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Parra MA, Gazes Y, Habeck C, Stern Y. Exploring the Association between Amyloid-β and Memory Markers for Alzheimer's Disease in Cognitively Unimpaired Older Adults. J Prev Alzheimers Dis 2024; 11:339-347. [PMID: 38374740 PMCID: PMC11007669 DOI: 10.14283/jpad.2024.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
BACKGROUND Memory tests vary in their sensitivity for detection of pre-symptomatic Alzheimer's disease (AD). The Visual Short-Term Memory Binding Test (VSTMBT) identifies AD-related performance deficits in older adults who are otherwise cognitively unimpaired. OBJECTIVE We investigated the association of this psychometric measure with brain amyloidosis and atrophy. DESIGN Cross-sectional mixed and correlational. SETTING Cognitive Reserve Study from Columbia University. PARTICIPANTS a sample of 39 cognitively unimpaired older adults (Age: M=65.3, SD=3.07) was obtained from the above study. MEASUREMENTS Extensive neuropsychological and neuroimaging (MRI and amyloid-β PET) assessments were carried out. RESULTS Performance on the VSTMBT allowed us to split the sample into Low Binding Cost (LBC, N=21) and High Binding Cost (HBC, N=18). Groups were matched according to age [p=0.702], years of education [0.071], and sex [p=0.291]. HBC's performance was comparable to that seen in symptomatic AD. Groups only differed in their amyloid-β deposition on PET in regions of the right ventral stream linked to visual cognition and affected early in AD pathogenesis (lateral-occipital cortex, p = 0.008; fusiform gyrus, p = 0.017; and entorhinal cortex, p = 0.046). Other regions known to be linked to low-level visual integration function also revealed increased amyloid-β deposition in HBC. CONCLUSIONS VSTMB deficits are associated with neuropathogenesis (i.e., amyloid-β deposition) in the earliest affected regions in pre-symptomatic AD. The VSTMB test holds potential for the identification of cognitively unimpaired older adults with very early AD pathogenesis and may thus be a useful tool for early intervention trials or other forms of clinical research.
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Affiliation(s)
- M A Parra
- Dr Mario A Parra, Department of Psychological Sciences and Health, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1QE, Room GH521, Tel.+44 (0) 141 548 4362,
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Tsapanou A, Mourtzi N, Gu Y, Habeck C, Belsky D, Stern Y. Polygenic indices for cognition in healthy aging; the role of brain measures. Neuroimage: Reports 2023; 3. [PMID: 36969093 PMCID: PMC10038095 DOI: 10.1016/j.ynirp.2022.100153] [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: 12/24/2022]
Abstract
Background Genome-wide association studies (GWAS) have identified large numbers of genetic variants associated with cognition. However, little is known about how these genetic discoveries impact cognitive aging. Methods We conducted polygenic-index (PGI) analysis of cognitive performance in n = 168 European-ancestry adults aged 20-80. We computed PGIs based on GWAS of cognitive performance in young/middle-aged and older adults. We tested associations of the PGI with cognitive performance, as measured through neuropsychological evaluation. We explored whether these associations were accounted for by magnetic resonance imaging (MRI) measures of brain-aging phenotypes: total gray matter volume (GM), cortical thickness (CT), and white matter hyperintensities burden (WMH). Results Participants with higher PGI values performed better on cognitive tests (B = 0.627, SE = 0.196, p = 0.002) (age, sex, and principal components as covariates). Associations remained significant with inclusion of covariates for MRI measures of brain aging; B = 0.439, SE: 0.198, p = 0.028). PGI associations were stronger in young and middle-aged (age<65) as compared to older adults. For further validation, linear regression for Cog PGI and cognition in the fully adjusted model and adding the interaction between age group and Cog PGI, showed significant results (B = 0.892, SE: 0.325, p = 0.007) driven by young and middle-aged adults (B = -0.403, SE: 0.193, p = 0.039). In ancillary analysis, the Cognitive PGI was not associated with any of the brain measures. Conclusions Genetics discovered in GWAS of cognition are associated with cognitive performance in healthy adults across age, but most strongly in young and middle-aged adults. Associations were not explained by brain-structural markers of brain aging. Genetics uncovered in GWAS of cognitive performance may contribute to individual differences established relatively early in life and may not reflect genetic mechanisms of cognitive aging.
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Affiliation(s)
- A. Tsapanou
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - N. Mourtzi
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Y. Gu
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - C. Habeck
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - D. Belsky
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
- Robert N Butler Columbia Aging Center, Columbia University, New York, USA
| | - Y. Stern
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Corresponding author. Cognitive Neuroscience Division, Columbia University Irving Medical Center, New York, NY, 10032, USA. (Y. Stern)
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Schneider LS, Bennett DA, Farlow MR, Peskind ER, Raskind MA, Sano M, Stern Y, Haneline S, Welsh-Bohmer KA, O'Neil J, Walter R, Maresca S, Culp M, Alexander R, Saunders AM, Burns DK, Chiang C. Adjudicating Mild Cognitive Impairment Due to Alzheimer's Disease as a Novel Endpoint Event in the TOMMORROW Prevention Clinical Trial. J Prev Alzheimers Dis 2022; 9:625-634. [PMID: 36281666 DOI: 10.14283/jpad.2022.72] [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: 06/16/2023]
Abstract
BACKGROUND The onset of mild cognitive impairment (MCI) is an essential outcome in Alzheimer's disease (AD) prevention trials and a compelling milestone for clinically meaningful change. Determining MCI, however, may be variable and subject to disagreement. Adjudication procedures may improve the reliability of these determinations. We report the performance of an adjudication committee for an AD prevention trial. METHODS The TOMMORROW prevention trial selected cognitively normal participants at increased genetic risk for AD and randomized them to low-dose pioglitazone or placebo treatment. When adjudication criteria were triggered, a participant's clinical information was randomly assigned to a three-member panel of a six-member independent adjudication committee. Determination of whether or not a participant reached MCI due to AD or AD dementia proceeded through up to three review stages - independent review, collaborative review, and full committee review - requiring a unanimous decision and ratification by the chair. RESULTS Of 3494 participants randomized, the committee adjudicated on 648 cases from 386 participants, resulting in 96 primary endpoint events. Most participants had cases that were adjudicated once (n = 235, 60.9%); the rest had cases that were adjudicated multiple times. Cases were evenly distributed among the eight possible three-member panels. Most adjudicated cases (485/648, 74.8%) were decided within the independent review (stage 1); 14.0% required broader collaborative review (stage 2), and 11.1% needed full committee discussion (stage 3). The primary endpoint event decision rate was 39/485 (8.0%) for stage 1, 29/91 (31.9%) for stage 2, and 28/72 (38.9%) for stage 3. Agreement between the primary event outcomes supported by investigators' clinical diagnoses and the decisions of the adjudication committee increased from 50% to approximately 93% (after around 100 cases) before settling at 80-90% for the remainder of the study. CONCLUSIONS The adjudication process was designed to provide independent, consistent determinations of the trial endpoints. These outcomes demonstrated the extent of uncertainty among trial investigators and agreement between adjudicators when the transition to MCI due to AD was prospectively assessed. These methods may inform clinical endpoint determination in future AD secondary prevention studies. Reliable, accurate assessment of clinical events is critical for prevention trials and may mean the difference between success and failure.
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Affiliation(s)
- L S Schneider
- Lon S. Schneider, Keck School of Medicine of USC, 1540 Alcazar St, CHP216, Los Angeles CA, 90033, USA, Phone no: +1 323 442 7600,
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Boyle R, Knight SP, De Looze C, Carey D, Scarlett S, Stern Y, Robertson IH, Kenny RA, Whelan R. Verbal intelligence is a more robust cross-sectional measure of cognitive reserve than level of education in healthy older adults. Alzheimers Res Ther 2021; 13:128. [PMID: 34253231 PMCID: PMC8276413 DOI: 10.1186/s13195-021-00870-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/28/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cognitive reserve is most commonly measured using socio-behavioural proxy variables. These variables are easy to collect, have a straightforward interpretation, and are widely associated with reduced risk of dementia and cognitive decline in epidemiological studies. However, the specific proxies vary across studies and have rarely been assessed in complete models of cognitive reserve (i.e. alongside both a measure of cognitive outcome and a measure of brain structure). Complete models can test independent associations between proxies and cognitive function in addition to the moderation effect of proxies on the brain-cognition relationship. Consequently, there is insufficient empirical evidence guiding the choice of proxy measures of cognitive reserve and poor comparability across studies. METHOD In a cross-sectional study, we assessed the validity of 5 common proxies (education, occupational complexity, verbal intelligence, leisure activities, and exercise) and all possible combinations of these proxies in 2 separate community-dwelling older adult cohorts: The Irish Longitudinal Study on Ageing (TILDA; N = 313, mean age = 68.9 years, range = 54-88) and the Cognitive Reserve/Reference Ability Neural Network Study (CR/RANN; N = 234, mean age = 64.49 years, range = 50-80). Fifteen models were created with 3 brain structure variables (grey matter volume, hippocampal volume, and mean cortical thickness) and 5 cognitive variables (verbal fluency, processing speed, executive function, episodic memory, and global cognition). RESULTS No moderation effects were observed. There were robust positive associations with cognitive function, independent of brain structure, for 2 individual proxies (verbal intelligence and education) and 16 composites (i.e. combinations of proxies). Verbal intelligence was statistically significant in all models. Education was significant only in models with executive function as the cognitive outcome variable. Three robust composites were observed in more than two-thirds of brain-cognition models: the composites of (1) occupational complexity and verbal intelligence, (2) education and verbal intelligence, and (3) education, occupational complexity, and verbal intelligence. However, no composite had larger average effects nor was more robust than verbal intelligence alone. CONCLUSION These results support the use of verbal intelligence as a proxy measure of CR in cross-sectional studies of cognitively healthy older adults.
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Affiliation(s)
- R Boyle
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - S P Knight
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - C De Looze
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - D Carey
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - S Scarlett
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Y Stern
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York City, USA
| | - I H Robertson
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - R A Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - R Whelan
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.
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Tsapanou A, Gao Y, Stern Y, Barral S. Polygenic score for sleep duration. Association with cognition. Sleep Med 2020; 74:262-266. [PMID: 32862010 DOI: 10.1016/j.sleep.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/19/2020] [Accepted: 07/02/2020] [Indexed: 01/01/2023]
Abstract
STUDY OBJECTIVES Age-related changes in sleep include a reduction in total sleep time and a greater incidence of sleep disorders, and are also an integral part of neurodegenerations. In the present study, we aimed to: a) identify common genetic variants that may influence self-reported sleep duration, and b) examine the association between the identified genetic variants and performance in different cognitive domains. METHODS A sample of 197 cognitively healthy participants, aged 20-80 years, mostly non-Hispanic Whites (69%), were selected from the Reference Abilities Neural Network and the Cognitive Reserve study. Each participant underwent an evaluation of sleep function and assessment of neuropsychological performance on global cognition and four different domains (memory, speed of processing, fluid reasoning, language). Published GWAS summary statistics from a Polygenic Score (PS) for sleep duration in a large European ancestry cohort (N = 30,251) were used to derive a PS in our study sample. Multivariate linear models were used to test the associations between the PS and sleep duration and cognitive performance. Age, sex, and education were used as covariates. Secondary analyses were conducted in three age-groups (young, middle, old). RESULTS Higher PS was linked to longer sleep duration and was also associated with better performance in global cognition, fluid reasoning, speed of processing, and language, but not memory. Results especially for fluid reasoning, language, and global cognition were driven mostly by the young group. CONCLUSIONS Our study replicated the previously reported association between sleep-PS and longer sleep duration. We additionally found a significant association between the sleep-PS and cognitive function. Our results suggest that common genetic variants may influence the link between sleep duration and cognitive health.
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Affiliation(s)
- A Tsapanou
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Medical Center, New York, NY, USA.
| | - Y Gao
- Department of Neurology, The Gertrude H. Sergievsky Center and the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
| | - Y Stern
- Cognitive Neuroscience Division, Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - S Barral
- Department of Neurology, The Gertrude H. Sergievsky Center and the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
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Gustafson DR, Bäckman K, Scarmeas N, Stern Y, Manly JJ, Mayeux R, Gu Y. Dietary fatty acids and risk of Alzheimer's disease and related dementias: Observations from the Washington Heights-Hamilton Heights-Inwood Columbia Aging Project (WHICAP). Alzheimers Dement 2020; 16:1638-1649. [PMID: 32715635 PMCID: PMC8409226 DOI: 10.1002/alz.12154] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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] [Indexed: 12/13/2022]
Abstract
Introduction: High dietary intake of long chain, polyunsaturated fatty acids is associated with lower Alzheimer’s disease (AD) risk. Methods: Washington Heights-Hamilton Heights-Inwood Columbia Aging Project is a multiethnic, prospective observational study of aging and dementia among elderly (≥ 65 years). Dietary intake was measured using a food frequency questionnaire. Dietary short-, medium-, and long-chain fatty acid intakes were categorized by number of carbons and double bonds. Consensus AD diagnoses were made. Associations between AD risk and dietary fatty acid and cholesterol intakes were estimated using multivariable Cox proportional hazards regression models. Results: Of 2612 multiethnic women (67%) and men (baseline age 76.3 [6.4] years), 380 developed AD over an average 4.5 years follow-up. Lower risk of AD was associated with increasing intakes of docosahexaenoic acid (DHA; hazard ratio [HR] = 0.73, 95% confidence interval [CI]: 0.57 to 0.95, P = 0.018) and eicosapentaenoic acid (EPA; HR = 0.74, 95% CI: 0.57 to 0.95, P = 0.021), and longer AD-free survival (P < 0.05). Discussion: Higher intake of DHA and EPA are protective for AD.
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Affiliation(s)
- Deborah R Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA.,Department of Neurochemistry and Psychiatry, Neuropsychiatric Epidemiology Unit, at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Bäckman
- Department of Neurochemistry and Psychiatry, Neuropsychiatric Epidemiology Unit, at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - N Scarmeas
- Department of Neurology, The Gertrude H. Sergievsky Center, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University and The New York Presbyterian Hospital, New York, New York, USA.,1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Y Stern
- Department of Neurology, The Gertrude H. Sergievsky Center, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University and The New York Presbyterian Hospital, New York, New York, USA
| | - J J Manly
- Department of Neurology, The Gertrude H. Sergievsky Center, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University and The New York Presbyterian Hospital, New York, New York, USA
| | - R Mayeux
- Department of Neurology, The Gertrude H. Sergievsky Center, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University and The New York Presbyterian Hospital, New York, New York, USA.,The Department of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Y Gu
- Department of Neurology, The Gertrude H. Sergievsky Center, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University and The New York Presbyterian Hospital, New York, New York, USA.,The Department of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, New York, USA
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van Loenhoud AC, Habeck C, van der Flier WM, Ossenkoppele R, Stern Y. Identifying a task-invariant cognitive reserve network using task potency. Neuroimage 2020; 210:116593. [PMID: 32007499 PMCID: PMC7895480 DOI: 10.1016/j.neuroimage.2020.116593] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 11/27/2022] Open
Abstract
Cognitive reserve (CR) is thought to protect against the consequence of age- or disease-related structural brain changes across multiple cognitive domains. The neural basis of CR may therefore comprise a functional network that is actively involved in many different cognitive processes. To investigate the existence of such a "task-invariant" CR network, we measured functional connectivity in a cognitively normal sample between 20 and 80 years old (N = 265), both at rest and during the performance of 11 separate tasks that aim to capture four latent cognitive abilities (i.e. vocabulary, episodic memory, processing speed, and fluid reasoning). For each individual, we determined the change in functional connectivity from the resting state to each task state, which is referred to as "task potency" (Chauvin et al., 2018, 2019). Task potency was calculated for each pair among 264 nodes (Power et al., 2012) and then summarized across tasks reflecting the same cognitive ability. Subsequently, we established the correlation between task potency and IQ or education (i.e. CR factors). We identified a set of 57 pairs in which task potency showed significant correlations with IQ, but not education, across all four cognitive abilities. These pairs were included in a principal component analysis, from which we extracted the first component to obtain a latent variable reflecting task potency in this task-invariant CR network. This task potency variable was associated with better episodic memory (β = 0.19, p < .01) and fluid reasoning performance (β = 0.17, p < .01) above and beyond the effects of cortical thickness (range [absolute] β = 0.28-0.32, p < .001). Our identification of this task-invariant network contributes to a better understanding of the mechanism underlying CR, which may facilitate the development of CR-enhancing treatments. Our work also offers a useful alternative operational measure of CR for future studies.
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Affiliation(s)
- A C van Loenhoud
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, 1081 HV, Amsterdam, the Netherlands.
| | - C Habeck
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY, 10032, USA
| | - W M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, 1081 HV, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam, UMC, 1081 HV, Amsterdam, the Netherlands
| | - R Ossenkoppele
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, 1081 HV, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam, UMC, 1081 HV, Amsterdam, the Netherlands; Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Y Stern
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY, 10032, USA
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Hampton LH, Stern Y, Roberts MY. Meta-analysis suggests early intervention for infants and toddlers at risk for autism may be effective for improving developmental outcomes. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/17489539.2018.1545398] [Citation(s) in RCA: 2] [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: 10/27/2022]
Affiliation(s)
- L. H. Hampton
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
| | - Y. Stern
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
| | - M. Y. Roberts
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
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Sunderaraman P, Omollo S, Ho S, Stern Y, Cosentino S. Aging & Dementia - 5
Cognitive Contributors to Financial Capacity in Older Adults. Arch Clin Neuropsychol 2018. [DOI: 10.1093/arclin/acy060.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Habeck C, Razlighi Q, Gazes Y, Barulli D, Steffener J, Stern Y. Cognitive Reserve and Brain Maintenance: Orthogonal Concepts in Theory and Practice. Cereb Cortex 2018; 27:3962-3969. [PMID: 27405332 DOI: 10.1093/cercor/bhw208] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/05/2016] [Indexed: 02/05/2023] Open
Abstract
Cognitive Reserve and Brain Maintenance have traditionally been understood as complementary concepts: Brain Maintenance captures the processes underlying the structural preservation of the brain with age, and might be assessed relative to age-matched peers. Cognitive Reserve, on the other hand, refers to how cognitive processing can be performed regardless of how well brain structure has been maintained. Thus, Brain Maintenance concerns the "hardware," whereas Cognitive Reserve concerns "software," that is, brain functioning explained by factors beyond mere brain structure. We used structural brain data from 368 community-dwelling adults, age 20-80, to derive measures of Brain Maintenance and Cognitive Reserve. We found that Brain Maintenance and Cognitive were uncorrelated such that values on one measure did not imply anything about the other measure. Further, both measures were positively correlated with verbal intelligence and education, hinting at formative influences of the latter to both measures. We performed extensive split-half simulations to check our derived measures' statistical robustness. Our approach enables the out-of-sample quantification of Brain Maintenance and Cognitive Reserve for single subjects on the basis of chronological age, neuropsychological performance and structural brain measures. Future work will investigate the prognostic power of these measures with regard to future cognitive status.
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Affiliation(s)
- C Habeck
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY 10032, USA
| | - Q Razlighi
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY 10032, USA
| | - Y Gazes
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY 10032, USA
| | - D Barulli
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY 10032, USA
| | - J Steffener
- PERFORM Center and Department of Psychology, Concordia University, Montréal, Québec, Canada H4B 1R6
| | - Y Stern
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY 10032, USA
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Reches A, Or-ly H, Weiss M, Stern Y, Baumeister J, Foss K, Ellis J, Laish B, Laufer O, Sadeh B, Ettinger M, Arthur T, Shaham G, Myer G, Kehat O, Shani-Hershkovich R, Peremen Z, Geva A. P 136 Brain network analysis of EEG data in the service of clinical assessment – utilizing big data and prior theoretical knowledge to identify a biomarker for mTBI in adolscents. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.06.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tsapanou A, Gu Y, O'Shea DM, Yannakoulia M, Kosmidis MH, Dardiotis E, Hadjigeorgiou G, Sakka P, Stern Y, Scarmeas N. Dataset on the associations between sleep quality/duration and cognitive performance in cognitively healthy older adults. Data Brief 2017; 14:720-723. [PMID: 28932777 PMCID: PMC5596325 DOI: 10.1016/j.dib.2017.08.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/18/2017] [Accepted: 08/24/2017] [Indexed: 11/28/2022] Open
Abstract
In the present data, we provide the details of the cross-sectional study examining the associations between sleep quality/sleep duration and cognitive performance. Data are from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD). A total of 1484 older adults (65 y.o. or older) took part in the study. Sleep measurements were drawn from the sleep scale of the Medical Outcomes Study (MOS). Cognition was used as a z-score drawn by different tests. The domains examined were: executive function, visuo-spatial ability, language, attention- speed of processing, as well as the composite z-score of all the cognitive domains (including memory). Linear regression models were conducted to investigate the associations between sleep quality and cognition, and sleep duration and cognition as well. We also conducted linear regression analyses for the associations between sleep quality/duration and cognitive domains/composite cognitive score based on the status of the Apolipoprotein E-ε4 (ApoE-ε4) genotype. Analyses were performed excluding both the demented and the Mild Cognitive Impairment (MCI) participants. Adjustments conducted for multiple covariates. For further analyses and enhanced discussion, see original article: "Sleep quality and duration in relation to memory in the elderly: initial results from the Hellenic Longitudinal Investigation of Aging and Diet" by Tsapanou et al. [1].
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Affiliation(s)
- A Tsapanou
- Department of Social Medicine, Psychiatry and Neurology, National and Kapodistrian University of Athens, Athens, Greece.,Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
| | - Y Gu
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
| | - D M O'Shea
- Department of Clinical and Health Psychology, University of Florida, FL, USA
| | - M Yannakoulia
- Department of Nutrition and Diabetics, Harokopio University, Athens, Greece
| | - M H Kosmidis
- Department of Psychology, Aristotle University of Thessaloniki, Greece
| | - E Dardiotis
- Department of Neurology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - G Hadjigeorgiou
- Department of Neurology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - P Sakka
- Athens Association of Alzheimer's Disease and Related Disorders, Athens, Greece
| | - Y Stern
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
| | - N Scarmeas
- Department of Social Medicine, Psychiatry and Neurology, National and Kapodistrian University of Athens, Athens, Greece.,Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
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Biederman J, Hammerness P, Sadeh B, Peremen Z, Amit A, Or-Ly H, Stern Y, Reches A, Geva A, Faraone SV. Diagnostic utility of brain activity flow patterns analysis in attention deficit hyperactivity disorder. Psychol Med 2017; 47:1259-1270. [PMID: 28065167 DOI: 10.1017/s0033291716003329] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND A previous small study suggested that Brain Network Activation (BNA), a novel ERP-based brain network analysis, may have diagnostic utility in attention deficit hyperactivity disorder (ADHD). In this study we examined the diagnostic capability of a new advanced version of the BNA methodology on a larger population of adults with and without ADHD. METHOD Subjects were unmedicated right-handed 18- to 55-year-old adults of both sexes with and without a DSM-IV diagnosis of ADHD. We collected EEG while the subjects were performing a response inhibition task (Go/NoGo) and then applied a spatio-temporal Brain Network Activation (BNA) analysis of the EEG data. This analysis produced a display of qualitative measures of brain states (BNA scores) providing information on cortical connectivity. This complex set of scores was then fed into a machine learning algorithm. RESULTS The BNA analysis of the EEG data recorded during the Go/NoGo task demonstrated a high discriminative capacity between ADHD patients and controls (AUC = 0.92, specificity = 0.95, sensitivity = 0.86 for the Go condition; AUC = 0.84, specificity = 0.91, sensitivity = 0.76 for the NoGo condition). CONCLUSIONS BNA methodology can help differentiate between ADHD and healthy controls based on functional brain connectivity. The data support the utility of the tool to augment clinical examinations by objective evaluation of electrophysiological changes associated with ADHD. Results also support a network-based approach to the study of ADHD.
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Affiliation(s)
- J Biederman
- Massachusettes General Hospital,Boston,MA,USA
| | | | | | | | - A Amit
- ElMindA Ltd,Herzliya,Israel
| | | | | | | | - A Geva
- ElMindA Ltd,Herzliya,Israel
| | - S V Faraone
- SUNY Upstate Medical University,Syracuse,NY,USA
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14
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Tsapanou A, Gu Y, O'Shea DM, Yannakoulia M, Kosmidis M, Dardiotis E, Hadjigeorgiou G, Sakka P, Stern Y, Scarmeas N. Sleep quality and duration in relation to memory in the elderly: Initial results from the Hellenic Longitudinal Investigation of Aging and Diet. Neurobiol Learn Mem 2017; 141:217-225. [PMID: 28455107 DOI: 10.1016/j.nlm.2017.04.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 12/23/2016] [Revised: 04/10/2017] [Accepted: 04/24/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Sleep is crucial for cognition, particularly for memory, given its complex association with neurodegenerative processes. The aim of the present study was to examine the association between sleep quality as well as sleep duration and memory performance in a Greek elderly population. SETTING Cross-sectional design in the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD), a population representative study of Greek elderly (65years or older). METHODS Data from 1589 participants free of sleep medication were included. Sleep quality was estimated by using the Sleep Scale from the Medical Outcomes Study. An extensive neuropsychological assessment examining memory was administered to each participant. Linear regression analyses were used to examine whether sleep quality (higher score, poor quality) and/or sleep duration were associated with memory expressed in the form of a z-score. Age, sex, education, and body mass index were included as covariates. The main analyses were conducted first on the total sample, then with the exclusion of demented participants, and finally with the exclusion of both demented and participants with Mild Cognitive Impairment (MCI). We then conducted further analyses on the non-demented, non-MCI group, initially stratified by Apolipoprotein E-ε4 gene. We further examined the role of co-morbidities, as well as the association between sleep duration groups and memory. We also explored any interaction effect between sex and sleep quality/duration on memory. We then examined the associations between components of sleep measures and memory scores. Lastly, we examined the associations between sleep quality/duration and verbal/non-verbal memory separately. RESULTS In the total sample, we noted significant associations between sleep duration and memory (B=-0.001, p≤0.0001), but not for sleep quality and memory (B=-0.038, p=0.121). After excluding the demented participants, the associations were significant for: sleep quality and memory (B=-0.054, p=0.023), and sleep duration and memory (B=-0.001, p≤0.0001). After excluding both the MCI and the demented subjects, the associations between sleep quality and memory (B=-0.065, p=0.006), and sleep duration and memory (B=-0.001, p=0.003) were still significant. The association between the sleep duration groups and memory function was also significant, such that poor memory performance was associated with the longer sleep duration group. The results remained significant even after controlling for the co-morbidities, as well as after adding in the model anxiety and depression as covariates. Associations between sleep quality and memory, and sleep duration and memory were present in the ApoE-ε4 non-carriers. The individual sleep questions that were probably shown to be driving the associations between sleep and memory were: time to fall asleep, sleep not quiet, getting enough sleep to feel rested upon waking in the morning, and getting the amount of sleep needed. Sleep duration was associated with both verbal and non-verbal memory, while sleep quality was only associated with verbal memory. CONCLUSION Poor sleep quality and longer sleep duration were linked to low memory performance, independent of demographic and clinical factors, in a large sample of cognitively healthy older Greek adults. Other parameters than sleep and memory measurements could play an important role on the association. Levels of melatonin, or circadian rhythms dysregulation might play a crucial role in the above associations.
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Affiliation(s)
- A Tsapanou
- Department of Social Medicine, Psychiatry and Neurology, National and Kapodistrian University of Athens, Athens, Greece; Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA.
| | - Y Gu
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
| | - D M O'Shea
- Department of Clinical and Health Psychology, University of Florida, FL, USA
| | - M Yannakoulia
- Department of Nutrition and Diabetics, Harokopio University, Athens, Greece
| | - M Kosmidis
- Department of Psychology, Aristotle University of Thessaloniki, Greece
| | - E Dardiotis
- Department of Neurology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - G Hadjigeorgiou
- Department of Neurology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - P Sakka
- Athens Association of Alzheimer's Disease and Related Disorders, Athens, Greece
| | - Y Stern
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
| | - N Scarmeas
- Department of Social Medicine, Psychiatry and Neurology, National and Kapodistrian University of Athens, Athens, Greece; Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
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15
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Alkan U, Nachalon Y, Vaisbuch Y, Katz O, Hamzany Y, Stern Y. Treating paediatric anterior glottic web: single-centre experience of 20 patients with comparison among techniques. Clin Otolaryngol 2016; 42:893-897. [PMID: 27608279 DOI: 10.1111/coa.12749] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- U Alkan
- Department of Otorhinolaryngology - Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Y Nachalon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Vaisbuch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Katz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Hamzany
- Department of Otorhinolaryngology - Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Y Stern
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Upper Airway Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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16
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Walner DL, Heffelfinger SC, Stern Y, Abrams MJ, Miller MA, Cotton RT. Potential Role of Growth Factors and Extracellular Matrix in Wound Healing after Laryngotracheal Reconstruction. Otolaryngol Head Neck Surg 2016; 122:363-6. [PMID: 10699811 DOI: 10.1016/s0194-5998(00)70049-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Laryngotracheal reconstruction (LTR) has been used for more than 20 years to treat infants and children with subglottic stenosis. Results after pediatric LTR have been satisfactory; however, approximately 10% of children have recurrent airway narrowing after LTR. The purpose of our study was to determine whether a correlation existed between specific growth factors and extracellular matrix in patients with adequate wound healing capability as compared with patients with poor wound healing capability. Histologic sections from 27 patients who underwent LTR were cut, and immunohistochemical staining was performed for transforming growth factor-β, platelet-derived growth factor, fibronectin, tenascin, transforming growth factor-α, and vascular endothelial growth factor. Results showed that patients with adequate wound healing capability had a positive correlation with vasculature fibronectin, vasculature tenascin, and stromal fibronectin. Patients with poor wound healing capability had a positive correlation with stromal vascular endothelial growth factor.
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Affiliation(s)
- D L Walner
- Department of Otolaryngology and Bronchoesophagology, Rush Presbyterian St. Lukes Medical Center, and Lutheran General Children's Hospital Park Ridge, IL, USA
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17
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Liu X, Marder K, Stern Y, Dooneief G, Bell K, Todak G, Joseph M, Elsadr W, Williams JB, Ehrhardt A, Stein Z, Mayeux R. Gender Differences in HIV-Related Neurological Progression in a Cohort of Injecting Drug Users Followed for 3.5 Years. ACTA ACUST UNITED AC 2016; 1:17-30. [PMID: 16873176 DOI: 10.1300/j128v01n04_03] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We evaluated potential gender differences in the development of HIV related neurologic impairment, by matching 38 pairs of HIV positive male and female injecting drug users on their baseline age, education, disease stage and CD4 counts, and following them for 3.5 years. Adjusting for age, education, drug use, history of head injury and baseline CD4 count, more women had sensory abnormalities and symptoms than men at baseline, but the odds of having neurological impairment, particularly extrapyramidal signs and sensory abnormalities were increased over time in men but not in women. Men with ARC or AIDS had more neurological impairment than women in similar stages of illness. This study suggests further investigations of gender differences in HIV disease progression.
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18
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Dooneief GH, Bello JA, Todak GG, Tang MX, Marder KS, Stern Y, Mayeux RP. Serial MRI in HIV Infection With and Without Neurologic Impairment. ACTA ACUST UNITED AC 2016; 1:49-57. [PMID: 16873178 DOI: 10.1300/j128v01n04_05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To assess the relationship of longitudinal brain magnetic resonance imaging (MRI) and infection with human immunodeficiency virus (HIV), a cohort of HIV+ and HIV− gay men and injection drug users (IDU) were evaluated prospectively. Subjects underwent two evaluations including MRI scans, neurologic examinations, neuropsychological assessments and lymphocyte subset determinations one year apart. MRI changes over a one year period were analyzed with respect to serostatus, risk group, CD4 counts, neurological findings and neuropsychological performance. The frequency of MRI changes was no different in subjects with or without HIV infection and no new opportunistic infections or neoplasms were seen. However, among HIV+ subjects with CD4 count < 200 at the time of the initial scan, an increase in white matter hyperintensities was significantly more common. Also among HIV+ subjects, atrophy increased in association with declining CD4 count. Finally, subjects who developed significant neurologic deterioration in one year were much more likely to have increased atrophy. These results suggest that while there are morphological brain changes associated with HIV infection, they are most often seen in association with immunologic or neurologic deterioration.
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Affiliation(s)
- G H Dooneief
- , College of Physicians and Surgeons, New York, NY
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19
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Grotz C, Meillon C, Amieva H, Stern Y, Dartigues JF, Adam S, Letenneur L. Why Is Later Age at Retirement Beneficial for Cognition? Results from a French Population-based Study. J Nutr Health Aging 2016; 20:514-9. [PMID: 27102789 DOI: 10.1007/s12603-015-0599-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine whether and how age at retirement influences the risk of dementia. The association between the age at retirement, the number of working years and the risk of dementia was evaluated over 12 years of follow-up. DESIGN A prospective population-based study. SETTING Three-City cohort, a French population-based study of community-dwelling individuals aged 65 to 95. PARTICIPANTS The sample consisted of 1,658 non-demented participants at baseline. MEASUREMENTS All participants were evaluated at home at the initial visit and at two years interval for a period of 12 years. An active research of dementia was conducted at each follow-up; all suspected cases were analysed by an independent committee of neurologists. Information regarding retirement age and number of working years was collected at baseline using a structured questionnaire. RESULTS The multivariate Cox model, including both the age at retirement and the number of working years and adjusted for potential confounders, revealed that the risk of dementia was independently associated with the age at retirement (p=0.022) but not with the number of working years (p=0.296). CONCLUSION Although our results are in accordance with previous studies (i.e., older age at retirement is associated with decreased risk of dementia), it provides additional information regarding the possible explanation for such results. Given that a longer working life did not reduce the risk of dementia, the age at retirement cannot be considered as a new factor of cognitive reserve but rather seems to be a psycho-social vulnerability factor. Further evidence is necessary to identify work and retirement related factors that influence the association between the age at retirement and the risk of dementia.
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Affiliation(s)
- C Grotz
- Catherine Grotz, Unité de Psychologie de la Sénescence, University of Liège, Traverse des Architectes (B63c) - Sart Tilman, B-4000 Liège, Belgium, Phone number: + 32 4 366 28 46; e-mail:
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20
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Ben-Amram A, Stern Y, London Y, Antman Y, Zadok A. Stable closed-loop fiber-optic delay of arbitrary radio-frequency waveforms. Opt Express 2015; 23:28244-28257. [PMID: 26561095 DOI: 10.1364/oe.23.028244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Thermal drifts in long fiber-optic delay lines are compensated based on chromatic dispersion. An arbitrary input radio-frequency (RF) waveform and a control RF sine wave modulate two different tunable laser sources and are coupled into the fiber delay line. The RF phase of the control tone at the output of the delay line is monitored and used to adjust the wavelengths of both sources, so that the effects of thermal drifts and dispersion cancel out. The input and control waveforms are separated in the optical domain, and no restrictions are imposed on their RF spectra. A figure of merit is proposed, in terms of the fiber delay, range of temperature changes that may be compensated for, and residual delay variations. An upper bound on performance is established in terms of the specifications of the tunable lasers. The principle is used in the stable distribution of sine waves and of broadband linear frequency-modulated (LFM) waveforms, which are commonly employed in radar systems. Lastly, the method is incorporated in stable interrogation of a localized hot-spot within a high-resolution, distributed Brillouin fiber sensing setup. The results demonstrate the applicability of the proposed protocol in the processing of arbitrary waveforms, as part of larger, more complex systems.
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21
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Habeck C, Gazes Y, Razlighi Q, Steffener J, Brickman A, Barulli D, Salthouse T, Stern Y. The Reference Ability Neural Network Study: Life-time stability of reference-ability neural networks derived from task maps of young adults. Neuroimage 2015; 125:693-704. [PMID: 26522424 DOI: 10.1016/j.neuroimage.2015.10.077] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 10/07/2015] [Accepted: 10/26/2015] [Indexed: 11/27/2022] Open
Abstract
Analyses of large test batteries administered to individuals ranging from young to old have consistently yielded a set of latent variables representing reference abilities (RAs) that capture the majority of the variance in age-related cognitive change: Episodic Memory, Fluid Reasoning, Perceptual Processing Speed, and Vocabulary. In a previous paper (Stern et al., 2014), we introduced the Reference Ability Neural Network Study, which administers 12 cognitive neuroimaging tasks (3 for each RA) to healthy adults age 20-80 in order to derive unique neural networks underlying these 4 RAs and investigate how these networks may be affected by aging. We used a multivariate approach, linear indicator regression, to derive a unique covariance pattern or Reference Ability Neural Network (RANN) for each of the 4 RAs. The RANNs were derived from the neural task data of 64 younger adults of age 30 and below. We then prospectively applied the RANNs to fMRI data from the remaining sample of 227 adults of age 31 and above in order to classify each subject-task map into one of the 4 possible reference domains. Overall classification accuracy across subjects in the sample age 31 and above was 0.80±0.18. Classification accuracy by RA domain was also good, but variable; memory: 0.72±0.32; reasoning: 0.75±0.35; speed: 0.79±0.31; vocabulary: 0.94±0.16. Classification accuracy was not associated with cross-sectional age, suggesting that these networks, and their specificity to the respective reference domain, might remain intact throughout the age range. Higher mean brain volume was correlated with increased overall classification accuracy; better overall performance on the tasks in the scanner was also associated with classification accuracy. For the RANN network scores, we observed for each RANN that a higher score was associated with a higher corresponding classification accuracy for that reference ability. Despite the absence of behavioral performance information in the derivation of these networks, we also observed some brain-behavioral correlations, notably for the fluid-reasoning network whose network score correlated with performance on the memory and fluid-reasoning tasks. While age did not influence the expression of this RANN, the slope of the association between network score and fluid-reasoning performance was negatively associated with higher ages. These results provide support for the hypothesis that a set of specific, age-invariant neural networks underlies these four RAs, and that these networks maintain their cognitive specificity and level of intensity across age. Activation common to all 12 tasks was identified as another activation pattern resulting from a mean-contrast Partial-Least-Squares technique. This common pattern did show associations with age and some subject demographics for some of the reference domains, lending support to the overall conclusion that aspects of neural processing that are specific to any cognitive reference ability stay constant across age, while aspects that are common to all reference abilities differ across age.
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Affiliation(s)
- C Habeck
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, NY, NY 10032, USA.
| | - Y Gazes
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, NY, NY 10032, USA
| | - Q Razlighi
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, NY, NY 10032, USA
| | - J Steffener
- PERFORM Center and Department of Psychology, Concordia University, Montréal, QC H4B 1R6, Canada
| | - A Brickman
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, NY, NY 10032, USA
| | - D Barulli
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, NY, NY 10032, USA
| | - T Salthouse
- Department of Psychology, University of Virginia, Charlottesville, VA 22904, USA
| | - Y Stern
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, NY, NY 10032, USA
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22
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Reches A, Nir RR, Shram M, Dickman D, Laufer I, Shani-Hershkovich R, Stern Y, Weiss M, Yarnitsky D, Geva A. A novel electroencephalography-based tool for objective assessment of network dynamics activated by nociceptive stimuli. Eur J Pain 2015; 20:250-62. [DOI: 10.1002/ejp.716] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2015] [Indexed: 11/05/2022]
Affiliation(s)
| | - R.-R. Nir
- Department of Neurology; Rambam Health Care Campus; Haifa Israel
- Clinical Neurophysiology Lab; Faculty of Medicine; Technion - Israel Institute of Technology; Haifa Israel
| | - M.J. Shram
- Altreos Research Partners, Inc.; Toronto ON Canada
- Department of Pharmacology and Toxicology; University of Toronto; Toronto ON Canada
| | | | | | | | | | | | - D. Yarnitsky
- Department of Neurology; Rambam Health Care Campus; Haifa Israel
- Clinical Neurophysiology Lab; Faculty of Medicine; Technion - Israel Institute of Technology; Haifa Israel
| | - A.B. Geva
- ElMindA Ltd.; Herzliya Israel
- Electrical and Computer Engineering; Ben Gurion University of the Negev; Beersheba Israel
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Kahle-Wrobleski K, Andrews JS, Belger M, Gauthier S, Stern Y, Rentz DM, Galasko D. Clinical and Economic Characteristics of Milestones along the Continuum of Alzheimer's Disease: Transforming Functional Scores into Levels of Dependence. J Prev Alzheimers Dis 2015; 2:115-120. [PMID: 28775969 DOI: 10.14283/jpad.2015.53] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Because Alzheimer's disease (AD) is characterized by a gradual decline, it can be difficult to identify distinct clinical milestones that signal disease advancement. Adapting a functional scale may be a useful way of staging disease progression that is more informative for healthcare systems. OBJECTIVES To adapt functional scale scores into discrete levels of dependence as a way of staging disease progression that is more informative to care providers and stakeholders who rely on the functional impact of diseases to determine access to supportive services and interventions. DESIGN Analysis of data from the GERAS study. SETTING GERAS is an 18-month prospective, multicenter, naturalistic, observational cohort study reflecting the routine care of patients with AD in France, Germany, and the United Kingdom. PARTICIPANTS Data were from baseline results of 1497 community-living patients, aged ≥55 years, diagnosed with probable AD and their caregivers. MEASUREMENTS We used data from the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL) and mapped items onto established categories of functional dependence, validated using clinical and economic measures. Cognitive function, behavioral symptoms, caregiver burden, and cost were assessed. Based on stages of functional dependence described by the Dependence Scale, individual ADCS-ADL items were used to approximate 6 dependence levels. RESULTS There was a significant relationship between assigned level of dependence derived from the ADCS-ADL score and cognitive severity category. As the assigned level of dependence increased, the associated clinical and economic indicators demonstrated a pattern of greater disease severity. CONCLUSIONS This mapping provides initial support for dependence levels as appropriate interim clinical milestones that characterize the functional deficits associated with AD.
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Affiliation(s)
| | - J S Andrews
- Eli Lilly and Company, Indianapolis, IN, USA
| | - M Belger
- Lilly Research Centre, Windlesham, UK
| | - S Gauthier
- McGill University, Montreal, Quebec, Canada
| | - Y Stern
- Columbia University, New York, NY, USA
| | - D M Rentz
- Harvard Medical School, Boston, MA, USA
| | - D Galasko
- University of California San Diego, San Diego, CA, USA
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Abstract
Clock-drawing is a widely used bedside test of constructional ability, but it has never been systematically studied or standardized. We examined 87 clocks drawn by neurologically impaired patients and age-matched controls, and propose a set of criteria for scoring clocks. Patients with probable Alzheimer's disease and other dementias have gross impairments in clock-drawing. These deficits include poor spatial arrangement of numbers, incorrect numerical sequence, insertion of stray lines, and addition of extra numbers. In Alzheimer's disease, the total score on the clock-drawing test correlates with the score on the Modified "Mini-Mental State" Examination. Non-demented patients with Parkinson's disease showed only defects in the spatial organization of the numbers, and non-demented patients with other diseases perform as well as controls.
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Affiliation(s)
- G Dal Pan
- Departments of Neurology and Psychiatry, Columbia University, College of Physicians and Surgeons
| | - Y Stern
- Departments of Neurology and Psychiatry, Columbia University, College of Physicians and Surgeons
| | - M Sano
- Departments of Neurology and Psychiatry, Columbia University, College of Physicians and Surgeons
| | - R Mayeux
- Departments of Neurology and Psychiatry, Columbia University, College of Physicians and Surgeons
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Achiron A, Chapman J, Magalashvili D, Dolev Dolgopiat M, Lavie M, Bercovich E, Stern Y, Kishner I, Khilkevich O, Menascu S, Socher A, Hararai G, Gurevich M, Barak Y. Modeling Long-Term Cognitive Decline in Multiple Sclerosis: A Population-Based Cross-Sectional Epidemiological Study (P04.111). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Barral S, Bird T, Goate A, Farlow MR, Diaz-Arrastia R, Bennett DA, Graff-Radford N, Boeve BF, Sweet RA, Stern Y, Wilson RS, Foroud T, Ott J, Mayeux R. Genotype patterns at PICALM, CR1, BIN1, CLU, and APOE genes are associated with episodic memory. Neurology 2012; 78:1464-71. [PMID: 22539578 DOI: 10.1212/wnl.0b013e3182553c48] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Several genome-wide association studies (GWAS) have associated variants in late-onset Alzheimer disease (LOAD) susceptibility genes; however, these single nucleotide polymorphisms (SNPs) have very modest effects, suggesting that single SNP approaches may be inadequate to identify genetic risks. An alternative approach is the use of multilocus genotype patterns (MLGPs) that combine SNPs at different susceptibility genes. METHODS Using data from 1,365 subjects in the National Institute on Aging Late-Onset Alzheimer's Disease Family Study, we conducted a family-based association study in which we tabulated MLGPs for SNPs at CR1, BIN1, CLU, PICALM, and APOE. We used generalized estimating equations to model episodic memory as the dependent endophenotype of LOAD and the MLGPs as predictors while adjusting for sex, age, and education. RESULTS Several genotype patterns influenced episodic memory performance. A pattern that included PICALM and CLU was the strongest genotypic profile for lower memory performance (β = -0.32, SE = 0.19, p = 0.021). The effect was stronger after addition of APOE (p = 0.016). Two additional patterns involving PICALM, CR1, and APOE and another pattern involving PICALM, BIN1, and APOE were also associated with significantly poorer memory performance (β = -0.44, SE = 0.09, p = 0.009 and β = -0.29, SE = 0.07, p = 0.012) even after exclusion of patients with LOAD. We also identified genotype pattern involving variants in PICALM, CLU, and APOE as a predictor of better memory performance (β = 0.26, SE = 0.10, p = 0.010). CONCLUSIONS MLGPs provide an alternative analytical approach to predict an individual's genetic risk for episodic memory performance, a surrogate indicator of LOAD. Identifying genotypic patterns contributing to the decline of an individual's cognitive performance may be a critical step along the road to preclinical detection of Alzheimer disease.
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Affiliation(s)
- S Barral
- Gertrude H. Sergievsky Center, The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain and the Department ofNeurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Achiron A, Chapman J, Dolev M, Magalashvili D, Stern Y, Hillel M, Kassierer T, Raz H, Gurevich M. Epidemiology of Anti-JCV Antibodies in Israeli Multiple Sclerosis Population (P02.138). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Blum S, Luchsinger JA, Manly JJ, Schupf N, Stern Y, Brown TR, DeCarli C, Small SA, Mayeux R, Brickman AM. Memory after silent stroke: hippocampus and infarcts both matter. Neurology 2012; 78:38-46. [PMID: 22201111 DOI: 10.1212/wnl.0b013e31823ed0cc] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Memory decline commonly occurs among elderly individuals. This observation is often attributed to early neurodegenerative changes in the hippocampus and related brain regions. However, the contribution of vascular lesions, such as brain infarcts, to hippocampal integrity and age-associated memory decline remains unclear. METHODS We studied 658 elderly participants without dementia from a prospective, community-based study on aging and dementia who received high-resolution structural MRI. Cortical and subcortical infarcts were identified, and hippocampal and relative brain volumes were calculated following standard protocols. Summary scores reflecting performance on tasks of memory, language, processing speed, and visuospatial function were derived from a comprehensive neuropsychological battery. We used multiple regression analyses to relate cortical and subcortical infarcts, hippocampal and relative brain volume, to measures of cognitive performance in domains of memory, language, processing speed, and visuospatial ability. RESULTS Presence of brain infarcts was associated with a smaller hippocampus. Smaller hippocampus volume was associated with poorer memory specifically. Brain infarcts were associated with poorer memory and cognitive performance in all other domains, which was independent of hippocampus volume. CONCLUSIONS Both hippocampal volume and brain infarcts independently contribute to memory performance in elderly individuals without dementia. Given that age-associated neurodegenerative conditions, such as Alzheimer disease, are defined primarily by impairment in memory, these findings have clinical implications for prevention and for identification of pathogenic factors associated with disease symptomatology.
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Affiliation(s)
- S Blum
- Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY, USA
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Tatemichi TK, Desmond DW, Mayeux R, Paik M, Stern Y, Sano M, Remien RH, Williams JBW, Mohr JP, Hauser WA, Figueroa M. Dementia after stroke: Baseline frequency, risks, and clinical features in a hospitalized cohort. Neurology 2011. [DOI: 10.1212/01.wnl.0000407272.31554.0e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Devanand DP, Schupf N, Stern Y, Parsey R, Pelton GH, Mehta P, Mayeux R. Plasma Aβ and PET PiB binding are inversely related in mild cognitive impairment. Neurology 2011; 77:125-31. [PMID: 21715709 PMCID: PMC3140071 DOI: 10.1212/wnl.0b013e318224afb7] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 03/22/2011] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To evaluate the relations between PET Pittsburgh compound B (PiB-PET) binding (amyloid imaging) and plasma Aβ in patients with mild cognitive impairment (MCI) and similarly aged controls. METHODS In 20 patients with MCI and 19 cognitively intact controls (case-control study), PiB binding potential (BP(nd)) was assessed in 4 regions, and total brain excluding cerebellum, referenced to cerebellar binding. The mean of plasma Aβ levels measured in duplicate was analyzed. RESULTS Plasma Aβ42/Aβ40 ratio was decreased in MCI compared to controls (mean 0.15 SD 0.04 vs mean 0.19 SD 0.07, p = 0.03) but Aβ40 (p = 0.3) and Aβ42 (p = 0.06) levels did not differ between the 2 groups. PiB BP(nd) was increased in MCI compared to controls in the cingulate (p = 0.02), parietal (p = 0.02), and total brain (p = 0.03), but not in prefrontal cortex (p = 0.08) or parahippocampal gyrus (p = 0.07). Linear regression analyses adjusting for age, sex, and cognitive test scores showed that low Aβ42/Aβ40 ratio was associated with high cingulate, parietal, and total brain PiB binding (0.01< p ≤ 0.05). These associations between PiB binding and the Aβ42/Aβ40 ratio were strongest in PiB-positive subjects and within the MCI group. CONCLUSIONS Though cross-sectional, the findings support the "sink" hypothesis that increased brain Aβ is accompanied by lower peripheral levels of Aβ, particularly the Aβ42/Aβ40 ratio in patients with MCI. The association between PiB binding and the plasma Aβ42/Aβ40 ratio suggests possible use of plasma Aβ combined with PiB binding as a risk biomarker with potential clinical application.
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Affiliation(s)
- D P Devanand
- Divisions of Geriatric Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA.
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Baecker R, Shim N, Tonon K, Pandeliev V, Birnholtz J, Stern Y, Steinerman J, Moffatt K. ‘Serious’ online gaming environments to enhance brain fitness in senior citizens. ACTA ACUST UNITED AC 2010. [DOI: 10.4017/gt.2010.09.02.265.00] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Steffener J, Tabert M, Stern Y. Investigating Hemodynamic Response Variability at the Group Level using Basis Functions. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)70212-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Zhu CW, Leibman C, Townsend R, McLaughlin T, Scarmeas N, Albert M, Brandt J, Blacker D, Sano M, Stern Y. Bridging from clinical endpoints to estimates of treatment value for external decision makers. J Nutr Health Aging 2009; 13:256-9. [PMID: 19262963 PMCID: PMC2694572 DOI: 10.1007/s12603-009-0068-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM While clinical endpoints provide important information on the efficacy of treatment in controlled conditions, they often are not relevant to decision makers trying to gauge the potential economic impact or value of new treatments. Therefore, it is often necessary to translate changes in cognition, function or behavior into changes in cost or other measures, which can be problematic if not conducted in a transparent manner. The Dependence Scale (DS), which measures the level of assistance a patient requires due to AD-related deficits, may provide a useful measure of the impact of AD progression in a way that is relevant to patients, providers and payers, by linking clinical endpoints to estimates of cost effectiveness or value. The aim of this analysis was to test the association of the DS to clinical endpoints and AD-related costs. METHOD The relationship between DS score and other endpoints was explored using the Predictors Study, a large, multi-center cohort of patients with probable AD followed annually for four years. Enrollment required a modified Mini-Mental State Examination (mMMS) score >or= 30, equivalent to a score of approximately >or= 16 on the MMSE. DS summated scores (range: 0- 15) were compared to measures of cognition (MMSE), function (Blessed Dementia Rating Scale, BDRS, 0-17), behavior, extrapyramidal symptoms (EPS), and psychotic symptoms (illusions, delusions or hallucinations). Also, estimates for total cost (sum of direct medical cost, direct non-medical cost, and cost of informal caregivers' time) were compared to DS scores. RESULTS For the 172 patients in the analysis, mean baseline scores were: DS: 5.2 (SD: 2.0), MMSE: 23.0 (SD: 3.5), BDRS: 2.9 (SD: 1.3), EPS: 10.8%, behavior: 28.9% psychotic symptoms: 21.1%. After 4 years, mean scores were: DS: 8.9 (SD: 2.9), MMSE: 17.2 (SD: 4.7), BDRS: 5.2 (SD: 1.4), EPS: 37.5%, behavior: 60.0%, psychotic symptoms: 46.7%. At baseline, DS scores were significantly correlated with MMSE (r=-0.299, p < 0.01), BDRS (r=0.610, p < 0.01), behavior (r=.2633, p=0.0005), EPS (r=0.1910, p=0.0137) and psychotic symptoms (r=0.253, p < 0.01); and at 4-year follow-up, DS scores were significantly correlated with MMSE (r=-0.3705, p=0.017), BDRS (r=0.6982, p < 0.001). Correlations between DS and behavior (-0.0085, p=0.96), EPS (r=0.3824, p=0.0794), psychotic symptoms (r=0.130, ns) were not statistically significant at follow-up. DS scores were also significantly correlated with total costs at baseline (r=0.2615, p=0.0003) and follow-up (r=0.3359, p=0.0318). DISCUSSION AD is associated with deficits in cognition, function and behavior, thus it is imperative that these constructs are assessed in trials of AD treatment. However, assessing multiple endpoints can lead to confusion for decision makers if treatments do not impact all endpoints similarly, especially if the measures are not used typically in practice. One potential method for translating these deficits into a more meaningful outcome would be to identify a separate construct, one that takes a broader view of the overall impact of the disease. Patient dependence, as measured by the DS, would appear to be a reasonable choice - it is associated with the three clinical endpoints, as well as measures of cost (medical and informal), thereby providing a bridge between measures of clinical efficacy and value in a single, transparent measure.
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Affiliation(s)
- C W Zhu
- Geriatric Research, Education and Clinical Center (GRECC), USA
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Helzner EP, Scarmeas N, Cosentino S, Tang MX, Schupf N, Stern Y. Survival in Alzheimer disease: a multiethnic, population-based study of incident cases. Neurology 2008; 71:1489-95. [PMID: 18981370 DOI: 10.1212/01.wnl.0000334278.11022.42] [Citation(s) in RCA: 162] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe factors associated with survival in Alzheimer disease (AD) in a multiethnic, population-based longitudinal study. METHODS AD cases were identified in the Washington Heights Inwood Columbia Aging Project, a longitudinal, community-based study of cognitive aging in Northern Manhattan. The sample comprised 323 participants who were initially dementia-free but developed AD during study follow-up (incident cases). Participants were followed for an average of 4.1 (up to 12.6) years. Possible factors associated with shorter lifespan were assessed using Cox proportional hazards models with attained age as the time to event (time from birth to death or last follow-up). In subanalyses, median postdiagnosis survival durations were estimated using postdiagnosis study follow-up as the timescale. RESULTS The mortality rate was 10.7 per 100 person-years. Mortality rates were highest [corrected] among those diagnosed at older ages, and among non-Hispanic whites compared to [corrected] Hispanic [corrected] The median lifespan of the entire sample was 92.2 years (95% CI: 90.3, 94.1). In a multivariable-adjusted Cox model, history of diabetes and history of hypertension were independently associated with a shorter lifespan. No differences in lifespan were seen by race/ethnicity after multivariable adjustment. The median postdiagnosis survival duration was 3.7 years among non-Hispanic whites, 4.8 years among African Americans, and 7.6 years among Hispanics. CONCLUSION Factors influencing survival in Alzheimer disease include race/ethnicity and comorbid diabetes and hypertension.
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Affiliation(s)
- E P Helzner
- Gertrude H Sergievsky Center, Columbia University Medical Center, New York, NY 10032, USA
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Andrieu S, Barberger-Gateau P, Raffaitin C, Berr C, Tzourio C, Dartigues JF, Gin H, Fitten LJ, Ortiz F, Fairbanks L, Bartzokis G, Lu P, Ringman J, Heyn PC, Locher JL, Salvà A, Andrieu S, Fernández E, Vellas B, van de Rest O, Geleijnse JM, Kok FJ, van Staveren WA, Beekman ATF, Hoefnagels WHL, de Groot CPGM, Angevaren M, Aufdemkampe G, Verhaar HJJ, Aleman A, Vannees L, Arkin S, Florez H, Gerstein H, Sheridan P, Bosch J, Goldberg R, Kaspar KM, Drawert SM, Marcus RL, Kidde J, Dibble L, Addison O, LaStayo PC, Scarmeas N, Stern Y, Schupf N, Luchsinger JA, Sharkey JR, Laditka JN, Laditka SB, Liu R, Hochhalter A, Robare JF, Türner N, Judge M, Foster TC, Erdos B, Cudykier I, Scarpace PJ, Weiss LA, Bergstrom J, Kritz-Silverstein D, Barrett-Connor E, Yurko-Mauro K, Nelson E, Quinn J, Sattler FR, Castaneda-Sceppa C, Binder EF, Schroeder ET, Wang Y, Bhasin S, Kawakubo M, Stewart Y, Hahn C, Colletti P, Roubenoff R, Yarasheski KE, Azen SP, Aoki Y, Yamamoto T, Otuka T, Blanc-Bisson C, Bourdel-Marchasson I, Bocock MA, Keller HH, Bowman G, Baxter J, Oken B, Frei B, Traber M, Leonard S, Kaye J, Shannon J, Quinn J, Carlsson M, Gustafson Y, Eriksson S, Littbrand H, Håglin L, Danthiir V, Wilson C, Nettelbeck T, Burns N, Wittert G, Noakes M, Clifton P, DiMaria-Ghalili RA, Grieger JA, Nowson CA, Wattanapenpaiboon NT, Holstein J, Robinson C, Hartmann C, Rueb S, Heffel L, Dintaman S, Reynolds J, Fleming L, Crull M, Goldey J, Serper LL, Hubbard R, Westengard J, Horning M, Ishige Y, Aoki Y, Keller HH, Keller HH, LaStayo PC, Marcus RL, Smith S, Kidde J, Dibble L, Butler C, Hill M, LaStayo PC, Marcus RL, Dibble L, Kidde J, Peters C, Meier W, Laughlin GA, Kritz-Silverstein D, von Muhlen D, Barrett-Connor E, Olariu L, Petcu M, Tulcan C, Pup M, Otilingam P, Gate M, Pasinetti GM, Ray B, Chauhan NB, Bailey JA, Lahiri DK, Shatenstein B, Kergoat MJ, Reid I, Chicoine ME, Vaz L, Stewart R, Sabbah W, Tsakos G, D’Aiuto F, Watt RG, Sturman M, Kelly J, Fleischman D, Leurgans S, Bennett D, Morris MC, Suominen MH, Muurinen S, Soini H, Pitkälä KH, Yamamoto T, Fujinoki C, Aoki Y. 3rd IANA (International Academy on Nutrition and Aging) Meeting Nutrition, Exercise & Alzheimer and Clinical Trials on Sarcopenia August 1–2, 2008 Hyatt Regency Tamaya Resort 1300 Tuyuna Trail Santa Ana Pueblo, NM USA. J Nutr Health Aging 2008. [DOI: 10.1007/bf02982702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cosentino S, Scarmeas N, Helzner E, Glymour MM, Brandt J, Albert M, Blacker D, Stern Y. APOE epsilon 4 allele predicts faster cognitive decline in mild Alzheimer disease. Neurology 2008; 70:1842-9. [PMID: 18401023 DOI: 10.1212/01.wnl.0000304038.37421.cc] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether APOE epsilon 4 predicts rate of cognitive change in incident and prevalent Alzheimer disease (AD). METHODS Individuals were recruited from two longitudinal cohort studies-the Washington Heights and Inwood Columbia Aging Project (WHICAP; population-based) and the Predictors Study (clinic-based)--and were followed for an average of 4 years. Three samples of participants diagnosed with AD, with diverse demographic characteristics and baseline cognitive functioning, were studied: 1) 199 (48%) of the incident WHICAP cases; 2) 215 (54%) of the prevalent WHICAP cases; and 3) 156 (71%) of the individuals diagnosed with AD in the Predictors Study. Generalized estimating equations were used to test whether rate of cognitive change, measured using a composite cognitive score in WHICAP and the Mini-Mental State Examination in Predictors, varied as a function of epsilon 4 status in each sample. RESULTS The presence of at least one epsilon 4 allele was associated with faster cognitive decline in the incident population-based AD group (p = 0.01). Parallel results were produced for the two prevalent dementia samples only when adjusting for disease severity or excluding the most impaired participants from the analyses. CONCLUSION APOE epsilon 4 may influence rate of cognitive decline most significantly in the earliest stages of Alzheimer disease.
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Affiliation(s)
- S Cosentino
- Cognitive Neuroscience Division of the Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY 10032, USA
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Luber B, Stanford AD, Bulow P, Nguyen T, Rakitin BC, Habeck C, Basner R, Stern Y, Lisanby SH. Remediation of sleep-deprivation-induced working memory impairment with fMRI-guided transcranial magnetic stimulation. Cereb Cortex 2008; 18:2077-85. [PMID: 18203694 DOI: 10.1093/cercor/bhm231] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) was applied to test the role of selected cortical regions in remediating sleep-deprivation-induced deficits in visual working memory (WM) performance. Three rTMS targets were chosen using a functional magnetic resonance imaging (fMRI)-identified network associated with sleep-deprivation-induced WM performance impairment: 2 regions from the network (upper left middle occipital gyrus and midline parietal cortex) and 1 nonnetwork region (lower left middle occipital gyrus). Fifteen participants underwent total sleep deprivation for 48 h. rTMS was applied at 5 Hz during a WM task in a within-subject sham-controlled design. The rTMS to the upper-middle occipital site resulted in a reduction of the sleep-induced reaction time deficit without a corresponding decrease in accuracy, whereas stimulation at the other sites did not. Each subject had undergone fMRI scanning while performing the task both pre- and postsleep deprivation, and the degree to which each individual activated the fMRI network was measured. The degree of performance enhancement with upper-middle occipital rTMS correlated with the degree to which each individual failed to sustain network activation. No effects were found in a subset of participants who performed the same rTMS procedure after recovering from sleep deprivation, suggesting that the performance enhancements seen following sleep deprivation were state dependent.
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Affiliation(s)
- B Luber
- Division of Brain Stimulation and Therapeutic Modulation, New York State Psychiatric Institute, NY 10032, USA.
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Anderson KE, Brickman AM, Flynn J, Scarmeas N, Van Heertum R, Sackeim H, Marder KS, Bell K, Moeller JR, Stern Y. Impairment of nonverbal recognition in Alzheimer disease: a PET O-15 study. Neurology 2007; 69:32-41. [PMID: 17538034 DOI: 10.1212/01.wnl.0000266561.47619.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize deficits in nonverbal recognition memory and functional brain changes associated with these deficits in Alzheimer disease (AD). METHODS Using O-15 PET, we studied 11 patients with AD and 17 cognitively intact elders during the combined encoding and retrieval periods of a nonverbal recognition task. Both task conditions involved recognition of line drawings of abstract shapes. In both conditions, subjects were first presented a list of shapes as study items, and then a list as test items, containing items from the study list and foils. In the titrated demand condition, the shape study list size (SLS) was adjusted prior to imaging so that each subject performed at approximately 75% recognition accuracy; difficulty during PET scanning in this condition was approximately matched across subjects. A control task was used in which SLS = 1 shape. RESULTS During performance of the titrated demand condition, SLS averaged 4.55 (+/-1.86) shapes for patients with AD and 7.53 (+/-4.81) for healthy elderly subjects (p = 0.031). However, both groups of subjects were closely matched on performance in the titrated demand condition during PET scanning with 72.17% (+/-7.98%) correct for patients with AD and 72.25% (+/-7.03%) for elders (p = 0.979). PET results demonstrated that patients with AD showed greater mean differences between the titrated demand condition and control in areas including the left fusiform and inferior frontal regions (Brodmann areas 19 and 45). CONCLUSIONS Relative fusiform and inferior frontal differences may reflect the Alzheimer disease (AD) patients' compensatory engagement of alternate brain regions. The strategy used by patients with AD is likely to be a general mechanism of compensation, rather than task-specific.
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Affiliation(s)
- K E Anderson
- Cognitive Neuroscience Division, Taub Institute for Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons of Columbia University, New York, NY, USA
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Devanand DP, Pradhaban G, Liu X, Khandji A, De Santi S, Segal S, Rusinek H, Pelton GH, Honig LS, Mayeux R, Stern Y, Tabert MH, de Leon MJ. Hippocampal and entorhinal atrophy in mild cognitive impairment: prediction of Alzheimer disease. Neurology 2007; 68:828-36. [PMID: 17353470 DOI: 10.1212/01.wnl.0000256697.20968.d7] [Citation(s) in RCA: 478] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the utility of MRI hippocampal and entorhinal cortex atrophy in predicting conversion from mild cognitive impairment (MCI) to Alzheimer disease (AD). METHODS Baseline brain MRI was performed in 139 patients with MCI, broadly defined, and 63 healthy controls followed for an average of 5 years (range 1 to 9 years). RESULTS Hippocampal and entorhinal cortex volumes were each largest in controls, intermediate in MCI nonconverters, and smallest in MCI converters to AD (37 of 139 patients converted to AD). In separate Cox proportional hazards models, covarying for intracranial volume, smaller hippocampal volume (risk ratio [RR] 3.62, 95% CI 1.93 to 6.80, p < 0.0001), and entorhinal cortex volume (RR 2.43, 95% CI 1.56 to 3.79, p < 0.0001) each predicted time to conversion to AD. Similar results were obtained for hippocampal and entorhinal cortex volume in patients with MCI with Mini-Mental State Examination (MMSE) scores > or = 27 out of 30 (21% converted to AD) and in the subset of patients with amnestic MCI (35% converted to AD). In the total patient sample, when both hippocampal and entorhinal volume were entered into an age-stratified Cox model with sex, MMSE, education, and intracranial volume, smaller hippocampal volume (RR 2.21, 95% CI 1.14 to 4.29, p < 0.02) and entorhinal cortex volume (RR 2.48, 95% CI 1.54 to 3.97, p < 0.0002) predicted time to conversion to AD. Similar results were obtained in a Cox model that also included Selective Reminding Test (SRT) delayed recall and Wechsler Adult Intelligence Scale-Revised (WAIS-R) Digit Symbol as predictors. Based on logistic regression models in the 3-year follow-up sample, for a fixed specificity of 80%, the sensitivities for MCI conversion to AD were as follows: age 43.3%, MMSE 43.3%, age + MMSE 63.7%, age + MMSE + SRT delayed recall + WAIS-R Digit Symbol 80.6% (79.6% correctly classified), hippocampus + entorhinal cortex 66.7%, age + MMSE + hippocampus + entorhinal cortex 76.7% (85% correctly classified), age + MMSE + SRT delayed recall + WAIS-R Digit Symbol + hippocampus + entorhinal cortex 83.3% (86.8% correctly classified). CONCLUSIONS Smaller hippocampal and entorhinal cortex volumes each contribute to the prediction of conversion to Alzheimer disease. Age and cognitive variables also contribute to prediction, and the added value of hippocampal and entorhinal cortex volumes is small. Nonetheless, combining these MRI volumes with age and cognitive measures leads to high levels of predictive accuracy that may have potential clinical application.
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Affiliation(s)
- D P Devanand
- Department of Biological Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
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Luber B, Kinnunen LH, Rakitin BC, Ellsasser R, Stern Y, Lisanby SH. Facilitation of performance in a working memory task with rTMS stimulation of the precuneus: Frequency- and time-dependent effects. Brain Res 2007; 1128:120-9. [PMID: 17113573 DOI: 10.1016/j.brainres.2006.10.011] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2006] [Revised: 10/03/2006] [Accepted: 10/05/2006] [Indexed: 11/29/2022]
Abstract
Although improvements in performance due to TMS have been demonstrated with some cognitive tasks, performance improvement has not previously been demonstrated with working memory tasks. In the present study, a delayed match-to-sample task was used in which repetitive TMS (rTMS) at 1, 5, or 20 Hz was applied to either left dorsolateral prefrontal or midline parietal cortex during the retention (delay) phase of the task. Only 5 Hz stimulation to the parietal site resulted in a significant decrease in reaction time (RT) without a corresponding decrease in accuracy. This finding was replicated in a second experiment, in which 5 Hz rTMS at the parietal site was applied during the retention phase or during presentation of the recognition probe. Significant speeding of RT occurred in the retention phase but not the probe phase. This finding suggests that TMS may improve working memory performance, in a manner that is specific to the timing of stimulation relative to performance of the task, and to stimulation frequency.
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Affiliation(s)
- B Luber
- Brain Stimulation and Therapeutic Modulation Division, New York State Psychiatric Institute, New York, NY 10032, USA.
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Zhu CW, Scarmeas N, Torgan R, Albert M, Brandt J, Blacker D, Sano M, Stern Y. Longitudinal study of effects of patient characteristics on direct costs in Alzheimer disease. Neurology 2006; 67:998-1005. [PMID: 16914696 DOI: 10.1212/01.wnl.0000230160.13272.1b] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To estimate long-term trajectories of direct cost of caring for patients with Alzheimer disease (AD) and examine the effects of patients' characteristics on cost longitudinally. METHODS The sample is drawn from the Predictors Study, a large, multicenter cohort of patients with probable AD, prospectively followed up annually for up to 7 years in three university-based AD centers in the United States. Random effects models estimated the effects of patients' clinical and sociodemographic characteristics on direct cost of care. Direct cost included cost associated with medical and nonmedical care. Clinical characteristics included cognitive status (measured by Mini-Mental State Examination), functional capacity (measured by Blessed Dementia Rating Scale [BDRS]), psychotic symptoms, behavioral problems, depressive symptoms, extrapyramidal signs, and comorbidities. The model also controlled for patients' sex, age, and living arrangements. RESULTS Total direct cost increased from approximately 9,239 dollars per patient per year at baseline, when all patients were at the early stages of the disease, to 19,925 dollars by year 4. After controlling for other variables, a one-point increase in the BDRS score increased total direct cost by 7.7%. One more comorbid condition increased total direct cost by 14.3%. Total direct cost was 20.8% lower for patients living at home compared with those living in an institutional setting. CONCLUSIONS Total direct cost of caring for patients with Alzheimer disease increased substantially over time. Much of the cost increases were explained by patients' clinical and demographic variables. Comorbidities and functional capacity were associated with higher direct cost over time.
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Affiliation(s)
- C W Zhu
- Geriatric Research, Education, and Clinical Center, Bronx VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA.
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Hurwitz I, Malkesman O, Stern Y, Schroeder M, Lavi-Avnon Y, Shayit M, Shavit Y, Wolf G, Yirmiya R, Weller A. Stress and pain responses in rats lacking CCK1 receptors. Peptides 2006; 27:1483-9. [PMID: 16289472 DOI: 10.1016/j.peptides.2005.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2005] [Revised: 10/10/2005] [Accepted: 10/10/2005] [Indexed: 11/24/2022]
Abstract
UNLABELLED CCK involvement in stress- and pain-responsiveness was examined by studying the behavior of infant (11-12-days-old) and adult OLETF rats that do not express CCK1 receptors. Infant odor- and texture-preferences were also assessed. We hypothesized that OLETF rats will show behavioral patterns similar to those previously observed after CCK1 antagonist administration. Rate of separation-induced ultrasonic vocalization was significantly greater in OLETF compared to controls, in two separate studies. Infant pups of the two strains did not differ in odor- and texture-preference tests. OLETF rats showed consistently longer hot-plate paw-lift (as infants, in two separate studies) and paw-lick (as adults) latencies. SUMMARY OLETF pups vocalized in isolation more than controls and showed relative hypoalgesic responses, evident also in adulthood, in concordance with the pharmacological literature.
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Affiliation(s)
- I Hurwitz
- Interdisciplinary Program in the Brain Sciences, Bar Ilan University, Ramat-Gan, Israel
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Zhu CW, Scarmeas N, Torgan R, Albert M, Brandt J, Blacker D, Sano M, Stern Y. Clinical features associated with costs in early AD: baseline data from the Predictors Study. Neurology 2006; 66:1021-8. [PMID: 16606913 DOI: 10.1212/01.wnl.0000204189.18698.c7] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Few studies on cost of caring for patients with Alzheimer disease (AD) have simultaneously considered multiple dimensions of disease costs and detailed clinical characteristics. OBJECTIVE To estimate empirically the incremental effects of patients' clinical characteristics on disease costs. METHODS Data are derived from the baseline visit of 180 patients in the Predictors Study, a large, multicenter cohort of patients with probable AD followed from early stages of the disease. All patients initially lived at home, in retirement homes, or in assisted living facilities. Costs of direct medical care included hospitalizations, outpatient treatment and procedures, assistive devices, and medications. Costs of direct nonmedical care included home health aides, respite care, and adult day care. Indirect costs were measured by caregiving time. Patients' clinical characteristics included cognitive status, functional capacity, psychotic symptoms, behavioral problems, depressive symptoms, extrapyramidal signs, comorbidities, and duration of illness. RESULTS A 1-point increase in the Blessed Dementia Rating Scale score was associated with a $1,411 increase in direct medical costs and a $2,718 increase in unpaid caregiving costs. Direct medical costs also were $3,777 higher among subjects with depressive symptoms than among those who were not depressed. CONCLUSIONS Medical care costs and unpaid caregiving costs relate differently to patients' clinical characteristics. Poorer functional status is associated with higher medical care costs and unpaid caregiving costs. Interventions may be particularly useful if targeted in the areas of basic and instrumental activities of daily living.
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Affiliation(s)
- C W Zhu
- Geriatric Research, Education, and Clinical Center, Bronx VA Medical Center, Bronx, NY 10468, USA.
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Abstract
BACKGROUND Some (but not all) epidemiological studies have noted faster rates of progression in high education patients with Alzheimer's disease (AD), which has been attributed to harbouring/tolerating a higher pathological burden at the time of clinical dementia for subjects with higher education. We wanted to assess the relationship between education and rates of decline in AD. METHODS During the course of a community based multiethnic prospective cohort study of individuals aged > or = 65 years living in New York, 312 patients were diagnosed with incident AD and were followed overall for 5.6 (up to 13.3) years. The subjects received an average of 3.7 (up to 9) neuropsychological assessments consisting of 12 individual tests. With the aid of a normative sample, a standardised composite cognitive score as well as individual cognitive domain scores were calculated. Generalised estimating equation models were used to examine the association between education and rates of cognitive decline. RESULTS Composite cognitive performance declined by 9% of a standard deviation per year. Rates of decline before and after AD incidence were similar. For each additional year of education there was 0.3% standard deviation lower composite cognitive performance for each year of follow up. The association between higher education and faster decline was noted primarily in the executive speed (0.6%) and memory (0.5%) cognitive domains and was present over and above age, gender, ethnicity, differential baseline cognitive performance, depression, and vascular comorbidity. CONCLUSIONS We conclude that higher education AD patients experience faster cognitive decline.
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Affiliation(s)
- N Scarmeas
- Cognitive Neuroscience Division, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, 622 West 168th Street, PH 19th Floor, New York, NY 10032, USA.
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Abstract
OBJECTIVE To determine whether specific cognitive deficits can predict the progression of Alzheimer disease (AD). METHODS Two hundred fifty-two patients with AD enrolled in the Predictors Study were followed at 6-month intervals for up to 4.5 years with neurologic, cognitive, and psychiatric examinations. Neuropsychological functions were assessed by the Modified Mini-Mental State Examination (mMMSE). Items of mMMSE were divided into five cognitive domains: temporospatial orientation, short-term memory, long-term memory, language, and visuoconstructive functions. Loss of autonomy was assessed by both the Dependency Scale (DS) and the Equivalent Institutional Care (EIC) rating. Cox proportional hazards models, adjusted for age, sex, estimated duration of illness at entry into the study, and presence of extrapyramidal signs and behavioral disturbances, were used to determine the predictive value of each neuropsychological domain on dependency outcomes. RESULTS Global mMMSE, temporospatial orientation, and short-term memory scores were associated with a greater relative risk of moderate or severe dependency. The visuoconstructive score predicted the development of severe dependency. Long-term memory and language scores were not predictive of the EIC or DS endpoints. CONCLUSIONS The presence of certain neuropsychological deficits at a patient's initial visit, such as short-term memory, temporospatial orientation, and constructive apraxia, predict more rapid dependency in patients with Alzheimer disease. Neuropsychological items have different weights in term of predictive power, and these effects are independent of the influence of age and disease duration at baseline.
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Affiliation(s)
- M Sarazin
- INSERM U 610 and Fédération de Neurologie, Centre de Neuropsychologie, Hôpital de la Salpêtrière, 47 Bd de l'Hôpital, 75013 Paris, France.
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Scarmeas N, Albert M, Brandt J, Blacker D, Hadjigeorgiou G, Papadimitriou A, Dubois B, Sarazin M, Wegesin D, Marder K, Bell K, Honig L, Stern Y. Motor signs predict poor outcomes in Alzheimer disease. Neurology 2006; 64:1696-703. [PMID: 15911793 PMCID: PMC3028937 DOI: 10.1212/01.wnl.0000162054.15428.e9] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine whether the presence of motor signs has predictive value for important outcomes in Alzheimer disease (AD). METHODS A total of 533 patients with AD at early stages (mean Folstein Mini-Mental State Examination [MMSE] 21/30 at entry) were recruited and followed semiannually for up to 13.1 years (mean 3) in five University-based AD centers in the United States and European Union. Four outcomes, assessed every 6 months, were used in Cox models: cognitive endpoint (Columbia Mini-Mental State Examination < or = 20/57 [ approximately MMSE < or = 10/30]), functional endpoint (Blessed Dementia Rating Scale > or = 10), institutionalization equivalent index, and death. Using a standardized portion of the Unified PD Rating Scale (administered every 6 months for a total of 3,149 visit-assessments, average 5.9 per patient), the presence of motor signs, as well as of individual motor sign domains, was examined as time-dependent predictor. The models controlled for cohort, recruitment center, sex, age, education, a comorbidity index, and baseline cognitive and functional performance. RESULTS A total of 39% of the patients reached the cognitive, 41% the functional, 54% the institutionalization, and 47% the mortality endpoint. Motor signs were noted for 14% of patients at baseline and for 45% at any evaluation. Their presence was associated with increased risk for cognitive decline (RR, 1.72; 95% CI, 1.24 to 2.38), functional decline (1.80 [1.33 to 2.45]), institutionalization (1.68 [1.26 to 2.25]), and death (1.38 [1.05 to 1.82]). Tremor was associated with increased risk for reaching the cognitive and bradykinesia for reaching the functional endpoints. Postural-gait abnormalities carried increased risk for institutionalization and mortality. Faster rates of motor sign accumulation were associated with increased risk for all outcomes. CONCLUSIONS Motor signs predict cognitive and functional decline, institutionalization, and mortality in Alzheimer disease. Different motor sign domains predict different outcomes.
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Affiliation(s)
- N Scarmeas
- Cognitive Neuroscience Division of the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY 10032, USA.
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Sarazin M, Stern Y, Berr C, Albert M, Brandt J, Dubois B. O2-6 Facteurs neuropsychologiques prédictifs de dépendance dans la maladie d’Alzheimer. Rev Neurol (Paris) 2005. [DOI: 10.1016/s0035-3787(05)85300-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Anosognosia, disordered awareness of cognitive and behavioral deficits, is a striking and common symptom of Alzheimer's disease (AD), yet its etiology, clinical correlates, and prognostic value are unclear. Historically, disordered awareness has been a conceptually challenging phenomenon, evidenced by the numerous and diverse theories that aim to explain the manner in which this syndrome arises. We review many of these theories, focusing on the neuroanatomic substrates of awareness, and highlighting the potential roles of critical regions such as the right prefrontal and parietal cortices in enabling self-awareness. We then address methodological limitations such as use of subjective measurement tools that likely contribute to the conceptual ambiguity surrounding anosognosia. We argue that metacognitive techniques used in healthy adults, such as the Feeling of Knowing task, offer models for dissecting awareness into clear and identifiable cognitive components in patients with AD. We critique several studies that have pioneered such tasks in AD, and offer guidelines for future implementation of such methods. A final goal of this review is to advocate for a multidimensional approach to studying metacognitive skills that will facilitate the objective investigation of deficit awareness as it relates to a variety of disease variables such as prognosis, neuropsychological profile, neuropathological distribution, psychiatric symptoms, and clinical course.
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Affiliation(s)
- S Cosentino
- Cognitive Neuroscience Division of the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, New York 10032, USA
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