1141 Daytime Napping Trajectory Over Time And Its Association With Cognitive Aging: A 13-year Community-based Longitudinal Study Of Older Adults

Introduction

Daytime napping is common in elderly adults and has been associated with cognitive impairment. Prior studies have assessed napping at one time point, making it difficult to examine the longitudinal progression of napping and its association with cognitive aging. We examined objectively measured daytime napping longitudinally across different stages of Alzheimer’s disease (AD): from no cognitive impairment (NCI), to mild cognitive impairment (MCI), and to Alzheimer’s dementia.

Methods

We studied 1,066 participants (female: 810; age: 81.0±7.3 [SD]) in the Rush Memory and Aging Project who have been followed for up to 13 years. Motor activities of up to 10 days were recorded annually and used to assess napping objectively. We defined daytime napping episodes as segments between 10AM and 7PM with continuous zero-activity for ≥10min but <1h (to avoid off-wrist periods). Segments that were <5min apart were merged. Cognitive and clinical evaluations were administered annually to render a clinical diagnostic classification of NCI, MCI, or Alzheimer’s dementia. To examine how napping duration and frequency change with the progression of AD, we performed linear mixed-effects models with 2 change points anchored at the diagnoses of MCI and AD while adjusted for age, sex, and education.

Results

At baseline, participants had 1.44±0.04 (mean±standard error) naps with an accumulated duration of 35.0±1.1 min per day. Napping duration increased by 5.2±0.3 min and frequency increased by 0.21±0.01 times every year (both p<0.0001). The rate of increase was more than doubled after MCI diagnosis with an annual increase of 11.4±0.7 min in duration and 0.40±0.02 times in frequency (both p<0.0001); these were doubled further after AD diagnosis with an annual change of 26.3±3.1 min in duration and 0.84±0.08 times in frequency (both p<0.0001).

Conclusion

Daytime napping duration and frequency increase with aging, and the increase was accelerated with AD progression.

Support

This work was supported by NIH grants RF1AG064312, RF1AG059867, R01AG017917, and R01AG56352.

1135 Longer And More Frequent Naps Predict Incident Alzheimer’s Dementia In Community-based Older Adults

Introduction

Excessive napping duration has been associated with cognitive decline. The effect of napping frequency is less understood, and little is known about the development of Alzheimer’s dementia associated with napping. We tested whether longer or more frequent naps in the elderly are linked to the development of incident Alzheimer’s dementia.

Methods

We studied 1,180 older adults (age: 81.0±7.3 [SD]) in the Rush Memory and Aging Project who have been followed for up to 14 years. Motor activities of up to 10 days were recorded at baseline to assess napping characteristics objectively. We defined daytime napping episodes as motor activity segments between 10AM and 7PM with continuous zero-activity for ≥10min but <1h (to avoid off-wrist periods). Segments that were <5min apart were merged. Alzheimer’s dementia diagnosis was determined using the criteria of the National Institute of Neurological and Communicative Disorders and Strone and the Alzheimer’s Disease and Related Disorders Association. Cox proportional hazards models were performed to examine the associations of daily napping duration and frequency with incident AD.

Results

Of 1,180 non-demented participants at baseline (including 264 with mild cognitive impairment), 277 developed Alzheimer’s dementia within 5.74±3.36 years. On average, participants napped for 38.3±1.0 (SE) min and1.56±0.04 (SE) times per day at baseline. After adjustment for age, sex, and education, every 30-min increase in daily napping duration was associated with a 20% increase in the risk of incident AD (95% confidence interval [CI]: 9%-31%; p=0.0002). One more nap per day was associated with a 19% increase in the risk of AD (95% CI: 8%-30%; p=0.0003). These associations remained after further adjustment for total sleep time.

Conclusion

Longer and more frequent daytime naps predict a higher risk of incident Alzheimer’s dementia. Future studies are needed to examine specific underlying mechanisms.

Support

This work was supported by NIH grants RF1AG064312, RF1AG059867, R01AG017917, and R01AG56352.

Commentary on a combined approach to the problem of developing biomarkers for the prediction of spontaneous preterm labor that leads to preterm birth

INTRODUCTION

Globally, preterm birth has replaced congenital malformation as the major cause of perinatal mortality and morbidity. The reduced rate of congenital malformation was not achieved through a single biophysical or biochemical marker at a specific gestational age, but rather through a combination of clinical, biophysical and biochemical markers at different gestational ages. Since the aetiology of spontaneous preterm birth is also multifactorial, it is unlikely that a single biomarker test, at a specific gestational age will emerge as the definitive predictive test.

METHODS

The Biomarkers Group of PREBIC, comprising clinicians, basic scientists and other experts in the field, with a particular interest in preterm birth have produced this commentary with short, medium and long-term aims: i) to alert clinicians to the advances that are being made in the prediction of spontaneous preterm birth; ii) to encourage clinicians and scientists to continue their efforts in this field, and not to be disheartened or nihilistic because of a perceived lack of progress and iii) to enable development of novel interventions that can reduce the mortality and morbidity associated with preterm birth.

RESULTS

Using language that we hope is clear to practising clinicians, we have identified 11 Sections in which there exists the potential, feasibility and capability of technologies for candidate biomarkers in the prediction of spontaneous preterm birth and how current limitations to this research might be circumvented.

DISCUSSION

The combination of biophysical, biochemical, immunological, microbiological, fetal cell, exosomal, or cell free RNA at different gestational ages, integrated as part of a multivariable predictor model may be necessary to advance our attempts to predict sPTL and PTB. This will require systems biological data using "omics" data and artificial intelligence/machine learning to manage the data appropriately. The ultimate goal is to reduce the mortality and morbidity associated with preterm birth.

Abstract P1-01-01: Systemic imaging fails to detect metastasis in early stage breast cancer

Background: Current NCCN guidelines for early stage breast cancer (Stage I and II) do not recommend routine systemic imaging in the absence of symptoms or abnormal labs suggestive of distant metastasis. This study aims to determine the frequency and appropriateness of these imaging studies performed, its impact on staging and the factors that influence physicians in ordering these imaging studies.

Methods: Patients with stage I and II breast cancer at initial presentation were retrospectively identified between years 2011-2015 from the tumor registry. Charts were reviewed to determine patients who got systemic imaging (CT scan, non-breast MRI, bone scan or PET scan) within 6 months of diagnosis. Provider notes and laboratory data were analyzed to establish the appropriateness of ordered imaging studies and if the imaging altered the stage. For each patient in the study, age at diagnosis, the grade of the breast tumor, hormonal receptor status and HER-2 status was documented. Statistical analysis was done using appropriate tests.

Results: A total of 1067 patient charts were screened, of which 882 were identified for inclusion in the study (544 stage I, 338 stage II). Amongst the cohort, 18.57% (101) of patients with stage I and 50.89% (172) of patients with stage II cancer received imaging studies within the first 6 months of diagnosis. Only 12.68% (69) of stage I patients and 18.24% (62) of stage II patients were judged appropriate for imaging based on symptoms and lab results suggesting metastasis. In the imaged cohort of Stage I patients, only 4.35% (3) of the appropriately imaged group and 13.33% (4) of the inappropriately imaged group had a change in stage. Similarly, in the Stage II cohort, only 4.84% (3) of the appropriately imaged group and 8.18% (9) of the inappropriately imaged group saw a change in state. The difference in stage change in the appropriately and inappropriately imaged groups was not statistically significant. (p = 0.11 for Stage I, p=0.41 for Stage II). Only 5.9% of Stage I and 2.9% of Stage II imaged patients changed to stage IV. Grade 1 patients were less likely to receive systemic imaging than grade 2 and 3 patients ((p <0.001). Similarly, the difference in imaging rates ordered in patients with ER and/or PR negative status versus ER and PR positive status was significant (p=0.0004). Triple negative (p <0.001) status and age≤ 50 years were statistically significant predictors of patients receiving imaging (p = 0.014). HER-2 status alone was not a significant predictor of getting imaged (p= 0.527).

Conclusions: We performed the first ever study to investigate a correlation between the appropriateness of ordered imaging studies in early stage breast cancer and its ability to detect a change in stage. Distant metastasis identification among stage I & II patients was extremely rare among both appropriately and inappropriately imaged groups. Our findings suggest a wide prevalence of inappropriately ordered imaging studies in Stage I and II breast cancer as well as limited utility for even appropriately ordered ones. Further, other factors such as grade of the tumor, ER/PR/HER2 status and age were found to be statistically significant predictors of whether patients received imaging studies.

Citation Format: Gaba AG, Kraft R, Stjern BK, Monu M, Gunderson MA, Hanish C, Samreen A, Paladugu G. Systemic imaging fails to detect metastasis in early stage breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-01-01.

Abstract OT2-01-16: Evaluating targets in localized and advanced breast cancer by sequencing tumor DNA at diagnosis and after progression (ELSA)

Background: Breast cancer therapy exerts strong selection pressure that shapes the evolution of the cancer. Despite the importance of these treatment-induced changes for the success of subsequent therapy, tumors have been rarely resampled and reanalyzed, with the exception of hematopoietic malignancies. The availability of next generation sequencing (NGS) has made it possible to get highly accurate sequencing that allows detection of mutations and other genetic alterations not only from tumor biopsies but also from circulating DNA fragments.

Objectives: To demonstrate the evolution of the molecular genotype of breast cancer as patients are diagnosed, treated, and upon relapse. This will be accomplished by NGS of the tumor at key time points during the natural history of the disease. The molecular profile at diagnosis will be compared to the profile at recurrence/metastasis and after treatment for metastasis. Correlation with treatment response and adverse clinical outcomes will be determined.

Study Design and Eligibility: We have initiated a prospective observational study in patients with a new diagnosis of Stage I, II and III breast cancer and an ECOG performance status of 0, 1 or 2. Patients should be medically suitable to give informed consent for a biopsy or surgical procedure. Enrollment will occur at community-based cancer centers with inclusion of under-served populations.

Methodology: Tumor samples and blood samples are collected at - initial diagnosis/definitive surgery, first local relapse, diagnosis of metastasis and at first progression after treatment for metastatic disease. Molecular genotype will be analyzed from the tumor samples and from the circulating tumor DNA (ctDNA) in blood samples at each of the time points. ctDNA will also be assessed on blood samples collected annually till the diagnosis of metastasis and then more frequently at 3-6 month intervals in patients with high risk breast cancer.

Statistical Design/Size of study sample: Formal sample size calculations are not required for this study as by design, it is based on participation. There is no discrete endpoint that can be powered by sample size calculation for this study. We are screening all patients who are diagnosed with breast cancer at our facility. The proposed enrollment is 300 patients per year. The study launched in December 2015 at 4 of our community-based cancer centers. Current enrollments is 46 patients.

Citation Format: Gaba AG, Powell SF, Jennifer WL, Megan LL, Chun-Hung C, Lora BJ, Ford JM. Evaluating targets in localized and advanced breast cancer by sequencing tumor DNA at diagnosis and after progression (ELSA) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT2-01-16.

Change in performance in response to training load adjustment based on autonomic activity

The primary aim of this study was to assess performance (Perf) changes in response to a new training strategy. Specifically, based on spectral analysis of heart rate variability (SA HRV) to determine autonomic nervous system (ANS) activity, training doses were adjusted to maintain vagal activity at a high and relatively stable level during training preparation. Trained athletes (5 male and 5 female) aged 23.2±4.2 years voluntarily participated in the study. ANS activity was assessed during an orthoclinostatic test, and was represented by calculating HRV variables and a total score index. Over 17 weeks, improvement (1.4-8.5%) and deterioration (0.1-8.8%) in Perf were detected in 7 and 3 athletes, respectively. A relationship (rs=0.684; P<0.05) between the change in Perf (ΔPerf) and supine PHF during season was found. Supine HRV indices (PHF, PT, and MSSD) for the last 3 weeks of the HRV-adjusting period correlated (rs=0.636; 0.648; 0.648, P<0.05) with ΔPerf. Based on the results, a high and relative stable vagal activity during preparation may indicate a readiness to train or appropriate recovery that positively affects Perf. In conclusion, daily quantification of ANS activity by SA HRV seems to be a promising tool for the enhancement of Perf.

Vagal threshold determination. Effect of age and gender

Progressive increases in exercise intensity cause significant decreases in vagal activity (VA) until a critical point called the vagal threshold (TVA) is reached. This is where further increases in exercise intensity cause negligible change in VA. This study was designed to develop the algorithm for the TVA determination and to assess the effects of age and gender on its level. The sample consisted of 40 subjects who were divided according to age and gender into 4 groups with 10 subjects each: G1-Men age 25-31, G2-Men age 40-57, G3-Women age 24-28, and G4-Women age 43-56. The vagal responses were assessed by spectral analysis of the heart rate variability method while walking on a treadmill in a steady-state at intensities of 20-70% of the maximal heart rate reserve (MHRR). The mean intensity of 45% MHRR was suggested as the TVA level which is related neither to age nor gender. Heart rate related to TVA (TVA-HR) was affected by gender. High frequency power at TVA was influenced by age. The TVA-HR was considered to be a promising tool for the prescription of a safe level of physical activity for subjects with higher risks of health complications involving elevated sympathoadrenal activity during exercise.

A highly conserved mechanism of regulated ribosome stalling mediated by fungal arginine attenuator peptides that appears independent of the charging status of arginyl-tRNAs

The Arg attenuator peptide (AAP) is an evolutionarily conserved peptide involved in Arg-specific negative translational control. It is encoded as an upstream open reading frame (uORF) in fungal mRNAs specifying the small subunit of Arg-specific carbamoyl phosphate synthetase. We examined the functions of the Saccharomyces cerevisiae CPA1 and Neurospora crassa arg-2 AAPs using translation extracts from S. cerevisiae, N. crassa, and wheat germ. Synthetic RNA containing AAP and firefly luciferase (LUC) sequences were used to program translation; analyses of LUC activity indicated that the AAPs conferred Arg-specific negative regulation in each system. The AAPs functioned either as uORFs or fused in-frame at the N terminus of LUC. Mutant AAPs lacking function in vivo did not function in vitro. Therefore, trans-acting factors conferring AAP-mediated regulation are in both fungal and plant systems. Analyses of ribosome stalling in the fungal extracts by primer extension inhibition (toeprint) assays showed that these AAPs acted similarly to stall ribosomes in the region immediately distal to the AAP coding region in response to Arg. The regulatory effect increased as the Arg concentration increased; all of the arginyl-tRNAs examined appeared maximally charged at low Arg concentrations. Therefore, AAP-mediated Arg-specific regulation appeared independent of the charging status of arginyl-tRNA.

Primary tumors of the foot: MR imaging

The findings at magnetic resonance (MR) imaging of eight patients with primary tumors of the foot were compared with those at gross pathologic examination. In all cases, there was excellent correlation between the two studies. When compared with computed tomography (CT), MR imaging was superior in defining the presence and extent of local disease. While the appearances of various foot neoplasms are nonspecific, the ease of multiplanar imaging, the superior contrast resolution, and the sensitivity to marrow abnormalities are major advantages of MR imaging over CT in staging foot neoplasms. These advantages are crucial when foot-sparing curative resection of a malignancy is contemplated. The combination of plain radiography and MR imaging may be all that is necessary for optimal preoperative detection and local staging of tumors of the foot.