furthermore, the SPI1 genotype was associated with CSF AD biomarkers, including t-Tau and p-Tau, in the ADNI cohort when the blood CRP level was increased (p < 0.01). Our findings suggest that elevated blood CRP, as a peripheral inflammatory biomarker, is an important moderator of the genetic effects of SPI1 and CD33 in addition to APOE ε4 on AD risk. Monitoring peripheral CRP levels may be helpful for precise intervention and prevention of AD for these genotype carriers.
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Affiliation(s)
- Jinghan Huang
- Departments of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA, USA
| | - Qiushan Tao
- Departments of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, Boston, MA, USA
| | - Ting Fang Alvin Ang
- Departments of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - John Farrell
- Departments of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA, USA
| | - Congcong Zhu
- Departments of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA, USA
| | - Yixuan Wang
- Departments of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA, USA
| | - Thor D Stein
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
- Alzheimer's Disease Research Center, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
| | - Kathryn L Lunetta
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Framingham Heart Study, Boston University School of Medicine, Framingham, MA, USA
| | - Joseph Massaro
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Framingham Heart Study, Boston University School of Medicine, Framingham, MA, USA
| | - Jesse Mez
- Alzheimer's Disease Research Center, Boston University School of Medicine, Boston, MA, USA
- Framingham Heart Study, Boston University School of Medicine, Framingham, MA, USA
- Departments of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Rhoda Au
- Departments of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Alzheimer's Disease Research Center, Boston University School of Medicine, Boston, MA, USA
- Framingham Heart Study, Boston University School of Medicine, Framingham, MA, USA
- Departments of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Lindsay A Farrer
- Departments of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Alzheimer's Disease Research Center, Boston University School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Framingham Heart Study, Boston University School of Medicine, Framingham, MA, USA
- Departments of Neurology, Boston University School of Medicine, Boston, MA, USA
- Departments of Ophthalmology, Boston University School of Medicine, Boston, MA, USA
| | - Wei Qiao Qiu
- Departments of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, Boston, MA, USA.
- Alzheimer's Disease Research Center, Boston University School of Medicine, Boston, MA, USA.
- Departments of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
| | - Xiaoling Zhang
- Departments of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA, USA.
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
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16
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Li J, Liu C, Ang TFA, Au R. BMI decline patterns and relation to dementia risk across four decades of follow‐up in the Framingham Study. Alzheimers Dement 2022. [DOI: 10.1002/alz.12839] [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] [Received: 01/27/2022] [Revised: 09/19/2022] [Accepted: 09/28/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Jinlei Li
- School of Population Medicine and Public Health Peking Union Medical College Beijing China
| | - Chunyu Liu
- Department of Biostatistics Boston University School of Public Health Boston Massachusetts USA
- Framingham Heart Study Boston University Chobanian & Avedisian School of Medicine Boston Massachusetts USA
| | - Ting Fang Alvin Ang
- Framingham Heart Study Boston University Chobanian & Avedisian School of Medicine Boston Massachusetts USA
- Department of Anatomy and Neurobiology Boston University Chobanian & Avedisian School of Medicine Boston Massachusetts USA
- Department of Epidemiology Boston University School of Public Health Boston Massachusetts USA
| | - Rhoda Au
- Framingham Heart Study Boston University Chobanian & Avedisian School of Medicine Boston Massachusetts USA
- Department of Anatomy and Neurobiology Boston University Chobanian & Avedisian School of Medicine Boston Massachusetts USA
- Department of Epidemiology Boston University School of Public Health Boston Massachusetts USA
- Department of Neurology Boston University Chobanian & Avedisian School of Medicine Boston Massachusetts USA
- Boston University Alzheimer's Disease Center and Boston University CTE Center Boston University Chobanian & Avedisian School of Medicine Boston Massachusetts USA
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17
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Liu C, Li Y, Ang TFA, Liu Y, Devine SA, Au R, Doraiswamy PM. Sex‐specific Biomarkers in Alzheimer's Disease Progression: Framingham Heart Study. Alzheimers Dement 2022. [DOI: 10.1002/alz.060884] [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)
- Chunyu Liu
- Framingham Heart Study Framingham MA USA
- Boston University School of Public Health Boston MA USA
| | - Yi Li
- Boston University Boston MA USA
| | | | - Yulin Liu
- Boston University School of Medicine Boston MA USA
| | | | - Rhoda Au
- Boston University School of Medicine Boston MA USA
- The Framingham Heart Study, Boston University School of Medicine; Boston University School of Public Health Boston MA USA
| | - P. Murali Doraiswamy
- Duke Institute for Brain Sciences Durham NC USA
- Duke University Medical Center Durham NC USA
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18
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Hwang PH, Ang TFA, Liu X, Liu Y, Gurnani AS, Mez JB, Auerbach SH, Joshi PS, Yuan J, Devine SA, Au R, Liu C. Modifying adult life course dementia risk: results from the Framingham Heart Study. Alzheimers Dement 2022. [DOI: 10.1002/alz.059081] [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)
| | - Ting Fang Alvin Ang
- Boston University School of Medicine Boston MA USA
- Framingham Heart Study Framingham MA USA
- Boston University School of Public Health Boston MA USA
| | - Xue Liu
- Boston University School of Medicine Boston MA USA
| | - Yulin Liu
- Boston University School of Medicine Boston MA USA
| | | | - Jesse B. Mez
- Boston University School of Medicine Boston MA USA
- Boston University Alzheimer’s Disease Research Center Boston MA USA
| | | | | | - Jing Yuan
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences Beijing China
- Peking Union Medical College Hospital Beijing China
| | | | - Rhoda Au
- Boston University School of Medicine Boston MA USA
- The Framingham Heart Study, Boston University School of Medicine; Boston University School of Public Health Boston MA USA
- Boston University Alzheimer’s Disease Center, Boston University Boston MA USA
| | - Chunyu Liu
- Framingham Heart Study Framingham MA USA
- Boston University School of Public Health Boston MA USA
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19
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Kang M, Mez JB, Ang TFA, Devine SA, Mukherjee S, Trittschuh EH, Saykin AJ, Crane PK, Au R, Lunetta KL, Farrer LA. A Genome‐Wide Search for Pleiotropy in Cognitive Domain Scores. Alzheimers Dement 2022. [DOI: 10.1002/alz.066834] [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)
- Moonil Kang
- Department of Medicine, Boston University School of Medicine Boston MA USA
| | - Jesse B. Mez
- Boston University School of Medicine Boston MA USA
| | - Ting Fang Alvin Ang
- Department of Anatomy and Neurobiology, Boston University School of Medicine Boston MA USA
- Framingham Heart Study, Boston University School of Medicine Boston MA USA
- Slone Epidemiology Center, Boston University School of Medicine Boston MA USA
| | - Sherral A. Devine
- Department of Anatomy and Neurobiology, Boston University School of Medicine Boston MA USA
- Framingham Heart Study, Boston University School of Medicine Boston MA USA
| | - Shubhabrata Mukherjee
- Department of General Internal Medicine, University of Washington School of Medicine Seattle WA USA
| | - Emily H. Trittschuh
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine Seattle WA USA
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System Seattle WA USA
| | - Andrew J. Saykin
- Department of Radiology and Imaging Services, Indiana University School of Medicine Indianapolis IN USA
- Indiana University School of Medicine Indianapolis IN USA
- Department of Medical and Molecular Genetics, Indiana University School of Medicine Indianapolis IN USA
| | - Paul K. Crane
- Department of General Internal Medicine, University of Washington School of Medicine Seattle WA USA
- University of Washington Alzheimer’s Disease Research Center, University of Washington School of Medicine Seattle WA USA
| | - Rhoda Au
- Department of Anatomy and Neurobiology, Boston University School of Medicine Boston MA USA
- Framingham Heart Study, Boston University School of Medicine Boston MA USA
- Slone Epidemiology Center, Boston University School of Medicine Boston MA USA
- Department of Neurology, Boston University School of Medicine Boston MA USA
- Department of Epidemiology, Boston University School of Public Health Boston MA USA
| | - Kathryn L. Lunetta
- Department of Biostatistics, Boston University School of Public Health Boston MA USA
| | - Lindsay A. Farrer
- Department of Neurology, Boston University School of Medicine Boston MA USA
- Department of Epidemiology, Boston University School of Public Health Boston MA USA
- Department of Biostatistics, Boston University School of Public Health Boston MA USA
- Boston University School of Medicine, Department of Medicine, Biomedical Genetics Boston MA USA
- Department of Ophthalmology, Boston University School of Medicine Boston MA USA
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20
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Tao Q, Akhter-Khan SC, Ang TFA, DeCarli C, Alosco ML, Mez J, Killiany R, Devine S, Rokach A, Itchapurapu IS, Zhang X, Lunetta KL, Steffens DC, Farrer LA, Greve DN, Au R, Qiu WQ. Different loneliness types, cognitive function, and brain structure in midlife: Findings from the Framingham Heart Study. EClinicalMedicine 2022; 53:101643. [PMID: 36105871 PMCID: PMC9465265 DOI: 10.1016/j.eclinm.2022.101643] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/29/2022] Open
Abstract
Background It remains unclear whether persistent loneliness is related to brain structures that are associated with cognitive decline and development of Alzheimer's disease (AD). This study aimed to investigate the relationships between different loneliness types, cognitive functioning, and regional brain volumes. Methods Loneliness was measured longitudinally, using the item from the Center for Epidemiologic Studies Depression Scale in the Framingham Heart Study, Generation 3, with participants' average age of 46·3 ± 8·6 years. Robust regression models tested the association between different loneliness types with longitudinal neuropsychological performance (n = 2,609) and regional magnetic resonance imaging brain data (n = 1,829) (2002-2019). Results were stratified for sex, depression, and Apolipoprotein E4 (ApoE4). Findings Persistent loneliness, but not transient loneliness, was strongly associated with cognitive decline, especially memory and executive function. Persistent loneliness was negatively associated with temporal lobe volume (β = -0.18, 95%CI [-0.32, -0.04], P = 0·01). Among women, persistent loneliness was associated with smaller frontal lobe (β = -0.19, 95%CI [-0.38, -0.01], P = 0·04), temporal lobe (β = -0.20, 95%CI [-0.37, -0.03], P = 0·02), and hippocampus volumes (β = -0.23, 95%CI [-0.40, -0.06], P = 0·007), and larger lateral ventricle volume (β = 0.15, 95%CI [0.02, 0.28], P = 0·03). The higher cumulative loneliness scores across three exams, the smaller parietal, temporal, and hippocampus volumes and larger lateral ventricle were evident, especially in the presence of ApoE4. Interpretation Persistent loneliness in midlife was associated with atrophy in brain regions responsible for memory and executive dysfunction. Interventions to reduce the chronicity of loneliness may mitigate the risk of age-related cognitive decline and AD. Funding US National Institute on Aging.
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Affiliation(s)
- Qiushan Tao
- Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, Boston, MA, USA
- Framingham Heart Study, Boston University School of Medicine, USA
| | - Samia C. Akhter-Khan
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ting Fang Alvin Ang
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Slone Epidemiology Center, Boston University School of Medicine, USA
| | - Charles DeCarli
- Alzheimer's Disease Center, University of California Davis Medical Center, CA, USA
| | - Michael L. Alosco
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Alzheimer's Diesease and Chronic Traumatic Encephalopathy Research Centers, Boston University, Boston, MA, USA
| | - Jesse Mez
- Framingham Heart Study, Boston University School of Medicine, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Alzheimer's Diesease and Chronic Traumatic Encephalopathy Research Centers, Boston University, Boston, MA, USA
| | - Ronald Killiany
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Sherral Devine
- Framingham Heart Study, Boston University School of Medicine, USA
- Department of Psychiatry, Boston University School of Medicine, USA
| | - Ami Rokach
- Department of Psychology, York University, Toronto, Canada
| | - Indira Swetha Itchapurapu
- Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, Boston, MA, USA
| | - Xiaoling Zhang
- Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Medicine, USA
| | | | - David C. Steffens
- Department of Psychiatry, University of Connecticut School of Medicine, USA
| | - Lindsay A. Farrer
- Framingham Heart Study, Boston University School of Medicine, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Medicine, USA
| | - Douglas N. Greve
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard University School of Medicine, USA
| | - Rhoda Au
- Framingham Heart Study, Boston University School of Medicine, USA
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Slone Epidemiology Center, Boston University School of Medicine, USA
| | - Wei Qiao Qiu
- Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, Boston, MA, USA
- Alzheimer's Diesease and Chronic Traumatic Encephalopathy Research Centers, Boston University, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, USA
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21
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Liu C, Li Y, Nwosu A, Ang TFA, Liu Y, Devine S, Au R, Doraiswamy PM. Sex‐specific biomarkers in Alzheimer's disease progression: Framingham Heart Study. Alz & Dem Diag Ass & Dis Mo 2022; 14:e12369. [DOI: 10.1002/dad2.12369] [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] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/27/2020] [Accepted: 10/06/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Chunyu Liu
- Department of Biostatistics Boston University School of Public Health Boston Massachusetts USA
- Framingham Heart Study Boston University School of Medicine Boston Massachusetts USA
| | - Yi Li
- Department of Biostatistics Boston University School of Public Health Boston Massachusetts USA
| | - Adaora Nwosu
- Departments of Psychiatry and Medicine Neurocognitive Disorders Program Duke University School of Medicine Durham North Carolina USA
| | - Ting Fang Alvin Ang
- Framingham Heart Study Boston University School of Medicine Boston Massachusetts USA
- Department of Anatomy and Neurobiology Boston University School of Medicine Boston Massachusetts USA
| | - Yulin Liu
- Framingham Heart Study Boston University School of Medicine Boston Massachusetts USA
- Department of Anatomy and Neurobiology Boston University School of Medicine Boston Massachusetts USA
| | - Sherral Devine
- Framingham Heart Study Boston University School of Medicine Boston Massachusetts USA
- Department of Anatomy and Neurobiology Boston University School of Medicine Boston Massachusetts USA
| | - Rhoda Au
- Framingham Heart Study Boston University School of Medicine Boston Massachusetts USA
- Department of Anatomy and Neurobiology Boston University School of Medicine Boston Massachusetts USA
- Department of Neurology Boston University School of Medicine Boston Massachusetts USA
- Department of Epidemiology Boston University School of Public Health Boston Massachusetts USA
| | - P. Murali Doraiswamy
- Departments of Psychiatry and Medicine Neurocognitive Disorders Program Duke University School of Medicine Durham North Carolina USA
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Tavabi N, Stück D, Signorini A, Karjadi C, Al Hanai T, Sandoval M, Lemke C, Glass J, Hardy S, Lavallee M, Wasserman B, Ang TFA, Nowak CM, Kainkaryam R, Foschini L, Au R. Cognitive Digital Biomarkers from Automated Transcription of Spoken Language. J Prev Alzheimers Dis 2022; 9:791-800. [PMID: 36281684 DOI: 10.14283/jpad.2022.66] [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: 06/16/2023]
Abstract
BACKGROUND Although patients with Alzheimer's disease and other cognitive-related neurodegenerative disorders may benefit from early detection, development of a reliable diagnostic test has remained elusive. The penetration of digital voice-recording technologies and multiple cognitive processes deployed when constructing spoken responses might offer an opportunity to predict cognitive status. OBJECTIVE To determine whether cognitive status might be predicted from voice recordings of neuropsychological testing. DESIGN Comparison of acoustic and (para)linguistic variables from low-quality automated transcriptions of neuropsychological testing (n = 200) versus variables from high-quality manual transcriptions (n = 127). We trained a logistic regression classifier to predict cognitive status, which was tested against actual diagnoses. SETTING Observational cohort study. PARTICIPANTS 146 participants in the Framingham Heart Study. MEASUREMENTS Acoustic and either paralinguistic variables (e.g., speaking time) from automated transcriptions or linguistic variables (e.g., phrase complexity) from manual transcriptions. RESULTS Models based on demographic features alone were not robust (area under the receiver-operator characteristic curve [AUROC] 0.60). Addition of clinical and standard acoustic features boosted the AUROC to 0.81. Additional inclusion of transcription-related features yielded an AUROC of 0.90. CONCLUSIONS The use of voice-based digital biomarkers derived from automated processing methods, combined with standard patient screening, might constitute a scalable way to enable early detection of dementia.
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Affiliation(s)
- N Tavabi
- Rhoda Au, 72 E. Concord Street, Boston University School of Medicine, Boston, MA 02118. Telephone: (617) 358-0089;
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Alosco ML, Mian AZ, Buch K, Farris CW, Uretsky M, Tripodis Y, Baucom Z, Martin B, Palmisano J, Puzo C, Ang TFA, Joshi P, Goldstein LE, Au R, Katz DI, Dwyer B, Daneshvar DH, Nowinski C, Cantu RC, Kowall NW, Huber BR, Alvarez VE, Stern RA, Stein TD, Killiany RJ, McKee AC, Mez J. Structural MRI profiles and tau correlates of atrophy in autopsy-confirmed CTE. Alzheimers Res Ther 2021; 13:193. [PMID: 34876229 PMCID: PMC8653514 DOI: 10.1186/s13195-021-00928-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/31/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic traumatic encephalopathy (CTE), a neurodegenerative tauopathy, cannot currently be diagnosed during life. Atrophy patterns on magnetic resonance imaging could be an effective in vivo biomarker of CTE, but have not been characterized. Mechanisms of neurodegeneration in CTE are unknown. Here, we characterized macrostructural magnetic resonance imaging features of brain donors with autopsy-confirmed CTE. The association between hyperphosphorylated tau (p-tau) and atrophy on magnetic resonance imaging was examined. METHODS Magnetic resonance imaging scans were obtained by medical record requests for 55 deceased symptomatic men with autopsy-confirmed CTE and 31 men (n = 11 deceased) with normal cognition at the time of the scan, all >60 years Three neuroradiologists visually rated regional atrophy and microvascular disease (0 [none]-4 [severe]), microbleeds, and cavum septum pellucidum presence. Neuropathologists rated tau severity and atrophy at autopsy using semi-quantitative scales. RESULTS Compared to unimpaired males, donors with CTE (45/55=stage III/IV) had greater atrophy of the orbital-frontal (mean diff.=1.29), dorsolateral frontal (mean diff.=1.31), superior frontal (mean diff.=1.05), anterior temporal (mean diff.=1.57), and medial temporal lobes (mean diff.=1.60), and larger lateral (mean diff.=1.72) and third (mean diff.=0.80) ventricles, controlling for age at scan (ps<0.05). There were no effects for posterior atrophy or microvascular disease. Donors with CTE had increased odds of a cavum septum pellucidum (OR = 6.7, p < 0.05). Among donors with CTE, greater tau severity across 14 regions corresponded to greater atrophy on magnetic resonance imaging (beta = 0.68, p < 0.01). CONCLUSIONS These findings support frontal-temporal atrophy as a magnetic resonance imaging finding of CTE and show p-tau accumulation is associated with atrophy in CTE.
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Affiliation(s)
- Michael L Alosco
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
| | - Asim Z Mian
- Department of Radiology, Boston University School of Medicine, Boston, USA
| | - Karen Buch
- Department of Radiology, Massachusetts General Hospital, Boston, USA
| | - Chad W Farris
- Department of Radiology, Boston University School of Medicine, Boston, USA
- Department of Radiology, Massachusetts General Hospital, Boston, USA
| | - Madeline Uretsky
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Zachary Baucom
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Brett Martin
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, USA
| | - Joseph Palmisano
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, USA
| | - Christian Puzo
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
| | - Ting Fang Alvin Ang
- Framingham Heart Study, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
| | - Prajakta Joshi
- Framingham Heart Study, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
| | - Lee E Goldstein
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Department of Radiology, Boston University School of Medicine, Boston, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, USA
- Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston, USA
| | - Rhoda Au
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Framingham Heart Study, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Douglas I Katz
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Brigid Dwyer
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Braintree Rehabilitation Hospital, Braintree, MA, USA
| | - Daniel H Daneshvar
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
| | | | - Robert C Cantu
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Concussion Legacy Foundation, Boston, MA, USA
- Department of Neurosurgery, Boston University School of Medicine, Boston, USA
- Department of Neurosurgery, Emerson Hospital, Concord, USA
| | - Neil W Kowall
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, USA
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, USA
| | - Bertrand Russell Huber
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, USA
- National Center for PTSD, VA Boston Healthcare, Boston, USA
| | - Victor E Alvarez
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Robert A Stern
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, USA
- Department of Neurosurgery, Boston University School of Medicine, Boston, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Framingham Heart Study, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, USA
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Ronald J Killiany
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, USA
- Center for Biomedical Imaging, Boston University School of Medicine, Boston, USA
| | - Ann C McKee
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Framingham Heart Study, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, USA
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Research Center and CTE Center, Department of Neurology, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA.
- Framingham Heart Study, Boston University School of Medicine, 72 E Concord Street, Suite B7800, Boston, MA, 02118, USA.
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Zhang X, Tong T, Chang A, Ang TFA, Tao Q, Auerbach SH, Devine S, Qiu W, Mez J, Massaro J, Lunetta KL, Au R, Farrer LA. Midlife measures of lipid fractions and fasting glucose are associated with late‐onset Alzheimer disease. Alzheimers Dement 2021. [DOI: 10.1002/alz.051163] [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)
| | - Tong Tong
- Boston University School of Medicine Boston MA USA
| | - Andrew Chang
- Boston University School of Medicine Boston MA USA
| | | | - Qiushan Tao
- Boston University School of Medicine Boston MA USA
| | | | | | - Wendy Qiu
- Boston University School of Medicine Boston MA USA
- Boston University Boston MA USA
| | - Jesse Mez
- Boston University School of Medicine Boston MA USA
- Boston University Alzheimer’s Disease Research Center Boston MA USA
| | | | | | - Rhoda Au
- The Framingham Heart Study, Boston University School of Medicine; Boston University School of Public Health Boston MA USA
- Boston University Schools of Medicine & Public Health Boston MA USA
- Boston University Alzheimer’s Disease Center, Boston University Boston MA USA
| | - Lindsay A. Farrer
- Boston University School of Medicine Boston MA USA
- Boston University School of Public Health Boston MA USA
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Li J, Joshi P, Ang TFA, Liu C, Auerbach S, Devine S, Au R, Au R. Mid- to Late-Life Body Mass Index and Dementia Risk: 38 Years of Follow-up of the Framingham Study. Am J Epidemiol 2021; 190:2503-2510. [PMID: 33831181 DOI: 10.1093/aje/kwab096] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 11/15/2020] [Accepted: 12/22/2020] [Indexed: 01/29/2023] Open
Abstract
Growing evidence relates body mass index (BMI) to poorer health outcomes; however, results across studies associating BMI and dementia are conflicting. A total of 3,632 Framingham Offspring participants aged 20 to 60 years at their second health examination (1979-1983) were included in this study, with 190 cases of incident dementia identified by 2017. Cox proportional hazards regression models were fitted to investigate the association of BMI at each of their 8 exams as a baseline for dementia risk and the associations between obesity and dementia across age groups. Spline models were fitted to investigate nonlinear associations between BMI and dementia. Each 1-unit increase in BMI at ages 40-49 years was associated with higher risk of dementia, but with lower risk after age 70 years. Obesity at ages 40-49 years was associated with higher risk of dementia. Overall, the relationship between BMI and dementia risk was heterogeneous across the adult age range. Monitoring BMI at different ages might mediate risk for dementia across an individual's lifetime.
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Affiliation(s)
| | | | | | | | | | | | | | - Rhoda Au
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA.,Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA.,Boston University Alzheimer's Disease Center and Boston University CTE Center, Boston University School of Medicine, Boston, MA, USA
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26
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Akhter-Khan SC, Tao Q, Ang TFA, Itchapurapu IS, Alosco ML, Mez J, Piers RJ, Steffens DC, Au R, Qiu WQ. Associations of loneliness with risk of Alzheimer's disease dementia in the Framingham Heart Study. Alzheimers Dement 2021; 17:1619-1627. [PMID: 33760348 PMCID: PMC8460688 DOI: 10.1002/alz.12327] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [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: 10/23/2020] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The relationship between persistent loneliness and Alzheimer's disease (AD) is unclear. We examined the relationship between different types of mid-life loneliness and the development of dementia and AD. METHODS Loneliness was assessed in cognitively normal adults using one item from the Center for Epidemiologic Studies Depression Scale. We defined loneliness as no loneliness, transient loneliness, incident loneliness,or persistent loneliness, and applied Cox regression models and Kaplan-Meier plots with dementia and AD as outcomes (n = 2880). RESULTS After adjusting for demographics, social network, physical health, and apolipoprotein E ε4, persistent loneliness was associated with higher (hazard ratio [HR], 1.91; 95% confidence interval [CI] 1.25-2.90; P < .01), and transient loneliness with lower (HR, 0.34; 95% CI 0.14-0.84; P < .05), risk of dementia onset, compared to no loneliness. Results were similar for AD risk. DISCUSSION Persistent loneliness in mid-life is an independent risk factor for dementia and AD, whereas recovery from loneliness suggests resilience to dementia risk.
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Affiliation(s)
- Samia C. Akhter-Khan
- Department of Psychology, Humboldt University of Berlin, Unter den Linden 6, 10117 Berlin, Germany
| | - Qiushan Tao
- Framingham Heart Study, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
- Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - Ting Fang Alvin Ang
- Department of Anatomy & Neurobiology, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
- Department of Epidemiology, Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA
- Slone Epidemiology Center, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - Indira Swetha Itchapurapu
- Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - Michael L. Alosco
- Department of Neurology, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
- Alzheimer’s Disease and CTE Centers, Boston University, 72 E Concord St, Boston, MA 02118, USA
| | - Jesse Mez
- Framingham Heart Study, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
- Department of Neurology, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
- Alzheimer’s Disease and CTE Centers, Boston University, 72 E Concord St, Boston, MA 02118, USA
| | - Ryan J. Piers
- Framingham Heart Study, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - David C. Steffens
- Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, USA
| | - Rhoda Au
- Framingham Heart Study, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
- Department of Anatomy & Neurobiology, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
- Department of Epidemiology, Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA
- Slone Epidemiology Center, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
- Department of Neurology, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
- Alzheimer’s Disease and CTE Centers, Boston University, 72 E Concord St, Boston, MA 02118, USA
| | - Wei Qiao Qiu
- Framingham Heart Study, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
- Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
- Alzheimer’s Disease and CTE Centers, Boston University, 72 E Concord St, Boston, MA 02118, USA
- Department of Psychiatry, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
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27
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Tao Q, Alvin Ang TF, Akhter-Khan SC, Itchapurapu IS, Killiany R, Zhang X, Budson AE, Turk KW, Goldstein L, Mez J, Alosco ML, Qiu WQ. Impact of C-Reactive Protein on Cognition and Alzheimer Disease Biomarkers in Homozygous APOE ɛ4 Carriers. Neurology 2021; 97:e1243-e1252. [PMID: 34266923 PMCID: PMC8480484 DOI: 10.1212/wnl.0000000000012512] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 06/28/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Previous research has shown that elevated blood C-reactive protein (CRP) is associated with increased Alzheimer disease (AD) risk only in APOE ε4 allele carriers; the objective of this study was to examine the interactive effects of plasma CRP and APOE genotype on cognition and AD biomarkers. METHODS Data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) study were analyzed, including APOE genotype; plasma CRP concentrations; diagnostic status (i.e., mild cognitive impairment and dementia due to AD); Mini-Mental State Examination (MMSE) and Clinical Dementia Rating Dementia Staging Instrument scores; CSF concentrations of β-amyloid peptide (Aβ42), total tau (t-Tau) and phosphorylated tau (p-Tau); and amyloid (AV45) PET imaging. Multivariable regression analyses tested the associations between plasma CRP and APOE on cognitive and biomarker outcomes. RESULTS Among 566 ADNI participants, 274 (48.4%) had no, 222 (39.2%) had 1, and 70 (12.4%) had 2 APOE ε4 alleles. Among only participants who had 2 APOE ε4 alleles, elevated CRP was associated with lower MMSE score at baseline (β [95% confidence interval] -0.52 [-1.01, -0.12]) and 12-month follow-up (β -1.09 [-1.88, -0.17]) after adjustment for sex, age, and education. The interaction of 2 APOE ε4 alleles and elevated plasma CRP was associated with increased CSF levels of t-Tau (β = 11.21, SE 3.37, p < 0.001) and p-Tau (β = +2.74, SE 1.14, p < 0.01). Among those who had no APOE ε4 alleles, elevated CRP was associated with decreased CSF t-Tau and p-Tau. These effects were stronger at the 12-month follow-up. DISCUSSION CRP released during peripheral inflammation could be a mediator in APOE ε4-related AD neurodegeneration and serve as a drug target for AD.
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Affiliation(s)
- Qiushan Tao
- From the Department of Pharmacology and Experimental Therapeutics (Q.T., I.S.I., W.Q.Q.), Framingham Heart Study (Q.T., T.F.A.A.), Department of Anatomy and Neurobiology (T.F.A.A., R.K.), Slone Epidemiology Center (T.F.A.A.), Department of Medicine (X.Z.), Department of Neurology (A.E.B., K.W.T., J.M., M.L.A.), Department of Psychiatry (W.Q.Q.), and Alzheimer's Disease and CTE Centers (A.E.B., K.W.T., L.G., J.M., M.L.A., W.Q.Q.), Boston University School of Medicine, MA; Department of Psychology (S.C.A.-K.), Humboldt University of Berlin, Germany; Department of Health Service and Population Research (S.C.A.-K.), King's College London, UK; and Veterans Affairs Boston Healthcare System (A.E.B., K.W.T.), MA
| | - Ting Fang Alvin Ang
- From the Department of Pharmacology and Experimental Therapeutics (Q.T., I.S.I., W.Q.Q.), Framingham Heart Study (Q.T., T.F.A.A.), Department of Anatomy and Neurobiology (T.F.A.A., R.K.), Slone Epidemiology Center (T.F.A.A.), Department of Medicine (X.Z.), Department of Neurology (A.E.B., K.W.T., J.M., M.L.A.), Department of Psychiatry (W.Q.Q.), and Alzheimer's Disease and CTE Centers (A.E.B., K.W.T., L.G., J.M., M.L.A., W.Q.Q.), Boston University School of Medicine, MA; Department of Psychology (S.C.A.-K.), Humboldt University of Berlin, Germany; Department of Health Service and Population Research (S.C.A.-K.), King's College London, UK; and Veterans Affairs Boston Healthcare System (A.E.B., K.W.T.), MA
| | - Samia C Akhter-Khan
- From the Department of Pharmacology and Experimental Therapeutics (Q.T., I.S.I., W.Q.Q.), Framingham Heart Study (Q.T., T.F.A.A.), Department of Anatomy and Neurobiology (T.F.A.A., R.K.), Slone Epidemiology Center (T.F.A.A.), Department of Medicine (X.Z.), Department of Neurology (A.E.B., K.W.T., J.M., M.L.A.), Department of Psychiatry (W.Q.Q.), and Alzheimer's Disease and CTE Centers (A.E.B., K.W.T., L.G., J.M., M.L.A., W.Q.Q.), Boston University School of Medicine, MA; Department of Psychology (S.C.A.-K.), Humboldt University of Berlin, Germany; Department of Health Service and Population Research (S.C.A.-K.), King's College London, UK; and Veterans Affairs Boston Healthcare System (A.E.B., K.W.T.), MA
| | - Indira Swetha Itchapurapu
- From the Department of Pharmacology and Experimental Therapeutics (Q.T., I.S.I., W.Q.Q.), Framingham Heart Study (Q.T., T.F.A.A.), Department of Anatomy and Neurobiology (T.F.A.A., R.K.), Slone Epidemiology Center (T.F.A.A.), Department of Medicine (X.Z.), Department of Neurology (A.E.B., K.W.T., J.M., M.L.A.), Department of Psychiatry (W.Q.Q.), and Alzheimer's Disease and CTE Centers (A.E.B., K.W.T., L.G., J.M., M.L.A., W.Q.Q.), Boston University School of Medicine, MA; Department of Psychology (S.C.A.-K.), Humboldt University of Berlin, Germany; Department of Health Service and Population Research (S.C.A.-K.), King's College London, UK; and Veterans Affairs Boston Healthcare System (A.E.B., K.W.T.), MA
| | - Ronald Killiany
- From the Department of Pharmacology and Experimental Therapeutics (Q.T., I.S.I., W.Q.Q.), Framingham Heart Study (Q.T., T.F.A.A.), Department of Anatomy and Neurobiology (T.F.A.A., R.K.), Slone Epidemiology Center (T.F.A.A.), Department of Medicine (X.Z.), Department of Neurology (A.E.B., K.W.T., J.M., M.L.A.), Department of Psychiatry (W.Q.Q.), and Alzheimer's Disease and CTE Centers (A.E.B., K.W.T., L.G., J.M., M.L.A., W.Q.Q.), Boston University School of Medicine, MA; Department of Psychology (S.C.A.-K.), Humboldt University of Berlin, Germany; Department of Health Service and Population Research (S.C.A.-K.), King's College London, UK; and Veterans Affairs Boston Healthcare System (A.E.B., K.W.T.), MA
| | - Xiaoling Zhang
- From the Department of Pharmacology and Experimental Therapeutics (Q.T., I.S.I., W.Q.Q.), Framingham Heart Study (Q.T., T.F.A.A.), Department of Anatomy and Neurobiology (T.F.A.A., R.K.), Slone Epidemiology Center (T.F.A.A.), Department of Medicine (X.Z.), Department of Neurology (A.E.B., K.W.T., J.M., M.L.A.), Department of Psychiatry (W.Q.Q.), and Alzheimer's Disease and CTE Centers (A.E.B., K.W.T., L.G., J.M., M.L.A., W.Q.Q.), Boston University School of Medicine, MA; Department of Psychology (S.C.A.-K.), Humboldt University of Berlin, Germany; Department of Health Service and Population Research (S.C.A.-K.), King's College London, UK; and Veterans Affairs Boston Healthcare System (A.E.B., K.W.T.), MA
| | - Andrew E Budson
- From the Department of Pharmacology and Experimental Therapeutics (Q.T., I.S.I., W.Q.Q.), Framingham Heart Study (Q.T., T.F.A.A.), Department of Anatomy and Neurobiology (T.F.A.A., R.K.), Slone Epidemiology Center (T.F.A.A.), Department of Medicine (X.Z.), Department of Neurology (A.E.B., K.W.T., J.M., M.L.A.), Department of Psychiatry (W.Q.Q.), and Alzheimer's Disease and CTE Centers (A.E.B., K.W.T., L.G., J.M., M.L.A., W.Q.Q.), Boston University School of Medicine, MA; Department of Psychology (S.C.A.-K.), Humboldt University of Berlin, Germany; Department of Health Service and Population Research (S.C.A.-K.), King's College London, UK; and Veterans Affairs Boston Healthcare System (A.E.B., K.W.T.), MA
| | - Katherine W Turk
- From the Department of Pharmacology and Experimental Therapeutics (Q.T., I.S.I., W.Q.Q.), Framingham Heart Study (Q.T., T.F.A.A.), Department of Anatomy and Neurobiology (T.F.A.A., R.K.), Slone Epidemiology Center (T.F.A.A.), Department of Medicine (X.Z.), Department of Neurology (A.E.B., K.W.T., J.M., M.L.A.), Department of Psychiatry (W.Q.Q.), and Alzheimer's Disease and CTE Centers (A.E.B., K.W.T., L.G., J.M., M.L.A., W.Q.Q.), Boston University School of Medicine, MA; Department of Psychology (S.C.A.-K.), Humboldt University of Berlin, Germany; Department of Health Service and Population Research (S.C.A.-K.), King's College London, UK; and Veterans Affairs Boston Healthcare System (A.E.B., K.W.T.), MA
| | - Lee Goldstein
- From the Department of Pharmacology and Experimental Therapeutics (Q.T., I.S.I., W.Q.Q.), Framingham Heart Study (Q.T., T.F.A.A.), Department of Anatomy and Neurobiology (T.F.A.A., R.K.), Slone Epidemiology Center (T.F.A.A.), Department of Medicine (X.Z.), Department of Neurology (A.E.B., K.W.T., J.M., M.L.A.), Department of Psychiatry (W.Q.Q.), and Alzheimer's Disease and CTE Centers (A.E.B., K.W.T., L.G., J.M., M.L.A., W.Q.Q.), Boston University School of Medicine, MA; Department of Psychology (S.C.A.-K.), Humboldt University of Berlin, Germany; Department of Health Service and Population Research (S.C.A.-K.), King's College London, UK; and Veterans Affairs Boston Healthcare System (A.E.B., K.W.T.), MA
| | - Jesse Mez
- From the Department of Pharmacology and Experimental Therapeutics (Q.T., I.S.I., W.Q.Q.), Framingham Heart Study (Q.T., T.F.A.A.), Department of Anatomy and Neurobiology (T.F.A.A., R.K.), Slone Epidemiology Center (T.F.A.A.), Department of Medicine (X.Z.), Department of Neurology (A.E.B., K.W.T., J.M., M.L.A.), Department of Psychiatry (W.Q.Q.), and Alzheimer's Disease and CTE Centers (A.E.B., K.W.T., L.G., J.M., M.L.A., W.Q.Q.), Boston University School of Medicine, MA; Department of Psychology (S.C.A.-K.), Humboldt University of Berlin, Germany; Department of Health Service and Population Research (S.C.A.-K.), King's College London, UK; and Veterans Affairs Boston Healthcare System (A.E.B., K.W.T.), MA
| | - Michael L Alosco
- From the Department of Pharmacology and Experimental Therapeutics (Q.T., I.S.I., W.Q.Q.), Framingham Heart Study (Q.T., T.F.A.A.), Department of Anatomy and Neurobiology (T.F.A.A., R.K.), Slone Epidemiology Center (T.F.A.A.), Department of Medicine (X.Z.), Department of Neurology (A.E.B., K.W.T., J.M., M.L.A.), Department of Psychiatry (W.Q.Q.), and Alzheimer's Disease and CTE Centers (A.E.B., K.W.T., L.G., J.M., M.L.A., W.Q.Q.), Boston University School of Medicine, MA; Department of Psychology (S.C.A.-K.), Humboldt University of Berlin, Germany; Department of Health Service and Population Research (S.C.A.-K.), King's College London, UK; and Veterans Affairs Boston Healthcare System (A.E.B., K.W.T.), MA
| | - Wei Qiao Qiu
- From the Department of Pharmacology and Experimental Therapeutics (Q.T., I.S.I., W.Q.Q.), Framingham Heart Study (Q.T., T.F.A.A.), Department of Anatomy and Neurobiology (T.F.A.A., R.K.), Slone Epidemiology Center (T.F.A.A.), Department of Medicine (X.Z.), Department of Neurology (A.E.B., K.W.T., J.M., M.L.A.), Department of Psychiatry (W.Q.Q.), and Alzheimer's Disease and CTE Centers (A.E.B., K.W.T., L.G., J.M., M.L.A., W.Q.Q.), Boston University School of Medicine, MA; Department of Psychology (S.C.A.-K.), Humboldt University of Berlin, Germany; Department of Health Service and Population Research (S.C.A.-K.), King's College London, UK; and Veterans Affairs Boston Healthcare System (A.E.B., K.W.T.), MA.
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Thomas RJ, Kim H, Maillard P, DeCarli CS, Heckman EJ, Karjadi C, Ang TFA, Au R. Digital sleep measures and white matter health in the Framingham Heart Study. Explor Med 2021; 2:253-267. [PMID: 34927164 PMCID: PMC8682916 DOI: 10.37349/emed.2021.00045] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/18/2021] [Indexed: 01/23/2023] Open
Abstract
AIM Impaired sleep quality and sleep oxygenation are common sleep pathologies. This study assessed the impact of these abnormalities on white matter (WM) integrity in an epidemiological cohort. METHODS The target population was the Framingham Heart Study Generation-2/Omni-1 Cohorts. Magnetic resonance imaging (diffusion tensor imaging) was used to assess WM integrity. Wearable digital devices were used to assess sleep quality: the (M1-SleepImage™ system) and the Nonin WristOx for nocturnal oxygenation. The M1 device collects trunk actigraphy and the electrocardiogram (ECG); sleep stability indices were computed using cardiopulmonary coupling using the ECG. Two nights of recording were averaged. RESULTS Stable sleep was positively associated with WM health. Actigraphic periods of wake during the sleep period were associated with increased mean diffusivity. One marker of sleep fragmentation which covaries with respiratory chemoreflex activation was associated with reduced fractional anisotropy and increased mean diffusivity. Both oxygen desaturation index and oxygen saturation time under 90% were associated with pathological directions of diffusion tensor imaging signals. Gender differences were noted across most variables, with female sex showing the larger and significant impact. CONCLUSIONS Sleep quality assessed by a novel digital analysis and sleep hypoxia was associated with WM injury, especially in women.
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Affiliation(s)
- Robert Joseph Thomas
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Hyun Kim
- Department of Anatomy & Neurobiology, and Framingham Heart Study, Boston University School of Medicine, Boston, MA 02118, USA
| | - Pauline Maillard
- Department of Neurology, University of California Davis Health, Sacramento, CA 95817, USA
| | - Charles S. DeCarli
- Department of Neurology, University of California Davis Health, Sacramento, CA 95817, USA
| | - Eric James Heckman
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Cody Karjadi
- Department of Anatomy & Neurobiology, and Framingham Heart Study, Boston University School of Medicine, Boston, MA 02118, USA
| | - Ting Fang Alvin Ang
- Department of Anatomy & Neurobiology, and Framingham Heart Study, Boston University School of Medicine, Boston, MA 02118, USA
| | - Rhoda Au
- Department of Anatomy & Neurobiology, and Framingham Heart Study, Boston University School of Medicine, Boston, MA 02118, USA
- Department of Neurology and Epidemiology, Boston University School of Medicine and Public Health, Boston, MA 02118, USA
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Lee YH, Chang YC, Ang TFA, Chiang T, Shelley M, Liu CT. Associations of staple food consumption and types of cooking oil with waist circumference and body mass index in older Chinese men and women: a panel analysis. Int Health 2021; 13:178-187. [PMID: 33045038 PMCID: PMC7902270 DOI: 10.1093/inthealth/ihaa074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/15/2020] [Accepted: 09/18/2020] [Indexed: 01/23/2023] Open
Abstract
Background The dietary landscape has changed rapidly in China in the past few decades. This research investigates the associations of older adults’ choices and consumption of staple foods and cooking oils with obesity-related measurements. Methods Panel data were extracted from the Chinese Longitudinal Health Longevity Survey from 3253 older participants with 6506 observations. Ordinary least squares and ordered logistic regression models were estimated with the outcomes of obesity determined by waist circumference (WC) and body mass index (BMI), respectively. Results Older men who consumed wheat had wider WCs (β=2.84 [95% confidence interval {CI} 1.55 to 4.13], p<0.01) and higher BMIs (adjusted odds ratio 1.74 [95% CI 1.40 to 2.17], p<0.01) than those who preferred rice. Female participants who used animal-based cooking oil had lower WCs and BMIs than their counterparts who consumed vegetable-based cooking oil. Increased consumption of staple foods was associated with increased rates of obesity in both sexes. Conclusion Dieticians and nutritionists should design appropriate dietary plans to help reduce obesity and chronic diseases among older Chinese adults. Further clinical trials are needed to continue investigating this topic.
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Affiliation(s)
- Yen-Han Lee
- Indiana University, School of Public Health, Department of Applied Health Sciences, Bloomington, IN 47401, USA
| | - Yen-Chang Chang
- National Tsing Hua University, Center for General Education, Hsinchu City, Taiwan 300
| | - Ting Fang Alvin Ang
- Boston University School of Medicine, Department of Anatomy and Neurobiology, Boston, MA 02118, USA.,Boston University School of Medicine, Slone Epidemiology Center, Boston, MA 02118, USA
| | - Timothy Chiang
- Pennsylvania State University, College of Medicine, Hershey, PA 17033, USA
| | - Mack Shelley
- Iowa State University, Department of Political Science and Department of Statistics, Ames, IA 50011, USA
| | - Ching-Ti Liu
- Boston University, School of Public Health, Department of Biostatistics, Boston, MA 02118, USA
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Abstract
China has a long history of smoking behavior. Currently, nearly 26% of Chinese citizens smoke daily. This research used a nationally representative database to study the urban and rural disparities on smoking patterns applying the social-ecological model. Using the 2011 China Health and Nutrition Survey, the study sample included adult participants who were at least 18 years of age (n = 12,688). A subanalysis was carried out to investigate smoking cessation duration among smoking quitters (n = 519). Multinomial logistic regression was used to examine participants' smoking status. Zero-inflated negative binomial regression was applied to investigate participants' number of cigarettes smoked per day, and multivariable logistic regression was used to examine nondaily smoking behavior. Negative binomial regression was carried out to assess the duration of smoking cessation for individuals who quit smoking. Urban residents had lower odds of reporting current smoking status (AOR [adjusted odds ratio] = 0.83, 95% CI [0.74, 0.95]) as compared to rural residents. Urban residents also had higher odds of reporting nondaily smoking status (AOR = 1.17, 95% CI [1.04, 1.32]) and smoked fewer cigarettes per day (IRR [incidence rate ratio] = 0.93, 95% CI [0.89, 0.98]) as compared to rural participants. The disparity between urban and rural areas was not observed for smoking cessation duration. Further efforts should target the disparity between urban and rural regions regarding smoking prevention.
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Zhang X, Tong T, Chang A, Ang TFA, Tao Q, Auerbach SH, Devine S, Qiu W, Mez J, Massaro J, Lunetta KL, Au R, Farrer LA. Early‐mid adulthood measures of HDL, triglycerides and fasting glucose are associated with late‐onset Alzheimer disease. Alzheimers Dement 2020. [DOI: 10.1002/alz.046125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Tong Tong
- Boston University School of Medicine Boston MA USA
| | - Andrew Chang
- Boston University School of Medicine Boston MA USA
| | | | - Qiushan Tao
- Boston University School of Medicine Boston MA USA
| | | | | | | | - Jesse Mez
- Boston University Alzheimer's Disease Center Boston MA USA
| | | | | | - Rhoda Au
- Boston University Schools of Medicine & Public Health Boston MA USA
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Joshi PS, Heydari M, Kannan S, Alvin Ang TF, Qin Q, Liu X, Mez J, Devine S, Au R, Kolachalama VB. Temporal association of neuropsychological test performance using unsupervised learning reveals a distinct signature of Alzheimer's disease status. Alzheimers Dement (N Y) 2019; 5:964-973. [PMID: 31921970 PMCID: PMC6944730 DOI: 10.1016/j.trci.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Subtle cognitive alterations that precede clinical evidence of cognitive impairment may help predict the progression to Alzheimer's disease (AD). Neuropsychological (NP) testing is an attractive modality for screening early evidence of AD. METHODS Longitudinal NP and demographic data from the Framingham Heart Study (FHS; N = 1696) and the National Alzheimer's Coordinating Center (NACC; N = 689) were analyzed using an unsupervised machine learning framework. Features, including age, logical memory-immediate and delayed recall, visual reproduction-immediate and delayed recall, the Boston naming tests, and Trails B, were identified using feature selection, and processed further to predict the risk of development of AD. RESULTS Our model yielded 83.07 ± 3.52% accuracy in FHS and 87.57 ± 1.19% accuracy in NACC, 80.52 ± 3.93%, 86.74 ± 1.63% sensitivity in FHS and NACC respectively, and 85.63 ± 4.71%, 88.41 ± 1.38% specificity in FHS and NACC, respectively. DISCUSSION Our results suggest that a subset of NP tests, when analyzed using unsupervised machine learning, may help distinguish between high- and low-risk individuals in the context of subsequent development of AD within 5 years. This approach could be a viable option for early AD screening in clinical practice and clinical trials.
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Affiliation(s)
- Prajakta S. Joshi
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Department of General Dentistry, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Megan Heydari
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Shruti Kannan
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Ting Fang Alvin Ang
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- The Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA
| | - Qiuyuan Qin
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Xue Liu
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Jesse Mez
- Boston University Alzheimer's Disease Center, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Sherral Devine
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
- The Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA
| | - Rhoda Au
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- The Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA
- Boston University Alzheimer's Disease Center, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Vijaya B. Kolachalama
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Boston University Alzheimer's Disease Center, Boston, MA, USA
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
- Hariri Institute for Computing and Computational Science & Engineering, Boston University, Boston, MA, USA
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Zhu H, Tao Q, Ang TFA, Massaro J, Gan Q, Salim S, Zhu RY, Kolachalama VB, Zhang X, Devine S, Auerbach SH, DeCarli C, Au R, Qiu WQ. Association of Plasma Amylin Concentration With Alzheimer Disease and Brain Structure in Older Adults. JAMA Netw Open 2019; 2:e199826. [PMID: 31433485 PMCID: PMC6707010 DOI: 10.1001/jamanetworkopen.2019.9826] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Preclinical studies suggest that amylin has a U-shaped dose-response association with risk of Alzheimer disease (AD). The association of plasma amylin with AD in humans is unknown. OBJECTIVES To measure amylin concentration in plasma by using enzyme-linked immunosorbent assay and to study the association between plasma amylin, incidence of AD, and brain structure in humans. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Framingham Heart Study offspring cohort from 1998 to 2015. Using a Monte Carlo approach, participants were divided into 3 plasma amylin concentration groups: (1) low (<75 pmol/L), (2) high (75-2800 pmol/L), and (3) extremely high (≥2800 pmol/L). Data analyses were conducted October 5, 2017, to December 18, 2018. EXPOSURES Baseline plasma amylin concentrations at examination 7. MAIN OUTCOMES AND MEASURES Incidence of dementia or AD and brain volumetric measures from structural magnetic resonance imaging data. RESULTS From the Framingham Heart Study offspring cohort, 3061 participants (mean [SD] age at baseline, 61.0 [9.5] years; 1653 [54.0%] women) who had plasma amylin measurements, dementia incidence, and brain volume measurements on record were included in this study. The distribution of plasma amylin concentrations was highly skewed (median [interquartile range], 7.5 [4.6-18.9] pmol/L; mean [SD], 302.3 [1941.0] pmol/L; range, 0.03-44 623.7 pmol/L). Compared with the low plasma amylin concentration group, the high plasma amylin concentration group had a lower rate of AD incidence (2.3% vs 5.6%; P = .04), but the extremely high plasma amylin concentration group had a higher rate of AD incidence (14.3%; P < .001). After adjusting for age, sex, education, body mass index, diabetes, cardiovascular disease, high-density lipoprotein level, and APOE4, high plasma amylin was not associated with decreased AD risk (hazard ratio, 0.42 [95% CI, 0.16-1.14]; P = .09) but was positively associated with volume of gray matter in the temporal lobe (β = 0.17 [SE, 0.05]; P < .001). In contrast, extremely high plasma amylin concentration was associated with a higher AD risk (hazard ratio, 2.51 [95% CI, 1.38-4.57]; P = .003) but not associated with temporal lobe volume (β = 0.02 [SE, 0.07]; P = .82). CONCLUSIONS AND RELEVANCE This study found that plasma amylin concentration was associated with AD incidence and brain structure with a U-shaped pattern. These findings are consistent with preclinical findings that suggest amylin is a neuropeptide that is physiological; however, at extremely high concentrations, it may lead to amylin aggregation and therefore may be a risk factor for AD.
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Affiliation(s)
- Haihao Zhu
- Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, Boston, Massachusetts
| | - Qiushan Tao
- Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, Boston, Massachusetts
| | - Ting Fang Alvin Ang
- Department of Epidemiology, School of Public Health, Boston University School of Medicine, Boston, Massachusetts
- Framingham Heart Study, Boston University School of Medicine, Boston, Massachusetts
| | - Joseph Massaro
- Department of Epidemiology, School of Public Health, Boston University School of Medicine, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Qini Gan
- Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, Boston, Massachusetts
| | - Saraf Salim
- Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, Boston, Massachusetts
| | - Rui-ying Zhu
- Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, Boston, Massachusetts
| | | | - Xiaoling Zhang
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Sheral Devine
- Department of Epidemiology, School of Public Health, Boston University School of Medicine, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Sanford H. Auerbach
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Charles DeCarli
- Alzheimer’s Disease Center, University of California Davis Medical Center, Sacramento
| | - Rhoda Au
- Department of Epidemiology, School of Public Health, Boston University School of Medicine, Boston, Massachusetts
- Framingham Heart Study, Boston University School of Medicine, Boston, Massachusetts
- Alzheimer’s Disease Center, Boston University School of Medicine, Boston, Massachusetts
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Wei Qiao Qiu
- Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
- Alzheimer’s Disease Center, Boston University School of Medicine, Boston, Massachusetts
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Abstract
Efforts to provide patients with individualized treatments have led to tremendous breakthroughs in healthcare. However, a precision medicine approach alone will not offset the rapid increase in prevalence and burden of chronic non-communicable illnesses that is continuing to pervade the world's aging population. With rapid advances in technology, it is now possible to collect digital metrics to assess, monitor and detect chronic disease indicators, much earlier in the disease course, potentially redefining what was previously considered asymptomatic to pre-symptomatic. Data science and artificial intelligence can drive the discovery of digital biomarkers before the emergence of overt clinical symptoms, thereby transforming the current healthcare approach from one centered on precision medicine to a more comprehensive focus on precision health, and by doing so enable the possibility of preventing disease altogether. Presented herein are the challenges to the current healthcare model and the proposition of first steps for reversing the prevailing intractable trend of rising healthcare costs and poorer health quality.
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Affiliation(s)
- Rhoda Au
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Boston, MA 01702, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA 02118, USA
| | - Marina Ritchie
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA 02118, USA
| | - Spencer Hardy
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA 02118, USA
| | - Ting Fang Alvin Ang
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Boston, MA 01702, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA 02118, USA
| | - Honghuang Lin
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Boston, MA 01702, USA
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
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Tao Q, Ang TFA, DeCarli C, Auerbach SH, Devine S, Stein TD, Zhang X, Massaro J, Au R, Qiu WQ. Association of Chronic Low-grade Inflammation With Risk of Alzheimer Disease in ApoE4 Carriers. JAMA Netw Open 2018; 1:e183597. [PMID: 30646251 PMCID: PMC6324596 DOI: 10.1001/jamanetworkopen.2018.3597] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/21/2018] [Indexed: 12/31/2022] Open
Abstract
Importance The association between peripheral inflammatory biomarkers and Alzheimer disease (AD) is not consistent in the literature. It is possible that chronic inflammation, rather than 1 episode of inflammation, interacts with genetic vulnerability to increase the risk for AD. Objective To study the interaction between the apolipoprotein E (ApoE) genotype and chronic low-grade inflammation and its association with the incidence of AD. Design, Setting, and Participants In this cohort study, data from 2656 members of the Framingham Heart Study offspring cohort (Generation 2; August 13, 1971-November 27, 2017) were evaluated, including longitudinal measures of serum C-reactive protein (CRP), diagnoses of incident dementia including AD, and brain volume. Chronic low-grade inflammation was defined as having CRP at a high cutoff level at a minimum of 2 time points. Statistical analysis was performed from December 1, 1979, to December 31, 2015. Main Outcomes and Measures Development of AD and brain volumes. Results Of the 3130 eligible participants, 2656 (84.9%; 1227 men and 1429 women; mean [SD] age at last CRP measurement, 61.6 [9.5] years) with both ApoE status and longitudinal CRP measurements were included in this study analysis. Median (interquartile range) CRP levels increased with mean (SD) age (43.3 [9.6] years, 0.95 mg/L [0.40-2.35 mg/L] vs 59.1 [9.6] years, 2.04 mg/L [0.93-4.75 mg/L] vs 61.6 [9.5] years, 2.21 mg/L [1.05-5.12 mg/L]; P < .001), but less so among those with ApoE4 alleles, followed by ApoE3 then ApoE2 genotypes. During the 17 years of follow-up, 194 individuals (7.3%) developed dementia, 152 (78.4%) of whom had AD. ApoE4 coupled with chronic low-grade inflammation, defined as a CRP level of 8 mg/L or higher, was associated with an increased risk of AD, especially in the absence of cardiovascular diseases (hazard ratio, 6.63; 95% CI, 1.80-24.50; P = .005), as well as an increased risk of earlier disease onset compared with ApoE4 carriers without chronic inflammation (hazard ratio, 3.52; 95% CI, 1.27-9.75; P = .009). This phenomenon was not observed among ApoE3 and ApoE2 carriers with chronic low-grade inflammation. Finally, a subset of 1761 individuals (66.3%) underwent brain magnetic resonance imaging, and the interaction between ApoE4 and chronic low-grade inflammation was associated with brain atrophy in the temporal lobe (β = -0.88, SE = 0.22; P < .001) and hippocampus (β = -0.04, SE = 0.01; P = .005), after adjusting for confounders. Conclusions and Relevance In this study, peripheral chronic low-grade inflammation in participants with ApoE4 was associated with shortened latency for onset of AD. Rigorously treating chronic systemic inflammation based on genetic risk could be effective for the prevention and intervention of AD.
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Affiliation(s)
- Qiushan Tao
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, Massachusetts
| | - Ting Fang Alvin Ang
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Charles DeCarli
- Alzheimer’s Disease Center, University of California Davis Medical Center, Sacramento
| | - Sanford H. Auerbach
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Sheral Devine
- Framingham Heart Study, Boston University School of Medicine, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Thor D. Stein
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
- Department of Pathology, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Alzheimer’s Disease Center, Boston University School of Medicine, Boston, Massachusetts
| | - Xiaoling Zhang
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Joseph Massaro
- Framingham Heart Study, Boston University School of Medicine, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Rhoda Au
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Framingham Heart Study, Boston University School of Medicine, Boston, Massachusetts
- Alzheimer’s Disease Center, Boston University School of Medicine, Boston, Massachusetts
| | - Wei Qiao Qiu
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
- Alzheimer’s Disease Center, Boston University School of Medicine, Boston, Massachusetts
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Stück D, Signorini A, Al Hanai T, Sandoval M, Lemke C, Glass J, Hardy S, Lavallee M, Wasserman B, Alvin Ang TF, Nowak C, Au R. P2‐267: NOVEL DIGITAL VOICE BIOMARKERS OF DEMENTIA FROM THE FRAMINGHAM STUDY. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | | | | | - Jim Glass
- Massachusetts Institute of TechnologyCambridgeMAUSA
| | - Spencer Hardy
- Framingham Heart StudyFraminghamMAUSA
- Boston University School of MedicineBostonMAUSA
| | - Maria Lavallee
- Framingham Heart StudyFraminghamMAUSA
- Boston University School of MedicineBostonMAUSA
| | - Brynna Wasserman
- Framingham Heart StudyFraminghamMAUSA
- Boston University School of MedicineBostonMAUSA
| | - Ting Fang Alvin Ang
- Framingham Heart StudyFraminghamMAUSA
- Boston University School of Public HealthBostonMAUSA
| | - Christina Nowak
- Framingham Heart StudyFraminghamMAUSA
- Boston University School of MedicineBostonMAUSA
| | - Rhoda Au
- Boston University Schools of Medicine and Public HealthBostonMAUSA
- Boston University Framingham Heart StudyBostonMAUSA
- Boston University Alzheimer's Disease CenterBostonMAUSA
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Alvin Ang TF, Ferretti MT, Au R. O1‐14‐06: SEX DIFFERENCES IN NEUROPSYCHOLOGICAL MEASURES IN THE FRAMINGHAM HEART STUDY. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.3052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Rhoda Au
- Boston University Schools of Medicine and Public HealthBostonMAUSA
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Lee YH, Ang TFA, Chiang TC, Kaplan WA. Growing concerns and controversies to Taiwan's National Health Insurance-what are the lessons from mainland China, South Korea and Singapore? Int J Health Plann Manage 2016; 33:e357-e366. [PMID: 27723118 DOI: 10.1002/hpm.2387] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/22/2016] [Indexed: 11/08/2022] Open
Abstract
It has been over 20 years since Taiwan's implementation of its National Health Insurance (NHI) program. Under this program, the health insurance coverage rate has reached approximately 99% of the population. Despite guaranteeing the residents of Taiwan equal access regardless of socioeconomic status and background, critical problems and controversies persist, and they continue to challenge the NHI. We analyze the primary issues facing the NHI program with emphasis on financial and consumer behavioral aspects. Furthermore, we apply models from mainland China, South Korea and Singapore to discuss what Taiwan could learn from the systems employed by these countries to modify the NHI. Targeting the needs of the NHI, we have three policy recommendations: separating the NHI scheme into different target populations, strengthening the NHI referral system and regulating the access of overseas citizens to health services while in Taiwan. After two decades in existence, problems persist and there is a continuing need to improve Taiwan's NHI. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yen-Han Lee
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Ting Fang Alvin Ang
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Timothy C Chiang
- College of Medicine, Pennsylvania State University-Hershey, Hershey, Pennsylvania, USA
| | - Warren A Kaplan
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
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