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Gupta A, Mahnken JD, Bernal J, Sharma P, Lepping RJ, Montgomery RN, Johnson DK, Parks A, Burns JM, Drew DA, Sarnak MJ, Brooks WM. Changes in Cognitive Function After Kidney Transplantation: A Longitudinal Cohort Study. Am J Kidney Dis 2024:S0272-6386(24)00624-3. [PMID: 38423160 DOI: 10.1053/j.ajkd.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/11/2023] [Accepted: 12/23/2023] [Indexed: 03/02/2024]
Abstract
RATIONALE & OBJECTIVE Kidney disease negatively affects cognition. We assessed the effect of kidney transplantation (KT) on different cognitive domains. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS We examined pre- versus post-KT cognition in patients waitlisted for KT at an academic center. PREDICTORS Transplant status. We measured cognitive function before KT (n=101), 3 months after KT (n=78), and 1 year after KT (n = 83). OUTCOMES Our primary outcome was change in cognitive function before versus after KT. We used standard neuropsychological tests to assess global cognition (Mini-Mental State Exam [MMSE]), episodic/declarative memory (Logical Memory), psychomotor speed/visuospatial function (Digit Symbol Substitution Test [DSST], Trail Making Test [TMT] A), working memory/attention (Digit Span), executive function (TMT B), and semantic memory/verbal fluency/language (Category Fluency). ANALYTICAL APPROACH Using linear mixed model analysis, we evaluated the changes in neuropsychological test scores adjusted for age, sex, race, education, and number of assessments. RESULTS Before KT, Logical Memory I and II, DSST, MMSE, Category Fluency (animal naming), and Digit Span backward scores were low compared with normative values from the National Alzheimer's Coordinating Center data. Logical Memory I and II scores improved after KT (pre- vs post-KT, estimated group difference [d]=3.3, P<0.001 for Logical Memory I; d=4.27, P<0.001 for Logical Memory II), such that post-KT scores were similar to normative values (post-KT vs normative values, d = -0.37, P=0.06 for Logical Memory I; d = -0.89, P=0.08 for Logical Memory II). Category Fluency (animal naming; d=2.4, P<0.001) and DSST (d=3.12, P=0.01) scores also improved with KT, but post-KT DSST scores remained lower than normative values (post-KT vs normative values, d = -5.17, P<0.001). MMSE, Digit Span, and TMT A and B scores did not change after KT. LIMITATIONS Single-center study. CONCLUSIONS Episodic and verbal declarative memory normalize after KT. Semantic memory, verbal fluency, language, psychomotor speed, and visuospatial function show partial improvement. Cognitive impairment in kidney disease is therefore at least partly reversible with KT. PLAIN-LANGUAGE SUMMARY Cognitive impairment in kidney disease affects self-esteem, vocational abilities, quality of life, health care costs, and mortality. It is not clear whether kidney transplantation (KT) improves cognition and whether the improvement is uniform across cognitive domains. The distinction between reversible and irreversible cognitive impairment has important implications in the clinical care of patients before and after KT. We assessed cognition before KT and 3 months and 12 months after KT and discovered that episodic and verbal declarative memory normalized with KT. Semantic memory, verbal fluency, language, psychomotor speed, and visuospatial function also improved with KT but did not reach normal levels. Cognitive impairment in kidney disease is therefore at least partly reversible.
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Affiliation(s)
- Aditi Gupta
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas; Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas; University of Kansas Alzheimer's Disease Center, University of Kansas Medical Center, Kansas City, Kansas; Frontiers Clinical and Translational Science Institute, University of Kansas Medical Center, Kansas City, Kansas.
| | - Jonathan D Mahnken
- University of Kansas Alzheimer's Disease Center, University of Kansas Medical Center, Kansas City, Kansas; Frontiers Clinical and Translational Science Institute, University of Kansas Medical Center, Kansas City, Kansas; Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Joshua Bernal
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Palash Sharma
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Rebecca J Lepping
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas; University of Kansas Alzheimer's Disease Center, University of Kansas Medical Center, Kansas City, Kansas; Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, Kansas
| | - Robert N Montgomery
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - David K Johnson
- Department of Neurology, University of California, Davis, Davis, California
| | - Adam Parks
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
| | - Jeffrey M Burns
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas; University of Kansas Alzheimer's Disease Center, University of Kansas Medical Center, Kansas City, Kansas
| | - David A Drew
- Division of Nephrology and Hypertension, Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Mark J Sarnak
- Division of Nephrology and Hypertension, Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts
| | - William M Brooks
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas; University of Kansas Alzheimer's Disease Center, University of Kansas Medical Center, Kansas City, Kansas; Frontiers Clinical and Translational Science Institute, University of Kansas Medical Center, Kansas City, Kansas; Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, Kansas
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Brake A, Heskett C, Alam N, Fry L, Le K, Mahnken JD, Abraham M. Glycoprotein inhibitors as a first line rescue treatment after unsuccessful recanalization of endovascular thrombectomy: A systematic review and meta-analysis. Interv Neuroradiol 2024:15910199241226470. [PMID: 38204180 DOI: 10.1177/15910199241226470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Intracranial atherosclerotic disease (ICAD) is a major cause of stroke with a high rate of re-occlusion following mechanical thrombectomy (MT). Among the available rescue options, glycoprotein IIb/IIIa inhibitors (GPI) have shown promise as a potential therapeutic strategy. This systematic review and meta-analysis examine studies exploring the use of glycoprotein inhibitors as a first-line treatment for refractory occlusion or high-grade stenosis following EVT in the setting of ICAD. METHODS A systematic review and meta-analysis were performed. Studies using GPI as the first-line rescue treatment (GPI-rt) after failed thrombectomy or in the setting with high-grade stenosis (>50%) were included. The primary outcome of interest was good clinical outcomes (defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days). Secondary outcomes of interest were successful recanalization (TICI 2b-3), symptomatic intracranial hemorrhage (sICH), and mortality by 90 days. RESULTS Our study processed 2111 articles, which yielded eight relevant studies for review, four single and four double arm. These studies comprised 763 patients, divided into GPI-rt (535 patients) and non-GPI-rt (228 patients) cohorts. The GPI-rt group had higher rates of mRS ≤ 2 at 90 days (58.5% vs 38.9%, p = 0.002) and lower mortality rates (7.8% vs 17.5%, p = 0.04) compared to the non-GPI-rt cohort. mTICI 2b-3 rates and rates of sICH were not significantly different between the cohorts. CONCLUSIONS First line GPI-rt demonstrates significant clinical benefit and significantly lower mortality without a rise in rates of sICH. GPI are a potential first line rescue treatment of ICAD.
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Affiliation(s)
- Aaron Brake
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Cody Heskett
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Naima Alam
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Lane Fry
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Kevin Le
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Jonathan D Mahnken
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Michael Abraham
- Department of Neurology, University of Kansas Health System, Kansas City, KS, USA
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Li J, Agbobli-Nuwoaty S, Palella FJ, Novak RM, Tedaldi E, Mayer C, Mahnken JD, Hou Q, Carlson K, Thompson-Paul AM, Durham MD, Buchacz K. Incidence of Hyperlipidemia among Adults Initiating Antiretroviral Therapy in the HIV Outpatient Study (HOPS), USA, 2007-2021. AIDS Res Treat 2023; 2023:4423132. [PMID: 38078054 PMCID: PMC10703529 DOI: 10.1155/2023/4423132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 02/12/2024] Open
Abstract
Current U.S. guidelines recommend integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) as initial treatment for people with HIV (PWH). We assessed long-term effects of INSTI use on lipid profiles in routine HIV care. We analyzed medical record data from the HIV Outpatient Study's participants in care from 2007 to 2021. Hyperlipidemia was defined based on clinical diagnoses, treatments, and laboratory results. We calculated hyperlipidemia incidence rates and rate ratios (RRs) during initial ART and assessed predictors of incident hyperlipidemia by using Poisson regression. Among 349 eligible ART-naïve PWH, 168 were prescribed INSTI-based ART (36 raltegravir (RAL), 51 dolutegravir (DTG), and 81 INSTI-others (elvitegravir and bictegravir)) and 181 non-INSTI-based ART, including 68 protease inhibitor (PI)-based ART. During a median follow-up of 1.4 years, hyperlipidemia rates were 12.8, 22.3, 22.7, 17.4, and 12.6 per 100 person years for RAL-, DTG-, INSTI-others-, non-INSTI-PI-, and non-INSTI-non-PI-based ART, respectively. In multivariable analysis, compared with the RAL group, hyperlipidemia rates were higher in INSTI-others (RR = 2.25; 95% confidence interval (CI): 1.29-3.93) and non-INSTI-PI groups (RR = 1.89; CI: 1.12-3.19) but not statistically higher for the DTG (RR = 1.73; CI: 0.95-3.17) and non-INSTI-non-PI groups (RR = 1.55; CI: 0.92-2.62). Other factors independently associated with hyperlipidemia included older age, non-Hispanic White race/ethnicity, and ART without tenofovir disoproxil fumarate. PWH using RAL-based regimens had lower rates of incident hyperlipidemia than PWH receiving non-INSTI-PI-based ART but had similar rates as those receiving DTG-based ART, supporting federal recommendations for using DTG-based regimens as the initial therapy for ART-naïve PWH.
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Affiliation(s)
- Jun Li
- Division of HIV Prevention, NCHHSTP, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Frank J. Palella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Ellen Tedaldi
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Cynthia Mayer
- St. Joseph's Comprehensive Research Institute, Tampa, FL, USA
| | | | | | | | - Angela M. Thompson-Paul
- Division for Heart Disease and Stroke Prevention, NCCDPHP, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marcus D. Durham
- Division of HIV Prevention, NCHHSTP, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kate Buchacz
- Division of HIV Prevention, NCHHSTP, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Ahmadnezhad P, Burns JM, Akinwuntan AE, Ranchet M, Kondyli A, Mahnken JD, Devos H. Driving Automation for Older Adults with Preclinical Alzheimer's Disease. Gerontology 2023; 69:1307-1314. [PMID: 37557082 PMCID: PMC10843675 DOI: 10.1159/000531263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 05/12/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Older adults with preclinical Alzheimer's disease (AD) show changes in on-road driving performance. The impact of preclinical AD on using automated vehicle (AV) technology is unknown. The aim was to evaluate safety and cognitive workload while operating AV technology in drivers with preclinical AD. INTRODUCTION This cross-sectional study included 40 participants: 19 older adults (age 74.16 ± 4.78; MOCA scores 26.42 ± 2.52) with preclinical AD, evidenced by elevated cortical beta-amyloid; and 21 controls (age 73.81 ± 5.62; MOCA scores 28.24 ± 1.67). All participants completed two scenarios in a driving simulator. Scenario 1 included conditional automation with an emergency event that required a manual take-over maneuver. Scenario 2 was identical but with a cognitive distractor task. Emergency response time was the main safety outcome measure. Cognitive workload was calculated using moment-to-moment changes in pupillary size and converted into an Index of Cognitive Activity (ICA). Mann-Whitney U and independent t tests were used to compare group differences. RESULTS Emergency response times were similar between drivers with preclinical AD and controls in scenario 1 (20.85 s ± 1.08 vs. 20.52 s ± 3.18; p = 0.83) and scenario 2 (14.83 s ± 7.37 vs. 13.45 s ± 10.43; p = 0.92). Likewise, no differences were found in ICA between drivers with preclinical AD and controls in scenario 1 (0.34 ± 0.08 vs. 0.33 ± 0.17; p = 0.74) or scenario 2 (0.30 ± 0.07 vs. 0.29 ± 0.17; p = 0.93). CONCLUSIONS Older drivers with preclinical AD may safely operate AV technology, without increased response times or cognitive workload. Future on-road studies with AV technology should confirm these preliminary results in drivers with preclinical AD.
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Affiliation(s)
- Pedram Ahmadnezhad
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas, USA,
| | - Jeffrey M Burns
- University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Kansas City, Kansas, USA
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Abiodun E Akinwuntan
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas, USA
- University of Kansas Center for Community Access, Rehabilitation Research, Education, and Service (KU-CARES), University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Maud Ranchet
- Université Gustave Eiffel, IFSTTAR, University Lyon, Lyon, France
| | - Alexandra Kondyli
- Department of Civil, Environmental, Architectural Engineering at University of Kansas, Kansas City, Kansas, USA
| | - Jonathan D Mahnken
- University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Kansas City, Kansas, USA
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Hannes Devos
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas, USA
- University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Kansas City, Kansas, USA
- University of Kansas Center for Community Access, Rehabilitation Research, Education, and Service (KU-CARES), University of Kansas Medical Center, Kansas City, Kansas, USA
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Hudson HM, Guggenmos DJ, Azin M, Vitale N, McKenzie KA, Mahnken JD, Mohseni P, Nudo RJ. Broad Therapeutic Time Window for Driving Motor Recovery After TBI Using Activity-Dependent Stimulation. Neurorehabil Neural Repair 2023; 37:384-393. [PMID: 36636754 DOI: 10.1177/15459683221145144] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND After an acquired injury to the motor cortex, the ability to generate skilled movements is impaired, leading to long-term motor impairment and disability. While rehabilitative therapy can improve outcomes in some individuals, there are no treatments currently available that are able to fully restore lost function. OBJECTIVE We previously used activity-dependent stimulation (ADS), initiated immediately after an injury, to drive motor recovery. The objective of this study was to determine if delayed application of ADS would still lead to recovery and if the recovery would persist after treatment was stopped. METHODS Rats received a controlled cortical impact over primary motor cortex, microelectrode arrays were implanted in ipsilesional premotor and somatosensory areas, and a custom brain-machine interface was attached to perform the ADS. Stimulation was initiated either 1, 2, or 3 weeks after injury and delivered constantly over a 4-week period. An additional group was monitored for 8 weeks after terminating ADS to assess persistence of effect. Results were compared to rats receiving no stimulation. RESULTS ADS was delayed up to 3 weeks from injury onset and still resulted in significant motor recovery, with maximal recovery occurring in the 1-week delay group. The improvements in motor performance persisted for at least 8 weeks following the end of treatment. CONCLUSIONS ADS is an effective method to treat motor impairments following acquired brain injury in rats. This study demonstrates the clinical relevance of this technique as it could be initiated in the post-acute period and could be explanted/ceased once recovery has occurred.
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Affiliation(s)
- Heather M Hudson
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - David J Guggenmos
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Meysam Azin
- Department of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, OH, USA
| | - Nicholas Vitale
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Katelyn A McKenzie
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jonathan D Mahnken
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Pedram Mohseni
- Department of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, OH, USA
| | - Randolph J Nudo
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA
- Landon Center on Aging, University of Kansas Medical Center, Kansas City, KS, USA
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McKenzie KA, Mahnken JD. Simulating and estimating agreement in the presence of multiple raters and covariates. Stat Med 2023; 42:1687-1698. [PMID: 36872574 PMCID: PMC10599607 DOI: 10.1002/sim.9694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 01/30/2023] [Accepted: 02/16/2023] [Indexed: 03/07/2023]
Abstract
Cohen's and Fleiss's kappa are popular estimators for assessing agreement among two and multiple raters, respectively, for a binary response. While additional methods have been developed to account for multiple raters and covariates, they are not always applicable, rarely used, and none simplify to Cohen's kappa. Furthermore, there are no methods to simulate Bernoulli observations under the kappa agreement structure such that the developed methods could be adequately assessed. This manuscript overcomes these shortfalls. First, we developed a model-based estimator for kappa that accommodates multiple raters and covariates through a generalized linear mixed model and encompasses Cohen's kappa as a special case. Second, we created a framework to simulate dependent Bernoulli observations that upholds all 2-tuple pair of rater's kappa agreement structure and includes covariates. We used this framework to assess our method when kappa was nonzero. Simulations showed that Cohen's and Fleiss's kappa estimates were inflated unlike our model-based kappa. We analyzed an Alzheimer's disease neuroimaging study and the classic cervical cancer pathology study. The proposed model-based kappa and advancement in simulation methodology demonstrates that the popular approaches of Cohen's and Fleiss's kappa are poised to yield invalid conclusions while our work overcomes shortfalls, leading to improved inferences.
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Affiliation(s)
- Katelyn A McKenzie
- Biostatistics & Data Science, The University of Kansas Medical Center, Kansas City, Missouri, USA
| | - Jonathan D Mahnken
- Biostatistics & Data Science, The University of Kansas Medical Center, Kansas City, Missouri, USA
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Myers JS, Parks AC, Mahnken JD, Young KJ, Pathak HB, Puri RV, Unrein A, Switzer P, Abdulateef Y, Sullivan S, Walker JF, Streeter D, Burns JM. First-Line Immunotherapy with Check-Point Inhibitors: Prospective Assessment of Cognitive Function. Cancers (Basel) 2023; 15:1615. [PMID: 36900405 PMCID: PMC10000599 DOI: 10.3390/cancers15051615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/25/2023] [Accepted: 03/04/2023] [Indexed: 03/08/2023] Open
Abstract
Approximately 40% of patients with cancer are eligible for check-point inhibitor (CPI) therapy. Little research has examined the potential cognitive impact of CPIs. First-line CPI therapy offers a unique research opportunity without chemotherapy-related confounders. The purpose of this prospective, observational pilot was to (1) demonstrate the feasibility of prospective recruitment, retention, and neurocognitive assessment for older adults receiving first-line CPI(s) and (2) provide preliminary evidence of changes in cognitive function associated with CPI(s). Patients receiving first-line CPI(s) (CPI Group) were assessed at baseline (n = 20) and 6 months (n = 13) for self-report of cognitive function and neurocognitive test performance. Results were compared to age-matched controls without cognitive impairment assessed annually by the Alzheimer's Disease Research Center (ADRC). Plasma biomarkers were measured at baseline and 6 months for the CPI Group. Estimated differences for CPI Group scores prior to initiating CPIs (baseline) trended to lower performance on the Montreal Cognitive Assessment-Blind (MOCA-Blind) test compared to the ADRC controls (p = 0.066). Controlling for age, the CPI Group's 6-months MOCA-Blind performance was lower than the ADRC control group's 12-months performance (p = 0.011). No significant differences in biomarkers were detected between baseline and 6 months, although significant correlations were noted for biomarker change and cognitive performance at 6 months. IFNγ, IL-1β, IL-2, FGF2, and VEGF were inversely associated with Craft Story Recall performance (p < 0.05), e.g., higher levels correlated with poorer memory performance. Higher IGF-1 and VEGF correlated with better letter-number sequencing and digit-span backwards performance, respectively. Unexpected inverse correlation was noted between IL-1α and Oral Trail-Making Test B completion time. CPI(s) may have a negative impact on some neurocognitive domains and warrant further investigation. A multi-site study design may be crucial to fully powering prospective investigation of the cognitive impact of CPIs. Establishment of a multi-site observational registry from collaborating cancer centers and ADRCs is recommended.
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Affiliation(s)
- Jamie S. Myers
- School of Nursing, University of Kansas, Kansas City, KS 66160, USA
| | - Adam C. Parks
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Jonathan D. Mahnken
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Kate J. Young
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Harsh B. Pathak
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Rajni V. Puri
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Amber Unrein
- University of Kansas Alzheimer’s Disease Research Center, Fairway, KS 66111, USA
| | - Phyllis Switzer
- University of Kansas Alzheimer’s Disease Research Center, Fairway, KS 66111, USA
| | - Yazan Abdulateef
- Department of Quality Assurance, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Samantha Sullivan
- University of Kansas Alzheimer’s Disease Research Center, Fairway, KS 66111, USA
| | - John F. Walker
- University of Kansas Alzheimer’s Disease Research Center, Fairway, KS 66111, USA
| | - David Streeter
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Jeffrey M. Burns
- University of Kansas Alzheimer’s Disease Research Center, Fairway, KS 66111, USA
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Devos H, Gustafson KM, Liao K, Ahmadnezhad P, Kuhlmann E, Estes BJ, Martin LE, Mahnken JD, Brooks WM, Burns JM. Effect of Cognitive Reserve on Physiological Measures of Cognitive Workload in Older Adults with Cognitive Impairments. J Alzheimers Dis 2023; 92:141-151. [PMID: 36710677 PMCID: PMC10023364 DOI: 10.3233/jad-220890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Cognitive reserve may protect against cognitive decline. OBJECTIVE This cross-sectional study investigated the association between cognitive reserve and physiological measures of cognitive workload in older adults with cognitive impairment. METHODS 29 older adults with cognitive impairment (age: 75±6, 11 (38%) women, MoCA: 20±7) and 19 with normal cognition (age: 74±6; 11 (58%) women; MoCA: 28±2) completed a working memory test of increasing task demand (0-, 1-, 2-back). Cognitive workload was indexed using amplitude and latency of the P3 event-related potential (ERP) at electrode sites Fz, Cz, and Pz, and changes in pupillary size, converted to an index of cognitive activity (ICA). The Cognitive Reserve Index questionnaire (CRIq) evaluated Education, Work Activity, and Leisure Time as a proxy of cognitive reserve. Linear mixed models evaluated the main effects of cognitive status, CRIq, and the interaction effect of CRIq by cognitive status on ERP and ICA. RESULTS The interaction effect of CRIq total score by cognitive status on P3 ERP and ICA was not significant. However, higher CRIq total scores were associated with lower ICA (p = 0.03). The interaction effects of CRIq subscores showed that Work Activity affected P3 amplitude (p = 0.03) and ICA (p = 0.03) differently between older adults with and without cognitive impairments. Similarly, Education affected ICA (p = 0.02) differently between the two groups. No associations were observed between CRIq and P3 latency. CONCLUSION Specific components of cognitive reserve affect cognitive workload and neural efficiency differently in older adults with and without cognitive impairments.
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Affiliation(s)
- Hannes Devos
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA.,University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kathleen M Gustafson
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.,Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - Ke Liao
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - Pedram Ahmadnezhad
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Emily Kuhlmann
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Bradley J Estes
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Laura E Martin
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jonathan D Mahnken
- University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - William M Brooks
- University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.,Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jeffrey M Burns
- University of Kansas Alzheimer's Disease Research Center, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
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Estes BJ, Gustafson K, Liao K, Martin LE, Ahmadnezhad P, Kuhlmann E, Brooks WM, Mahnken JD, Burns JM, Devos H. Longitudinal Changes in P3 Event‐related Potential among Older Adults with Preclinical Alzheimer’s Disease: A 1‐year Follow‐Up. Alzheimers Dement 2022. [DOI: 10.1002/alz.061369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Kathleen Gustafson
- University of Kansas Medical Center Kansas City KS USA
- Hoglund Brain Imaging Center, University of Kansas Medical Center Kansas City KS USA
| | - Ke Liao
- University of Kansas Medical Center Kansas City KS USA
- Hoglund Brain Imaging Center, University of Kansas Medical Center Kansas City KS USA
| | | | | | | | - William M Brooks
- University of Kansas Medical Center Kansas City KS USA
- Hoglund Brain Imaging Center, University of Kansas Medical Center Kansas City KS USA
| | | | - Jeffrey M. Burns
- University of Kansas Medical Center Kansas City KS USA
- University of Kansas Alzheimer’s Disease Center Kansas City KS USA
| | - Hannes Devos
- University of Kansas Medical Center Kansas City KS USA
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10
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Durham MD, Armon C, Novak RM, Mahnken JD, Carlson K, Li J, Buchacz K. Longitudinal Changes in, and Factors Associated with, the Frequency of Condomless Sex Among People in Care for HIV Infection, HIV Outpatient Study USA, 2007-2019. AIDS Behav 2022; 26:3199-3209. [PMID: 35364730 PMCID: PMC10246446 DOI: 10.1007/s10461-022-03655-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 11/01/2022]
Abstract
During 2007-2019, the percentage of HIV Outpatient Study participants reporting anal or vaginal condomless sex in the past 6 months ranged from a low of 17% among heterosexual males to 59% for men who have sex with men (MSM). MSM reported having had condomless sex more frequently than heterosexual males and females and were the only group in which an increase in condomless sex was observed during the study period (from 39 to 59%). Although persons with undetectable HIV viral load have effectively no risk of transmitting HIV sexually (U = U), there is still the potential risk of transmission or acquisition of other sexually transmitted infections (STIs) when engaging in condomless sex. Continuing education about risks of HIV and STI transmission as well as ongoing screening for and treatment of STIs, retention in HIV treatment, and support for sexual health are critical components of care for people living with HIV.
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Affiliation(s)
- Marcus D Durham
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Centers for Disease Control and Prevention, 1600 Clifton Road, MS US8-4, Atlanta, GA, 30333, USA.
| | - Carl Armon
- Cerner Corporation, Kansas City, MO, USA
| | | | - Jonathan D Mahnken
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Jun Li
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Centers for Disease Control and Prevention, 1600 Clifton Road, MS US8-4, Atlanta, GA, 30333, USA
| | - Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Centers for Disease Control and Prevention, 1600 Clifton Road, MS US8-4, Atlanta, GA, 30333, USA.
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11
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Gupta A, Mahnken JD, Cibrik DM. The physical frailty phenotype: Not ready for implementation. Am J Transplant 2022; 22:2276. [PMID: 35285138 DOI: 10.1111/ajt.17025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Aditi Gupta
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.,Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jonathan D Mahnken
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA.,Frontiers Clinical & Translational Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Diane M Cibrik
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.,Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA
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12
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Vidoni ED, Morris JK, Palmer JA, Li Y, White D, Kueck PJ, John CS, Honea RA, Lepping RJ, Lee P, Mahnken JD, Martin LE, Billinger SA. Dementia risk and dynamic response to exercise: A non-randomized clinical trial. PLoS One 2022; 17:e0265860. [PMID: 35802628 PMCID: PMC9269742 DOI: 10.1371/journal.pone.0265860] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background Physical exercise may support brain health and cognition over the course of typical aging. The goal of this nonrandomized clinical trial was to examine the effect of an acute bout of aerobic exercise on brain blood flow and blood neurotrophic factors associated with exercise response and brain function in older adults with and without possession of the Apolipoprotein epsilon 4 (APOE4) allele, a genetic risk factor for developing Alzheimer’s. We hypothesized that older adult APOE4 carriers would have lower cerebral blood flow regulation and would demonstrate blunted neurotrophic response to exercise compared to noncarriers. Methods Sixty-two older adults (73±5 years old, 41 female [67%]) consented to this prospectively enrolling clinical trial, utilizing a single arm, single visit, experimental design, with post-hoc assessment of difference in outcomes based on APOE4 carriership. All participants completed a single 15-minute bout of moderate-intensity aerobic exercise. The primary outcome measure was change in cortical gray matter cerebral blood flow in cortical gray matter measured by magnetic resonance imaging (MRI) arterial spin labeling (ASL), defined as the total perfusion (area under the curve, AUC) following exercise. Secondary outcomes were changes in blood neurotrophin concentrations of insulin-like growth factor-1 (IGF-1), vascular endothelial growth factor (VEGF), and brain derived neurotrophic factor (BDNF). Results Genotyping failed in one individual (n = 23 APOE4 carriers and n = 38 APOE4 non-carriers) and two participants could not complete primary outcome testing. Cerebral blood flow AUC increased immediately following exercise, regardless of APOE4 carrier status. In an exploratory regional analyses, we found that cerebral blood flow increased in hippocampal brain regions, while showing no change in cerebellum across both groups. Among high inter-individual variability, there were no significant changes in any of the 3 neurotrophic factors for either group immediately following exercise. Conclusions Our findings show that both APOE4 carriers and non-carriers show similar effects of exercise-induced increases in cerebral blood flow and neurotrophic response to acute aerobic exercise. Our results provide further evidence that acute exercise-induced increases in cerebral blood flow may be regional specific, and that exercise-induced neurotrophin release may show a differential effect in the aging cardiovascular system. Results from this study provide an initial characterization of the acute brain blood flow and neurotrophin responses to a bout of exercise in older adults with and without this known risk allele for cardiovascular disease and Alzheimer’s disease. Trial registration Dementia Risk and Dynamic Response to Exercise (DYNAMIC); Identifier: NCT04009629.
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Affiliation(s)
- Eric D. Vidoni
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States of America
- * E-mail:
| | - Jill K. Morris
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Jacqueline A. Palmer
- Department of Physical Therapy, Rehabilitation Science and Athletic Training, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Yanming Li
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Dreu White
- Department of Physical Therapy, Rehabilitation Science and Athletic Training, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Paul J. Kueck
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Casey S. John
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Robyn A. Honea
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Rebecca J. Lepping
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Phil Lee
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Jonathan D. Mahnken
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Laura E. Martin
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Sandra A. Billinger
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States of America
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13
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Devos H, Gustafson K, Liao K, Ahmadnezhad P, Estes B, Martin LE, Mahnken JD, Brooks WM, Burns JM. EEG/ERP evidence of possible hyperexcitability in older adults with elevated beta-amyloid. Transl Neurodegener 2022; 11:8. [PMID: 35139917 PMCID: PMC8827181 DOI: 10.1186/s40035-022-00282-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although growing evidence links beta-amyloid (Aβ) and neuronal hyperexcitability in preclinical mouse models of Alzheimer's disease (AD), a similar association in humans is yet to be established. The first aim of the study was to determine the association between elevated Aβ (Aβ+) and cognitive processes measured by the P3 event-related potential (ERP) in cognitively normal (CN) older adults. The second aim was to compare the event-related power between CNAβ+ and CNAβ-. METHODS Seventeen CNAβ+ participants (age: 73 ± 5, 11 females, Montreal Cognitive Assessment [MoCA] score 26 ± 2) and 17 CNAβ- participants group-matched for age, sex, and MOCA completed a working memory task (n-back with n = 0, 1, 2) test while wearing a 256-channel electro-encephalography net. P3 peak amplitude and latency of the target, nontarget and task difference effect (nontarget-target), and event-related power in the delta, theta, alpha, and beta bands, extracted from Fz, Cz, and Pz, were compared between groups using linear mixed models. P3 amplitude of the task difference effect at Fz and event-related power in the delta band were considered main outcomes. Correlations of mean Aβ standard uptake value ratios (SUVR) using positron emission tomography with P3 amplitude and latency of the task difference effect were analyzed using Pearson Correlation Coefficient r. RESULTS The P3 peak amplitude of the task difference effect at Fz was lower in the CNAβ+ group (P = 0.048). Similarly, power was lower in the delta band for nontargets at Fz in the CNAβ+ participants (P = 0.04). The CNAβ+ participants also demonstrated higher theta and alpha power in channels at Cz and Pz, but no changes in P3 ERP. Strong correlations were found between the mean Aβ SUVR and the latency of the 1-back (r = - 0.69; P = 0.003) and 2-back (r = - 0.69; P = 0.004) of the task difference effect at channel Fz in the CNAβ+ group. CONCLUSIONS Our data suggest that the elevated amyloid in cognitively normal older adults is associated with neuronal hyperexcitability. The decreased P3 task difference likely reflects early impairments in working memory processes. Further research is warranted to determine the validity of ERP in predicting clinical, neurobiological, and functional manifestations of AD.
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Affiliation(s)
- Hannes Devos
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
| | - Kathleen Gustafson
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, 66160, USA
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Ke Liao
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Pedram Ahmadnezhad
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Bradley Estes
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Laura E Martin
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, 66160, USA
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Jonathan D Mahnken
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS, 66160, USA
- University of Kansas Alzheimer's Disease Center, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - William M Brooks
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, 66160, USA
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, 66160, USA
- University of Kansas Alzheimer's Disease Center, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Jeffrey M Burns
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, 66160, USA
- University of Kansas Alzheimer's Disease Center, University of Kansas Medical Center, Kansas City, KS, 66160, USA
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14
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Devos H, Gustafson K, Liao K, Ahmadnezhad P, Brooks W, Mahnken JD, Burns JM. The relationship between beta‐amyloid accumulation and P3 event‐related potential in older adults: A pilot study. Alzheimers Dement 2021. [DOI: 10.1002/alz.052414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Hannes Devos
- University of Kansas Medical Center Kansas City KS USA
| | - Kathleen Gustafson
- University of Kansas Medical Center Kansas City KS USA
- Hoglund Brain Imaging Center University of Kansas Medical Center Kansas City KS USA
| | - Ke Liao
- University of Kansas Medical Center Kansas City KS USA
- Hoglund Brain Imaging Center University of Kansas Medical Center Kansas City KS USA
| | | | - William Brooks
- University of Kansas Medical Center Kansas City KS USA
- Hoglund Brain Imaging Center University of Kansas Medical Center Kansas City KS USA
| | - Jonathan D Mahnken
- University of Kansas Medical Center Kansas City KS USA
- University of Kansas Alzheimer's Disease Center Fairway KS USA
| | - Jeffrey M. Burns
- University of Kansas Medical Center Kansas City KS USA
- University of Kansas Alzheimer's Disease Center Fairway KS USA
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15
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Devos H, Brooks W, Gustafson K, Liao K, Ahmadnezhad P, Mahnken JD, Burns JM. The relationship between hippocampal volume and P3 event‐related potential in cognitively normal older adults without and with elevated amyloid: A pilot study. Alzheimers Dement 2021. [DOI: 10.1002/alz.052418] [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: 11/06/2022]
Affiliation(s)
- Hannes Devos
- University of Kansas Medical Center Kansas City KS USA
| | - William Brooks
- University of Kansas Medical Center Kansas City KS USA
- Hoglund Brain Imaging Center University of Kansas Medical Center Kansas City KS USA
| | - Kathleen Gustafson
- University of Kansas Medical Center Kansas City KS USA
- Hoglund Brain Imaging Center University of Kansas Medical Center Kansas City KS USA
| | - Ke Liao
- University of Kansas Medical Center Kansas City KS USA
- Hoglund Brain Imaging Center University of Kansas Medical Center Kansas City KS USA
| | | | - Jonathan D Mahnken
- University of Kansas Medical Center Kansas City KS USA
- University of Kansas Alzheimer's Disease Center Fairway KS USA
| | - Jeffrey M. Burns
- University of Kansas Medical Center Kansas City KS USA
- University of Kansas Alzheimer's Disease Center Fairway KS USA
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16
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Taylor MK, Sullivan DK, Morris JK, Vidoni ED, Honea RA, Mahnken JD, Burns JM. High Glycemic Diet Is Related to Brain Amyloid Accumulation Over One Year in Preclinical Alzheimer's Disease. Front Nutr 2021; 8:741534. [PMID: 34646853 PMCID: PMC8502814 DOI: 10.3389/fnut.2021.741534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/31/2021] [Indexed: 12/23/2022] Open
Abstract
Objective: To test the hypothesis that high glycemic diet is related to 1-year change in brain amyloid based on our prior cross-sectional evidence that high glycemic diet is associated with brain amyloid. Methods: This longitudinal, observational study assessed the relationship between reported habitual consumption of a high glycemic diet (HGDiet) pattern and 1-year brain amyloid change measured by Florbetapir F18 PET scans in 102 cognitively normal older adults with elevated or sub-threshold amyloid status that participated in a 1-year randomized, controlled exercise trial at the University of Kansas Medical Center in Kansas City. Results: Among all participants (n = 102), higher daily intake of the HGDiet pattern (β = 0.06, p = 0.04), sugar (β = 0.07, p = 0.01), and total carbohydrate (β = 0.06, p = 0.04) were related to more precuneal amyloid accumulation. These relationships in the precuneus were accentuated in participants with elevated amyloid at enrollment (n = 70) where higher intake of the HGDiet pattern, sugar, and carbohydrate were related to more precuneal amyloid accumulation (β = 0.11, p = 0.01 for all measures). In individuals with elevated amyloid, higher intake of the HGDiet pattern was also related to more amyloid accumulation in the lateral temporal lobe (β = 0.09, p < 0.05) and posterior cingulate gyrus (β = 0.09, p < 0.05) and higher sugar and carbohydrate intake were also related to more amyloid accumulation in the posterior cingulate gyrus (β = 0.10, p < 0.05 for both measures). Conclusion: This longitudinal observational analysis suggests that a high glycemic diet relates to higher brain amyloid accumulation over 1 year in regions of the temporoparietal cortex in cognitively normal adults, particularly in those with elevated amyloid status. Further studies are required to assess whether there is causal link between a high glycemic diet and brain amyloid. Clinical Trial Registration:ClinicalTrials.gov, Identifier (NCT02000583).
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Affiliation(s)
- Matthew K Taylor
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas, KS, United States.,University of Kansas Alzheimer's Disease Center, Fairway, KS, United States
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas, KS, United States.,University of Kansas Alzheimer's Disease Center, Fairway, KS, United States
| | - Jill K Morris
- University of Kansas Alzheimer's Disease Center, Fairway, KS, United States.,Department of Neurology, University of Kansas Medical Center, Kansas, KS, United States
| | - Eric D Vidoni
- University of Kansas Alzheimer's Disease Center, Fairway, KS, United States.,Department of Neurology, University of Kansas Medical Center, Kansas, KS, United States
| | - Robyn A Honea
- University of Kansas Alzheimer's Disease Center, Fairway, KS, United States.,Department of Neurology, University of Kansas Medical Center, Kansas, KS, United States
| | - Jonathan D Mahnken
- University of Kansas Alzheimer's Disease Center, Fairway, KS, United States.,Department of Biostatistics, University of Kansas Medical Center, Kansas, KS, United States
| | - Jeffrey M Burns
- University of Kansas Alzheimer's Disease Center, Fairway, KS, United States.,Department of Neurology, University of Kansas Medical Center, Kansas, KS, United States
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17
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Morris JK, McCoin CS, Fuller KN, John CS, Wilkins HM, Green ZD, Wang X, Sharma P, Burns JM, Vidoni ED, Mahnken JD, Shankar K, Swerdlow RH, Thyfault JP. Mild Cognitive Impairment and Donepezil Impact Mitochondrial Respiratory Capacity in Skeletal Muscle. Function (Oxf) 2021; 2:zqab045. [PMID: 34661111 PMCID: PMC8515006 DOI: 10.1093/function/zqab045] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/18/2021] [Accepted: 08/31/2021] [Indexed: 01/07/2023]
Abstract
Alzheimer's Disease (ad) associates with insulin resistance and low aerobic capacity, suggestive of impaired skeletal muscle mitochondrial function. However, this has not been directly measured in AD. This study ( n = 50) compared muscle mitochondrial respiratory function and gene expression profiling in cognitively healthy older adults (CH; n = 24) to 26 individuals in the earliest phase of ad-related cognitive decline, mild cognitive impairment (MCI; n = 11) or MCI taking the ad medication donepezil (MCI + med; n = 15). Mitochondrial respiratory kinetics were measured in permeabilized muscle fibers from muscle biopsies of the vastus lateralis. Untreated MCI exhibited lower lipid-stimulated skeletal muscle mitochondrial respiration (State 3, ADP-stimulated) than both CH ( P = .043) and MCI + med (P = .007) groups. MCI also exhibited poorer mitochondrial coupling control compared to CH (P = .014). RNA sequencing of skeletal muscle revealed unique differences in mitochondrial function and metabolism genes based on both MCI status (CH vs MCI) and medication treatment (MCI vs MCI + med). MCI + med modified over 600 skeletal muscle genes compared to MCI suggesting donepezil powerfully impacts the transcriptional profile of muscle. Overall, skeletal muscle mitochondrial respiration is altered in untreated MCI but normalized in donepezil-treated MCI participants while leak control is impaired regardless of medication status. These results provide evidence that mitochondrial changes occur in the early stages of AD, but are influenced by a common ad medicine. Further study of mitochondrial bioenergetics and the influence of transcriptional regulation in early ad is warranted.
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Affiliation(s)
| | - Colin S McCoin
- Department of Molecular and Integrative Physiology and Internal Medicine-Division of Endocrinology and Metabolism, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kelly N Fuller
- Department of Molecular and Integrative Physiology and Internal Medicine-Division of Endocrinology and Metabolism, University of Kansas Medical Center, Kansas City, KS, USA
| | - Casey S John
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Alzheimer's Disease Center, Kansas City, KS, USA
| | - Heather M Wilkins
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Alzheimer's Disease Center, Kansas City, KS, USA
| | - Zachary D Green
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Alzheimer's Disease Center, Kansas City, KS, USA
| | - Xiaowan Wang
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Alzheimer's Disease Center, Kansas City, KS, USA
| | - Palash Sharma
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jeffrey M Burns
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Alzheimer's Disease Center, Kansas City, KS, USA
| | - Eric D Vidoni
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Alzheimer's Disease Center, Kansas City, KS, USA
| | - Jonathan D Mahnken
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Alzheimer's Disease Center, Kansas City, KS, USA
| | - Kartik Shankar
- Pediatrics, Section of Nutrition, The University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Russell H Swerdlow
- University of Kansas Alzheimer's Disease Center, Kansas City, KS, USA
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
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18
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Sharma P, Montgomery RN, Graves RS, Meyer K, Hunt SL, Vidoni ED, Mahnken JD, Swerdlow RH, Burns JM, Mudaranthakam DP. CONSENSUS: a Shiny application of dementia evaluation and reporting for the KU ADC longitudinal Clinical Cohort database. JAMIA Open 2021; 4:ooab060. [PMID: 34350395 PMCID: PMC8327371 DOI: 10.1093/jamiaopen/ooab060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/26/2021] [Accepted: 07/09/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The University of Kansas Alzheimer's Disease Center (KU ADC) maintains several large databases to track participant recruitment, enrollment, and capture various research-related activities. It is challenging to manage and coordinate all the research-related activities. One of the crucial activities involves generating a consensus diagnosis and communicating with participants and their primary care providers. PROCESS To effectively manage the cohort, the KU ADC utilizes a combination of open-source electronic data capture (EDC) (i.e. REDCap), along with other homegrown data management and analytic systems developed using R-studio and Shiny. PROCESS EVALUATION In this article, we describe the method and utility of the user-friendly dashboard that was developed for the rapid reporting of dementia evaluations which allows clinical researchers to summarize recruitment metrics, automatically generate letters to both participants and healthcare providers, which ultimately help optimize workflows. CONCLUSIONS We believe this general framework would be beneficial to any institution that build reports and summarizing key metrics of their research from longitudinal databases.
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Affiliation(s)
- Palash Sharma
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Robert N Montgomery
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Rasinio S Graves
- University of California Davis Alzheimer’s Disease Center, Sacramento, California, USA
| | - Kayla Meyer
- University of Kansas Alzheimer’s Disease Center, Fairway, Kansas, USA
| | - Suzanne L Hunt
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
- University of Kansas Alzheimer’s Disease Center, Fairway, Kansas, USA
| | - Eric D Vidoni
- University of Kansas Alzheimer’s Disease Center, Fairway, Kansas, USA
| | - Jonathan D Mahnken
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
- University of Kansas Alzheimer’s Disease Center, Fairway, Kansas, USA
| | | | - Jeffrey M Burns
- University of Kansas Alzheimer’s Disease Center, Fairway, Kansas, USA
| | - Dinesh Pal Mudaranthakam
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
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19
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Lepping RJ, Montgomery RN, Sharma P, Mahnken JD, Vidoni ED, Choi IY, Sarnak MJ, Brooks WM, Burns JM, Gupta A. Normalization of Cerebral Blood Flow, Neurochemicals, and White Matter Integrity after Kidney Transplantation. J Am Soc Nephrol 2021; 32:177-187. [PMID: 33067382 PMCID: PMC7894653 DOI: 10.1681/asn.2020050584] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/06/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND CKD is associated with abnormalities in cerebral blood flow, cerebral neurochemical concentrations, and white matter integrity. Each of these is associated with adverse clinical consequences in the non-CKD population, which may explain the high prevalence of dementia and stroke in ESKD. Because cognition improves after kidney transplantation, comparing these brain abnormalities before and after kidney transplantation may identify potential reversibility in ESKD-associated brain abnormalities. METHODS In this study of patients with ESKD and age-matched healthy controls, we used arterial spin labeling to assess the effects of kidney transplantation on cerebral blood flow and magnetic resonance spectroscopic imaging to measure cerebral neurochemical concentrations (N-acetylaspartate, choline, glutamate, glutamine, myo-inositol, and total creatine). We also assessed white matter integrity measured by fractional anisotropy (FA) and mean diffusivity (MD) with diffusion tensor imaging. We used a linear mixed model analysis to compare longitudinal, repeated brain magnetic resonance imaging measurements before, 3 months after, and 12 months after transplantation and compared these findings with those of healthy controls. RESULTS Study participants included 29 patients with ESKD and 19 controls; 22 patients completed post-transplant magnetic resonance imaging. Cerebral blood flow, which was higher in patients pretransplant compared with controls (P=0.003), decreased post-transplant (P<0.001) to values in controls. Concentrations of neurochemicals choline and myo-inositol that were higher pretransplant compared with controls (P=0.001 and P<0.001, respectively) also normalized post-transplant (P<0.001 and P<0.001, respectively). FA increased (P=0.001) and MD decreased (P<0.001) post-transplant. CONCLUSIONS Certain brain abnormalities in CKD are reversible and normalize with kidney transplantation. Further studies are needed to understand the mechanisms underlying these brain abnormalities and to explore interventions to mitigate them even in patients who cannot be transplanted. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Cognitive Impairment and Imaging Correlates in End Stage Renal Disease, NCT01883349.
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Affiliation(s)
- Rebecca J. Lepping
- Hoglund Biomedical Imaging Center, Kansas City, Kansas,University of Kansas Alzheimer’s Disease Center, Fairway, Kansas
| | - Robert N. Montgomery
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Palash Sharma
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Jonathan D. Mahnken
- University of Kansas Alzheimer’s Disease Center, Fairway, Kansas,Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Eric D. Vidoni
- University of Kansas Alzheimer’s Disease Center, Fairway, Kansas,Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
| | - In-Young Choi
- Hoglund Biomedical Imaging Center, Kansas City, Kansas,Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
| | - Mark J. Sarnak
- Division of Nephrology and Hypertension, Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts
| | - William M. Brooks
- Hoglund Biomedical Imaging Center, Kansas City, Kansas,University of Kansas Alzheimer’s Disease Center, Fairway, Kansas,Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas,Frontiers: University of Kanas Clinical and Translational Science Institute, University of Kansas Medical Center, Kansas City, Kansas
| | - Jeffrey M. Burns
- University of Kansas Alzheimer’s Disease Center, Fairway, Kansas,Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas,Frontiers: University of Kanas Clinical and Translational Science Institute, University of Kansas Medical Center, Kansas City, Kansas
| | - Aditi Gupta
- University of Kansas Alzheimer’s Disease Center, Fairway, Kansas,Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas,The Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas
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20
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Devos H, Gustafson K, Ahmadnezhad P, Liao K, Mahnken JD, Brooks WM, Burns JM. Psychometric Properties of NASA-TLX and Index of Cognitive Activity as Measures of Cognitive Workload in Older Adults. Brain Sci 2020; 10:E994. [PMID: 33339224 PMCID: PMC7766152 DOI: 10.3390/brainsci10120994] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/01/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022] Open
Abstract
Cognitive workload is increasingly recognized as an important determinant of performance in cognitive tests and daily life activities. Cognitive workload is a measure of physical and mental effort allocation to a task, which can be determined through self-report or physiological measures. However, the reliability and validity of these measures have not been established in older adults with a wide range of cognitive ability. The aim of this study was to establish the test-retest reliability of the National Aeronautics and Space Administration Task Load Index (NASA-TLX) and Index of Cognitive Activity (ICA), extracted from pupillary size. The convergent validity of these measures against event-related potentials (ERPs) was also investigated. A total of 38 individuals with scores on the Montreal Cognitive Assessment ranging between 17 and 30 completed a working memory test (n-back) with three levels of difficulty at baseline and at a two-week follow-up. The intraclass correlation coefficients (ICC) values of the NASA-TLX ranged between 0.71 and 0.81, demonstrating good to excellent reliability. The mean ICA scores showed fair to good reliability, with ICCs ranging between 0.56 and 0.73. The mean ICA and NASA-TLX scores showed significant and moderate correlations (Pearson's r ranging between 0.30 and 0.33) with the third positive peak of the ERP at the midline channels. We conclude that ICA and NASA-TLX are reliable measures of cognitive workload in older adults. Further research is needed in dissecting the subjective and objective constructs of cognitive workload.
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Affiliation(s)
- Hannes Devos
- Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Kathleen Gustafson
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA; (K.G.); (W.M.B.); (J.M.B.)
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Pedram Ahmadnezhad
- Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Ke Liao
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Jonathan D. Mahnken
- University of Kansas Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, KS 66160, USA;
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - William M. Brooks
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA; (K.G.); (W.M.B.); (J.M.B.)
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS 66160, USA;
- University of Kansas Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Jeffrey M. Burns
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA; (K.G.); (W.M.B.); (J.M.B.)
- University of Kansas Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, KS 66160, USA;
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21
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Abstract
This article introduces a global hypothesis test intended for studies with multiple endpoints. Our test makes use of a priori predictions about the direction of the result of each endpoint and we weight these predictions using the sample correlation matrix. The global alternative hypothesis concerns a parameter, ϕ, defined as the researcher's ability to correctly predict the direction of each measure, essentially a binomial parameter. This allows for the test to include expected effects that are all positive, all negative or both while still using the cumulative information across those endpoints. A rejection of the null hypothesis (H0:ϕ≤ϕ0) provides evidence that the researcher's underlying theory about the natural process provides a better prediction of the observed results relative to the null hypothesized predictive ability, thus indicating the theory is worthy of further study. We compare our test to O'Brien's ordinary least squares (OLS) test and show that for small samples and situations where the effect is not in the same direction across all endpoints our approach has better power, while if the effect is equidirectional across all endpoints the OLS test can have greater power.
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Affiliation(s)
- Robert N. Montgomery
- Department of Biostatistics & Data ScienceUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Jonathan D. Mahnken
- Department of Biostatistics & Data ScienceUniversity of Kansas Medical CenterKansas CityKansasUSA
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22
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Chalise P, Sharma P, Hui D, Mahnken JD, Michaelis ML, Michaelis EK, Swerdlow RH. Association of Alzheimer’s disease progression with baseline clinical and genetic characteristics. Alzheimers Dement 2020. [DOI: 10.1002/alz.042362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Palash Sharma
- University of Kansas Medical Center Kansas City KS USA
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23
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Kimber C, Zhang S, Johnson C, West RE, Prokopienko AJ, Mahnken JD, Yu AS, Hoofnagle AN, Ir D, Robertson CE, Miyazaki M, Chonchol M, Jovanovich A, Kestenbaum B, Frank DN, Nolin TD, Stubbs JR. Randomized, Placebo-Controlled Trial of Rifaximin Therapy for Lowering Gut-Derived Cardiovascular Toxins and Inflammation in CKD. ACTA ACUST UNITED AC 2020; 1:1206-1216. [PMID: 34322673 PMCID: PMC8315698 DOI: 10.34067/kid.0003942020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Recent evidence suggests the systemic accumulation of by-products of gut microbes contributes to cardiovascular morbidity in patients with CKD. Limiting the generation of toxic bacterial by-products by manipulating the intestinal microbiota may be a novel strategy for reducing cardiovascular disease in CKD. Rifaximin is a minimally absorbed, oral antibiotic that targets intestinal pathogens and is commonly used as chronic therapy for the prevention of encephalopathy in patients with cirrhosis. Methods We conducted a randomized, double-blinded, placebo-controlled trial to determine the effect of a 10-day course of oral rifaximin 550 mg BID versus placebo on circulating concentrations of gut-derived cardiovascular toxins and proinflammatory cytokines in patients with stage 3-5 CKD (n=38). The primary clinical outcome was change in serum trimethylamine N-oxide (TMAO) concentrations from baseline to study end. Secondary outcomes included change in serum concentrations of p-cresol sulfate, indoxyl sulfate, kynurenic acid, deoxycholic acid, and inflammatory cytokines (C-reactive protein, IL-6, IL-1β), and change in composition and diversity of fecal microbiota. Results A total of 19 patients were randomized to each of the rifaximin and placebo arms, with n=17 and n=14 completing both study visits in these respective groups. We observed no difference in serum TMAO change (post-therapy minus baseline TMAO) between the rifaximin and placebo groups (mean TMAO change -3.9±15.4 for rifaximin versus 0.5±9.5 for placebo, P=0.49). Similarly, we found no significant change in serum concentrations for p-cresol sulfate, indoxyl sulfate, kynurenic acid, deoxycholic acid, and inflammatory cytokines. We did observe differences in colonic bacterial communities, with the rifaximin group exhibiting significant decreases in bacterial richness (Chao1, P=0.02) and diversity (Shannon H, P=0.05), along with altered abundance of several bacterial genera. Conclusions Short-term rifaximin treatment failed to reduce gut-derived cardiovascular toxins and inflammatory cytokines in patients with CKD. Clinical Trial registry name and registration number Rifaximin Therapy in Chronic Kidney Disease, NCT02342639.
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Affiliation(s)
- Cassandra Kimber
- The Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas.,Division of Nephrology and Hypertension, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Shiqin Zhang
- The Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas.,Division of Nephrology and Hypertension, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Cassandra Johnson
- The Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas
| | - Raymond E West
- Department of Pharmacy and Therapeutics, Center for Clinical Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alexander J Prokopienko
- Department of Pharmacy and Therapeutics, Center for Clinical Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jonathan D Mahnken
- The Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas.,Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Alan S Yu
- The Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas.,Division of Nephrology and Hypertension, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Andrew N Hoofnagle
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Diana Ir
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado
| | - Charles E Robertson
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado
| | - Makoto Miyazaki
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anna Jovanovich
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Bryan Kestenbaum
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington.,Kidney Research Institute, Seattle, Washington
| | - Daniel N Frank
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado
| | - Thomas D Nolin
- Department of Pharmacy and Therapeutics, Center for Clinical Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jason R Stubbs
- The Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas.,Division of Nephrology and Hypertension, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas
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24
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Siengsukon CF, Nelson E, Williams-Cooke C, Ludwig R, Beck ES, Vidoni ED, Mahnken JD, Stevens S, Drerup M, Bruce J, Burns JM. Cognitive behavioral therapy for insomnia to enhance cognitive function and reduce the rate of Aβ deposition in older adults with symptoms of insomnia: A single-site randomized pilot clinical trial protocol. Contemp Clin Trials 2020; 99:106190. [PMID: 33091586 DOI: 10.1016/j.cct.2020.106190] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/16/2020] [Accepted: 10/16/2020] [Indexed: 12/16/2022]
Abstract
Lifestyle interventions to increase exercise and improve diet have been the focus of recent clinical trials to potentially prevent Alzheimer's disease (AD). However, despite the strong links between sleep disruptions, cognitive decline, and AD, sleep enhancement has yet to be targeted as a lifestyle intervention to prevent AD. A recent meta-analysis suggests that approximately 15% of AD may be prevented by an efficacious intervention aimed to reduce sleep disturbances and sleep disorders. Chronic insomnia is the most frequent sleep disorder occurring in at least 40% of older adults. Individuals with insomnia are more likely to be diagnosed with Alzheimer's Disease (AD) and demonstrate decline in cognitive function at long-term follow-up. AD is characterized by the accumulation of amyloid-β (Aβ) plaques and tau tangles in the brain, and growing evidence shows impaired sleep contributes to the accumulation of Aβ. An intervention aimed at improving insomnia may be a critical opportunity for primary prevention to slow cognitive decline and potentially delay the onset of AD. Cognitive behavioral therapy for insomnia (CBT-I) is an efficacious treatment for insomnia, but the use of CBT-I to improve cognitive function and potentially reduce the rate of Aβ accumulation has never been examined. Therefore, the objective of the proposed study is to examine the efficacy of CBT-I on improving cognitive function in older adults with symptoms of insomnia. An exploratory aim is to assess the effect of CBT-I on rate of Aβ accumulation.
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Affiliation(s)
- Catherine F Siengsukon
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, United States of America.
| | - Eryen Nelson
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Cierra Williams-Cooke
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Rebecca Ludwig
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Eber Silveira Beck
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Eric D Vidoni
- University of Kansas Alzheimer's Disease Center, Fairway, KS, United States of America
| | - Jonathan D Mahnken
- University of Kansas Alzheimer's Disease Center, Fairway, KS, United States of America; Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Suzanne Stevens
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Michelle Drerup
- Sleep Disorders Clinic, Cleveland Clinic, Cleveland, OH, United States of America
| | - Jared Bruce
- Department of Biomedical and Health Informatics, University of Missouri - Kansas City School of Medicine, Kansas City, MO, United States of America
| | - Jeffrey M Burns
- University of Kansas Alzheimer's Disease Center, Fairway, KS, United States of America
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25
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Devos H, Burns JM, Liao K, Ahmadnezhad P, Mahnken JD, Brooks WM, Gustafson K. Reliability of P3 Event-Related Potential During Working Memory Across the Spectrum of Cognitive Aging. Front Aging Neurosci 2020; 12:566391. [PMID: 33192459 PMCID: PMC7604307 DOI: 10.3389/fnagi.2020.566391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/24/2020] [Indexed: 11/24/2022] Open
Abstract
Event-related potentials (ERPs) offer unparalleled temporal resolution in tracing distinct electrophysiological processes related to normal and pathological cognitive aging. The stability of ERPs in older individuals with a vast range of cognitive ability has not been established. In this test-retest reliability study, 39 older individuals (age 74.10 (5.4) years; 23 (59%) women; 15 non β-amyloid elevated, 16 β-amyloid elevated, 8 cognitively impaired) with scores on the Montreal Cognitive Assessment (MOCA) ranging between 3 and 30 completed a working memory (n-back) test with three levels of difficulty at baseline and 2-week follow-up. The main aim was to evaluate stability of the ERP on grand averaged task effects for both visits in the total sample (n = 39). Secondary aims were to evaluate the effect of age, group (non β-amyloid elevated; β-amyloid elevated, cognitively impaired), cognitive status (MOCA), and task difficulty on ERP reliability. P3 peak amplitude and latency were measured in predetermined channels. P3 peak amplitude at Fz, our main outcome variable, showed excellent reliability in 0-back (intraclass correlation coefficient (ICC), 95% confidence interval = 0.82 (0.67-0.90) and 1-back (ICC = 0.87 (0.76-0.93), however, only fair reliability in 2-back (ICC = 0.53 (0.09-0.75). Reliability of P3 peak latencies was substantially lower, with ICCs ranging between 0.17 for 2-back and 0.54 for 0-back. Generalized linear mixed models showed no confounding effect of age, group, or task difficulty on stability of P3 amplitude and latency of Fz. By contrast, MOCA scores tended to negatively correlate with P3 amplitude of Fz (p = 0.07). We conclude that P3 peak amplitude, and to lesser extent P3 peak latency, provide a stable measure of electrophysiological processes in older individuals.
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Affiliation(s)
- Hannes Devos
- Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jeffrey M. Burns
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
- University of Kansas Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, KS, United States
| | - Ke Liao
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS, United States
| | - Pedram Ahmadnezhad
- Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jonathan D. Mahnken
- University of Kansas Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, United States
| | - William M. Brooks
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
- University of Kansas Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, KS, United States
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS, United States
| | - Kathleen Gustafson
- University of Kansas Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, KS, United States
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS, United States
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Pomann GM, Boulware LE, Cayetano SM, Desai M, Enders FT, Gallis JA, Gelfond J, Grambow SC, Hanlon AL, Hendrix A, Kulkarni P, Lapidus J, Lee HJ, Mahnken JD, McKeel JP, Moen R, Oster RA, Peskoe S, Samsa G, Stewart TG, Truong T, Wruck L, Thomas SM. Methods for training collaborative biostatisticians. J Clin Transl Sci 2020; 5:e26. [PMID: 33948249 PMCID: PMC8057395 DOI: 10.1017/cts.2020.518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/01/2020] [Accepted: 07/25/2020] [Indexed: 11/06/2022] Open
Abstract
The emphasis on team science in clinical and translational research increases the importance of collaborative biostatisticians (CBs) in healthcare. Adequate training and development of CBs ensure appropriate conduct of robust and meaningful research and, therefore, should be considered as a high-priority focus for biostatistics groups. Comprehensive training enhances clinical and translational research by facilitating more productive and efficient collaborations. While many graduate programs in Biostatistics and Epidemiology include training in research collaboration, it is often limited in scope and duration. Therefore, additional training is often required once a CB is hired into a full-time position. This article presents a comprehensive CB training strategy that can be adapted to any collaborative biostatistics group. This strategy follows a roadmap of the biostatistics collaboration process, which is also presented. A TIE approach (Teach the necessary skills, monitor the Implementation of these skills, and Evaluate the proficiency of these skills) was developed to support the adoption of key principles. The training strategy also incorporates a "train the trainer" approach to enable CBs who have successfully completed training to train new staff or faculty.
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Affiliation(s)
- Gina-Maria Pomann
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - L. Ebony Boulware
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Shari Messinger Cayetano
- Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Manisha Desai
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - John A. Gallis
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Jonathan Gelfond
- Biostatistics Division, Department of Epidemiology & Biostatistics, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Steven C. Grambow
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Alexandra L. Hanlon
- Center for Biostatistics and Health Data Science, Department of Statistics, Virginia Tech, Roanoke, VA, USA
| | | | - Pandurang Kulkarni
- Global Statistical Sciences, Eli Lilly and Company, Indianapolis, IN, USA
| | - Jodi Lapidus
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Hui-Jie Lee
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Jonathan D. Mahnken
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Julie P. McKeel
- Duke Clinical and Translational Science Institute, Duke University, Durham, NC, USA
| | - Rebecca Moen
- Duke Clinical and Translational Science Institute, Duke University, Durham, NC, USA
| | - Robert A. Oster
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah Peskoe
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Greg Samsa
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Thomas G. Stewart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Lisa Wruck
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Samantha M. Thomas
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
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27
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Swerdlow RH, Hui D, Chalise P, Sharma P, Wang X, Andrews SJ, Pa J, Mahnken JD, Morris J, Wilkins HM, Burns JM, Michaelis ML, Michaelis EK. Exploratory analysis of mtDNA haplogroups in two Alzheimer's longitudinal cohorts. Alzheimers Dement 2020; 16:1164-1172. [PMID: 32543785 PMCID: PMC9847473 DOI: 10.1002/alz.12119] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/06/2020] [Accepted: 04/29/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Inherited mitochondrial DNA (mtDNA) variants may influence Alzheimer's disease (AD) risk. METHODS We sequenced mtDNA from 146 AD and 265 cognitively normal (CN) subjects from the University of Kansas AD Center (KUADC) and assigned haplogroups. We further considered 244 AD and 242 CN AD Neuroimaging Initiative (ADNI) subjects with equivalent data. RESULTS Without applying multiple comparisons corrections, KUADC haplogroup J AD and CN frequencies were 16.4% versus 7.6% (P = .007), and haplogroup K AD and CN frequencies were 4.8% versus 10.2% (P = .063). ADNI haplogroup J AD and CN frequencies were 10.7% versus 7.0% (P = .20), and haplogroup K frequencies were 4.9% versus 8.7% (P = .11). For the combined 390 AD and 507 CN cases haplogroup J frequencies were 12.8% versus 7.3% (P = .006), odds ratio (OR) = 1.87, and haplogroup K frequencies were 4.9% versus 9.5% (P = .010), OR = 0.49. Associations remained significant after adjusting for apolipoprotein E, age, and sex. CONCLUSION This exploratory analysis suggests inherited mtDNA variants influence AD risk.
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Affiliation(s)
- Russell H. Swerdlow
- Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Dongwei Hui
- Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Prabhakar Chalise
- Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Palash Sharma
- Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Xinkun Wang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Shea J. Andrews
- Ronald M. Loeb Center for Alzheimer’s Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Judy Pa
- Alzheimer’s Disease Research Center, Mark and Mary Stevens Neuroimaging and Informatics InstituteUniversity of Southern California, Los Angeles, California, USA
| | - Jonathan D. Mahnken
- Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jill Morris
- Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Heather M. Wilkins
- Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jeffrey M. Burns
- Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mary L. Michaelis
- Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Elias K. Michaelis
- Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, Kansas, USA
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28
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El Ters M, Zhou X, Lepping RJ, Lu P, Karcher RT, Mahnken JD, Brooks WM, Winklhofer FT, Li X, Yu AS. Biological Efficacy and Safety of Niacinamide in Patients With ADPKD. Kidney Int Rep 2020; 5:1271-1279. [PMID: 32775826 PMCID: PMC7403550 DOI: 10.1016/j.ekir.2020.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/11/2020] [Accepted: 06/02/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Autosomal dominant polycystic kidney disease (ADPKD) is characterized by progressive cyst enlargement, leading to kidney failure. Sirtuin-1 is upregulated in ADPKD and accelerates disease progression by deacetylating p53. Niacinamide is a dietary supplement that inhibits sirtuins at high doses. METHODS We conducted an open-label, single-arm intervention trial (study 1, N = 10), and a randomized, double blinded, placebo-controlled trial (study 2, N = 36) to assess the biological activity and safety of niacinamide. Patients with ADPKD were given 30 mg/kg oral niacinamide or placebo, for 12 months. The primary endpoint was the ratio of acetylated p53 to total p53 protein in peripheral blood mononuclear cells (PBMCs). RESULTS There was no sustained effect of niacinamide on acetylated/total p53 in either study and no difference between placebo and niacinamide arms. There was no difference in the change in height-adjusted total kidney volume over 12 months between niacinamide and placebo. Niacinamide was generally well tolerated. The most common adverse effects were nausea, diarrhea, gastroesophageal reflux, headache, and acneiform rash but there was no difference in their incidence between niacinamide and placebo. CONCLUSIONS In conclusion, niacinamide is safe and well-tolerated in patients with ADPKD. However, we were unable to detect a sustained inhibition of sirtuin activity over 12 months of treatment, and there was no signal to suggest a beneficial effect on any efficacy measure.
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Affiliation(s)
- Mireille El Ters
- Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Kansas, USA
- Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Xia Zhou
- Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Kansas, USA
- Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Rebecca J. Lepping
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Pengcheng Lu
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Rainer T. Karcher
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jonathan D. Mahnken
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - William M. Brooks
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, Kansas, USA
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Franz T. Winklhofer
- Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Kansas, USA
- Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Xiaogang Li
- Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Kansas, USA
- Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Alan S.L. Yu
- Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Kansas, USA
- Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA
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Vidoni ED, Choi IY, Lee P, Reed G, Zhang N, Pleen J, Mahnken JD, Clutton J, Becker A, Sherry E, Bothwell R, Anderson H, Harris RA, Brooks W, Wilkins HM, Mosconi L, Burns JM, Swerdlow RH. Safety and target engagement profile of two oxaloacetate doses in Alzheimer's patients. Alzheimers Dement 2020; 17:7-17. [PMID: 32715609 DOI: 10.1002/alz.12156] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/19/2020] [Accepted: 06/28/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Brain bioenergetics are defective in Alzheimer's disease (AD). Preclinical studies find oxaloacetate (OAA) enhances bioenergetics, but human safety and target engagement data are lacking. METHODS We orally administered 500 or 1000 mg OAA, twice daily for 1 month, to AD participants (n = 15 each group) and monitored safety and tolerability. To assess brain metabolism engagement, we performed fluorodeoxyglucose positron emission tomography (FDG PET) and magnetic resonance spectroscopy before and after the intervention. We also assessed pharmacokinetics and cognitive performance. RESULTS Both doses were safe and tolerated. Compared to the lower dose, the higher dose benefited FDG PET glucose uptake across multiple brain regions (P < .05), and the higher dose increased parietal and frontoparietal glutathione (P < .05). We did not demonstrate consistent blood level changes and cognitive scores did not improve. CONCLUSIONS 1000 mg OAA, taken twice daily for 1 month, is safe in AD patients and engages brain energy metabolism.
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Affiliation(s)
- Eric D Vidoni
- University of Kansas Alzheimer's Center, Fairway, Kansas, USA
- Department of Neurology, Kansas University Medical Center, Kansas City, Kansas, USA
| | - In-Young Choi
- University of Kansas Alzheimer's Center, Fairway, Kansas, USA
- Hoglund Biomedical Imaging Center, Kansas City, Kansas, USA
- Department of Neurology, Kansas University Medical Center, Kansas City, Kansas, USA
- Department of Molecular and Integrative Physiology, Kansas University Medical Center, Kansas City, Kansas, USA
| | - Phil Lee
- University of Kansas Alzheimer's Center, Fairway, Kansas, USA
- Hoglund Biomedical Imaging Center, Kansas City, Kansas, USA
- Department of Molecular and Integrative Physiology, Kansas University Medical Center, Kansas City, Kansas, USA
- Department of Radiology, Kansas University Medical Center, Kansas City, Kansas, USA
| | - Gregory Reed
- Department of Pharmacology and Toxicology, Kansas University Medical Center, Kansas City, Kansas, USA
| | - Na Zhang
- Department of Pharmacology and Toxicology, Kansas University Medical Center, Kansas City, Kansas, USA
| | - Joseph Pleen
- University of Kansas Alzheimer's Center, Fairway, Kansas, USA
- Department of Neurology, Kansas University Medical Center, Kansas City, Kansas, USA
| | - Jonathan D Mahnken
- University of Kansas Alzheimer's Center, Fairway, Kansas, USA
- Department of Biostatistics, Kansas University Medical Center, Kansas City, Kansas, USA
| | | | - Annette Becker
- University of Kansas Alzheimer's Center, Fairway, Kansas, USA
| | - Erica Sherry
- University of Kansas Alzheimer's Center, Fairway, Kansas, USA
| | | | - Heidi Anderson
- University of Kansas Alzheimer's Center, Fairway, Kansas, USA
| | - Robert A Harris
- Biochemistry and Molecular Biology, Kansas University Medical Center, Kansas City, Kansas, USA
| | - William Brooks
- University of Kansas Alzheimer's Center, Fairway, Kansas, USA
- Hoglund Biomedical Imaging Center, Kansas City, Kansas, USA
- Department of Neurology, Kansas University Medical Center, Kansas City, Kansas, USA
- Department of Molecular and Integrative Physiology, Kansas University Medical Center, Kansas City, Kansas, USA
| | - Heather M Wilkins
- University of Kansas Alzheimer's Center, Fairway, Kansas, USA
- Department of Neurology, Kansas University Medical Center, Kansas City, Kansas, USA
| | - Lisa Mosconi
- Department of Neurology, Weill Cornell Medical College, New York, New York, USA
| | - Jeffrey M Burns
- University of Kansas Alzheimer's Center, Fairway, Kansas, USA
- Department of Neurology, Kansas University Medical Center, Kansas City, Kansas, USA
- Department of Molecular and Integrative Physiology, Kansas University Medical Center, Kansas City, Kansas, USA
| | - Russell H Swerdlow
- University of Kansas Alzheimer's Center, Fairway, Kansas, USA
- Department of Neurology, Kansas University Medical Center, Kansas City, Kansas, USA
- Department of Molecular and Integrative Physiology, Kansas University Medical Center, Kansas City, Kansas, USA
- Biochemistry and Molecular Biology, Kansas University Medical Center, Kansas City, Kansas, USA
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30
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Morris JK, Zhang G, Dougherty RJ, Mahnken JD, John CS, Lose SR, Cook DB, Burns JM, Vidoni ED, Okonkwo O. Collective effects of age, sex, genotype, and cognitive status on fitness outcomes. Alzheimers Dement (Amst) 2020; 12:e12058. [PMID: 32695870 PMCID: PMC7364859 DOI: 10.1002/dad2.12058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Individuals with Alzheimer's disease (AD) broadly exhibit lower cardiorespiratory fitness (CRF) compared to cognitively healthy older adults. Other factors, such as increasing age and female sex, are also known to track with lower CRF levels. However, it is unclear how these factors together with AD diagnosis and genetic risk (apolipoprotein e4 ; APOE4) collectively affect CRF. METHODS Our primary objective was to characterize the collective relationship of age, sex, APOE4 carrier status , and cognitive status (nondemented or AD) with two commonly reported CRF outcomes, VO2 max and oxygen uptake efficiency slope (OUES). To interrogate the unique and combined effect of age, sex, APOE4, and cognitive status on CRF, we pooled multiple datasets and tested several statistical models allowing all possible interactions. RESULTS AD diagnosis was consistently associated with lower maximal CRF, which declined with increasing age. APOE4 was also associated with lower maximal CRF (VO2max), but only in male subjects. Submaximal CRF (OUES) was lower in APOE4 carriers of both sexes, although this difference converged in male subjects with advancing age. DISCUSSION This multi-cohort analysis (n = 304) suggests that APOE4 carrier status and sex are important considerations for studies that evaluate maximal and submaximal CRF.
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Affiliation(s)
- Jill K. Morris
- Department of NeurologyUniversity of Kansas Medical CenterKansas CityKansasUSA
- University of Kansas Alzheimer's Disease Research CenterFairwayKansasUSA
| | - Guanlin Zhang
- Department of Biostatistics and Data ScienceUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Ryan J Dougherty
- Department of KinesiologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA
| | - Jonathan D. Mahnken
- Department of Biostatistics and Data ScienceUniversity of Kansas Medical CenterKansas CityKansasUSA
- University of Kansas Alzheimer's Disease Research CenterFairwayKansasUSA
| | - Casey S. John
- University of Kansas Alzheimer's Disease Research CenterFairwayKansasUSA
| | - Sarah R. Lose
- Department of MedicineUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA
| | - Dane B. Cook
- Department of KinesiologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- William S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Jeffrey M. Burns
- Department of NeurologyUniversity of Kansas Medical CenterKansas CityKansasUSA
- University of Kansas Alzheimer's Disease Research CenterFairwayKansasUSA
| | - Eric D. Vidoni
- Department of NeurologyUniversity of Kansas Medical CenterKansas CityKansasUSA
- University of Kansas Alzheimer's Disease Research CenterFairwayKansasUSA
| | - Ozioma Okonkwo
- Department of MedicineUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA
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31
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Durham MD, Armon C, Mahnken JD, Novak RM, Palella FJ, Tedaldi E, Buchacz K. Rates of suicidal ideation among HIV-infected patients in care in the HIV Outpatient Study 2000-2017, USA. Prev Med 2020; 134:106011. [PMID: 32027915 PMCID: PMC10132173 DOI: 10.1016/j.ypmed.2020.106011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 01/21/2020] [Accepted: 02/01/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Suicidal ideation (SI) refers to an individual thinking about, considering or planning suicide. Identifying and characterizing persons with HIV (PWH) at greater risk for SI may lead to better suicide prevention strategies and quality of life improvement. METHODS Using clinical data gathered from medical chart abstraction for HIV Outpatient Study (HOPS) participants from 2000 to 2017, we assessed SI frequency among PWH in care and explored factors associated with the presence of SI diagnoses using linear mixed models analyses. RESULTS Among 6706 participants, 224 (3.3%) had a charted diagnosis of SI. Among those with SI, median age (interquartile range [IQR]) was 43.4 years [IQR: 38.7-50.3], median (IQR) CD4+ cell count was 439 cells/mm3 (IQR: 237-686), 71.4% were male, 54% were men who have sex with men (MSM), 25.4% heterosexual, and 13.4% persons who inject drugs. In multivariable analysis, persons at increased risk for SI were more likely to be: <50 years old (adjusted rate ratio [aRR] 1.86, 95% confidence interval [95%CI] 1.36-2.53), non-Hispanic/Latino black (aRR 1.75; 95%CI 1.29-2.38), have CD4+ cell count <350 cells/mm3 (aRR 1.32; 95%CI 1.05-1.65), have a viral load ≥50 copies/mL (aRR 1.49; 95%CI 1.12-1.98), have stopped antiretroviral therapy (aRR 1.46; 95%CI 1.10-1.95), have a history of: alcohol dependence (aRR 2.75; 95%CI 1.67-4.52), and drug overdose (aRR 4.09; 95%CI 2.16-7.71). CONCLUSION Routine mental health assessment and monitoring are needed in HIV clinical practice to better understand factors associated with SI and to inform the development of preventive interventions.
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Affiliation(s)
- Marcus D Durham
- Division of HIV/AIDS Prevention Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Carl Armon
- Cerner Corporation, Kansas City, MO, USA
| | - Jonathan D Mahnken
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | - Ellen Tedaldi
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Kate Buchacz
- Division of HIV/AIDS Prevention Centers for Disease Control and Prevention, Atlanta, GA, USA
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32
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Jain N, Hunt SL, Cui H, Phadnis MA, Mahnken JD, Shireman TI, Dai J, Mehta JL, Rasu RS. Trends for and Clinical Factors Associated with Choice of Oral P2Y 12 Inhibitors for Patients on Chronic Dialysis. Cardiovasc Drugs Ther 2019; 33:511-521. [PMID: 31729588 PMCID: PMC6904390 DOI: 10.1007/s10557-019-06913-w] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Trends and clinical factors associated with prescribing choices for oral P2Y12 inhibitors (P2Y12-I) remain unknown for patients on chronic dialysis, i.e., with end-stage renal disease (ESRD). Methods From 2011–2014 U.S. Renal Data System registry, we identified 36,542 ESRD patients who received new prescriptions for P2Y12-I (median age 64.0 years and 54% males). Of the cohort, 93% were receiving hemodialysis and 7% on peritoneal dialysis. We analyzed trends and investigated clinical factors associated with specific P2Y12-I prescribed. Results Clopidogrel was prescribed for 95%, prasugrel for 3%, and ticagrelor for 2%. Clopidogrel was favored for those ≥75 years (18% of cohort). Compared to Caucasians, African Americans (36% of cohort) and Hispanics (19% of cohort) were less likely to receive prasugrel and ticagrelor (P<0.05). Patients receiving hemodialysis versus peritoneal dialysis were less likely to receive prasugrel over clopidogrel, adjusted odds ratio (aOR) 0.67 (0.55-0.82). Each additional year of dialysis decreased the odds of receiving prasugrel over clopidogrel, aOR 0.91 (0.85-0.98). History of atrial fibrillation reduced the odds of receiving ticagrelor or prasugrel over clopidogrel, aOR 0.69 (0.54-0.89) and 0.73 (0.60-0.89), respectively. Concomitant oral anticoagulant use was not associated with choice of P2Y12-I. Occurrence of non-ST segment elevation myocardial infarction or percutaneous coronary intervention within the 6-month period prior to the index date favored ticagrelor over prasugrel, aOR 1.31 (1.06-1.62) and 1.29 (1.01-1.66), respectively. However, prescribing trends favoring ticagrelor over prasugrel were not observed for deployment of drug-eluting, or multiple coronary stents. Conclusion Between 2011 and 2014, clopidogrel remained the most common P2Y12-I whereas ticagrelor and prasugrel remained underutilized in ESRD patients. Prescribing practices for these drugs were based upon clinically approved indication for their use in the general population as well as perceived complexity of an ESRD patient including demographics, dialysis-related factors and comorbidities. Comparative effectiveness studies involving ESRD patients are needed to prove that ticagrelor and prasugrel are just as safe and effective as clopidogrel before clinicians can make informed decisions for choice of P2Y12-I in this patient population. Electronic supplementary material The online version of this article (10.1007/s10557-019-06913-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nishank Jain
- Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, Slot 501, Little Rock, AR, 72205, USA. .,Central Arkansas Veterans Affairs Medical Center, Little Rock, AR, USA.
| | - Suzanne L Hunt
- Department of Biostatistics, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Huizhong Cui
- Department of Biostatistics, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Milind A Phadnis
- Department of Biostatistics, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Jonathan D Mahnken
- Department of Biostatistics, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Theresa I Shireman
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Junqiang Dai
- Department of Biostatistics, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Jawahar L Mehta
- Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, Slot 501, Little Rock, AR, 72205, USA.,Central Arkansas Veterans Affairs Medical Center, Little Rock, AR, USA
| | - Rafia S Rasu
- Department of Pharmacy Practice, School of Pharmacy, University of North Texas, Fort Worth, TX, USA
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33
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McKenzie KA, Hunt SL, Hulshof G, Mudaranthakam DP, Meyer K, Vidoni ED, Burns JM, Mahnken JD. A semi-automated pipeline for fulfillment of resource requests from a longitudinal Alzheimer's disease registry. JAMIA Open 2019; 2:516-520. [PMID: 32025648 PMCID: PMC6993996 DOI: 10.1093/jamiaopen/ooz032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/21/2019] [Accepted: 07/22/2019] [Indexed: 12/22/2022] Open
Abstract
Objective Managing registries with continual data collection poses challenges, such as following reproducible research protocols and guaranteeing data accessibility. The University of Kansas (KU) Alzheimer’s Disease Center (ADC) maintains one such registry: Curated Clinical Cohort Phenotypes and Observations (C3PO). We created an automated and reproducible process by which investigators have access to C3PO data. Materials and Methods Data was input into Research Electronic Data Capture. Monthly, data part of the Uniform Data Set (UDS), that is data also collected at other ADCs, was uploaded to the National Alzheimer’s Coordinating Center (NACC). Quarterly, NACC cleaned, curated, and returned the UDS to the KU Data Management and Statistics (DMS) Core, where it was stored in C3PO with other quarterly curated site-specific data. Investigators seeking to utilize C3PO submitted a research proposal and requested variables via the publicly accessible and searchable data dictionary. The DMS Core used this variable list and an automated SAS program to create a subset of C3PO. Results C3PO contained 1913 variables stored in 15 datasets. From 2017 to 2018, 38 data requests were completed for several KU departments and other research institutions. Completing data requests became more efficient; C3PO subsets were produced in under 10 seconds. Discussion The data management strategy outlined above facilitated reproducible research practices, which is fundamental to the future of research as it allows replication and verification to occur. Conclusion We created a transparent, automated, and efficient process of extracting subsets of data from a registry where data was changing daily.
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Affiliation(s)
- Katelyn A McKenzie
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Suzanne L Hunt
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA.,University of Kansas Alzheimer's Disease Center, Fairway, Kansas, USA
| | - Genevieve Hulshof
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Dinesh Pal Mudaranthakam
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA.,University of Kansas Alzheimer's Disease Center, Fairway, Kansas, USA
| | - Kayla Meyer
- University of Kansas Alzheimer's Disease Center, Fairway, Kansas, USA
| | - Eric D Vidoni
- University of Kansas Alzheimer's Disease Center, Fairway, Kansas, USA.,Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jeffrey M Burns
- University of Kansas Alzheimer's Disease Center, Fairway, Kansas, USA.,Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jonathan D Mahnken
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA.,University of Kansas Alzheimer's Disease Center, Fairway, Kansas, USA
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Morris JK, McCoin CS, Fuller KN, John CS, Wilkins HM, Wang X, Mahnken JD, Swerdlow RH, Thyfault JP. P1-197: SKELETAL MUSCLE MITOCHONDRIAL FUNCTION IN COGNITIVELY HEALTHY ELDERLY AND MCI SUBJECTS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.752] [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]
Affiliation(s)
| | | | | | - Casey S. John
- University of Kansas Medical Center; Kansas City KS USA
| | | | - Xiaowan Wang
- University of Kansas Medical Center; Kansas City KS USA
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35
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Vidoni ED, Choi IY, Lee P, Clutton J, Becker AM, Sherry E, Bothwell R, Anderson H, Mahnken JD, Wilkins HM, Brooks W, Reed G, Burns JM, Swerdlow RH. P3-008: TRIAL OF OXALOACETATE IN ALZHEIMER'S DISEASE (TOAD): FINAL RESULTS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Eric D. Vidoni
- University of Kansas Alzheimer's Disease Center; Fairway KS USA
| | - In-Young Choi
- University of Kansas Alzheimer's Disease Center; Fairway KS USA
| | - Phil Lee
- University of Kansas Alzheimer's Disease Center; Fairway KS USA
| | | | | | - Erica Sherry
- University of Kansas Alzheimer's Disease Center; Fairway KS USA
| | | | - Heidi Anderson
- University of Kansas Alzheimer's Disease Center; Fairway KS USA
| | | | | | - William Brooks
- Hoglund Brain Imaging Center; University of Kansas Medical Center; Kansas City KS USA
| | - Greg Reed
- University of Kansas Alzheimer's Disease Center; Fairway KS USA
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36
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Choi IY, Lee P, Vidoni ED, Clutton J, Becker AM, Sherry E, Bothwell R, Anderson H, Mahnken JD, Wilkins HM, Brooks W, Reed G, Burns JM, Swerdlow RH. P2-037: EFFECTS OF OXALOACETATE TREATMENTS ON CEREBRAL ANTIOXIDANT AND NEUROCHEMICAL PROFILE IN PATIENTS WITH ALZHEIMER'S DISEASE USING IN VIVO METABOLIC NEUROIMAGING. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.1259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- In-Young Choi
- University of Kansas Medical Center; Kansas City KS USA
| | - Phil Lee
- University of Kansas Medical Center; Kansas City KS USA
| | - Eric D. Vidoni
- University of Kansas; Alzheimer's Disease Center; Fairway KS USA
| | - Jonathan Clutton
- University of Kansas; Alzheimer's Disease Center; Fairway KS USA
| | | | - Erica Sherry
- University of Kansas; Alzheimer's Disease Center; Fairway KS USA
| | - Rebecca Bothwell
- University of Kansas; Alzheimer's Disease Center; Fairway KS USA
| | - Heidi Anderson
- University of Kansas; Alzheimer's Disease Center; Fairway KS USA
| | | | | | | | - Greg Reed
- University of Kansas Medical Center; Kansas City KS USA
| | - Jeffrey M. Burns
- University of Kansas; Alzheimer's Disease Center; Fairway KS USA
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Burns NC, Watts A, Perales J, Montgomery RN, Morris JK, Mahnken JD, Lowther J, Vidoni ED. The Impact of Creative Arts in Alzheimer's Disease and Dementia Public Health Education. J Alzheimers Dis 2019; 63:457-463. [PMID: 29578491 DOI: 10.3233/jad-180092] [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] [Indexed: 11/15/2022]
Abstract
Previous research involving dramatic performances about Alzheimer's disease and dementia perception have targeted health care workers or caretakers. We examined the influence of a theater performance on the emotional affect of a general audience to determine the utility of this type of theater in large-scale public health education efforts. Our study included 147 participants that attended a self-revelatory theater performance based on the social/relationship experiences of those with dementia and those who care for them. This type of theater engages the audience and actors in a dual transformative process, supporting the emotional growth of all involved. Participants completed pre- and post-performance questionnaires regarding their beliefs and feelings surrounding the topic of dementia and the importance of the Arts for educating on issues surrounding dementia care. We tested for change in emotional affect pre- and post-performance using sensitivity and center of gravity statistical analyses. We found a significant change in emotional affect from an initial strong negative affect to slightly more positive/relaxed view after viewing the performance. Findings support self-revelatory theater as a resource to destigmatize preconceived notions of dementia. Large-scale community health education efforts could benefit from using this style of theater to elicit a change in audience perception of disease realities.
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Affiliation(s)
- Nicole C Burns
- The University of Kansas Alzheimer's Disease Center, Fairway, KS, USA
| | - Amber Watts
- Department of Clinical Psychology, University of Kansas, Lawrence, KS, USA
| | - Jaime Perales
- The University of Kansas Alzheimer's Disease Center, Fairway, KS, USA
| | | | - Jill K Morris
- The University of Kansas Alzheimer's Disease Center, Fairway, KS, USA
| | - Jonathan D Mahnken
- The University of Kansas Alzheimer's Disease Center, Fairway, KS, USA.,Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Eric D Vidoni
- The University of Kansas Alzheimer's Disease Center, Fairway, KS, USA
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38
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Gupta A, Montgomery RN, Bedros V, Lesko J, Mahnken JD, Chakraborty S, Drew D, Klein JA, Thomas TS, Ilahe A, Budhiraja P, Brooks WM, Schmitt TM, Sarnak MJ, Burns JM, Cibrik DM. Subclinical Cognitive Impairment and Listing for Kidney Transplantation. Clin J Am Soc Nephrol 2019; 14:567-575. [PMID: 30890576 PMCID: PMC6450345 DOI: 10.2215/cjn.11010918] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 09/12/2018] [Accepted: 01/17/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Cognitive impairment is common in patients with kidney disease and can affect physicians' perception and/or patients' ability to complete the pretransplant evaluation. We examined whether cognitive impairment influences the likelihood for transplant listing and whether patients with cognitive impairment take longer to be listed. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a single-center longitudinal cohort study. Patients presenting for their index kidney transplant evaluation were screened for cognitive impairment using the Montreal Cognitive Assessment. A score <26 indicated cognitive impairment. The transplant selection committee was blinded to the scores. Kaplan-Meier analysis assessed time to active listing by level of cognition. A Cox proportional hazards model that included age, sex, race/ethnicity, smoking, coronary artery disease, and diabetes was constructed to evaluate the association between Montreal Cognitive Assessment score and listing for transplant. RESULTS In total, 349 patients who underwent Montreal Cognitive Assessment testing at their initial visit were included in the analysis. Patients with cognitive impairment were more likely to be older, black, and smokers. The time to listing in patients with cognitive impairment was longer than the time to listing in those with no cognitive impairment (median time, 10.6 versus 6.3 months; log rank test P=0.01). Cognitive impairment was independently associated with a lower likelihood of being listed for transplant (hazard ratio, 0.93 per unit lower Montreal Cognitive Assessment score; 95% confidence interval, 0.88 to 0.99; P=0.02). A lower proportion of patients with cognitive impairment were listed compared with patients without cognitive impairment at 1 month (2% versus 11%), 6 months (17% versus 37%), and 1 year (23% versus 41%), (P<0.001 for all). CONCLUSIONS Cognitive impairment is associated with a lower likelihood of being listed for kidney transplant, and is associated with longer time to transplant listing.
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Affiliation(s)
| | | | - Victor Bedros
- Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - John Lesko
- Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | | | - Shweta Chakraborty
- Transplant Administration, University of Kansas Health System, Kansas City, Kansas; and
| | - David Drew
- Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts
| | | | | | | | | | | | | | - Mark J Sarnak
- Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts
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Stubbs JR, Stedman MR, Liu S, Long J, Franchetti Y, West RE, Prokopienko AJ, Mahnken JD, Chertow GM, Nolin TD. Trimethylamine N-Oxide and Cardiovascular Outcomes in Patients with ESKD Receiving Maintenance Hemodialysis. Clin J Am Soc Nephrol 2019; 14:261-267. [PMID: 30665924 PMCID: PMC6390920 DOI: 10.2215/cjn.06190518] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 05/17/2018] [Accepted: 11/09/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Trimethylamine N-oxide (TMAO), a compound derived from byproducts of intestinal bacteria, has been shown to accelerate atherosclerosis in rodents. To date, there are conflicting data regarding the association of serum TMAO with cardiovascular outcomes in patients with ESKD, a population exhibiting both high serum TMAO and excessive atherosclerosis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We measured baseline serum TMAO concentrations in a subset of participants (n=1243) from the Evaluation of Cinacalcet Hydrochloride Therapy to Lower Cardiovascular Events (EVOLVE) trial and conducted post hoc analyses evaluating the association between baseline serum TMAO and cardiovascular outcomes. RESULTS We observed a wide distribution of serum TMAO in our cohort, with approximately 80% of participants exhibiting TMAO concentrations ≥56 µM and a maximum TMAO concentration of 1103.1 µM. We found no association between TMAO and our primary outcome, a composite of cardiovascular mortality, myocardial infarction, peripheral vascular event, stroke, and hospitalization for unstable angina. Moreover, in unadjusted and adjusted analyses, we observed no relation between TMAO and all-cause mortality, the independent components of our composite outcome, or the original EVOLVE primary outcome. Although we did observe higher TMAO concentrations in white participants, further subgroup analyses did not confirm the previously identified interaction between TMAO and race observed in a prior study in patients receiving dialysis. CONCLUSIONS We found no evidence linking TMAO to adverse clinical outcomes in patients receiving maintenance hemodialysis with moderate to severe secondary hyperparathyroidism.
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Affiliation(s)
- Jason R Stubbs
- The Jared Grantham Kidney Institute, .,Division of Nephrology and Hypertension, and
| | - Margaret R Stedman
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and
| | - Sai Liu
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and
| | - Jin Long
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and
| | - Yoko Franchetti
- Department of Pharmacy and Therapeutics, Center for Clinical Pharmaceutical, Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Raymond E West
- Department of Pharmacy and Therapeutics, Center for Clinical Pharmaceutical, Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alexander J Prokopienko
- Department of Pharmacy and Therapeutics, Center for Clinical Pharmaceutical, Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jonathan D Mahnken
- The Jared Grantham Kidney Institute.,Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas
| | - Glenn M Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and
| | - Thomas D Nolin
- Department of Pharmacy and Therapeutics, Center for Clinical Pharmaceutical, Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
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Baker HA, Brown AR, Mahnken JD, Shireman TI, Webb CE, Lipe BC. Application of risk factors for venous thromboembolism in patients with multiple myeloma starting chemotherapy, a real-world evaluation. Cancer Med 2019; 8:455-462. [PMID: 30585435 PMCID: PMC6346245 DOI: 10.1002/cam4.1927] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/23/2018] [Accepted: 11/26/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Within the first year of diagnosis, up to 1 in 3 multiple myeloma (MM) patients will experience a venous thromboembolism (VTE). The International Myeloma Working Group (IMWG) has thromboprophylaxis guidelines that stratify patients into low or high risk for thrombosis and subsequently recommend thromboprophylaxis, but it is unknown if these recommendations are being followed or if they are effective. The purpose of this study was to assess efficacy of the IMWG guidelines and investigate other potential VTE risk factors. METHODS Study participants were treated at the University of Kansas Medical Center between 2007 and 2013, and charts were reviewed to extract data. Cases (MM and VTE) were matched to controls (MM and no VTE) at approximately 1:3 ratio based on gender, age (±5 years), and time of MM diagnosis (±5 years). RESULTS A total of 80 cases and 211 controls were matched. Most patients (82%) were considered high risk for experiencing a VTE at the time of their MM diagnosis and 18% were considered low risk. Neither risk category (P = 0.16) nor thromboprophylaxis at baseline (P = 0.37) predicted VTE, though cases were more likely than controls to have an increased risk of thrombosis at the time of clot compared to their baseline risk (P = 0.09). CONCLUSION Our results suggest that IMWG guidelines are not being consistently followed and therefore could not be validated. Additional risk factors were not identified, but risk for VTE may change over time suggesting patients may require ongoing assessment of VTE risk and thromboprophylaxis throughout the disease course.
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Affiliation(s)
| | | | | | | | | | - Brea C. Lipe
- University of Rochester Medical CenterRochesterNew York
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41
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McKenzie KA, El Ters M, Torres VE, Harris PC, Chapman AB, Mrug M, Rahbari-Oskoui FF, Bae KT, Landsittel DP, Bennett WM, Yu ASL, Mahnken JD. Relationship between caffeine intake and autosomal dominant polycystic kidney disease progression: a retrospective analysis using the CRISP cohort. BMC Nephrol 2018; 19:378. [PMID: 30591038 PMCID: PMC6307167 DOI: 10.1186/s12882-018-1182-0] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 12/10/2018] [Indexed: 02/08/2023] Open
Abstract
Background Caffeine has been proposed, based on in vitro cultured cell studies, to accelerate progression of autosomal dominant polycystic kidney disease (ADPKD) by increasing kidney size. Since ADPKD patients are advised to minimize caffeine intake, we investigated the effect of caffeine on disease progression in the Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease (CRISP), a prospective, observational cohort study. Methods Our study included 239 patients (mean age = 32.3 ± 8.9 ys; 188 caffeine consumers) with a median follow-up time of 12.5 years. Caffeine intake reported at baseline was dichotomized (any vs. none). Linear mixed models, unadjusted and adjusted for age, race, sex, BMI, smoking, hypertension, genetics and time, were used to model height-adjusted total kidney volume (htTKV) and iothalamate clearance (mGFR). Cox proportional hazards models and Kaplan-Meier plots examined the effect of caffeine on time to ESRD or death. Results Caffeine-by-time was statistically significant when modeling ln(htTKV) in unadjusted and adjusted models (p < 0.01) indicating that caffeine consumers had slightly faster kidney growth (by 0.6% per year), but htTKV remained smaller from baseline throughout the study. Caffeine consumption was not associated with a difference in mGFR, or in the time to ESRD or death (p > 0.05). Moreover the results were similar when outcomes were modeled as a function of caffeine dose. Conclusion We conclude that caffeine does not have a significant detrimental effect on disease progression in ADPKD. Electronic supplementary material The online version of this article (10.1186/s12882-018-1182-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katelyn A McKenzie
- Department of Biostatistics, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.
| | - Mirelle El Ters
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Vicente E Torres
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Peter C Harris
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Arlene B Chapman
- Section of Nephrology, University of Chicago School of Medicine, Chicago, IL, USA
| | - Michal Mrug
- Division of Nephrology, University of Alabama and the Department of Veterans Affairs Medical Center, Birmingham, AL, USA
| | | | - Kyongtae Ty Bae
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Douglas P Landsittel
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Alan S L Yu
- Division of Nephrology and Hypertension and the Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jonathan D Mahnken
- Department of Biostatistics, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
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Vidoni ED, Clutton J, Becker AM, Sherry E, Bothwell R, Mahnken JD, Wilkins HM, Lee P, Choi IY, Brooks W, Reed G, Burns JM, Swerdlow RH. P4‐009: TRIAL OF OXALOACETATE IN ALZHEIMER'S DISEASE (TOAD): INTERIM FDG PET ANALYSIS. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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)
- Eric D. Vidoni
- University of Kansas Alzheimer's Disease CenterFairwayKSUSA
| | | | | | - Erica Sherry
- University of Kansas Alzheimer's Disease CenterFairwayKSUSA
| | | | | | | | - Phil Lee
- University of Kansas Alzheimer's Disease CenterFairwayKSUSA
| | - In-Young Choi
- University of Kansas Alzheimer's Disease CenterFairwayKSUSA
| | - William Brooks
- University of Kansas Alzheimer's Disease CenterFairwayKSUSA
| | - Greg Reed
- University of Kansas Alzheimer's Disease CenterFairwayKSUSA
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Wilkins HM, Mahnken JD, Welch P, Bothwell R, Koppel S, Jackson RL, Burns JM, Swerdlow RH. A Mitochondrial Biomarker-Based Study of S-Equol in Alzheimer's Disease Subjects: Results of a Single-Arm, Pilot Trial. J Alzheimers Dis 2018; 59:291-300. [PMID: 28598847 DOI: 10.3233/jad-170077] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Reductions in bioenergetic fluxes, mitochondrial enzyme activities, and mitochondrial number are observed in Alzheimer's disease (AD). Preclinical work indicates estrogen pathway signaling by either estrogen or selective β estrogen receptor (ERβ) agonists benefits these parameters. To assess whether an ERβ agonist could improve mitochondrial function in actual AD subjects, we administered S-equol (10 mg twice daily) to 15 women with AD and determined the platelet mitochondria cytochrome oxidase (COX) activity before initiating S-equol (lead-in), after two weeks of S-equol (active treatment), and two weeks after stopping S-equol (wash-out). Because the intra-individual variation of this enzyme across samples taken at different times was unknown we used a nonparametric, single-arm, dichotomous endpoint that classified subjects whose active treatment COX activity exceeded the average of their lead-in and wash-out measures as positive responders. Eleven positive responses were observed (p < 0.06). The implications of this finding on our null hypothesis (that S-equol does not influence platelet mitochondria COX activity) are discussed. To our knowledge, this is the first time a direct mitochondrial target engagement biomarker has been utilized in an AD clinical study.
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Affiliation(s)
- Heather M Wilkins
- University of Kansas Alzheimer's Disease Center, Kansas City, KS, USA.,Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jonathan D Mahnken
- University of Kansas Alzheimer's Disease Center, Kansas City, KS, USA.,Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Paul Welch
- University of Kansas Alzheimer's Disease Center, Kansas City, KS, USA
| | - Rebecca Bothwell
- University of Kansas Alzheimer's Disease Center, Kansas City, KS, USA
| | - Scott Koppel
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Jeffrey M Burns
- University of Kansas Alzheimer's Disease Center, Kansas City, KS, USA.,Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Russell H Swerdlow
- University of Kansas Alzheimer's Disease Center, Kansas City, KS, USA.,Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Biochemistry and Molecular Biology, University of Kansas Medical Center, Kansas City, KS, USA
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Abstract
Background Whether slow graft function (SGF) represents an intermediate phenotype between immediate graft function (IGF) and delayed graft function (DGF) in kidney transplant recipients is unknown. Material/Methods In a retrospective cohort analysis of 1,222 kidney transplant recipients, we classified patients as having IGF, SGF, and DGF using two different schemas. SGF was defined as serum creatinine (Cr) ≥3.0 mg/dL by postoperative day 5 in Schema 1, and in Schema 2, SGF was defined as Cr >1.5 mg/dL plus a creatinine reduction ratio <20% between postoperative days 1 and 3. A complementary log-log model was used to examine the association of graft function with graft survival and patient survival. Results Mean age of study patients was 51.5±13.3 years, 59.9% were male, and 66.7% were white. In Schema 1, SGF and DGF were associated with comparable increases in risk of graft failure compared to IGF (hazard ratio (HR) 1.46, 95% confidence intervals (CI) 1.02–2.10 for SGF and HR 1.56, CI 1.11–2.22 for IGF); estimates were similar for Schema 2 (HR 1.52, CI 1.05–2.20 for SGF and HR 1.54, CI 1.10–2.17 for IGF). However, for mortality, outcomes for SGF were similarly to IGF, both SGF and IGF were associated with lower risk relative to DGF (HR 0.54, CI 0.36–0.80 for SGF in Schema 1; HR 0.58, CI 0.39–0.85 for SGF in Schema 2). Conclusions These findings suggest that SGF may be a marker for graft failure but not for mortality, and SGF may therefore represent a phenotype separate from IGF and DGF.
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Affiliation(s)
- Connie J Wang
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Ahmad Tuffaha
- Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS, USA.,The Kidney Institute, University of Kansas Medical Center, Kansas City, KS, USA
| | - Milind A Phadnis
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jonathan D Mahnken
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - James B Wetmore
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN, USA.,Chronic Disease Research Group, Minneapolis, MN, USA
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Taylor MK, Sullivan DK, Mahnken JD, Burns JM, Swerdlow RH. Feasibility and efficacy data from a ketogenic diet intervention in Alzheimer's disease. Alzheimers Dement (N Y) 2017; 4:28-36. [PMID: 29955649 PMCID: PMC6021549 DOI: 10.1016/j.trci.2017.11.002] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction We assessed the feasibility and cognitive effects of a ketogenic diet (KD) in participants with Alzheimer's disease. Methods The Ketogenic Diet Retention and Feasibility Trial featured a 3-month, medium-chain triglyceride-supplemented KD followed by a 1-month washout in clinical dementia rating (CDR) 0.5, 1, and 2 participants. We obtained urine acetoacetate, serum β-hydroxybutyrate, food record, and safety data. We administered the Alzheimer's Disease Assessment Scale-cognitive subscale and Mini-Mental State Examination before the KD, and following the intervention and washout. Results We enrolled seven CDR 0.5, four CDR 1, and four CDR 2 participants. One CDR 0.5 and all CDR 2 participants withdrew citing caregiver burden. The 10 completers achieved ketosis. Most adverse events were medium-chain triglyceride-related. Among the completers, the mean of the Alzheimer's Disease Assessment Scale-cognitive subscale score improved by 4.1 points during the diet (P = .02) and reverted to baseline after the washout. Discussion This pilot trial justifies KD studies in mild Alzheimer's disease.
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Affiliation(s)
- Matthew K Taylor
- University of Kansas Alzheimer's Disease Center, Fairway, KS, USA.,Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
| | - Debra K Sullivan
- University of Kansas Alzheimer's Disease Center, Fairway, KS, USA.,Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jonathan D Mahnken
- University of Kansas Alzheimer's Disease Center, Fairway, KS, USA.,Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jeffrey M Burns
- University of Kansas Alzheimer's Disease Center, Fairway, KS, USA.,Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Russell H Swerdlow
- University of Kansas Alzheimer's Disease Center, Fairway, KS, USA.,Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Biochemistry and Molecular Biology, University of Kansas Medical Center, Kansas City, KS, USA
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Taylor MK, Sullivan DK, Swerdlow RH, Vidoni ED, Morris JK, Mahnken JD, Burns JM. A high-glycemic diet is associated with cerebral amyloid burden in cognitively normal older adults. Am J Clin Nutr 2017; 106:1463-1470. [PMID: 29070566 PMCID: PMC5698843 DOI: 10.3945/ajcn.117.162263] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/02/2017] [Indexed: 12/19/2022] Open
Abstract
Background: Little is known about the relation between dietary intake and cerebral amyloid accumulation in aging.Objective: We assessed the association of dietary glycemic measures with cerebral amyloid burden and cognitive performance in cognitively normal older adults.Design: We performed cross-sectional analyses relating dietary glycemic measures [adherence to a high-glycemic-load diet (HGLDiet) pattern, intakes of sugar and carbohydrates, and glycemic load] with cerebral amyloid burden (measured by florbetapir F-18 positron emission tomography) and cognitive performance in 128 cognitively normal older adults who provided eligibility screening data for the University of Kansas's Alzheimer's Prevention through Exercise (APEX) Study. The study began in November 2013 and is currently ongoing.Results: Amyloid was elevated in 26% (n = 33) of participants. HGLDiet pattern adherence (P = 0.01), sugar intake (P = 0.03), and carbohydrate intake (P = 0.05) were significantly higher in participants with elevated amyloid burden. The HGLDiet pattern was positively associated with amyloid burden both globally and in all regions of interest independently of age, sex, and education (all P ≤ 0.001). Individual dietary glycemic measures (sugar intake, carbohydrate intake, and glycemic load) were also positively associated with global amyloid load and nearly all regions of interest independently of age, sex, and educational level (P ≤ 0.05). Cognitive performance was associated only with daily sugar intake, with higher sugar consumption associated with poorer global cognitive performance (global composite measure and Mini-Mental State Examination) and performance on subtests of Digit Symbol, Trail Making Test B, and Block Design, controlling for age, sex, and education.Conclusion: A high-glycemic diet was associated with greater cerebral amyloid burden, which suggests diet as a potential modifiable behavior for cerebral amyloid accumulation and subsequent Alzheimer disease risk. This trial was registered at clinicaltrials.gov as NCT02000583.
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Affiliation(s)
- Matthew K Taylor
- Departments of Dietetics and Nutrition and,University of Kansas Alzheimer’s Disease Center, Fairway, KS
| | - Debra K Sullivan
- Departments of Dietetics and Nutrition and,University of Kansas Alzheimer’s Disease Center, Fairway, KS
| | | | - Eric D Vidoni
- University of Kansas Alzheimer’s Disease Center, Fairway, KS
| | - Jill K Morris
- University of Kansas Alzheimer’s Disease Center, Fairway, KS
| | - Jonathan D Mahnken
- Biostatistics, University of Kansas Medical Center, Kansas City, KS; and,University of Kansas Alzheimer’s Disease Center, Fairway, KS
| | - Jeffrey M Burns
- University of Kansas Alzheimer's Disease Center, Fairway, KS
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Jiang W, Wick JA, He J, Mahnken JD, Mayo MS. Bayesian design for two-arm randomized Phase II clinical trials with endpoints from the exponential family using multiple constraints. J Biopharm Stat 2017; 28:824-839. [PMID: 29172970 DOI: 10.1080/10543406.2017.1402779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Frequentist design for two-arm randomized Phase II clinical trials with outcomes from the exponential dispersion family was proposed previously, where the total sample sizes are minimized under multiple constraints on the standard errors of the estimated group means and their difference. This design was generalized from an approach specific for dichotomous outcomes. The two previous approaches measure the central tendency of each group and treatment effect based on mean and difference in means. Other measures such as median or hazard ratio are more appropriate under certain situations. In addition, the frequentist approaches assume that unknown parameters are fixed values. This does not reflect the reality that uncertainty always exists for unknowns. Compared to the frequentist methods, the Bayesian approach offers a flexible way to measure central tendency and treatment effect, and incorporate uncertainty in parameters of interest into considerations. In this article, we generalize a Bayesian design for Phase II clinical trials with endpoints in the exponential family from the two previously developed frequentist approaches. The proposed design minimizes the total sample sizes under pre-specified constraints on the expected length of posterior credible intervals for measures of treatment effect and central tendency in each group. The design is applicable for trials with fixed or optimal randomization allocation ratio and can be applied under adaptive procedure. Examples of method implementations are provided for different types of endpoints from the exponential family in both fixed and adaptive settings.
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Affiliation(s)
- Wei Jiang
- a Department of Biostatistics , University of Kansas Medical Center , Kansas City , Kansas , USA
| | - Jo A Wick
- a Department of Biostatistics , University of Kansas Medical Center , Kansas City , Kansas , USA
| | - Jianghua He
- a Department of Biostatistics , University of Kansas Medical Center , Kansas City , Kansas , USA
| | - Jonathan D Mahnken
- a Department of Biostatistics , University of Kansas Medical Center , Kansas City , Kansas , USA
| | - Matthew S Mayo
- a Department of Biostatistics , University of Kansas Medical Center , Kansas City , Kansas , USA
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Gupta A, Thomas TS, Klein JA, Montgomery RN, Mahnken JD, Johnson DK, Drew DA, Sarnak MJ, Burns JM. Discrepancies between Perceived and Measured Cognition in Kidney Transplant Recipients: Implications for Clinical Management. Nephron Clin Pract 2017; 138:22-28. [PMID: 29049997 DOI: 10.1159/000481182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/20/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cognitive impairment is common in kidney transplant (KT) recipients and affects quality of life, graft survival, morbidity, and mortality. Failure to identify patients with cognitive impairment can withhold appropriate and timely intervention. This study determines whether measured cognition with standard screening tools offers any advantage over perceived cognition in screening transplant patients for cognitive impairment. METHODS Cognition was assessed in 157 KT recipients using the Montreal Cognitive Assessment (MoCA; measured cognition). In addition, transplant physicians and nurse coordinators were asked to rate transplant recipients' level of cognition after routine clinical interactions (perceived cognition). Physicians and nurses were blind to MoCA scores. Perceived cognition scores were compared to MoCA scores. RESULTS Perceived cognition scores fairly correlated with MOCA scores (γ = 0.24, p = 0.001 for physicians and γ = 0.33, p < 0.0001 for nurses). Physician scores moderately correlated with nurses scores (κ = 0.44, p < 0.0001). Clinical perception had a low accuracy for identifying patients with cognitive impairment (sensitivity 66% for physicians, 65% for nurses), and those without cognitive impairment (specificity 67% for physicians, 76% for nurses). CONCLUSION Clinical perception is inaccurate at detecting cognitive impairment in KT recipients. Objective tests should be considered to screen KT recipients for cognitive impairment.
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Affiliation(s)
- Aditi Gupta
- Division of Nephrology and The Kidney Institute, University of Kansas Medical Center, Kansas City, KS, USA
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49
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Wilkins HM, Koppel S, Bothwell R, Mahnken JD, Burns JM, Swerdlow RH. [P3–229]: PLATELET MITOCHONDRIA CYTOCHROME OXIDASE AND CITRATE SYNTHASE IN APOE4‐CARRIER AD SUBJECTS. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.1442] [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)
| | - Scott Koppel
- University of Kansas Medical CenterKansas CityKSUSA
| | | | | | | | - Russell H. Swerdlow
- University of Kansas Alzheimer's Disease CenterFairwayKSUSA
- University of Kansas Medical CenterKansas CityKSUSA
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50
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Gupta A, Mahnken JD, Johnson DK, Thomas TS, Subramaniam D, Polshak T, Gani I, John Chen G, Burns JM, Sarnak MJ. Prevalence and correlates of cognitive impairment in kidney transplant recipients. BMC Nephrol 2017; 18:158. [PMID: 28499360 PMCID: PMC5429555 DOI: 10.1186/s12882-017-0570-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/02/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is a high prevalence of cognitive impairment in dialysis patients. The prevalence of cognitive impairment after kidney transplantation is unknown. METHODS Study Design: Cross-sectional study. SETTING AND PARTICIPANTS Single center study of prevalent kidney transplant recipients from a transplant clinic in a large academic center. INTERVENTION Assessment of cognition using the Montreal Cognitive Assessment (MoCA). Demographic and clinical variables associated with cognitive impairment were also examined. Outcomes and Measurements: a) Prevalence of cognitive impairment defined by a MoCA score of <26. b) Multivariable linear and logistic regression to examine the association of demographic and clinical factors with cognitive impairment. RESULTS Data from 226 patients were analyzed. Mean (SD) age was 54 (13.4) years, 73% were white, 60% were male, 37% had diabetes, 58% had an education level of college or above, and the mean (SD) time since kidney transplant was 3.4 (4.1) years. The prevalence of cognitive impairment was 58.0%. Multivariable linear regression demonstrated that older age, male gender and absence of diabetes were associated with lower MoCA scores (p < 0.01 for all). Estimated glomerular filtration rate (eGFR) was not associated with level of cognition. The logistic regression analysis confirmed the association of older age with cognitive impairment. CONCLUSION Cognitive impairment is common in prevalent kidney transplant recipients, at a younger age compared to general population, and is associated with certain demographic variables, but not level of eGFR.
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Affiliation(s)
- Aditi Gupta
- Division of Nephrology, University of Kansas Medical Center, Kansas City, KS USA
- Division of Nephrology and Hypertension, Department of Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160 USA
| | - Jonathan D. Mahnken
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS USA
| | - David K. Johnson
- Department of Psychology, Alzheimer’s Disease Center, University of Kansas, Lawrence, KS USA
| | - Tashra S. Thomas
- Division of Nephrology, University of Kansas Medical Center, Kansas City, KS USA
| | - Dipti Subramaniam
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS USA
| | - Tyler Polshak
- Division of Nephrology, University of Kansas Medical Center, Kansas City, KS USA
| | - Imran Gani
- Division of Internal Medicine, University of Kansas Medical Center, Kansas City, KS USA
| | - G. John Chen
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS USA
| | - Jeffrey M. Burns
- Department of Neurology, Alzheimer’s Disease Center, University of Kansas Medical Center, Kansas City, KS USA
| | - Mark J. Sarnak
- Division of Nephrology, Tufts Medical Center, Boston, MA USA
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