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Farrer TJ, Bigler ED, Tsui-Caldwell YHW, Abildskov TJ, Tschanz JT, Welsh-Bohmer KA. Scheltens ratings, clinical white matter hyperintensities and executive: Functioning in the Cache County Memory Study. Appl Neuropsychol Adult 2023:1-7. [PMID: 38052027 DOI: 10.1080/23279095.2023.2287140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVE Examine the association between neuropsychologically assessed executive function and clinically identifiable white matter burden from magnetic resonance imaging, using a visual rating system (Scheltens Rating System) applied to the Cache County Memory Study (CCMS) archival database. METHOD We used the Scheltens Ratings Scale to quantify white matter lesion burden in the CCMS sample and used this metric as a predictor of executive function. The sample included 60 individuals with dementia and 13 healthy controls. RESULTS Higher Scheltens ratings were associated with poorer task performance on an Executive Function composite score of common neuropsychological tests. This association held true for both controls and dementing cases. CONCLUSIONS The current findings support extensive prior literature demonstrating the association between brain vascular health determined by white matter burden and clinical outcomes based on neuropsychological assessment of cognitive performance.
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Affiliation(s)
- Thomas J Farrer
- WWAMI Medical Education Program, University of Idaho, Moscow, ID, USA
| | - Erin D Bigler
- Department of Psychology, Brigham Young University, Provo, UT, USA
- Neuroscience Center, Brigham Young University, Provo, UT, USA
| | | | - Tracy J Abildskov
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - JoAnn T Tschanz
- Department of Psychology, Utah State University, Logan, UT, USA
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Kauzor K, Drewel M, Gonzalez H, Rattinger GB, Hammond AG, Wengreen H, Lyketsos CG, Tschanz JT. Malnutrition and neuropsychiatric symptoms in dementia: the Cache County Dementia Progression Study. Int Psychogeriatr 2023; 35:653-663. [PMID: 37246509 PMCID: PMC10592578 DOI: 10.1017/s1041610223000467] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Among people with dementia, poor nutritional status has been associated with worse cognitive and functional decline, but few studies have examined its association with neuropsychiatric symptoms (NPS). We examined this topic in a population-based sample of persons with dementia. DESIGN Longitudinal, observational cohort study. SETTING Community. PARTICIPANTS Two hundred ninety-two persons with dementia (71.9% Alzheimer's disease, 56.2% women) were followed up to 6 years. MEASUREMENTS We used a modified Mini-Nutritional Assessment (mMNA) and the Neuropsychiatric Inventory (NPI) to evaluate nutritional status and NPS, respectively. Individual linear mixed effects models examined the associations between time-varying mMNA total score or clinical categories (malnourishment, risk for malnourishment, or well-nourished) and NPI total score (excluding appetite domain) or NPI individual domain or cluster (e.g. psychosis) scores. Covariates tested were dementia onset age, type, and duration, medical comorbidities, sex, apolipoprotein E (APOE) genotype, and education. RESULTS Compared to the well-nourished, those at risk for malnourishment and those malnourished had higher total NPI scores [b (95% CI) = 1.76 (0.04, 3.48) or 3.20 (0.62, 5.78), respectively], controlling for significant covariates. Higher mMNA total score (better nutritional status) was associated with lower total NPI [b (95% CI) = -0.58 (-0.86, -0.29)] and lower domain scores for psychosis [b (95% CI) = -0.08 (-0.16, .004)], depression [b (95% CI = -0.11 (-0.16, -0.05], and apathy [b (95% CI = -0.19 (-0.28, -0.11)]. CONCLUSIONS Worse nutritional status is associated with more severe NPS. Dietary or behavioral interventions to prevent malnutrition may be beneficial for persons with dementia.
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Affiliation(s)
- Kaitlyn Kauzor
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84321-2810, USA
| | - Mikaela Drewel
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84321-2810, USA
| | - Hector Gonzalez
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84321-2810, USA
| | - Gail B Rattinger
- School of Pharmacy and Pharmaceutical Sciences, Binghamton University, P.O. Box 6000. Binghamton, NY 13902-6000, USA
| | - Alexandra G Hammond
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84321-2810, USA
| | - Heidi Wengreen
- Nutrition Dietetics and Food Sciences, Utah State University, 8710 Old Main Hill, Logan, UT 84322-8710, USA
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, 5300 Alpha Commons Drive, 4th Floor, Baltimore, MD 21224, USA
| | - JoAnn T Tschanz
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84321-2810, USA
- Alzheimer's Disease and Dementia Research Center, Utah State University, 6405 Old Main Hill, Logan, UT, 84322-6405, USA
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Vernon EK, Gonzalez HL, Schwartz S, Rattinger GB, Drewel M, Smith KR, DeBerard S, Kauwe J, Buhusi M, Tschanz JT. Sex differences in risk for Alzheimer’s disease with extended maternal and paternal family history and vascular risk factors. The Cache County Study. Alzheimers Dement 2022. [DOI: 10.1002/alz.062914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Murray J, Gonzalez HL, Schwartz S, Rattinger GB, Liu Y, Hammond AG, Kauzor KE, Drewel M, Tschanz JT. Sleep disturbance and association with cognitive and functional trajectories in all cause dementia: The Cache County Dementia Progression Study. Alzheimers Dement 2021. [DOI: 10.1002/alz.054131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | | | - Yin Liu
- Utah State University Logan UT USA
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Burhanullah MH, Tschanz JT, Peters ME, Leoutsakos JM, Matyi J, Lyketsos CG, Nowrangi MA, Rosenberg PB. Neuropsychiatric Symptoms as Risk Factors for Cognitive Decline in Clinically Normal Older Adults: The Cache County Study. Am J Geriatr Psychiatry 2020; 28:64-71. [PMID: 31186157 PMCID: PMC6874723 DOI: 10.1016/j.jagp.2019.03.023] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 02/17/2019] [Accepted: 03/18/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION There has been considerable progress in identifying early cognitive and biomarker predictors of Alzheimer's disease (AD). Neuropsychiatric symptoms (NPS) are common in AD and appear to predict progression after the onset of mild cognitive impairment or dementia. OBJECTIVES The objective of the study is to examine the relationship between NPS in clinically normal older adults and subsequent cognitive decline in a population-based sample. METHODS The Cache County Study on Memory in Aging consists of a population-based sample of 5,092 older adults. We identified 470 clinically normal adults who were followed for an average period of 5.73 years. NPS were evaluated at the baseline clinical assessment using the Neuropsychiatric Inventory (NPI). NPI domain scores were quantified as the product of frequency X severity in individual NPI domains, and then summed for the NPI-Total. Neuropsychological measures were collected at baseline and at each subsequent follow-up wave. Linear mixed-effects models assessed the association of NPI-Total, NPI-Depression, and NPI-Anxiety scores (obtained at baseline) on longitudinal change in neuropsychological performance, controlling for age, sex, and education. RESULTS Baseline NPI-Total score was associated with a more rapid rate of decline in word list memory, praxis recall, and animal fluency. Baseline NPI-Depression was not associated with later decline on any of the cognitive tests, while baseline NPI-Anxiety was associated with decline in Symbol Digit Modality. CONCLUSION In conclusion, among clinically normal older adults derived from this population-based study, total burden of NPS was associated with longitudinal cognitive decline. These results add to the evidence that NPS are risk factors for or clinical indicators of preclinical dementia syndrome. Our study was an exploratory study and we did not control for multiple comparisons.
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Kauzor KE, Schwartz S, Tubbs Z, Hammond AG, Tschanz JT. P1-478: PATTERNS OF NEUROPSYCHIATRIC SYMPTOMS AND SURVIVAL AMONG OLDER ADULTS WITH VARIOUS SUBTYPES OF DEMENTIA: THE CACHE COUNTY DEMENTIA PROGRESSION STUDY. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.1083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rozum WJ, Cooley B, Vernon E, Matyi J, Tschanz JT. Neuropsychiatric symptoms in severe dementia: Associations with specific cognitive domains the Cache County Dementia Progression Study. Int J Geriatr Psychiatry 2019; 34:1087-1094. [PMID: 30945374 PMCID: PMC6812503 DOI: 10.1002/gps.5112] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 03/18/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To examine the prevalence of neuropsychiatric symptoms (NPS) and cognitive correlates in severe dementia. METHODS A population-based sample of 56 individuals with severe dementia (85.7% Alzheimer's type; 67.9% female) were assessed with the Severe Cognitive Impairment Profile (SCIP) and the Neuropsychiatric Inventory (NPI). Descriptive statistics displayed the frequency of NPS and bivariate and multiple regression analyses examined the associations between cognitive domains on the SCIP and NPS total, domain, and cluster scores. RESULTS NPS were common in severe dementia with 98% of the sample exhibiting at least one symptom. Most common were delusions, apathy, agitation/aggression, and aberrant motor behavior, affecting 50% or more of participants. SCIP comportment was significantly associated with NPI total score and apathy (r = -.350 and -.292, respectively). All SCIP domains except for arithmetic, visuospatial, comportment, and motor behavior were significantly associated with agitation/aggression (r = -.285 to -.350). These associations remained in individual multiple regression models. CONCLUSION In severe dementia, impairment in specific cognitive domains was associated with more severe NPS. Environmental manipulations to reduce processing demands in persons with severe dementia may be a useful strategy to target agitation and aggressive behaviors.
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Affiliation(s)
| | | | | | | | - JoAnn T. Tschanz
- Department of Psychology, Utah State University;,Center for Epidemiologic Studies, Utah State University
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Tschanz JT, Vernon EK, Kauzor KE, Hammond AG, Corcoran C, Cannon-Albright L, Teerlink C, Kauwe J. P3-569: RISK OF ALZHEIMER'S DISEASE AND RELATED DEMENTIAS VARIES BY MATERNAL, PATERNAL AND SIBLING FAMILY HISTORY AND SEX: THE CACHE COUNTY STUDY. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | | | - Craig Teerlink
- University of Utah School of Medicine; Salt Lake City UT USA
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Hammond AG, Vernon EK, Kauzor KE, Tschanz JT. P2-560: BASELINE COGNITIVE STATUS AND CONVERSION TO ALZHEIMER'S DISEASE BASED ON GENDER: THE CACHE COUNTY MEMORY STUDY. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.2969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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10
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Vernon EK, Cooley B, Rozum W, Rattinger GB, Behrens S, Matyi J, Fauth E, Lyketsos CG, Tschanz JT. Caregiver-Care Recipient Relationship Closeness is Associated With Neuropsychiatric Symptoms in Dementia. Am J Geriatr Psychiatry 2019; 27:349-359. [PMID: 30616905 PMCID: PMC6812501 DOI: 10.1016/j.jagp.2018.11.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/07/2018] [Accepted: 11/22/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Closer caregiver-care recipient (CG-CR) relationships are associated with better cognitive and functional abilities, activities of daily living (in persons with dementia), and lower informal care costs. METHODS Due to the difficulty in treating neuropsychiatric symptoms (NPSs) and their detrimental effects on caregivers and care recipients, we examined whether closeness of CG-CR relationships was associated with overall NPS severity or with specific NPS symptom domains in care recipients. In a longitudinal population-based study in Cache County, Utah, the 12-item Neuropsychiatric Inventory (NPI-12) was assessed in 300 CG-CR dyads. Caregivers reported current relationship closeness using the Whitlatch Relationship Closeness Scale. Linear mixed models examined associations between CG-CR closeness and NPI-12 total score or selected symptom domains over time (observation period: 2002-2012). RESULTS In unadjusted linear mixed models, higher closeness scores were associated with a five-point lower NPI-12 score and a one-point lesser increase in NPI-12 per year. NPI scores also showed lower affective cluster scores (two points) and lesser increase in psychosis cluster (approximately 0.5 points per year) and agitation/aggression (0.16 points per year) for each unit increase in closeness. When controlling for NPI caregiver distress, associations between closeness and NPSs diminished to a 0.5-point lesser increase in total NPI-12 score per year. Adjusted models for NPI domains/clusters showed -0.32 points per year for the psychosis cluster, -0.11 points per year for agitation/aggression, and -0.67 overall for the affective cluster. CONCLUSION Higher CG-CR closeness, a potentially modifiable factor, is associated with lower NPS severity and may provide a target for intervention.
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Affiliation(s)
- Elizabeth K Vernon
- Department of Psychology (EKV, BC, WR, SB, JM, JTT), Utah State University, Logan, UT
| | - Bryce Cooley
- Department of Psychology (EKV, BC, WR, SB, JM, JTT), Utah State University, Logan, UT
| | - William Rozum
- Department of Psychology (EKV, BC, WR, SB, JM, JTT), Utah State University, Logan, UT
| | - Gail B Rattinger
- Department of Health Outcomes and Administrative Sciences (GBR), School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Binghamton, NY
| | - Stephanie Behrens
- Department of Psychology (EKV, BC, WR, SB, JM, JTT), Utah State University, Logan, UT
| | - Joshua Matyi
- Department of Psychology (EKV, BC, WR, SB, JM, JTT), Utah State University, Logan, UT
| | - Elizabeth Fauth
- Department of Human Development and Family Studies (EF), Utah State University, Logan, UT
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences (CGL), Johns Hopkins University, Baltimore
| | - JoAnn T Tschanz
- Department of Psychology (EKV, BC, WR, SB, JM, JTT), Utah State University, Logan, UT; Center for Epidemiological Studies (JTT), Utah State University, Logan, UT.
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11
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Wright SM, Jensen SL, Cockriel KL, Davis B, Tschanz JT, Munger RG, Corcoran CD, Kauwe JSK. Association study of rs3846662 with Alzheimer's disease in a population-based cohort: the Cache County Study. Neurobiol Aging 2019; 84:242.e1-242.e6. [PMID: 30975575 DOI: 10.1016/j.neurobiolaging.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/05/2019] [Accepted: 03/08/2019] [Indexed: 11/28/2022]
Abstract
3-Hydroxy-3-methylglutaryl coenzyme A reductase is associated with monitoring cholesterol levels. The presence of the single-nucleotide polymorphism rs3846662 introduces alternative splicing at exon 13; the exclusion of this exon leads to a reduction in total cholesterol levels. Lower cholesterol levels are linked to a reduction in Alzheimer's disease (AD) risk. The major allele of rs3846662, which encourages the splicing of exon 13, has recently been shown to act as a preventative allele for AD, especially in women. The purpose of our research was to replicate and confirm this finding. Using logistic regressions and survival curves, we found a significant association between AD and rs3846662, with a stronger association in individuals who carry the APOE e4 allele, supporting previously published work. The effect of rs3846662 on women is insignificant in our cohort. We confirmed that rs3846662 is associated with reduced risk for AD without gender differences; however, we failed to detect association between rs3846662 and delayed mild cognitive impairment conversion to AD for either of the APOE e4 allelic groups.
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Affiliation(s)
- Sage M Wright
- Department of Biology, Brigham Young University, Provo, UT, USA
| | | | | | - Brian Davis
- Department of Biology, Brigham Young University, Provo, UT, USA
| | - JoAnn T Tschanz
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Ronald G Munger
- Department of Nutrition, Dietetics, and Food Science, Utah State University, Logan, UT, USA
| | | | - John S K Kauwe
- Department of Biology, Brigham Young University, Provo, UT, USA.
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Rattinger GB, Sanders CL, Vernon E, Schwartz S, Behrens S, Lyketsos CG, Tschanz JT. Neuropsychiatric symptoms in patients with dementia and the longitudinal costs of informal care in the Cache County population. Alzheimers Dement (N Y) 2019; 5:81-88. [PMID: 30911601 PMCID: PMC6416410 DOI: 10.1016/j.trci.2019.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Severity of dementia and neuropsychiatric symptoms contribute to increasing informal care costs. We examined which neuropsychiatric symptoms subdomains (NPS-SD) were associated with informal costs in a population-based sample. METHODS Dementia progression and informal costs (2015 dollars) were estimated from the Cache County Dementia Progression Study. Overall NPS and specific NPS-SD were assessed with the Neuropsychiatric Inventory. Generalized Estimating Equations (GEE with gamma-distribution/log-link) modeled the relationship between NPS-SDs and informal cost trajectories. RESULTS Two hundred eighty participants (52.1% female; age M = 85.67, SD = 5.60) exhibited an adjusted cost increase of 5.6% (P = .005), 6.4% (P < .001), 7.6% (P = .030), and 13% (P = .024) for every increasing Neuropsychiatric Inventory unit in psychosis-SD, affective-SD, agitation/aggression-SD, and apathy-SD, respectively. An increase in each unit of apathy was associated with a 2% annual decrease in costs (P = .040). DISCUSSION We extend our prior work on informal costs and dementia severity by identifying NPS-SD associated with informal costs. Interventions targeting NPS-SD may lower informal costs.
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Affiliation(s)
- Gail B. Rattinger
- School of Pharmacy and Pharmaceutical Sciences, Binghamton University State University of New York, New York, NY, USA
| | | | | | - Sarah Schwartz
- Department of Mathematics and Statistics, Utah State University, Logan, UT, USA
- Center for Epidemiologic Studies, Utah State University, Logan, UT, USA
| | | | | | - JoAnn T. Tschanz
- Department of Psychology, Utah State University, Logan, UT, USA
- Center for Epidemiologic Studies, Utah State University, Logan, UT, USA
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Tsui-Caldwell YHW, Farrer TJ, McDonnell Z, Christensen Z, Finuf C, Bigler ED, Tschanz JT, Norton MC, Welsh-Bohmer KA. MRI Clinical Ratings and Cognitive Function in a Cross-Sectional Population Study of Dementia: The Cache County Memory Study. J Prev Alzheimers Dis 2019; 6:100-107. [PMID: 30756116 DOI: 10.14283/jpad.2019.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND White matter integrity in aging populations is associated with increased risk of cognitive decline, dementia diagnosis, and mortality. Population-based data can elucidate this association. OBJECTIVES To examine the association between white matter integrity, as measured by a clinical rating scale of hyperintensities, and mental status in older adults including advanced aging. DESIGN Scheltens Ratings Scale was used to qualitatively assess white matter (WM) hyperintensities in participants of the Cache County Memory Study (CCMS), an epidemiological study of Alzheimer's disease in an exceptionally long-lived population. Further, the relation between Mini-Mental State Exam (MMSE) and WM hyperintensities were explored. METHOD Participants consisted of 415 individuals with dementia and 22 healthy controls. RESULTS CCMS participants, including healthy controls, had high levels of WM pathology as measured by Scheltens Ratings Scale score. While age did not significantly relate to WM pathology, higher Scheltens Ratings Scale scores were associated with lower MMSE findings (correlation between -0.14 and -0.22; p < .05). CONCLUSIONS WM pathology was common in this county-wide population sample of those ranging in age from 65 to 106. Increased WM burden was found to be significantly associated with decreased overall MMSE performance.
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Affiliation(s)
- Y H W Tsui-Caldwell
- Thomas J. Farrer Ph.D., 932 Morreene Road, Durham, NC 27710, USA, (919)-668-6802,
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14
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Matyi J, Tschanz JT, Rattinger GB, Sanders C, Vernon EK, Corcoran C, Kauwe JSK, Buhusi M. Erratum to: “Sex Differences in Risk for Alzheimer’s Disease Related to Neurotrophin Gene Polymorphisms: The Cache County Memory Study”. J Gerontol A Biol Sci Med Sci 2018; 73:311. [DOI: 10.1093/gerona/glx220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - JoAnn T Tschanz
- Department of Psychology, Utah State University
- Center for Epidemiologic Studies, Utah State University
| | - Gail B Rattinger
- Department of health Outcomes and Administrative Sciences, School of Pharmacy and Pharmaceutical Sciences, Binghamton University, New York
| | | | | | - Chris Corcoran
- Department of Mathematics and Statistics, Utah State University
| | - John S K Kauwe
- Department of Biology, Brigham Young University, Provo, Utah
| | - Mona Buhusi
- Department of Psychology, Utah State University
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15
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Matyi J, Tschanz JT, Rattinger GB, Sanders C, Vernon EK, Corcoran C, Kauwe JSK, Buhusi M. Sex Differences in Risk for Alzheimer's Disease Related to Neurotrophin Gene Polymorphisms: The Cache County Memory Study. J Gerontol A Biol Sci Med Sci 2017; 72:1607-1613. [PMID: 28498887 DOI: 10.1093/gerona/glx092] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 01/26/2017] [Indexed: 01/10/2023] Open
Abstract
Neurotrophins, including nerve-growth factor and brain-derived neurotrophic factor, have been implicated in Alzheimer's disease (AD). Associations between AD and neurotrophin signaling genes have been inconsistent, with few studies examining sex differences in risk. We examined four single-nucleotide polymorphisms (SNPs) involved in neurotrophin signaling (rs6265, rs56164415, rs2289656, rs2072446) and risk for AD by sex in a population-based sample of older adults. Three thousand four hundred and ninety-nine individuals without dementia at baseline [mean (standard deviation) age = 74.64 (6.84), 58% female] underwent dementia screening and assessment over four triennial waves. Cox regression was used to examine time to AD or right censoring for each SNP. Female carriers of the minor T allele for rs2072446 and rs56164415 had a 60% (hazard ratio [HR] = 1.60, 95% confidence interval [CI] = 1.02-2.51) and 93% (HR = 1.93, 95% CI = 1.30-2.84) higher hazard for AD, respectively, than male noncarriers of the T allele. Furthermore, male carriers of the T allele of rs2072446 had a 61% lower hazard (HR = 0.39, 95% CI = 0.14-1.06) than male noncarriers at trend-level significance (p = .07). The association between certain neurotrophin gene polymorphisms and AD differs by sex and may explain inconsistent findings in the literature.
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Affiliation(s)
| | - JoAnn T Tschanz
- Department of Psychology, Utah State University.,Center for Epidemiologic Studies, Utah State University
| | - Gail B Rattinger
- Department of health Outcomes and Administrative Sciences, School of Pharmacy and Pharmaceutical Sciences, Binghamton University, New York
| | | | | | - Chris Corcoran
- Department of Mathematics and Statistics, Utah State University
| | - John S K Kauwe
- Department of Biology, Brigham Young University, Provo, Utah
| | - Mona Buhusi
- Department of Psychology, Utah State University
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Sanders C, Behrens S, Schwartz S, Wengreen H, Corcoran CD, Lyketsos CG, Tschanz JT. Nutritional Status is Associated with Faster Cognitive Decline and Worse Functional Impairment in the Progression of Dementia: The Cache County Dementia Progression Study1. J Alzheimers Dis 2017; 52:33-42. [PMID: 26967207 DOI: 10.3233/jad-150528] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Nutritional status may be a modifiable factor in the progression of dementia. We examined the association of nutritional status and rate of cognitive and functional decline in a U.S. population-based sample. Study design was an observational longitudinal study with annual follow-ups up to 6 years of 292 persons with dementia (72% Alzheimer's disease, 56% female) in Cache County, UT using the Mini-Mental State Exam (MMSE), Clinical Dementia Rating Sum of Boxes (CDR-sb), and modified Mini Nutritional Assessment (mMNA). mMNA scores declined by approximately 0.50 points/year, suggesting increasing risk for malnutrition. Lower mMNA score predicted faster rate of decline on the MMSE at earlier follow-up times, but slower decline at later follow-up times, whereas higher mMNA scores had the opposite pattern (mMNA by time β= 0.22, p = 0.017; mMNA by time2 β= -0.04, p = 0.04). Lower mMNA score was associated with greater impairment on the CDR-sb over the course of dementia (β= 0.35, p < 0.001). Assessment of malnutrition may be useful in predicting rates of progression in dementia and may provide a target for clinical intervention.
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Affiliation(s)
- Chelsea Sanders
- Department of Psychology, Utah State University, Logan, UT, USA
| | | | - Sarah Schwartz
- Department of Mathematics and Statistics, Utah State University, Logan, UT, USA
| | - Heidi Wengreen
- Department of Nutrition and Food Sciences, Utah State University, Logan, UT, USA
| | - Chris D Corcoran
- Department of Mathematics and Statistics, Utah State University, Logan, UT, USA.,Center for Epidemiologic Studies, Utah State University, Logan, UT, USA
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Bayview, Johns Hopkins University, Baltimore, MD, USA
| | - JoAnn T Tschanz
- Department of Psychology, Utah State University, Logan, UT, USA.,Center for Epidemiologic Studies, Utah State University, Logan, UT, USA
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17
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Hartin PJ, Nugent CD, McClean SI, Cleland I, Tschanz JT, Clark CJ, Norton MC. The Empowering Role of Mobile Apps in Behavior Change Interventions: The Gray Matters Randomized Controlled Trial. JMIR Mhealth Uhealth 2016; 4:e93. [PMID: 27485822 PMCID: PMC4987494 DOI: 10.2196/mhealth.4878] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 12/02/2015] [Accepted: 01/07/2016] [Indexed: 01/15/2023] Open
Abstract
Background Health education and behavior change programs targeting specific risk factors have demonstrated their effectiveness in reducing the development of future diseases. Alzheimer disease (AD) shares many of the same risk factors, most of which can be addressed via behavior change. It is therefore theorized that a behavior change intervention targeting these risk factors would likely result in favorable rates of AD prevention. Objective The objective of this study was to reduce the future risk of developing AD, while in the short term promoting vascular health, through behavior change. Methods The study was an interventional randomized controlled trial consisting of subjects who were randomly assigned into either treatment (n=102) or control group (n=42). Outcome measures included various blood-based biomarkers, anthropometric measures, and behaviors related to AD risk. The treatment group was provided with a bespoke “Gray Matters” mobile phone app designed to encourage and facilitate behavior change. The app presented evidence-based educational material relating to AD risk and prevention strategies, facilitated self-reporting of behaviors across 6 behavioral domains, and presented feedback on the user’s performance, calculated from reported behaviors against recommended guidelines. Results This paper explores the rationale for a mobile phone–led intervention and details the app’s effect on behavior change and subsequent clinical outcomes. Via the app, the average participant submitted 7.3 (SD 3.2) behavioral logs/day (n=122,719). Analysis of these logs against primary outcome measures revealed that participants who improved their high-density lipoprotein cholesterol levels during the study duration answered a statistically significant higher number of questions per day (mean 8.30, SD 2.29) than those with no improvement (mean 6.52, SD 3.612), t97.74=−3.051, P=.003. Participants who decreased their body mass index (BMI) performed significantly better in attaining their recommended daily goals (mean 56.21 SD 30.4%) than those who increased their BMI (mean 40.12 SD 29.1%), t80 = −2.449, P=.017. In total, 69.2% (n=18) of those who achieved a mean performance percentage of 60% or higher, across all domains, reduced their BMI during the study, whereas 60.7% (n=34) who did not, increased their BMI. One-way analysis of variance of systolic blood pressure category changes showed a significant correlation between reported efforts to reduce stress and category change as a whole, P=.035. An exit survey highlighted that respondents (n=83) reported that the app motivated them to perform physical activity (85.4%) and make healthier food choices (87.5%). Conclusions In this study, the ubiquitous nature of the mobile phone excelled as a delivery platform for the intervention, enabling the dissemination of educational intervention material while simultaneously monitoring and encouraging positive behavior change, resulting in desirable clinical effects. Sustained effort to maintain the achieved behaviors is expected to mitigate future AD risk. Trial Registration ClinicalTrails.gov NCT02290912; https://clinicaltrials.gov/ct2/show/NCT02290912 (Archived by WebCite at http://www.webcitation.org/6ictUEwnm)
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Affiliation(s)
- Phillip J Hartin
- Computer Science Research Institute, Ulster University, Newtownabbey, United Kingdom.
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18
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Hippen AA, Ebbert MTW, Norton MC, Tschanz JT, Munger RG, Corcoran CD, Kauwe JSK. Presenilin E318G variant and Alzheimer's disease risk: the Cache County study. BMC Genomics 2016; 17 Suppl 3:438. [PMID: 27357204 PMCID: PMC4943516 DOI: 10.1186/s12864-016-2786-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Alzheimer's disease is the leading cause of dementia in the elderly and the third most common cause of death in the United States. A vast number of genes regulate Alzheimer’s disease, including Presenilin 1 (PSEN1). Multiple studies have attempted to locate novel variants in the PSEN1 gene that affect Alzheimer's disease status. A recent study suggested that one of these variants, PSEN1 E318G (rs17125721), significantly affects Alzheimer's disease status in a large case–control dataset, particularly in connection with the APOEε4 allele. Methods Our study looks at the same variant in the Cache County Study on Memory and Aging, a large population-based dataset. We tested for association between E318G genotype and Alzheimer’s disease status by running a series of Fisher’s exact tests. We also performed logistic regression to test for an additive effect of E318G genotype on Alzheimer’s disease status and for the existence of an interaction between E318G and APOEε4. Results In our Fisher’s exact test, it appeared that APOEε4 carriers with an E318G allele have slightly higher risk for AD than those without the allele (3.3 vs. 3.8); however, the 95 % confidence intervals of those estimates overlapped completely, indicating non-significance. Our logistic regression model found a positive but non-significant main effect for E318G (p = 0.895). The interaction term between E318G and APOEε4 was also non-significant (p = 0.689). Conclusions Our findings do not provide significant support for E318G as a risk factor for AD in APOEε4 carriers. Our calculations indicated that the overall sample used in the logistic regression models was adequately powered to detect the sort of effect sizes observed previously. However, the power analyses of our Fisher’s exact tests indicate that our partitioned data was underpowered, particularly in regards to the low number of E318G carriers, both AD cases and controls, in the Cache county dataset. Thus, the differences in types of datasets used may help to explain the difference in effect magnitudes seen. Analyses in additional case–control datasets will be required to understand fully the effect of E318G on Alzheimer's disease status.
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Affiliation(s)
- Ariel A Hippen
- Department of Biology, Brigham Young University, Provo, UT, USA
| | - Mark T W Ebbert
- Department of Biology, Brigham Young University, Provo, UT, USA
| | - Maria C Norton
- Department of Psychology, Utah State University, Logan, UT, USA
| | - JoAnn T Tschanz
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Ronald G Munger
- Department of Nutrition, Dietetics, and Food Science, Utah State University, Logan, UT, USA
| | | | - John S K Kauwe
- Department of Biology, Brigham Young University, Provo, UT, USA.
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19
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Rattinger GB, Fauth EB, Behrens S, Sanders C, Schwartz S, Norton MC, Corcoran C, Mullins CD, Lyketsos CG, Tschanz JT. Closer caregiver and care-recipient relationships predict lower informal costs of dementia care: The Cache County Dementia Progression Study. Alzheimers Dement 2016; 12:917-24. [PMID: 27103262 DOI: 10.1016/j.jalz.2016.03.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 02/24/2016] [Accepted: 03/18/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Identifying factors associated with lower dementia care costs is essential. We examined whether two caregiver factors were associated with lower costs of informal care. METHODS A total of 271 care dyads of the Cache County Dementia Study were included. Estimates of informal costs were based on caregiver reports of time spent in care-related activities and inflation-adjusted 2012 Utah median hourly wages. Caregiver coping and emotional closeness with the care-recipient were assessed using the Ways of Coping Checklist-Revised and Relationship Closeness Scale, respectively. RESULTS Higher closeness was associated with 24% lower costs (expβ = 0.763 [95% confidence interval: 0.583-0.999]) in linear mixed models controlling for demographics and baseline dementia severity and duration. Problem-focused coping was not associated with informal costs (P = .354). DISCUSSION Caregiver closeness, a potentially modifiable factor, predicted lower dementia informal care costs over time. Future studies examining the care environment in closer dyads may identify specific care-related behaviors or strategies that are associated with lower costs.
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Affiliation(s)
- Gail B Rattinger
- School of Pharmacy and Pharmaceutical Sciences, Binghamton University State University of New York, Binghamton, NY, USA; Pharmacy Practice Division, School of Pharmacy, Fairleigh Dickinson University, Florham Park, NJ, USA
| | - Elizabeth B Fauth
- Department of Family, Consumer and Human Development, Utah State University, Logan, UT, USA
| | | | - Chelsea Sanders
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Sarah Schwartz
- Department of Mathematics and Statistics, Utah State University, Logan, UT, USA; Center for Epidemiologic Studies, Utah State University, Logan, UT, USA
| | - Maria C Norton
- Department of Family, Consumer and Human Development, Utah State University, Logan, UT, USA; Center for Epidemiologic Studies, Utah State University, Logan, UT, USA
| | - Chris Corcoran
- Department of Mathematics and Statistics, Utah State University, Logan, UT, USA; Center for Epidemiologic Studies, Utah State University, Logan, UT, USA
| | - C Daniel Mullins
- Pharmaceutical Health Services Research Department, University of Maryland Baltimore School of Pharmacy, Baltimore, MD, USA
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - JoAnn T Tschanz
- Department of Psychology, Utah State University, Logan, UT, USA; Center for Epidemiologic Studies, Utah State University, Logan, UT, USA.
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20
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Norton MC, Fauth E, Clark CJ, Hatch D, Greene D, Pfister R, Tschanz JT, Smith KR. Family member deaths across adulthood predict Alzheimer's disease risk: The Cache County Study. Int J Geriatr Psychiatry 2016; 31:256-63. [PMID: 26133120 PMCID: PMC4950508 DOI: 10.1002/gps.4319] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 05/18/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Parental death during childhood, and offspring and spouse death during adulthood have individually been associated with faster cognitive decline and higher Alzheimer's disease (AD) risk in late life. However, the cumulative effect of childhood and adulthood family deaths on AD risk among different age cohorts has not been studied. METHODS To examine these associations, this prospective cohort study uses a population-based sample of 4545 initially non-demented participants (56.7% female; age M = 75.0/SD = 6.9 years) observed at four triennial waves, linked with objective Utah Population Database data on cumulative mother, father, sibling, spouse, and offspring death experienced during childhood and adulthood. Cox regression modeled survival time from baseline interview to AD onset, as a function of family deaths during childhood or adulthood, among different age groups, along with gender and presence of ε4 allele at apolipoprotein E (APOE) polymorphic genetic locus. RESULTS Age group significantly moderated the relationship between family death and AD; among persons aged 65-69 years at baseline (children of the Great Depression), those exposed to 3-4 deaths and 5+ deaths during adulthood exhibited a doubling of AD risk (adjusted hazard ratio, aHR = 2.25, p = .038, and aHR = 2.72, p = .029), while among persons aged 80 years and older, those exposed to 3-4 deaths during adulthood exhibited lower AD risk (HR = 0.539, p = 0.014). In a combined model of childhood and adulthood deaths, these findings persisted. CONCLUSIONS Results suggest a cohort effect in the link between family member deaths during adulthood and AD risk later in life.
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Affiliation(s)
- Maria C. Norton
- Department of Family Consumer and Human Development, Utah State University,Department of Psychology, Utah State University,Center for Epidemiologic Studies, Utah State University
| | - Elizabeth Fauth
- Department of Family Consumer and Human Development, Utah State University
| | - Christine J. Clark
- Department of Family Consumer and Human Development, Utah State University
| | - Dan Hatch
- Center for the Study of Aging and Human Development, Duke University
| | - Daylee Greene
- Department of Family Consumer and Human Development, Utah State University
| | | | - JoAnn T. Tschanz
- Department of Psychology, Utah State University,Center for Epidemiologic Studies, Utah State University
| | - Ken R. Smith
- Department of Family and Consumer Studies and the Huntsman Cancer Institute, University of Utah
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21
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Hartin PJ, Nugent CD, McClean SI, Cleland I, Norton MC, Sanders C, Tschanz JT. A smartphone application to evaluate technology adoption and usage in persons with dementia. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:5389-92. [PMID: 25571212 DOI: 10.1109/embc.2014.6944844] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dementia affects a proportionally large number of the older population, presenting a set of symptoms that cause cognitive decline and negatively affect quality of life. Technology offers an assistive role for some of these symptoms, specifically in addressing forgetfulness. Current works have explored the benefits of reminding technology, which whilst useful is only effective for those who adopt the technology. Therefore it is of merit to establish the individual parameters that characterize an adopter and non-adopter, to better target future interventions and their deployment. To aid the collection of this data a smartphone app was developed for persons with dementia. It has been designed as both a reminder application to help those with dementia accommodate their forgetfulness and a data collection tool to log usage and compliance with reminders. The app has been evaluated by a pre-pilot cohort (n=9) and was found to have a mean reminder acknowledgement of 73.09%.
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22
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Rattinger GB, Schwartz S, Mullins CD, Corcoran C, Zuckerman IH, Sanders C, Norton MC, Fauth EB, Leoutsakos JMS, Lyketsos CG, Tschanz JT. Dementia severity and the longitudinal costs of informal care in the Cache County population. Alzheimers Dement 2015; 11:946-54. [PMID: 25614127 PMCID: PMC4506892 DOI: 10.1016/j.jalz.2014.11.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 07/01/2014] [Accepted: 11/24/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Dementia costs are critical for influencing healthcare policy, but limited longitudinal information exists. We examined longitudinal informal care costs of dementia in a population-based sample. METHODS Data from the Cache County Study included dementia onset, duration, and severity assessed by the Mini-Mental State Examination (MMSE), Clinical Dementia Rating Scale (CDR), and Neuropsychiatric Inventory (NPI). Informal costs of daily care (COC) was estimated based on median Utah wages. Mixed models estimated the relationship between severity and longitudinal COC in separate models for MMSE and CDR. RESULTS Two hundred and eighty-seven subjects (53% female, mean (standard deviation) age was 82.3 (5.9) years) participated. Overall COC increased by 18% per year. COC was 6% lower per MMSE-point increase and compared with very mild dementia, COC increased over twofold for mild, fivefold for moderate, and sixfold for severe dementia on the CDR. CONCLUSIONS Greater dementia severity predicted higher costs. Disease management strategies addressing dementia progression may curb costs.
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Affiliation(s)
- Gail B Rattinger
- Pharmacy Practice Division, School of Pharmacy, Fairleigh Dickinson University, Florham Park, NJ, USA
| | - Sarah Schwartz
- Center for Epidemiologic Studies, Utah State University, Logan, UT, USA; Department of Mathematics and Statistics, Utah State University, Logan, UT, USA
| | - C Daniel Mullins
- Pharmaceutical Health Services Research Department, University of Maryland Baltimore School of Pharmacy, Baltimore, MD, USA
| | - Chris Corcoran
- Center for Epidemiologic Studies, Utah State University, Logan, UT, USA; Department of Mathematics and Statistics, Utah State University, Logan, UT, USA
| | - Ilene H Zuckerman
- Pharmaceutical Health Services Research Department, University of Maryland Baltimore School of Pharmacy, Baltimore, MD, USA
| | - Chelsea Sanders
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Maria C Norton
- Center for Epidemiologic Studies, Utah State University, Logan, UT, USA; Department of Family, Consumer and Human Development, Utah State University, Logan, UT, USA
| | - Elizabeth B Fauth
- Center for Epidemiologic Studies, Utah State University, Logan, UT, USA; Department of Family, Consumer and Human Development, Utah State University, Logan, UT, USA
| | | | | | - JoAnn T Tschanz
- Center for Epidemiologic Studies, Utah State University, Logan, UT, USA; Department of Psychology, Utah State University, Logan, UT, USA.
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23
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Wang LS, Naj AC, Graham RR, Crane PK, Kunkle BW, Cruchaga C, Murcia JDG, Cannon-Albright L, Baldwin CT, Zetterberg H, Blennow K, Kukull WA, Faber KM, Schupf N, Norton MC, Tschanz JT, Munger RG, Corcoran CD, Rogaeva E, Lin CF, Dombroski BA, Cantwell LB, Partch A, Valladares O, Hakonarson H, St George-Hyslop P, Green RC, Goate AM, Foroud TM, Carney RM, Larson EB, Behrens TW, Kauwe JSK, Haines JL, Farrer LA, Pericak-Vance MA, Mayeux R, Schellenberg GD, Albert MS, Albin RL, Apostolova LG, Arnold SE, Barber R, Barmada M, Barnes LL, Beach TG, Becker JT, Beecham GW, Beekly D, Bennett DA, Bigio EH, Bird TD, Blacker D, Boeve BF, Bowen JD, Boxer A, Burke JR, Buxbaum JD, Cairns NJ, Cao C, Carlson CS, Carroll SL, Chui HC, Clark DG, Cribbs DH, Crocco EA, DeCarli C, DeKosky ST, Demirci FY, Dick M, Dickson DW, Duara R, Ertekin-Taner N, Fallon KB, Farlow MR, Ferris S, Frosch MP, Galasko DR, Ganguli M, Gearing M, Geschwind DH, Ghetti B, Gilbert JR, Glass JD, Graff-Radford NR, Growdon JH, Hamilton RL, Hamilton-Nelson KL, Harrell LE, Head E, Honig LS, Hulette CM, Hyman BT, Jarvik GP, Jicha GA, Jin LW, Jun G, Jun G, Kamboh MI, Karydas A, Kaye JA, Kim R, Koo EH, Kowall NW, Kramer JH, LaFerla FM, Lah JJ, Leverenz JB, Levey AI, Li G, Lieberman AP, Lopez OL, Lunetta KL, Lyketsos CG, Mack WJ, Marson DC, Martin ER, Martiniuk F, Mash DC, Masliah E, McCormick WC, McCurry SM, McDavid AN, McKee AC, Mesulam WM, Miller BL, Miller CA, Miller JW, Montine TJ, Morris JC, Murrell JR, Olichney JM, Parisi JE, Perry W, Peskind E, Petersen RC, Pierce A, Poon WW, Potter H, Quinn JF, Raj A, Raskind M, Reiman EM, Reisberg B, Reitz C, Ringman JM, Roberson ED, Rosen HJ, Rosenberg RN, Sano M, Saykin AJ, Schneider JA, Schneider LS, Seeley WW, Smith AG, Sonnen JA, Spina S, Stern RA, Tanzi RE, Thornton-Wells TA, Trojanowski JQ, Troncoso JC, Tsuang DW, Van Deerlin VM, Van Eldik LJ, Vardarajan BN, Vinters HV, Vonsattel JP, Weintraub S, Welsh-Bohmer KA, Williamson J, Wishnek S, Woltjer RL, Wright CB, Younkin SG, Yu CE, Yu L. Rarity of the Alzheimer disease-protective APP A673T variant in the United States. JAMA Neurol 2015; 72:209-16. [PMID: 25531812 DOI: 10.1001/jamaneurol.2014.2157] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Recently, a rare variant in the amyloid precursor protein gene (APP) was described in a population from Iceland. This variant, in which alanine is replaced by threonine at position 673 (A673T), appears to protect against late-onset Alzheimer disease (AD). We evaluated the frequency of this variant in AD cases and cognitively normal controls to determine whether this variant will significantly contribute to risk assessment in individuals in the United States. OBJECTIVE To determine the frequency of the APP A673T variant in a large group of elderly cognitively normal controls and AD cases from the United States and in 2 case-control cohorts from Sweden. DESIGN, SETTING, AND PARTICIPANTS Case-control association analysis of variant APP A673T in US and Swedish white individuals comparing AD cases with cognitively intact elderly controls. Participants were ascertained at multiple university-associated medical centers and clinics across the United States and Sweden by study-specific sampling methods. They were from case-control studies, community-based prospective cohort studies, and studies that ascertained multiplex families from multiple sources. MAIN OUTCOMES AND MEASURES Genotypes for the APP A673T variant were determined using the Infinium HumanExome V1 Beadchip (Illumina, Inc) and by TaqMan genotyping (Life Technologies). RESULTS The A673T variant genotypes were evaluated in 8943 US AD cases, 10 480 US cognitively normal controls, 862 Swedish AD cases, and 707 Swedish cognitively normal controls. We identified 3 US individuals heterozygous for A673T, including 1 AD case (age at onset, 89 years) and 2 controls (age at last examination, 82 and 77 years). The remaining US samples were homozygous for the alanine (A673) allele. In the Swedish samples, 3 controls were heterozygous for A673T and all AD cases were homozygous for the A673 allele. We also genotyped a US family previously reported to harbor the A673T variant and found a mother-daughter pair, both cognitively normal at ages 72 and 84 years, respectively, who were both heterozygous for A673T; however, all individuals with AD in the family were homozygous for A673. CONCLUSIONS AND RELEVANCE The A673T variant is extremely rare in US cohorts and does not play a substantial role in risk for AD in this population. This variant may be primarily restricted to Icelandic and Scandinavian populations.
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Affiliation(s)
- Li-San Wang
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Adam C Naj
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Robert R Graham
- Department of Human Genetics, Genentech Inc, South San Francisco, California
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle
| | - Brian W Kunkle
- John P. Hussman Institute for Human Genomics, University of Miami, Miami, Florida
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri7Hope Center Program on Protein Aggregation and Neurodegeneration, Washington University School of Medicine, St Louis, Missouri
| | | | - Lisa Cannon-Albright
- Division of Genetic Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City10George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Clinton T Baldwin
- Biomedical Genetics, Department of Medicine, Boston University, Boston, Massachusetts
| | - Henrik Zetterberg
- Institute of Neurology, University College London, London, England13Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska Uni
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Walter A Kukull
- Department of Epidemiology, University of Washington, Seattle
| | - Kelley M Faber
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis
| | - Nicole Schupf
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York17Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York18Gertrude H. Sergievsky Center, Columbia
| | - Maria C Norton
- Department of Family, Consumer, and Human Development, Utah State University, Logan20Department of Psychology, Utah State University, Logan
| | | | - Ronald G Munger
- Department of Nutrition, Dietetics, and Food Sciences, Utah State University, Logan
| | | | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario, Canada
| | | | - Chiao-Feng Lin
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Beth A Dombroski
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Laura B Cantwell
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Amanda Partch
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Otto Valladares
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Hakon Hakonarson
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Peter St George-Hyslop
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario, Canada25Cambridge Institute for Medical Research, Department of Clinical Neurosciences, University of Cambridge, Cambridge, England
| | - Robert C Green
- Division of Genetics, Department of Medicine and Partners Center for Personalized Genetic Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Alison M Goate
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri7Hope Center Program on Protein Aggregation and Neurodegeneration, Washington University School of Medicine, St Louis, Missouri
| | - Tatiana M Foroud
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis
| | - Regina M Carney
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Eric B Larson
- Department of Medicine, University of Washington, Seattle28Group Health Research Institute, Seattle, Washington
| | - Timothy W Behrens
- Department of Human Genetics, Genentech Inc, South San Francisco, California
| | - John S K Kauwe
- Department of Biology, Brigham Young University, Provo, Utah
| | - Jonathan L Haines
- Center for Human Genetics and Research, Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, Tennessee
| | - Lindsay A Farrer
- Department of Biology, Brigham Young University, Provo, Utah30Department of Biostatistics, Boston University, Boston, Massachusetts31Department of Ophthalmology, Boston University, Boston, Massachusetts32Department of Neurology, Boston University, Boston
| | - Margaret A Pericak-Vance
- John P. Hussman Institute for Human Genomics, University of Miami, Miami, Florida34Dr John T. Macdonald Foundation Department of Human Genetics, University of Miami, Miami, Florida
| | - Richard Mayeux
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York18Gertrude H. Sergievsky Center, Columbia University, New York, New York35Department of Neurology, Columbia University, New York, New York
| | - Gerard D Schellenberg
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Snyder CM, Fauth E, Wanzek J, Piercy KW, Norton MC, Corcoran C, Rabins PV, Lyketsos CG, Tschanz JT. Dementia caregivers' coping strategies and their relationship to health and well-being: the Cache County Study. Aging Ment Health 2015; 19:390-9. [PMID: 25093439 PMCID: PMC4845636 DOI: 10.1080/13607863.2014.939610] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Prior research identifies that psychological outcomes among dementia caregivers are associated with their use of coping strategies. Few studies have tested the association of coping and health longitudinally. METHOD This study examined factors associated with the use of coping strategies over time and their associations with physical and mental health outcomes in a population-based sample of 226 dementia caregivers in Cache County, Utah, USA. Caregivers annually completed the Ways of Coping Checklist-Revised, the Beck Anxiety Inventory, and a health interview. Care-recipient cognitive and functional abilities were obtained using the Mini-Mental State Exam and the Clinical Dementia Rating. Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory. RESULTS Caregivers most frequently identified providing care as a problem (37.6%). Linear mixed models of caregiver coping strategies found that the use of most strategies were stable except for increasing Avoidance among adult child caregivers (β = 0.14, p = 0.048). On average, increased Wishful Thinking (β = 2.48, p < 0.001) or Blames Self (β = 1.06, p = 0.002) was associated with higher anxiety scores. Increased use of Blames Others among males (interaction, β = 0.28, p = 0.02) and greater use of Wishful Thinking among younger caregivers (interaction, β = -0.01, p = 0.01) were associated with more caregiver health conditions. Coping strategies were not associated with change in anxiety or health conditions over time. CONCLUSION Our results emphasize the importance of caregiver coping strategies on caregiver health and well-being and may identify subgroups of persons at risk for worse outcomes.
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Affiliation(s)
| | - Elizabeth Fauth
- Family Consumer and Human Development, Utah State University
| | | | | | - Maria C. Norton
- Family Consumer and Human Development, Utah State University,Center for Epidemiological Studies, Utah State University
| | - Chris Corcoran
- Center for Epidemiological Studies, Utah State University,Mathematics and Statistics Department, Utah State University
| | | | | | - JoAnn T. Tschanz
- Psychology Department, Utah State University,Center for Epidemiological Studies, Utah State University,Corresponding author.
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Bradford D, Tschanz JT, Smith KR, Østbye T, Corcoran C, Welsh-Bohmer KA, Norton MC. Impact of offspring death on cognitive health in late life: the Cache County study. Am J Geriatr Psychiatry 2014; 22:1307-15. [PMID: 23954042 PMCID: PMC3923854 DOI: 10.1016/j.jagp.2013.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 04/21/2013] [Accepted: 05/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Experiencing the death of a child is associated with negative short-term mental health consequences, but less is known about cognitive outcomes and whether such associations extend to late life. We tested the hypothesis that experiencing an offspring death (OD) is associated with an increased rate of cognitive decline in late life. METHODS This population-based longitudinal study observed four cognitive statuses spaced 3-4 years apart, linked to an extensive database containing objective genealogic and vital statistics data. Home visits were conducted with 3,174 residents of a rural county in northern Utah, initially without dementia, aged 65-105. Cognitive status was measured with the Modified Mini-Mental State Exam at baseline and at 3-, 7-, and 10-year follow-ups. OD was obtained from the Utah Population Database, which contains statewide birth and death records. RESULTS In linear mixed models, controlling for age, gender, education, and apolipoprotein E status, subjects who experienced OD while younger than age 31 years experienced a significantly faster rate of cognitive decline in late life, but only if they had an ε4 allele. Reclassifying all OD (regardless of age) according to subsequent birth of another child, OD was only related to faster cognitive decline when there were no subsequent births. CONCLUSION Experiencing OD in early adulthood has a long-term association with cognitive functioning in late life, with a gene-environment interaction at the apolipoprotein E locus. Subsequent birth of another child attenuates this association.
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Affiliation(s)
- Daylee Bradford
- Department of Family Consumer and Human Development, Utah State University
| | - JoAnn T. Tschanz
- Department of Psychology, Center for Epidemiologic Studies, Utah State University
| | - Ken R. Smith
- Department of Family and Consumer Studies; Population Sciences, Huntsman Cancer Institute, University of Utah
| | - Truls Østbye
- Duke Global Health Institute, Duke University, and Duke – NUS Graduate Medical School, Singapore
| | - Chris Corcoran
- Department of Mathematics and Statistics, Center for Epidemiologic Studies, Utah State University
| | | | - Maria C. Norton
- Department of Family Consumer and Human Development, Utah State University,Department of Psychology, Center for Epidemiologic Studies, Utah State University
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26
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Lythgoe C, Perkes A, Peterson M, Schmutz C, Leary M, Ebbert MTW, Ridge PG, Norton MC, Tschanz JT, Munger RG, Corcoran CD, Kauwe JSK. Population-based analysis of cholesteryl ester transfer protein identifies association between I405V and cognitive decline: the Cache County Study. Neurobiol Aging 2014; 36:547.e1-3. [PMID: 25260850 DOI: 10.1016/j.neurobiolaging.2014.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 06/05/2014] [Accepted: 08/22/2014] [Indexed: 11/16/2022]
Abstract
Cholesterol has been implicated in the pathogenesis of late-onset Alzheimer's disease (LOAD) and the cholesteryl ester transfer protein (CETP) is critical to cholesterol regulation within the cell, making CETP an Alzheimer's disease candidate gene. Several studies have suggested that CETP I405V (rs5882) is associated with cognitive function and LOAD risk, but findings vary and most studies have been conducted using relatively small numbers of samples. To test whether this variant is involved in cognitive function and LOAD progression, we genotyped 4486 subjects with up to 12 years of longitudinal cognitive assessment. Analyses revealed an average 0.6-point decrease per year in the rate of cognitive decline for each additional valine (p < 0.011). We failed to detect the association between CETP I405V and LOAD status (p < 0.28). We conclude that CETP I405V is associated with preserved cognition over time but is not associated with LOAD status.
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Affiliation(s)
- Caitlin Lythgoe
- Department of Biology, Brigham Young University, Provo, UT, USA
| | - Ammon Perkes
- Department of Biology, Brigham Young University, Provo, UT, USA
| | | | - Cameron Schmutz
- Department of Biology, Brigham Young University, Provo, UT, USA
| | - Maegan Leary
- Department of Biology, Brigham Young University, Provo, UT, USA
| | - Mark T W Ebbert
- Department of Biology, Brigham Young University, Provo, UT, USA; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Perry G Ridge
- Department of Biology, Brigham Young University, Provo, UT, USA
| | - Maria C Norton
- Department of Family Consumer and Human Development, Utah State University, Logan, UT, USA; Center for Epidemiologic Studies, Utah State University, Logan, UT, USA
| | - JoAnn T Tschanz
- Center for Epidemiologic Studies, Utah State University, Logan, UT, USA; Department of Psychology, Utah State University, Logan, UT, USA
| | - Ronald G Munger
- Center for Epidemiologic Studies, Utah State University, Logan, UT, USA; Department of Nutrition, Dietetics, and Food Sciences, Utah State University, Logan, UT, USA
| | - Christopher D Corcoran
- Center for Epidemiologic Studies, Utah State University, Logan, UT, USA; Department of Mathematics and Statistics, Utah State University, Logan, UT, USA
| | - John S K Kauwe
- Department of Biology, Brigham Young University, Provo, UT, USA.
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27
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Ridge PG, Maxwell TJ, Foutz SJ, Bailey MH, Corcoran CD, Tschanz JT, Norton MC, Munger RG, O'Brien E, Kerber RA, Cawthon RM, Kauwe JSK. Mitochondrial genomic variation associated with higher mitochondrial copy number: the Cache County Study on Memory Health and Aging. BMC Bioinformatics 2014; 15 Suppl 7:S6. [PMID: 25077862 PMCID: PMC4110732 DOI: 10.1186/1471-2105-15-s7-s6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background The mitochondria are essential organelles and are the location of cellular respiration, which is responsible for the majority of ATP production. Each cell contains multiple mitochondria, and each mitochondrion contains multiple copies of its own circular genome. The ratio of mitochondrial genomes to nuclear genomes is referred to as mitochondrial copy number. Decreases in mitochondrial copy number are known to occur in many tissues as people age, and in certain diseases. The regulation of mitochondrial copy number by nuclear genes has been studied extensively. While mitochondrial variation has been associated with longevity and some of the diseases known to have reduced mitochondrial copy number, the role that the mitochondrial genome itself has in regulating mitochondrial copy number remains poorly understood. Results We analyzed the complete mitochondrial genomes from 1007 individuals randomly selected from the Cache County Study on Memory Health and Aging utilizing the inferred evolutionary history of the mitochondrial haplotypes present in our dataset to identify sequence variation and mitochondrial haplotypes associated with changes in mitochondrial copy number. Three variants belonging to mitochondrial haplogroups U5A1 and T2 were significantly associated with higher mitochondrial copy number in our dataset. Conclusions We identified three variants associated with higher mitochondrial copy number and suggest several hypotheses for how these variants influence mitochondrial copy number by interacting with known regulators of mitochondrial copy number. Our results are the first to report sequence variation in the mitochondrial genome that causes changes in mitochondrial copy number. The identification of these variants that increase mtDNA copy number has important implications in understanding the pathological processes that underlie these phenotypes.
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Cruchaga C, Karch CM, Jin SC, Benitez BA, Cai Y, Guerreiro R, Harari O, Norton J, Budde J, Bertelsen S, Jeng AT, Cooper B, Skorupa T, Carrell D, Levitch D, Hsu S, Choi J, Ryten M, Sassi C, Bras J, Gibbs RJ, Hernandez DG, Lupton MK, Powell J, Forabosco P, Ridge PG, Corcoran CD, Tschanz JT, Norton MC, Munger RG, Schmutz C, Leary M, Demirci FY, Bamne MN, Wang X, Lopez OL, Ganguli M, Medway C, Turton J, Lord J, Braae A, Barber I, Brown K, Pastor P, Lorenzo-Betancor O, Brkanac Z, Scott E, Topol E, Morgan K, Rogaeva E, Singleton A, Hardy J, Kamboh MI, George-Hyslop PS, Cairns N, Morris JC, Kauwe JS, Goate AM. Rare coding variants in the phospholipase D3 gene confer risk for Alzheimer's disease. Nature 2014; 505:550-554. [PMID: 24336208 PMCID: PMC4050701 DOI: 10.1038/nature12825] [Citation(s) in RCA: 339] [Impact Index Per Article: 33.9] [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: 08/07/2013] [Accepted: 10/31/2013] [Indexed: 01/18/2023]
Abstract
Genome-wide association studies (GWAS) have identified several risk variants for late-onset Alzheimer's disease (LOAD). These common variants have replicable but small effects on LOAD risk and generally do not have obvious functional effects. Low-frequency coding variants, not detected by GWAS, are predicted to include functional variants with larger effects on risk. To identify low-frequency coding variants with large effects on LOAD risk, we carried out whole-exome sequencing (WES) in 14 large LOAD families and follow-up analyses of the candidate variants in several large LOAD case-control data sets. A rare variant in PLD3 (phospholipase D3; Val232Met) segregated with disease status in two independent families and doubled risk for Alzheimer's disease in seven independent case-control series with a total of more than 11,000 cases and controls of European descent. Gene-based burden analyses in 4,387 cases and controls of European descent and 302 African American cases and controls, with complete sequence data for PLD3, reveal that several variants in this gene increase risk for Alzheimer's disease in both populations. PLD3 is highly expressed in brain regions that are vulnerable to Alzheimer's disease pathology, including hippocampus and cortex, and is expressed at significantly lower levels in neurons from Alzheimer's disease brains compared to control brains. Overexpression of PLD3 leads to a significant decrease in intracellular amyloid-β precursor protein (APP) and extracellular Aβ42 and Aβ40 (the 42- and 40-residue isoforms of the amyloid-β peptide), and knockdown of PLD3 leads to a significant increase in extracellular Aβ42 and Aβ40. Together, our genetic and functional data indicate that carriers of PLD3 coding variants have a twofold increased risk for LOAD and that PLD3 influences APP processing. This study provides an example of how densely affected families may help to identify rare variants with large effects on risk for disease or other complex traits.
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Affiliation(s)
- Carlos Cruchaga
- Department of Psychiatry, Washington University, St.
Louis, MO, USA
- Hope Center Program on Protein Aggregation and
Neurodegeneration, Washington University St. Louis, MO, USA
| | - Celeste M. Karch
- Department of Psychiatry, Washington University, St.
Louis, MO, USA
- Hope Center Program on Protein Aggregation and
Neurodegeneration, Washington University St. Louis, MO, USA
| | - Sheng Chih Jin
- Department of Psychiatry, Washington University, St.
Louis, MO, USA
| | - Bruno A. Benitez
- Department of Psychiatry, Washington University, St.
Louis, MO, USA
| | - Yefei Cai
- Department of Psychiatry, Washington University, St.
Louis, MO, USA
| | - Rita Guerreiro
- Department of Molecular Neuroscience, UCL Institute of
Neurology, London WC1N 3BG, UK
- Laboratory of Neurogenetics, National Institute on Aging,
National Institutes of Health, Bethesda, Maryland, United States of America
| | - Oscar Harari
- Department of Psychiatry, Washington University, St.
Louis, MO, USA
| | - Joanne Norton
- Department of Psychiatry, Washington University, St.
Louis, MO, USA
| | - John Budde
- Department of Psychiatry, Washington University, St.
Louis, MO, USA
| | - Sarah Bertelsen
- Department of Psychiatry, Washington University, St.
Louis, MO, USA
| | - Amanda T. Jeng
- Department of Psychiatry, Washington University, St.
Louis, MO, USA
| | - Breanna Cooper
- Department of Psychiatry, Washington University, St.
Louis, MO, USA
| | - Tara Skorupa
- Department of Psychiatry, Washington University, St.
Louis, MO, USA
| | - David Carrell
- Department of Psychiatry, Washington University, St.
Louis, MO, USA
| | - Denise Levitch
- Department of Psychiatry, Washington University, St.
Louis, MO, USA
| | - Simon Hsu
- Department of Psychiatry, Washington University, St.
Louis, MO, USA
| | - Jiyoon Choi
- Department of Psychiatry, Washington University, St.
Louis, MO, USA
| | - Mina Ryten
- Department of Molecular Neuroscience, UCL Institute of
Neurology, London WC1N 3BG, UK
- on behalf of UKBEC (UK Brain Expression Consortium)
| | - Celeste Sassi
- Department of Molecular Neuroscience, UCL Institute of
Neurology, London WC1N 3BG, UK
- Laboratory of Neurogenetics, National Institute on Aging,
National Institutes of Health, Bethesda, Maryland, United States of America
| | - Jose Bras
- Department of Molecular Neuroscience, UCL Institute of
Neurology, London WC1N 3BG, UK
| | - Raphael J. Gibbs
- Department of Molecular Neuroscience, UCL Institute of
Neurology, London WC1N 3BG, UK
- Laboratory of Neurogenetics, National Institute on Aging,
National Institutes of Health, Bethesda, Maryland, United States of America
| | - Dena G. Hernandez
- Department of Molecular Neuroscience, UCL Institute of
Neurology, London WC1N 3BG, UK
- Laboratory of Neurogenetics, National Institute on Aging,
National Institutes of Health, Bethesda, Maryland, United States of America
| | - Michelle K. Lupton
- Institute of Psychiatry, King's College London, London,
UK
- Neuroimaging Genetics, QIMR Berghofer Medical Research
Institute, Brisbane, Australia
| | - John Powell
- Institute of Psychiatry, King's College London, London,
UK
| | - Paola Forabosco
- Istituto di Genetica delle Popolazioni – CNR,
Sassari, Italy
| | - Perry G. Ridge
- Department of Biology, Brigham Young University, Provo,
UT, 84602
| | - Christopher D. Corcoran
- Department of Mathematics and Statistics, Utah State
University, Logan, UT
- Center for Epidemiologic Studies, Utah State University,
Logan, UT
| | - JoAnn T. Tschanz
- Center for Epidemiologic Studies, Utah State University,
Logan, UT
- Department of Psychology, Utah State University, Logan,
UT
| | - Maria C. Norton
- Center for Epidemiologic Studies, Utah State University,
Logan, UT
- Department of Psychology, Utah State University, Logan,
UT
- Department of Family Consumer and Human Development,
Utah State University, Logan, UT
| | - Ronald G. Munger
- Department of Family Consumer and Human Development,
Utah State University, Logan, UT
- Department of Nutrition, Dietetics, and Food Sciences,
Utah State University, Logan, UT
| | - Cameron Schmutz
- Department of Biology, Brigham Young University, Provo,
UT, 84602
| | - Maegan Leary
- Department of Biology, Brigham Young University, Provo,
UT, 84602
| | - F. Yesim Demirci
- Department of Human Genetics, University of Pittsburgh,
Pittsburgh, PA
| | - Mikhil N. Bamne
- Department of Human Genetics, University of Pittsburgh,
Pittsburgh, PA
| | - Xingbin Wang
- Department of Human Genetics, University of Pittsburgh,
Pittsburgh, PA
| | - Oscar L. Lopez
- Alzheimer's Disease Research Center, University of
Pittsburgh, Pittsburgh, PA
- Department of Neurology, University of Pittsburgh,
Pittsburgh, PA
| | - Mary Ganguli
- Department of Psychiatry, University of Pittsburgh,
Pittsburgh, PA
| | - Christopher Medway
- Human Genetics, School of Molecular Medical Sciences,
University of Nottingham, Nottingham, NG7 2UH, UK
| | - James Turton
- Human Genetics, School of Molecular Medical Sciences,
University of Nottingham, Nottingham, NG7 2UH, UK
| | - Jenny Lord
- Human Genetics, School of Molecular Medical Sciences,
University of Nottingham, Nottingham, NG7 2UH, UK
| | - Anne Braae
- Human Genetics, School of Molecular Medical Sciences,
University of Nottingham, Nottingham, NG7 2UH, UK
| | - Imelda Barber
- Human Genetics, School of Molecular Medical Sciences,
University of Nottingham, Nottingham, NG7 2UH, UK
| | - Kristelle Brown
- Human Genetics, School of Molecular Medical Sciences,
University of Nottingham, Nottingham, NG7 2UH, UK
| | | | - Pau Pastor
- Neurogenetics Laboratory, Division of Neurosciences,
Center for Applied Medical Research, University of Navarra, Pamplona, Spain
- Department of Neurology, Clínica Universidad de
Navarra, School of Medicine, University of Navarra, Pamplona, Spain
- CIBERNED, Centro de Investigación
Biomédica en Red de Enfermedades Neurodegenerativas, Instituto de Salud
Carlos III, Spain
| | - Oswaldo Lorenzo-Betancor
- Neurogenetics Laboratory, Division of Neurosciences,
Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | | | - Erick Scott
- The Scripps Research Institute, La Jolla, CA, US
| | - Eric Topol
- The Scripps Research Institute, La Jolla, CA, US
| | - Kevin Morgan
- Human Genetics, School of Molecular Medical Sciences,
University of Nottingham, Nottingham, NG7 2UH, UK
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases,
University of Toronto
| | - Andy Singleton
- Laboratory of Neurogenetics, National Institute on Aging,
National Institutes of Health, Bethesda, Maryland, United States of America
| | - John Hardy
- Department of Molecular Neuroscience, UCL Institute of
Neurology, London WC1N 3BG, UK
| | - M. Ilyas Kamboh
- Alzheimer's Disease Research Center, University of
Pittsburgh, Pittsburgh, PA
- Department of Psychiatry, University of Pittsburgh,
Pittsburgh, PA
| | - Peter St George-Hyslop
- Tanz Centre for Research in Neurodegenerative Diseases,
University of Toronto
- Cambridge Institute for Medical Research, and the
Department of Clinical Neurosciences, University of Cambridge
| | - Nigel Cairns
- Hope Center Program on Protein Aggregation and
Neurodegeneration, Washington University St. Louis, MO, USA
- Pathology and Immunology, Washington University, St.
Louis, MO, USA
| | - John C. Morris
- Pathology and Immunology, Washington University, St.
Louis, MO, USA
- Department of Neurology, Washington University, St. Louis,
MO, USA
- Knight ADRC, Washington University, St. Louis, MO,
USA
| | - John S.K. Kauwe
- Department of Biology, Brigham Young University, Provo,
UT, 84602
| | - Alison M. Goate
- Department of Psychiatry, Washington University, St.
Louis, MO, USA
- Hope Center Program on Protein Aggregation and
Neurodegeneration, Washington University St. Louis, MO, USA
- Department of Neurology, Washington University, St. Louis,
MO, USA
- Knight ADRC, Washington University, St. Louis, MO,
USA
- Department of Genetics, Washington University, St. Louis,
MO, USA
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Tschanz JT, Norton MC, Zandi PP, Lyketsos CG. The Cache County Study on Memory in Aging: factors affecting risk of Alzheimer's disease and its progression after onset. Int Rev Psychiatry 2013; 25:673-85. [PMID: 24423221 PMCID: PMC4089882 DOI: 10.3109/09540261.2013.849663] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The Cache County Study on Memory in Aging is a longitudinal, population-based study of Alzheimer's disease (AD) and other dementias. Initiated in 1995 and extending to 2013, the study has followed over 5,000 elderly residents of Cache County, Utah (USA) for over twelve years. Achieving a 90% participation rate at enrolment, and spawning two ancillary projects, the study has contributed to the literature on genetic, psychosocial and environmental risk factors for AD, late-life cognitive decline, and the clinical progression of dementia after its onset. This paper describes the major study contributions to the literature on AD and dementia.
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Affiliation(s)
- JoAnn T. Tschanz
- Department of Psychology, Utah State University,Center for Epidemiologic Studies, Utah State University
| | - Maria C. Norton
- Center for Epidemiologic Studies, Utah State University,Department of Family, Consumer & Human Development, Utah State University
| | - Peter P. Zandi
- Bloomberg School of Public Health, Johns Hopkins University
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Tschanz JT, Pfister R, Wanzek J, Corcoran C, Smith K, Tschanz BT, Steffens DC, Østbye T, Welsh-Bohmer KA, Norton MC. Stressful life events and cognitive decline in late life: moderation by education and age. The Cache County Study. Int J Geriatr Psychiatry 2013; 28:821-30. [PMID: 23037866 PMCID: PMC3706540 DOI: 10.1002/gps.3888] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [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: 07/12/2011] [Accepted: 09/05/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Stressful life events (SLE) have been associated with increased dementia risk, but their association with cognitive decline has been inconsistent. In a longitudinal population-based study of older individuals, we examined the association between SLE and cognitive decline, and the role of potential effect modifiers. METHODS A total of 2665 non-demented participants of the Cache County Memory Study completed an SLE questionnaire at Wave 2 and were revisited 4 and 7 years later. The events were represented via several scores: total number, subjective rating (negative, positive, and unexpected), and a weighted summary based on their impact. Cognition was assessed at each visit with the modified Mini-Mental State Exam. General linear models were used to examine the association between SLE scores and cognition. Effect modification by age, education, and APOE genotype was tested. RESULTS Years of formal education (p = 0.006) modified the effect of number of SLE, and age (p = 0.009) modified the effect of negative SLE on the rate of cognitive decline. Faster decline was observed among those with fewer years of education experiencing more SLE and also among younger participants experiencing more negative SLE. There was no association between other indicators of SLE and cognitive decline. APOE genotype did not modify any of the aforementioned associations. CONCLUSIONS The effects of SLE on cognition in late life are complex and vary by individual factors such as age and education. These results may explain some of the contradictory findings in the literature.
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Affiliation(s)
- JoAnn T. Tschanz
- Department of Psychology, Utah State University,Center for Epidemiologic Studies, Utah State University
| | | | | | - Chris Corcoran
- Center for Epidemiologic Studies, Utah State University,Department of Mathematics and Statistics, Utah State University
| | - Ken Smith
- Department of Family and Human Development, University of Utah
| | | | | | | | - Kathleen A. Welsh-Bohmer
- Department of Psychiatry and Behavioral Sciences, Duke University,The Joseph and Kathleen Bryan Alzheimer’s Disease Research Center, Duke University
| | - Maria C. Norton
- Department of Psychology, Utah State University,Center for Epidemiologic Studies, Utah State University,Department of Family, Consumer and Human Development, Utah State University
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31
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Fauth EB, Schwartz S, Tschanz JT, Østbye T, Corcoran C, Norton MC. Baseline disability in activities of daily living predicts dementia risk even after controlling for baseline global cognitive ability and depressive symptoms. Int J Geriatr Psychiatry 2013; 28:597-606. [PMID: 22968965 PMCID: PMC3565032 DOI: 10.1002/gps.3865] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 06/25/2012] [Accepted: 07/11/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Late-life disability in activities of daily living (ADL) is theorized to be driven by underlying cognitive and/or physical impairment, interacting with psychological and environmental factors. Although we expect that cognitive deficits would explain associations between ADL disability and dementia risk, the current study examined ADL as a predictor of future dementia after controlling for global cognitive status. METHODS The population-based Cache County Memory Study (N = 3547) assessed individuals in four triennial waves (average age 74.9 years, years of education 13.36 years; 57.9% were women). Cox proportional hazards regression models assessed whether baseline ADL disability (presence of 2+ Instrumental ADL and/or 1+ Personal ADL) predicted incident dementia after controlling for APOE status, gender, age, baseline cognitive ability (Modified Mini-mental State Exam, 3MS-R; adjusted for education level), and baseline depressive symptoms (Diagnostic Interview Schedule). RESULTS Over the course of study, 571 cases of incident dementia were identified through in-depth cognitive assessment, ending in expert consensus diagnosis. Results from Cox models suggest that ADL disability is a statistically significant predictor of incident dementia (adjusted hazard ratio = 1.83, p < 0.001), even after controlling for covariates. CONCLUSIONS Findings suggest that ADL disability offers unique contributions in risk for incident dementia, even after controlling for global cognitive status. We discuss how physical impairment and executive function may play important roles in this relationship, and how ADL is useful, not just a diagnostic tool at, or after dementia onset, but also as a risk factor for future dementia, even in individuals not impaired on global cognitive tests.
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Affiliation(s)
- Elizabeth B. Fauth
- Department of Family, Consumer, and Human Development, Utah State University
- Center for Epidemiological Studies, Utah State University
| | - Sarah Schwartz
- Center for Epidemiological Studies, Utah State University
| | - JoAnn T. Tschanz
- Center for Epidemiological Studies, Utah State University
- Department of Psychology, Utah State University
| | - Truls Østbye
- Department of Community and Family Medicine, Duke University School of Medicine
| | - Christopher Corcoran
- Center for Epidemiological Studies, Utah State University
- Department of Mathematics and Statistics, Utah State University
| | - Maria C. Norton
- Department of Family, Consumer, and Human Development, Utah State University
- Center for Epidemiological Studies, Utah State University
- Department of Psychology, Utah State University
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Piercy KW, Fauth EB, Norton MC, Pfister R, Corcoran CD, Rabins PV, Lyketsos C, Tschanz JT. Predictors of dementia caregiver depressive symptoms in a population: the Cache County dementia progression study. J Gerontol B Psychol Sci Soc Sci 2012; 68:921-6. [PMID: 23241850 DOI: 10.1093/geronb/gbs116] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Previous research has consistently reported elevated rates of depressive symptoms in dementia caregivers, but mostly with convenience samples. This study examined rates and correlates of depression at the baseline visit of a population sample of dementia caregivers (N = 256). METHOD Using a modified version of Williams (Williams, I. C. [2005]. Emotional health of black and white dementia caregivers: A contextual examination. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 60, P287-P295) ecological contextual model, we examined 5 contexts that have contributed to dementia caregiver depression. A series of linear regressions were performed to determine correlates of depression. RESULTS Rates of depressive symptoms were lower than those reported in most convenience studies. We found fewer depressive symptoms in caregivers with higher levels of education and larger social support networks, fewer health problems, greater likelihood of using problem-focused coping, and less likelihood of wishful thinking and with fewer behavioral disturbances in the persons with dementia. DISCUSSION These results suggest that depression may be less prevalent in populations of dementia caregivers than in clinic-based samples, but that the correlates of depression are similar for both population and convenience samples. Interventions targeting individuals with small support networks, emotion-focused coping styles, poorer health, low quality of life, and those caring for persons with higher numbers of behavioral problems need development and testing.
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Affiliation(s)
- Kathleen W Piercy
- Correspondence should be addressed to Kathleen Piercy, Department of Family, Consumer, and Human Development, 2905 Old Main Hill, Utah State University, Logan, UT 84322-2905. E-mail:
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Ridge PG, Maxwell TJ, Corcoran CD, Norton MC, Tschanz JT, O’Brien E, Kerber RA, Cawthon RM, Munger RG, Kauwe JSK. Mitochondrial genomic analysis of late onset Alzheimer's disease reveals protective haplogroups H6A1A/H6A1B: the Cache County Study on Memory in Aging. PLoS One 2012; 7:e45134. [PMID: 23028804 PMCID: PMC3444479 DOI: 10.1371/journal.pone.0045134] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 08/14/2012] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Alzheimer's disease (AD) is the most common cause of dementia and AD risk clusters within families. Part of the familial aggregation of AD is accounted for by excess maternal vs. paternal inheritance, a pattern consistent with mitochondrial inheritance. The role of specific mitochondrial DNA (mtDNA) variants and haplogroups in AD risk is uncertain. METHODOLOGY/PRINCIPAL FINDINGS We determined the complete mitochondrial genome sequence of 1007 participants in the Cache County Study on Memory in Aging, a population-based prospective cohort study of dementia in northern Utah. AD diagnoses were made with a multi-stage protocol that included clinical examination and review by a panel of clinical experts. We used TreeScanning, a statistically robust approach based on haplotype networks, to analyze the mtDNA sequence data. Participants with major mitochondrial haplotypes H6A1A and H6A1B showed a reduced risk of AD (p=0.017, corrected for multiple comparisons). The protective haplotypes were defined by three variants: m.3915G>A, m.4727A>G, and m.9380G>A. These three variants characterize two different major haplogroups. Together m.4727A>G and m.9380G>A define H6A1, and it has been suggested m.3915G>A defines H6A. Additional variants differentiate H6A1A and H6A1B; however, none of these variants had a significant relationship with AD case-control status. CONCLUSIONS/SIGNIFICANCE Our findings provide evidence of a reduced risk of AD for individuals with mtDNA haplotypes H6A1A and H6A1B. These findings are the results of the largest study to date with complete mtDNA genome sequence data, yet the functional significance of the associated haplotypes remains unknown and replication in others studies is necessary.
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Affiliation(s)
- Perry G. Ridge
- Department of Biology, Brigham Young University, Provo, Utah, United States of America
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, Utah, United States of America
| | - Taylor J. Maxwell
- Human Genetics Center, University of Texas School of Public Health, Houston, Texas, United States of America
| | - Christopher D. Corcoran
- Department of Mathematics and Statistics, Utah State University, Logan, Utah, United States of America
- Center for Epidemiologic Studies, Utah State University, Logan, Utah, United States of America
| | - Maria C. Norton
- Center for Epidemiologic Studies, Utah State University, Logan, Utah, United States of America
- Department of Family Consumer and Human Development, Utah State University, Logan, Utah, United States of America
- Department of Psychology, Utah State University, Logan, Utah, United States of America
| | - JoAnn T. Tschanz
- Center for Epidemiologic Studies, Utah State University, Logan, Utah, United States of America
- Department of Psychology, Utah State University, Logan, Utah, United States of America
| | - Elizabeth O’Brien
- Department of Epidemiology and Population Health, University of Louisville, Louisville, Kentucky, United States of America
| | - Richard A. Kerber
- Department of Epidemiology and Population Health, University of Louisville, Louisville, Kentucky, United States of America
| | - Richard M. Cawthon
- Department of Human Genetics, University of Utah, Salt Lake City, Utah, United States of America
| | - Ronald G. Munger
- Center for Epidemiologic Studies, Utah State University, Logan, Utah, United States of America
- Department of Nutrition, Dietetics, and Food Sciences, Utah State University, Logan, Utah, United States of America
| | - John S. K. Kauwe
- Department of Biology, Brigham Young University, Provo, Utah, United States of America
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Mielke MM, Leoutsakos JM, Corcoran CD, Green RC, Norton MC, Welsh-Bohmer KA, Tschanz JT, Lyketsos CG. Effects of Food and Drug Administration-approved medications for Alzheimer's disease on clinical progression. Alzheimers Dement 2012; 8:180-7. [PMID: 22301194 DOI: 10.1016/j.jalz.2011.02.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 02/14/2011] [Accepted: 02/16/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Observational studies suggest that cholinesterase inhibitors and/or memantine may delay clinical progression of Alzheimer's disease (AD) in 40% of individuals taking the medications. Given this response and existence of side effects, we sought to quantify medication use and benefits in a population-based study of incident AD cases. METHODS The Cache County Dementia Progression Study enrolled and followed a cohort of 327 incident AD cases for a maximum of 9 years. Drug exposure was expressed using a persistency index (PI), calculated as total years of drug use divided by total years of observation. Linear mixed-effects models examined PI, and interactions with sex and apolipoprotein E (APOE) as predictors of clinical progression on the Mini-Mental State Examination and Clinical Dementia Rating-Sum of Boxes. RESULTS A total of 69 participants (21.1%) reported having ever used cholinesterase inhibitors or memantine. There was a strong three-way interaction between PI, sex, and time. Among women, a higher PI (i.e., greater duration of use) of cholinesterase inhibitors was associated with slower progression on the Mini-Mental State Examination and Clinical Dementia Rating-Sum of Boxes, particularly among those with an APOE ɛ4 allele. In contrast, higher PI was associated with faster progression in males. CONCLUSION A low percentage of individuals with AD in the community are taking cholinesterase inhibitors or memantine. This study suggests that women, particularly those with an APOE ɛ4 allele, may benefit the most from these medications. With the newly approved increased dose of donepezil, it will be imperative to determine whether a higher dose is needed in men or whether other factors warrant consideration.
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Affiliation(s)
- Michelle M Mielke
- Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Mielke MM, Leoutsakos JM, Tschanz JT, Green RC, Tripodis Y, Corcoran CD, Norton MC, Lyketsos CG. Interaction between vascular factors and the APOE ε4 allele in predicting rate of progression in Alzheimer's disease. J Alzheimers Dis 2012; 26:127-34. [PMID: 21593560 DOI: 10.3233/jad-2011-110086] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [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]
Abstract
Vascular factors have been shown to affect the rate of Alzheimer's disease (AD) progression. However, the effect of the APOE ε4 allele on rate of progression has been ambiguous. Little research to date has examined an interaction between vascular factors and the APOE ε4 allele in predicting decline among AD patients. 216 participants with incident AD from a population of elderly persons in Cache County, Utah, were followed for a mean of 3.3 years and 4.2 follow-up visits. A history of vascular risk factors and conditions and anti-hypertensive use was assessed at the diagnostic visit. Linear mixed effects models tested interactions between the vascular factors, APOE ε4, and time as predictors of clinical progression on the Mini-Mental State Exam (MMSE) and Clinical Dementia Rating-Sum of Boxes (CDR-SB). Multiple comparisons were corrected using the Holm-Bonferroni method. There was a 3-way interaction between stroke, APOE ε4 and time in predicting MMSE decline (LR χ² = 10.32, 2 df, p = 0.006). For the CDR-SB, there were 3-way interactions between the APOE ε4, time and either myocardial infarction (LR χ² = 17.83, 2 df, p = 0.0001) or stroke (LR χ² = 11.48, 2 df, p = 0.003. Results suggest a complex relationship between the APOE ε4 and vascular factors in predicting cognitive and functional progression. Among individuals with a history of stroke or myocardial infarction at baseline, progression of AD is influenced by APOE ε4 carrier status and varies by time after AD diagnosis.
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Affiliation(s)
- Michelle M Mielke
- Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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Tate DF, Neeley ES, Norton MC, Tschanz JT, Miller MJ, Wolfson L, Hulette C, Leslie C, Welsh-Bohmer KA, Plassman B, Bigler ED. Intracranial volume and dementia: some evidence in support of the cerebral reserve hypothesis. Brain Res 2010; 1385:151-62. [PMID: 21172323 DOI: 10.1016/j.brainres.2010.12.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 12/02/2010] [Accepted: 12/11/2010] [Indexed: 10/18/2022]
Abstract
The brain reserve hypothesis has been posited as being one important mediating factor for developing dementia, especially Alzheimer's disease (AD). Evidence for this hypothesis is mixed though different methodologies have made these findings difficult to interpret. We examined imaging data from a large cohort (N=194) of mixed dementia patients and controls, 65years old and older from the Cache County, Utah Study of Memory and Aging for evidence of the brain reserve hypothesis using total intracranial volume (TICV) as a quantitative measure of pre-morbid brain size and a vicarious indicator of reserve. A broader spectrum of non-demented elderly control subjects from previous studies was also included for comparison (N=423). In addition, non-parametric Classification and Regression Tree (CART) analyses were performed to model group heterogeneity and identify any subgroups of patients where TICV might be an important predictor of dementia. Parametrically, no main effect was found for TICV when predicting a dementia diagnosis; however, the CART analysis did reveal important TICV subgroups, including a sex differential wherein ε4 APOE allele presence in males and low TICV predicted AD classification. TICV, APOE, and other potential mediator/moderator variables are discussed in the context of the brain reserve hypothesis.
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Affiliation(s)
- D F Tate
- Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Norton MC, Smith KR, Østbye T, Tschanz JT, Corcoran C, Schwartz S, Piercy KW, Rabins PV, Steffens DC, Skoog I, Breitner JCS, Welsh-Bohmer KA. Greater risk of dementia when spouse has dementia? The Cache County study. J Am Geriatr Soc 2010; 58:895-900. [PMID: 20722820 DOI: 10.1111/j.1532-5415.2010.02806.x] [Citation(s) in RCA: 97] [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: 11/30/2022]
Abstract
OBJECTIVES To examine the effects of caring for a spouse with dementia on the caregiver's risk for incident dementia. DESIGN Population-based study of incident dementia in spouses of persons with dementia. SETTING Rural county in northern Utah. PARTICIPANTS Two thousand four hundred forty-two subjects (1,221 married couples) aged 65 and older. MEASUREMENTS Incident dementia was diagnosed in 255 subjects, with onset defined as age when subject met Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, criteria for dementia. Cox proportional hazards regression tested the effect of time-dependent exposure to dementia in one's spouse, adjusted for potential confounders. RESULTS A subject whose spouse experienced incident dementia onset had a six times greater risk for incident dementia as subjects whose spouses were dementia free (hazard rate ratio (HRR)=6.0, 95% confidence interval (CI)=2.2-16.2, P<.001). In sex-specific analyses, husbands had higher risks (HRR=11.9, 95% CI=1.7-85.5, P=.01) than wives (HRR=3.7, 95% CI=1.2-11.6, P=.03). CONCLUSION The chronic and often severe stress associated with dementia caregiving may exert substantial risk for the development of dementia in spouse caregivers. Additional (not mutually exclusive) explanations for findings are discussed.
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Affiliation(s)
- Maria C Norton
- Department of Family, Consumer, and Human Development Utah State University, Logan, Utah, USA.
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Treiber K, Carlson M, Corcoran C, Foley B, Stein DM, Deberard S, Maria N, Piercy K, Welsh-Bohmer KA, Breitner JC, Lyketsos C, Tschanz JT. P3‐115: Cognitive activity and decline in Alzheimer's disease: The Cache County study. Alzheimers Dement 2010. [DOI: 10.1016/j.jalz.2010.05.1612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tschanz JT, Corcoran C, Norton MC, Piercy K, Rabins PV, Fauth E, DeBerard S, Snyder C, Smith C, Lee LS, Morrsion A, Lyketsos CG. P2‐113: Caregiver coping strategies predict cognitive decline in dementia: The Cache County Dementia Progression Study. Alzheimers Dement 2010. [DOI: 10.1016/j.jalz.2010.05.1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Buckley T, Norton MC, Deberard MS, Welsh-Bohmer KA, Tschanz JT. A brief metacognition questionnaire for the elderly: comparison with cognitive performance and informant ratings the Cache County Study. Int J Geriatr Psychiatry 2010; 25:739-47. [PMID: 19823990 PMCID: PMC2891290 DOI: 10.1002/gps.2416] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the utility of a brief, metacognition questionnaire by examining its association with objective cognitive testing and informant ratings. We hypothesized that the association between self-ratings of change and both outcomes would be greater among individuals without dementia than among those with dementia. METHODS Participants were 535 persons without dementia and 152 with dementia from the Cache County Memory Study who had completed a metacognition questionnaire, two administrations of the Modified Mini-Mental State Exam (3 MS) and who had data on the Informant Questionnaire of Cognitive Decline in the Elderly (IQCODE). Cronbach's alpha was calculated as a measure of internal consistency of the metacognition questionnaire. Multiple regression was used to examine the relationship between metacognition and 3 MS change. Logistic regression was used to examine the relationship between metacognition and IQCODE ratings (no change vs. worse). RESULTS Cronbach's alpha was 0.75. Among individuals without dementia, metacognition significantly predicted 3 MS change (p = .027) and IQCODE ratings (OR = 4.0, 95% CI = 1.2-13.8, p = .029), suggesting consistency among measures. For those with dementia, there was a weak, inverse relationship between 3 MS change and metacognition (r = -0.16, p = .056). IQCODE ratings were not significantly associated with metacognition (p = .729). Degree of dementia severity did not modify the relationship between metacognition and either outcome (p > .05). CONCLUSIONS We demonstrated adequate internal consistency and evidence for validity of a brief metacognition questionnaire. The questionnaire may provide a useful adjunct to memory and functional assessments for assessing anosognosia in elderly populations.
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Affiliation(s)
| | - Maria C. Norton
- Department of Psychology, Utah State University
- Department of Family, Consumer and Human Development, Utah State University
- Center for Epidemiologic Studies, Utah State University
| | | | | | - JoAnn T. Tschanz
- Department of Psychology, Utah State University
- Center for Epidemiologic Studies, Utah State University
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Hayden KM, Warren LH, Pieper CF, Østbye T, Tschanz JT, Norton MC, Breitner JCS, Welsh-Bohmer KA. Identification of VaD and AD prodromes: the Cache County Study. Alzheimers Dement 2009; 1:19-29. [PMID: 19595812 DOI: 10.1016/j.jalz.2005.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is unclear whether vascular dementia (VaD) has a cognitive prodrome, akin to the mild cognitive impairment (MCI) prodrome to Alzheimer's dementia (AD). To evaluate whether VaD has a cognitive prodrome, and if it can be differentiated from prodromal AD, we examined neuropsychological test performance of participants in a nested case-control study within a population-based cohort aged 65 or older. METHODS Participants (n = 485) were identified from the Cache County Study, a large population-based study of aging and dementia. After an average of 3 years of follow-up, a total of 62 incident dementia cases were identified (14 VaD, 48 AD). We identified a number of neuropsychological tests (executive and memory) that discriminated between diagnosed VaD and AD cases. Multivariate analyses sought to differentiate between these same groups 3 years before clinical diagnosis. RESULTS The Consortium to Establish a Registry for Alzheimer's Disease Word List Recognition Test correct recognition of foils (mean difference, 1.25; 95% confidence interval [CI], 0.42 to 2.07; p < 0.01), Logical Memory I (mean difference, 7.16; 95% CI, 0.78 to 13.55, p < 0.05), Logical Memory II delayed recall (mean difference, 8.67; 95% CI, 1.59 to 15.74, p < 0.05), and percent savings (mean difference, 51.07; 95% CI, 32.58 to 69.56, p < 0.0001) differentiated VaD from AD cases after adjustment for age, sex, education, and dementia severity. Three years before dementia diagnosis, word list recognition ("no" responses mean difference, 1.40; 95% CI, 0.64 to 2.17; p < 0.001, and "yes" responses mean difference, -1.14; 95% CI, -2.14 to -0.13; p < 0.03) discriminated between prodromal VaD and AD. CONCLUSION These results suggest that VaD has a prodromal syndrome, the cognitive features of which are distinguishable from the cognitive prodrome of AD.
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Affiliation(s)
- K M Hayden
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
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Plassman BL, Khachaturian AS, Townsend JJ, Ball MJ, Steffens DC, Leslie CE, Tschanz JT, Norton MC, Burke JR, Welsh-Bohmer KA, Hulette CM, Nixon RR, Tyrey M, Breitner JCS. Comparison of clinical and neuropathologic diagnoses of Alzheimer's disease in 3 epidemiologic samples. Alzheimers Dement 2009; 2:2-11. [PMID: 19595851 DOI: 10.1016/j.jalz.2005.11.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Revised: 10/26/2005] [Accepted: 11/03/2005] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies of dementia in populations avoid many of the selection biases in clinical samples but require special evaluation and diagnostic methods to obtain high participation rates. To address this issue, we developed a unique in-home dementia assessment. We assessed validity of these assessments using neuropathologic confirmation of the clinical diagnosis in 3 epidemiologic samples. METHODS Subjects were 175 participants in 3 ongoing studies of dementia. Two were population based and identified dementia by cognitive screening. The third study sought volunteers via advertisements. Dementia evaluations were then conducted at the participants' residences by specially trained nurses and psychometricians. Evaluation results were interpreted, and preliminary diagnoses were assigned by a geropsychiatrist or neurologist and a psychologist. Final diagnoses were assigned by a consensus panel of neurologists, geropsychiatrists, and psychologists. We compared the clinical diagnoses with the gold-standard neuropathologic diagnoses for those participants who subsequently underwent autopsy. RESULTS Among the demented, the sensitivity of a clinical diagnosis of probable or possible Alzheimer's disease (AD) was 93% across the 3 studies. The rate of overall diagnostic agreement was 81%. Measures of agreement did not differ meaningfully across varying levels of dementia severity. CONCLUSIONS Rates of neuropathologic confirmation for clinical AD diagnoses in these studies were similar to those reported from clinic-based samples. These results support the validity of clinical diagnoses of AD from a structured in-home assessment of community dwelling and institutionalized individuals using relatively economical methods of dementia screening and assessment.
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Affiliation(s)
- Brenda L Plassman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
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Tschanz JT, Corcoran CD, Green RC, Munger R, Mielke MM, Norton MC, Rabins PV, Welsh‐Bohmer KA, Buckley T, Breitner JC, Lyketsos CG. P1‐069: Interaction between C‐Reactive protein level and APOE genotype in predicting rate of progression in Alzheimer's disease: The Cache County dementia progression study. Alzheimers Dement 2009. [DOI: 10.1016/j.jalz.2009.04.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Welsh-Bohmer KA, Ostbye T, Sanders L, Pieper CF, Hayden KM, Tschanz JT, Norton MC. Neuropsychological performance in advanced age: influences of demographic factors and Apolipoprotein E: findings from the Cache County Memory Study. Clin Neuropsychol 2009; 23:77-99. [PMID: 18609337 PMCID: PMC2761675 DOI: 10.1080/13854040801894730] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The Cache County Study of Memory in Aging (CCMS) is an epidemiological study of Alzheimer's disease (AD), mild cognitive disorders, and aging in a population of exceptionally long-lived individuals (7th to 11th decade). Observation of population members without dementia provides an opportunity for establishing the range of normal neurocognitive performance in a representative sample of the very old. We examined neurocognitive performance of the normal participants undergoing full clinical evaluations (n = 507) and we tested the potential modifying effects of apolipoprotein E (APOE) genotype, a known genetic risk factor for the later development of AD. The results indicate that advanced age and low education are related to lower test scores across nearly all of the neurocognitive measures. Gender and APOE epsilon4 both had negligible and inconsistent influences, affecting only isolated measures of memory and expressive speech (in case of gender). The gender and APOE effects disappeared once age and education were controlled. The study of this exceptionally long-lived population provides useful normative information regarding the broad range of "normal" cognition seen in advanced age. Among elderly without dementia or other cognitive impairment, APOE does not appear to exert any major effects on cognition once other demographic influences are controlled.
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Affiliation(s)
- Katheen A Welsh-Bohmer
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA.
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Tschanz JT, Corcoran C, Shao H, Zandi PP, Norton M, Mielke M, Green RC, Rabins PV, Steinberg M, Welsh-Bohmer KA, Breitner JC, Lyketsos CG. O2‐01–08: Assocation between neuropsychiatric syndromes and mortality in a population‐based sample of incident Alzheimer's disease and other dementias: The Cache County dementia progression study. Alzheimers Dement 2008. [DOI: 10.1016/j.jalz.2008.05.311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - Huibo Shao
- The Johns Hopkins UniversityBaltimoreMDUSA
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Warren LH, Hayden KM, Sanders L, Ostbye T, Pieper CF, Tschanz JT, Norton MC, Hartman M, Welsh-Bohmer KA. P1‐174: Stability and prediction of future dementia for multiple transitional cognitive states: The cache county study. Alzheimers Dement 2008. [DOI: 10.1016/j.jalz.2008.05.762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Lauren Half Warren
- Duke University Medical CenterDurhamNCUSA
- University of North Carolina at Chapel HillChapel HillNCUSA
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Welsh-Bohmer KA, Hayden KM, Sanders L, Pieper CF, Østbye T, Warren LH, Norton MC, Tschanz JT, Zandi PP, Toohill M, Sassano N, Corcoran C, Leslie C, Steinberg M, Raj P, Christopher E, Gagliardi J, Plassman BL, Steffens DC, Burke JR, Lyketsos C, Munger R, Breitner JC. P4‐057: Prevalence of prodromal Alzheimer's disease across late life: Results from the Cache County Study. Alzheimers Dement 2008. [DOI: 10.1016/j.jalz.2008.05.2122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - John C.S. Breitner
- VA Puget Sound Health Care System & University of WashingtonSeattleWAUSA
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Hayden KM, Zandi PP, Khachaturian AS, Szekely CA, Fotuhi M, Norton MC, Tschanz JT, Pieper CF, Corcoran C, Lyketsos CG, Breitner JCS, Welsh-Bohmer KA. Does NSAID use modify cognitive trajectories in the elderly?: The Cache County Study. Neurology 2007; 69:275-82. [PMID: 17636065 DOI: 10.1212/01.wnl.0000265223.25679.2a] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [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 Epidemiologic studies have suggested that nonsteroidal anti-inflammatory drugs (NSAIDs) may be useful for the prevention of Alzheimer disease (AD). By contrast, clinical trials have not supported NSAID use to delay or treat AD. Few studies have evaluated cognitive trajectories of NSAID users over time. METHODS Residents of Cache County, UT, aged 65 or older on January 1, 1995, were invited to participate in the study. At baseline, participants provided a detailed inventory of their medications and completed a revised Modified Mini-Mental State Examination (3MS). Participants (n = 3,383) who were cognitively normal at baseline were re-examined after 3 and 8 years. The association between NSAID use and 3MS scores over time was estimated using random effects modeling. RESULTS Associations depended upon when NSAIDs were started and APOE genotype. In participants who started NSAID use prior to age 65, those with no APOE epsilon4 alleles performed similarly to nonusers (a difference of 0.10 points per year; p = 0.19), while those with one or more epsilon4 allele(s) showed more protection (0.40 points per year; p = 0.0005). Among participants who first used NSAIDs at or after age 65, those with one or more epsilon4 alleles had higher baseline scores (0.95 points; p = 0.03) but did not show subsequent difference in change in score over time (0.06 points per year; p = 0.56). Those without an epsilon4 allele who started NSAID use after age 65 showed greater decline than nonusers (-0.16 points per year; p = 0.02). CONCLUSIONS Nonsteroidal anti-inflammatory drug use may help to prevent cognitive decline in older adults if started in midlife rather than late life. This effect may be more notable in those who have one or more APOE epsilon4 alleles.
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Affiliation(s)
- K M Hayden
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA.
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Hayden KM, Tschanz JT, Norton MC, Pieper CF, Ostbye T, Sanders L, Welsh-Bohmer KA. O2–02–02: Early identification of cognitive trajectories with neuropsychological testing. The cache county study. Alzheimers Dement 2007. [DOI: 10.1016/j.jalz.2007.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Onyike CU, Sheppard JME, Tschanz JT, Norton MC, Green RC, Steinberg M, Welsh-Bohmer KA, Breitner JC, Lyketsos CG. Epidemiology of apathy in older adults: the Cache County Study. Am J Geriatr Psychiatry 2007; 15:365-75. [PMID: 17463187 DOI: 10.1097/01.jgp.0000235689.42910.0d] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this study are to describe the distribution of apathy in community-based older adults and to investigate its relationships with cognition and day-to-day functioning. METHODS Data from the Cache County Study on Memory, Health and Aging were used to estimate the frequency of apathy in groups of elders defined by demographic, cognitive, and functional status and to examine the associations of apathy with impairments of cognition and day-to-day functioning. RESULTS Apathy was measured with the Neuropsychiatric Inventory. Clinical apathy (Neuropsychiatric Inventory score > or = 4) was found in 1.4% of individuals classified as cognitively normal, 3.1% of those with a mild cognitive syndrome, and 17.3% of those with dementia. Apathy status was associated with cognitive and functional impairments and higher levels of stress experienced by caregivers. Among participants with normal cognition, apathy was associated with worse performance on the Mini-Mental State Examination, the Boston Naming and Animal Fluency tests, and the Trail Making Test-Part B. The association of apathy with cognitive impairment was independent of its association with Neuropsychiatric Inventory depression. CONCLUSIONS In a cohort of community-based older adults, the frequency and severity of apathy is positively correlated with the severity of cognitive impairment. In addition, apathy is associated with cognitive and functional impairments in elders adjudged to have normal cognition. The results suggest that apathy is an early sign of cognitive decline and that delineating phenotypes in which apathy and a mild cognitive syndrome co-occur may facilitate earlier identification of individuals at risk for dementia.
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Affiliation(s)
- Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.
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