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Larsen FK, Baksh RA, McGlinchey E, Langballe EM, Benejam B, Beresford‐Webb J, McCarron M, Coppus A, Falquero S, Fortea J, Levin J, Loosli SV, Mark R, Rebillat A, Zaman S, Strydom A. Age of Alzheimer's disease diagnosis in people with Down syndrome and associated factors: Results from the Horizon 21 European Down syndrome consortium. Alzheimers Dement 2024; 20:3270-3280. [PMID: 38506627 PMCID: PMC11095427 DOI: 10.1002/alz.13779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION People with Down syndrome (DS) have high risk of developing Alzheimer's disease (AD). This study examined mean ages of AD diagnosis and associations with co-occurring conditions among adults with DS from five European countries. METHODS Data from 1335 people with DS from the Horizon 21 European DS Consortium were used for the analysis. RESULTS Mean ages of AD diagnosis ranged between 51.4 (SD 7.0) years (United Kingdom) and 55.6 (SD 6.8) years (France). Sleep-related and mental health problems were associated with earlier age of AD diagnosis. The higher number of co-occurring conditions the more likely the person with DS is diagnosed with AD at an earlier age. DISCUSSION Mean age of AD diagnosis in DS was relatively consistent across countries. However, co-occurring conditions varied and impacted on age of diagnosis, suggesting that improvements can be made in diagnosing and managing these conditions to delay onset of AD in DS. HIGHLIGHTS Mean age of AD diagnosis was relatively consistent between countries Sleep problems and mental health problems were associated with earlier age of AD diagnosis APOE ε4 carriers were diagnosed with AD at an earlier age compared to non-carriers Number of co-occurring conditions was associated with earlier age of AD diagnosis No differences between level of intellectual disability and mean age of AD diagnosis.
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Affiliation(s)
- Frode Kibsgaard Larsen
- The Norwegian National Centre for Ageing and HealthVestfold Hospital TrustTønsbergNorway
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloOsloNorway
| | - R. Asaad Baksh
- Institute of PsychiatryPsychology, and NeuroscienceDepartment of Forensic and Neurodevelopmental Sciences, King's College LondonLondonUK
- The London Down Syndrome (LonDownS) ConsortiumLondonUK
| | - Eimear McGlinchey
- Trinity Centre for Ageing and Intellectual DisabilityTrinity College Dublin, Lincoln GateDublinIreland
- Global Brain Health InstituteTrinity College Dublin & University of CaliforniaSan FranciscoCaliforniaUSA
| | - Ellen Melbye Langballe
- The Norwegian National Centre for Ageing and HealthVestfold Hospital TrustTønsbergNorway
- Department of Geriatric MedicineOslo University HospitalOsloNorway
| | - Bessy Benejam
- Barcelona Down Medical CenterFundació Catalana Síndrome de DownBarcelonaSpain
| | - Jessica Beresford‐Webb
- Department of PsychiatryUniversity of CambridgeThe Old SchoolsCambridgeUK
- Cambridgeshire & Peterborough NHS Foundation TrustFulbourn HospitalCambridgeUK
| | - Mary McCarron
- Trinity Centre for Ageing and Intellectual DisabilityTrinity College Dublin, Lincoln GateDublinIreland
| | - Antonia Coppus
- Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
| | | | - Juan Fortea
- Barcelona Down Medical CenterFundació Catalana Síndrome de DownBarcelonaSpain
- Sant Pau Memory UnitDepartment of NeurologyHospital of Sant Pau, Sant Pau Research InstituteBarcelonaSpain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED)Monforte de LemosMadridSpain
| | - Johannes Levin
- Department of NeurologyLudwig‐Maximilians‐Universität MünchenMunichGermany
- German Center for Neurodegenerative DiseasesMunichGermany
- Munich Cluster for Systems Neurology (SyNergy)MunichGermany
| | - Sandra V. Loosli
- Department of NeurologyLudwig‐Maximilians‐Universität MünchenMunichGermany
- Department of NeurologyUniversity Hospital ZurichZurichSwitzerland
| | - Ruth Mark
- Cognitive NeuropsychologyTilburg UniversityTilburgThe Netherlands
| | | | - Shahid Zaman
- Department of PsychiatryUniversity of CambridgeThe Old SchoolsCambridgeUK
- Cambridgeshire & Peterborough NHS Foundation TrustFulbourn HospitalCambridgeUK
| | - Andre Strydom
- Institute of PsychiatryPsychology, and NeuroscienceDepartment of Forensic and Neurodevelopmental Sciences, King's College LondonLondonUK
- The London Down Syndrome (LonDownS) ConsortiumLondonUK
- South London and the Maudsley NHS Foundation TrustLondonUK
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Rubenstein E, Michals A, Wang N, Scott A, Tewolde S, Levine AA, Tripodis Y, Skotko BG. Medicaid Enrollment and Service Use Among Adults With Down Syndrome. JAMA HEALTH FORUM 2023; 4:e232320. [PMID: 37566429 PMCID: PMC10422190 DOI: 10.1001/jamahealthforum.2023.2320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/01/2023] [Indexed: 08/12/2023] Open
Abstract
Importance Down syndrome is the leading genetic cause of intellectual disability and automatically qualifies individuals for Social Security Insurance. Therefore, Medicaid is the major health insurance provider for a population at high risk for dementia, obesity, and premature mortality. Despite the importance of Medicaid for adults with Down syndrome, little is known about how this population uses Medicaid. Objective To describe enrollment in, health care use in, and cost to Medicaid for adults with Down syndrome compared with adults with intellectual disability and a random sample of adults enrolled in Medicaid. Design, Setting, and Participants In this cohort study, the data are from a claims cohort of adults aged 18 years or older enrolled in Medicaid at any point between January 1, 2011, and December 31, 2019. Participants were enrollees with 1 or more inpatient claim or 2 or more other claims with an International Classification of Diseases, Ninth Revision code or an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code for Down syndrome or intellectual disability as well as a random sample of those without developmental disability. Analyses were conducted from June 2022 to February 2023. Main Outcomes and Measures Data were linked across 2 data reporting systems. Main outcomes were enrollee demographic characteristics, enrollment characteristics, cost, and service use. Results This cohort study included 123 024 individuals with Down syndrome (820 273 person-years of coverage; mean [SD] age, 35 [14.7] years; median age, 33 years [IQR, 21-48 years]; 51.6% men; 14.1% Black individuals; 16.7% Hispanic individuals; and 74.6% White individuals), 1 182 246 individuals with intellectual disability (mean [SD] age, 37.1 [16.8] years; median age, 33 years [IQR, 22-50 years]; 56.5% men; 22.0% Black individuals; 11.7% Hispanic individuals; and 69.5% White individuals), and 3 176 371 individuals with no developmental disabilities (mean [SD] age, 38 [18.6] years; median age, 33 years [IQR, 21-52 years]; 43.8% men; 23.7% Black individuals; 20.7% Hispanic individuals; and 61.3% White individuals). Median enrollment in Medicaid for a person with Down syndrome was 8.0 years (IQR, 5.0-9.0 years; mean [SD], 6.6 [2.6] years). Costs were higher for the Down syndrome group (median, $26 278 per person-year [IQR, $11 145-$55 928 per person-year]) relative to the group with no developmental disabilities (median, $6173 per person-year [IQR, $868-$58 390 per person-year]). Asian, Black, Hispanic, Native American, and Pacific Islander adults with Down syndrome had fewer costs and claims per person-year compared with White adults with Down syndrome. Conclusion and Relevance This cohort study of individuals with Down syndrome enrolled in Medicaid found consistent enrollment and high use of health care in a population with high health care needs. Results were similar comparing individuals with Down syndrome and those with intellectual disability, with both groups differing from a sample of Medicaid enrollees with no developmental disabilities. Medicaid data are a useful tool for understanding the health and well-being of individuals with Down syndrome.
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Affiliation(s)
- Eric Rubenstein
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Amy Michals
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Na Wang
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Ashley Scott
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Salina Tewolde
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - A. Alex Levine
- Department of Health Policy Law and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Brian G. Skotko
- Down Syndrome Program, Massachusetts General Hospital, Boston, Massachusetts
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Rubenstein E, Kyprianou N, Kumar PS, Kriova AM, Sokoloff A, Hillerstrom H, Hendrix J. Healthcare and Behavior Changes for Adults With Down Syndrome 1-Year Into COVID-19. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2023; 128:273-281. [PMID: 37470258 PMCID: PMC10512186 DOI: 10.1352/1944-7558-128.4.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/02/2022] [Indexed: 07/21/2023]
Abstract
Individuals with Down syndrome (DS) have been disproportionately harmed by the COVID-19 pandemic and may have been more likely to have sacrificed opportunity and activity to avoid potential exposures. Our objective was to describe the experience one to one and half years into the COVID-19 pandemic for adults with DS, as reported by their caregivers in an online survey conducted between April 2021 and September of 2021. In our sample of 438 adults with DS, caregivers reported that adults with DS lost activities, struggled with employment, had negative behavioral changes, lost skills, and developed more mental health conditions. For adults with DS, one in five caregivers reported less healthcare usage, one in four reported delayed routine care, and 86.5% reported lost activities. As the pandemic continues, targeted support for adults with DS is needed to prevent further skill loss and mental health conditions.
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Affiliation(s)
- Eric Rubenstein
- Eric Rubenstein, Nichole Kyprianou, Prisha Sujin Kumar, and Anna-Mariya Kriova, Boston University School of Public Health
| | - Nichole Kyprianou
- Eric Rubenstein, Nichole Kyprianou, Prisha Sujin Kumar, and Anna-Mariya Kriova, Boston University School of Public Health
| | - Prisha Sujin Kumar
- Eric Rubenstein, Nichole Kyprianou, Prisha Sujin Kumar, and Anna-Mariya Kriova, Boston University School of Public Health
| | - Anna-Mariya Kriova
- Eric Rubenstein, Nichole Kyprianou, Prisha Sujin Kumar, and Anna-Mariya Kriova, Boston University School of Public Health
| | | | - Hampus Hillerstrom
- Eric Rubenstein, Nichole Kyprianou, Prisha Sujin Kumar, and Anna-Mariya Kriova, Boston University School of Public Health
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Rodríguez-Hidalgo E, García-Alba J, Novell R, Esteba-Castillo S. The Global Deterioration Scale for Down Syndrome Population (GDS-DS): A Rating Scale to Assess the Progression of Alzheimer's Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5096. [PMID: 36982004 PMCID: PMC10049652 DOI: 10.3390/ijerph20065096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 06/18/2023]
Abstract
The aim of this study is to adapt and validate the global deterioration scale (GDS) for the systematic tracking of Alzheimer's disease (AD) progression in a population with Down syndrome (DS). A retrospective dual-center cohort study was conducted with 83 participants with DS (46.65 ± 5.08 years) who formed the primary diagnosis (PD) group: cognitive stability (n = 48), mild cognitive impairment (n = 24), and Alzheimer's disease (n = 11). The proposed scale for adults with DS (GDS-DS) comprises six stages, from cognitive and/or behavioral stability to advanced AD. Two neuropsychologists placed the participants of the PD group in each stage of the GDS-DS according to cognitive, behavioral and daily living skills data. Inter-rater reliability in staging with the GDS-DS was excellent (ICC = 0.86; CI: 0.80-0.93), and the agreement with the diagnosis categories of the PD group ranged from substantial to excellent with κ values of 0.82 (95% CI: 0.73-0.92) and 0.85 (95% CI: 0.72, 0.99). Performance with regard to the CAMCOG-DS total score and orientation subtest of the Barcelona test for intellectual disability showed a slight progressive decline across all the GDS-DS stages. The GDS-DS scale is a sensitive tool for staging the progression of AD in the DS population, with special relevance in daily clinical practice.
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Affiliation(s)
- Emili Rodríguez-Hidalgo
- Specialized Service in Mental Health and Intellectual Disability, Institute of Health Assistance (IAS), Parc Hospitalari Martí i Julià, 17190 Girona, Spain
- Neurodevelopmental Group [Girona Biomedical Research Institute]-IDIBGI, Institute of Health Assistance (IAS), Parc Hospitalari Martí i Julià, 17190 Girona, Spain
| | - Javier García-Alba
- Research and Psychology in Education Department, Complutense University of Madrid, 28040 Madrid, Spain
| | - Ramon Novell
- Specialized Service in Mental Health and Intellectual Disability, Institute of Health Assistance (IAS), Parc Hospitalari Martí i Julià, 17190 Girona, Spain
- Neurodevelopmental Group [Girona Biomedical Research Institute]-IDIBGI, Institute of Health Assistance (IAS), Parc Hospitalari Martí i Julià, 17190 Girona, Spain
| | - Susanna Esteba-Castillo
- Specialized Service in Mental Health and Intellectual Disability, Institute of Health Assistance (IAS), Parc Hospitalari Martí i Julià, 17190 Girona, Spain
- Neurodevelopmental Group [Girona Biomedical Research Institute]-IDIBGI, Institute of Health Assistance (IAS), Parc Hospitalari Martí i Julià, 17190 Girona, Spain
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Fernández A, Ramírez-Toraño F, Bruña R, Zuluaga P, Esteba-Castillo S, Abásolo D, Moldenhauer F, Shumbayawonda E, Maestú F, García-Alba J. Brain signal complexity in adults with Down syndrome: Potential application in the detection of mild cognitive impairment. Front Aging Neurosci 2022; 14:988540. [PMID: 36337705 PMCID: PMC9631477 DOI: 10.3389/fnagi.2022.988540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Down syndrome (DS) is considered the most frequent cause of early-onset Alzheimer’s disease (AD), and the typical pathophysiological signs are present in almost all individuals with DS by the age of 40. Despite of this evidence, the investigation on the pre-dementia stages in DS is scarce. In the present study we analyzed the complexity of brain oscillatory patterns and neuropsychological performance for the characterization of mild cognitive impairment (MCI) in DS. Materials and methods Lempel-Ziv complexity (LZC) values from resting-state magnetoencephalography recordings and the neuropsychological performance in 28 patients with DS [control DS group (CN-DS) (n = 14), MCI group (MCI-DS) (n = 14)] and 14 individuals with typical neurodevelopment (CN-no-DS) were analyzed. Results Lempel-Ziv complexity was lowest in the frontal region within the MCI-DS group, while the CN-DS group showed reduced values in parietal areas when compared with the CN-no-DS group. Also, the CN-no-DS group exhibited the expected pattern of significant increase of LZC as a function of age, while MCI-DS cases showed a decrease. The combination of reduced LZC values and a divergent trajectory of complexity evolution with age, allowed the discrimination of CN-DS vs. MCI-DS patients with a 92.9% of sensitivity and 85.7% of specificity. Finally, a pattern of mnestic and praxic impairment was significantly associated in MCI-DS cases with the significant reduction of LZC values in frontal and parietal regions (p = 0.01). Conclusion Brain signal complexity measured with LZC is reduced in DS and its development with age is also disrupted. The combination of both features might assist in the detection of MCI within this population.
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Affiliation(s)
- Alberto Fernández
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid, Spain
- Institute of Sanitary Investigation (IdISSC), Hospital Universitario San Carlos, Madrid, Spain
- Center for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, Madrid, Spain
| | - Federico Ramírez-Toraño
- Center for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, Madrid, Spain
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Universidad Complutense de Madrid, Madrid, Spain
| | - Ricardo Bruña
- Center for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, Madrid, Spain
- Department of Radiology, Universidad Complutense de Madrid, Madrid, Spain
- Department of Industrial Engineering & IUNE & ITB, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Pilar Zuluaga
- Statistics & Operations Research Department, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Susanna Esteba-Castillo
- Neurodevelopmental Group, Girona Biomedical Research Institute-IDIBGI, Institute of Health Assistance (IAS), Parc Hospitalari Martí i Julià, Girona, Spain
| | - Daniel Abásolo
- Centre for Biomedical Engineering, School of Mechanical Engineering Sciences, University of Surrey, Guildford, United Kingdom
| | - Fernando Moldenhauer
- Adult Down Syndrome Unit, Internal Medicine Department, Health Research Institute, Hospital Universitario de La Princesa, Madrid, Spain
| | - Elizabeth Shumbayawonda
- Centre for Biomedical Engineering, School of Mechanical Engineering Sciences, University of Surrey, Guildford, United Kingdom
| | - Fernando Maestú
- Center for Cognitive and Computational Neuroscience, Universidad Complutense de Madrid, Madrid, Spain
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier García-Alba
- Department of Research and Psychology in Education, Universidad Complutense de Madrid, Madrid, Spain
- *Correspondence: Javier García-Alba,
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Fleming V, Hom CL, Clare ICH, Hurd-Thomas SL, Krinsky-McHale S, Handen B, Hartley SL. Cognitive outcome measures for tracking Alzheimer's disease in Down syndrome. INTERNATIONAL REVIEW OF RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 62:227-263. [PMID: 37396708 PMCID: PMC10312212 DOI: 10.1016/bs.irrdd.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Down syndrome (DS) is now viewed as a genetic type of Alzheimer's disease (AD), given the near-universal presence of AD pathology in middle adulthood and the elevated risk for developing clinical AD in DS. As the field of DS prepares for AD clinical intervention trials, there is a strong need to identify cognitive measures that are specific and sensitive to the transition from being cognitively stable to the prodromal (e.g., Mild Cognitive Impairment-Down syndrome) and clinical AD (e.g., Dementia) stages of the disease in DS. It is also important to determine cognitive measures that map onto biomarkers of early AD pathology during the transition from the preclinical to the prodromal stage of the disease, as this transition period is likely to be targeted and tracked in AD clinical trials. The present chapter discusses the current state of research on cognitive measures that could be used to screen/select study participants and as potential outcome measures in future AD clinical trials with adults with DS. In this chapter, we also identify key challenges that need to be overcome and questions that need to be addressed by the DS field as it prepares for AD clinical trials in the coming years.
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Affiliation(s)
- Victoria Fleming
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- School of Human Ecology, University of Wisconsin-Madison, Madison, WI, United States
| | - Christy L Hom
- Department of Psychiatry and Human Behavior, University of California, Irvine School of Medicine, Orange, CA, United States
| | - Isabel C H Clare
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | | | - Sharon Krinsky-McHale
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY, United States
| | - Benjamin Handen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sigan L Hartley
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- School of Human Ecology, University of Wisconsin-Madison, Madison, WI, United States
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Edwards G, Jones C, Pearson E, Royston R, Oliver C, Tarver J, Crawford H, Shelley L, Waite J. Prevalence of anxiety symptomatology and diagnosis in syndromic intellectual disability: A systematic review and meta-analysis. Neurosci Biobehav Rev 2022; 138:104719. [PMID: 35661754 DOI: 10.1016/j.neubiorev.2022.104719] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/24/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
Individuals with syndromic intellectual disability are at increased risk of experiencing anxiety. Comparing prevalence estimates of anxiety will allow the identification of at-risk groups and inform causal pathways of anxiety. No known study has explored estimates of anxiety symptomatology and diagnosis, including specific anxiety profiles, across groups whilst accounting for methodological quality of studies. This systematic review and meta-analysis aimed to fill this gap. Prior to review completion, methodology and analysis plans were registered and documented in a protocol (CRD42019123561). Data from 83 papers, involving a pooled sample of 13,708 across eight syndromes were synthesised using a random effects model. Anxiety prevalence ranged from 9 % (95 % CI: 4-14) in Down syndrome to 73% in Rett syndrome (95 % CI: 70-77). Anxiety prevalence across syndromic intellectual disability was higher than for intellectual disability of mixed aetiology and general population estimates. Substantial variability between syndromes identified groups at higher risk than others. The identification of high-risk groups is crucial for early intervention, allowing us to refine models of risk and identify divergent profiles.
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Affiliation(s)
- Georgina Edwards
- The School of Psychology, College of Health and Life Sciences, Aston University, UK.
| | - Chris Jones
- School of Psychology, University of Birmingham, Edgbaston, UK.
| | - Effie Pearson
- The School of Psychology, College of Health and Life Sciences, Aston University, UK.
| | - Rachel Royston
- School of Psychology, University of Birmingham, Edgbaston, UK.
| | - Chris Oliver
- School of Psychology, University of Birmingham, Edgbaston, UK.
| | - Joanne Tarver
- The School of Psychology, College of Health and Life Sciences, Aston University, UK.
| | - Hayley Crawford
- Mental Health and Wellbeing Unit, Warwick Medical School, University of Warwick, UK.
| | - Lauren Shelley
- The School of Psychology, College of Health and Life Sciences, Aston University, UK.
| | - Jane Waite
- The School of Psychology, College of Health and Life Sciences, Aston University, UK.
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Varshney K, Iriowen R, Morrell K, Pillay P, Fossi A, Stephens MM. Disparities and outcomes of patients living with Down Syndrome undergoing healthcare transitions from pediatric to adult care: A scoping review. Am J Med Genet A 2022; 188:2293-2302. [PMID: 35686676 PMCID: PMC9545419 DOI: 10.1002/ajmg.a.62854] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/01/2022] [Accepted: 05/13/2022] [Indexed: 11/11/2022]
Abstract
Down Syndrome (DS) is one of the most common chromosomal disorders worldwide, and people with DS experience more co-morbidities and have poorer health outcomes compared to the general population. An area that is not well understood is how patients with DS transition from pediatric to adult care, as well as the details, barriers, and difficulties of these transitions for patients. Hence, we aimed to provide a scoping review of the literature in PubMed, Scopus, and CINAHL on the topic of healthcare transitions (HCTs) for patients with DS. Findings suggest patients with DS who continued receiving care as an adult from a pediatric care provider tended to experience co-morbidities and other adverse health issues at higher rates than those who entirely switch to an adult-care team. Patients with DS were unable to undergo transition due to multiple barriers, such as low income, limited/public insurance, gender, and race. We propose potential steps for transition, which focus on ensuring early planning, communicating better, coordinating services, assessing decision-making capacity, and providing ongoing social and financial support. Future research must further identify and address barriers to HCTs for people with DS.
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Affiliation(s)
- Karan Varshney
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Rosemary Iriowen
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kayla Morrell
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Preshon Pillay
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Alexander Fossi
- Center for Autism and Neurodiversity, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mary M Stephens
- Department of Family & Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Center for Special Healthcare Needs, Christiana, Delaware, USA
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9
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Pérez-Villarreal JM, Aviña-Padilla K, Beltrán-López E, Guadrón-Llanos AM, López-Bayghen E, Magaña-Gómez J, Meraz-Ríos MA, Varela-Echavarría A, Angulo-Rojo C. Profiling of circulating chromosome 21-encoded microRNAs, miR-155, and let-7c, in down syndrome. Mol Genet Genomic Med 2022; 10:e1938. [PMID: 35411714 PMCID: PMC9184673 DOI: 10.1002/mgg3.1938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/02/2022] [Accepted: 03/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Down syndrome (DS) is the most common chromosomal survival aneuploidy. The increase in DS life expectancy further heightens the risk of dementia, principally early‐onset Alzheimer's disease (AD). AD risk in DS is higher, considering that this population may also develop metabolic diseases such as obesity, dyslipidemias, and diabetes mellitus. The extra genetic material that characterizes DS causes an imbalance in the genetic dosage, including over‐expression of AD's key pathophysiological molecules and the gene expression regulators, the microRNAs (miRNAs). Two miRNAs, chromosome 21‐encoded, miR‐155, and let‐7c, are associated with cognitive impairment and dementia in adults; but, expression dynamics and relationship with clinical variables during the DS's lifespan had remained hitherto unexplored. Methods The anthropometric, clinical, biochemical, and profile expression of circulating miR‐155 and let‐7c were analyzed in a population of 52 control and 50 DS subjects divided into the young group (Aged ≤20 years) and the adult group (Aged ≥21 years). Results The expression changes for miR‐155 were not significant; nevertheless, a negative correlation with HDL‐Cholesterol concentrations was observed. Notably, let‐7c was over‐expressed in DS from young and old ages. Conclusion Overall, our results suggest that let‐7c plays a role from the early stages of DS's cognitive impairment while overexpression of miR‐155 may be related to lipid metabolism changes. Further studies of both miRNAs will shed light on their potential as therapeutic targets to prevent or delay DS's cognitive impairment.
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Affiliation(s)
- Jesús Manuel Pérez-Villarreal
- Laboratorio de Neurociencias, Centro de Investigación Aplicada a la Salud Pública (CIASaP), Facultad de Medicina, Universidad Autónoma de Sinaloa, Culiacán, Mexico.,Maestría en Ciencias Biomédicas, Facultad de Ciencias Químico-Biológicas, Universidad Autónoma de Sinaloa, Culiacán, Mexico.,Laboratorio de Nutrición Molecular, Escuela de Nutrición y Gastronomía, Universidad Autónoma de Sinaloa, Culiacán, Mexico
| | - Katia Aviña-Padilla
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, Mexico.,Laboratorio de Bioinformática y de Redes Complejas, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IRAPUATO), Mexico
| | - Evangelina Beltrán-López
- Laboratorio Edificio Central, Facultad de Ciencias Químico-Biológicas, Universidad Autónoma de Sinaloa, Culiacán, Mexico
| | - Alma Marlene Guadrón-Llanos
- Laboratorio de Diabetes y comorbilidades, Centro de Investigación Aplicada a la Salud Pública (CIASaP), Facultad de Medicina, Universidad Autónoma de Sinaloa, Culiacán, Mexico
| | - Esther López-Bayghen
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), México City, Mexico
| | - Javier Magaña-Gómez
- Maestría en Ciencias Biomédicas, Facultad de Ciencias Químico-Biológicas, Universidad Autónoma de Sinaloa, Culiacán, Mexico.,Laboratorio de Nutrición Molecular, Escuela de Nutrición y Gastronomía, Universidad Autónoma de Sinaloa, Culiacán, Mexico
| | - Marco Antonio Meraz-Ríos
- Departamento de Biomedicina Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), México City, Mexico
| | | | - Carla Angulo-Rojo
- Laboratorio de Neurociencias, Centro de Investigación Aplicada a la Salud Pública (CIASaP), Facultad de Medicina, Universidad Autónoma de Sinaloa, Culiacán, Mexico.,Centro de Investigación y Docencia en Ciencias de la Salud (CIDOCS), Universidad Autónoma de Sinaloa, Culiacán, Mexico
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10
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DiProspero ND, Keator DB, Phelan M, van Erp TGM, Doran E, Powell DK, Van Pelt KL, Schmitt FA, Head E, Lott IT, Yassa MA. Selective Impairment of Long-Range Default Mode Network Functional Connectivity as a Biomarker for Preclinical Alzheimer's Disease in People with Down Syndrome. J Alzheimers Dis 2022; 85:153-165. [PMID: 34776436 PMCID: PMC9017677 DOI: 10.3233/jad-210572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Down syndrome (DS) is associated with increased risk for Alzheimer's disease (AD). In neurotypical individuals, clinical AD is preceded by reduced resting state functional connectivity in the default mode network (DMN), but it is unknown whether changes in DMN connectivity predict clinical onset of AD in DS. OBJECTIVE Does lower DMN functional connectivity predict clinical onset of AD and cognitive decline in people with DS? METHODS Resting state functional MRI (rsfMRI), longitudinal neuropsychological, and clinical assessment data were collected on 15 nondemented people with DS (mean age = 51.66 years, SD = 5.34 years, range = 42-59 years) over four years, during which 4 transitioned to dementia. Amyloid-β (Aβ) PET data were acquired on 13 of the 15 participants. Resting state fMRI, neuropsychological, and clinical assessment data were also acquired on an independent, slightly younger unimpaired sample of 14 nondemented people with DS (mean age = 44.63 years, SD = 7.99 years, range = 38-61 years). RESULTS Lower functional connectivity between long-range but not short-range DMN regions predicts AD diagnosis and cognitive decline in people with DS. Aβ accumulation in the inferior parietal cortex is associated with lower regional DMN functional connectivity. CONCLUSION Reduction of long-range DMN connectivity is a potential biomarker for AD in people with DS that precedes and predicts clinical conversion.
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Affiliation(s)
- Natalie D. DiProspero
- Department of Neurobiology and Behavior, University of California, Irvine, CA 92697
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA 92697
| | - David B. Keator
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA 92697
| | - Michael Phelan
- Institute for Memory Impairments and Neurological Disorders, UC Irvine, CA 92697
| | - Theo G. M. van Erp
- Department of Pediatrics, University of California, Irvine Medical Center, Orange, CA 92868
| | - Eric Doran
- Department of Pediatrics, University of California, Irvine Medical Center, Orange, CA 92868
| | - David K. Powell
- Department of Neuroscience, University of Kentucky Medical Center, Lexington, KY 40536
| | - Kathryn L. Van Pelt
- Sanders-Brown Center on Aging, University of Kentucky Medical Center, Lexington, KY 40536
| | - Frederick A. Schmitt
- Sanders-Brown Center on Aging, University of Kentucky Medical Center, Lexington, KY 40536
- Department of Neurology, University of Kentucky Medical Center, Lexington, KY 40536
| | - Elizabeth Head
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA 92697
| | - Ira T. Lott
- Department of Pediatrics, University of California, Irvine Medical Center, Orange, CA 92868
| | - Michael A. Yassa
- Department of Neurobiology and Behavior, University of California, Irvine, CA 92697
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA 92697
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA 92697
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11
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Wallace ER, Harp JP, Van Pelt KL, Koehl LM, Caban-Holt AM, Anderson-Mooney AJ, Jicha GA, Lightner DD, Robertson WC, Head E, Schmitt FA. Identifying dementia in Down syndrome with the Severe Impairment Battery, Brief Praxis Test and Dementia Scale for People with Learning Disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:1085-1096. [PMID: 34786786 PMCID: PMC8842513 DOI: 10.1111/jir.12901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Individuals with Down syndrome (DS) are at high risk for dementia, specifically Alzheimer's disease. However, many measures regularly used for the detection of dementia in the general population are not suitable for individuals with DS due in part to floor effects. Some measures, including the Severe Impairment Battery (SIB), Brief Praxis Test (BPT) and Dementia Scale for People with Learning Disabilities (DLD), have been used in clinical trials and other research with this population. Validity research is limited, particularly regarding the use of such tools for detection of prodromal dementia in the DS population. The current project presents baseline cross-sectional SIB, BPT and DLD performance in order to characterise their predictive utility in discriminating normal cognition, possible dementia and probable dementia in adult DS. METHOD Baseline SIB, BPT and DLD performances from 100 individuals (no dementia = 68, possible dementia = 16 & probable dementia = 16) were examined from a longitudinal cohort of aging individuals with DS. Receiver operating characteristic curves investigated the accuracy of these measures in relation to consensus dementia diagnoses, diagnoses which demonstrated high percent agreement with the examining neurologist's independent diagnostic impression. RESULTS The SIB and BPT exhibited fair discrimination ability for differentiating no/possible versus probable dementia [area under the curve (AUC) = 0.61 and 0.66, respectively]. The DLD exhibited good discrimination ability for differentiating no versus possible/probable dementia (AUC = 0.75) and further demonstrated better performance of the DLD Cognitive subscale compared with the DLD Social subscale (AUC = 0.77 and 0.67, respectively). CONCLUSIONS Results suggest that the SIB, BPT and DLD are able to reasonably discriminate consensus dementia diagnoses in individuals with DS, supporting their continued use in the clinical assessment of dementia in DS. The general performance of these measures suggests that further work in the area of test development is needed to improve on the AUCs for dementia status discrimination in this unique population. At present, however, the current findings suggest that the DLD may be the best option for reliable identification of prodromal dementia in this population, reinforcing the importance of including informant behaviour ratings in assessment of cognition for adults with DS.
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Affiliation(s)
| | | | | | | | | | | | - Gregory A. Jicha
- Department of Neurology, University of Kentucky
- Sanders-Brown Center on Aging, University of Kentucky
| | | | | | - Elizabeth Head
- Department of Pathology & Laboratory Medicine, University of California—Irvine
| | - Frederick A. Schmitt
- Department of Neurology, University of Kentucky
- Sanders-Brown Center on Aging, University of Kentucky
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12
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Esteba-Castillo S, Garcia-Alba J, Rodríguez-Hildago E, Vaquero L, Novell R, Moldenhauer F, Castellanos MÁ. Proposed diagnostic criteria for mild cognitive impairment in Down syndrome population. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:495-505. [PMID: 34693611 DOI: 10.1111/jar.12959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/08/2021] [Accepted: 10/08/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite presenting higher risk of dementia, mild cognitive impairment (MCI) is not well defined in Down syndrome population. OBJECTIVE We aimed to describe cognitive and neuropsychological patterns associated with MCI in Down syndrome individuals. METHOD Two groups of adults with Down syndrome (control and prodromal) were studied throughout 3 years. Two linear mixed models and a model including the variables that best predicted group membership were built. RESULTS Behavioural Regulation Index (BRI) (Behaviour Rating Inventory of Executive Function test) and the model composed of BRI, abstraction and delayed verbal memory were the variable and model best predicting group membership, respectively. CONCLUSION Suggest a diagnosis of MCI when BRI is the earliest change perceived by caregivers and this is combined with low scores in abstract thinking, and when an amnesic pattern in delayed verbal memory is observed, but adaptive skills are preserved.
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Affiliation(s)
- Susanna Esteba-Castillo
- Specialized Service in Mental Health and Intellectual Disability, Institute of Health Assistance, Girona, Spain.,Neurodevelopmental Group [Girona Biomedical Research Institute]-IDIBGI, Institute of Health Assistance (IAS), Girona, Spain
| | - Javier Garcia-Alba
- Research and Psychology in Education Department (Faculty of Education), Complutense University of Madrid, Madrid, Spain
| | - Emili Rodríguez-Hildago
- Specialized Service in Mental Health and Intellectual Disability, Institute of Health Assistance, Girona, Spain
| | - Lucía Vaquero
- Laboratory of Cognitive and Computational Neuroscience, Department of Legal Medicine, Psychiatry and Pathology (Faculty of Medicine), Complutense University of Madrid, Madrid, Spain
| | - Ramon Novell
- Specialized Service in Mental Health and Intellectual Disability, Institute of Health Assistance, Girona, Spain.,Neurodevelopmental Group [Girona Biomedical Research Institute]-IDIBGI, Institute of Health Assistance (IAS), Girona, Spain
| | - Fernando Moldenhauer
- Adults' Section of the Down syndrome Department, Internal Medicine Department, La Princesa University Hospital, Madrid, Spain
| | - Miguel Ángel Castellanos
- Department of Methodology for Behavioral Science, Complutense University of Madrid, Madrid, Spain
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13
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Fleming V, Piro-Gambetti B, Bazydlo A, Zammit M, Alexander AL, Christian BT, Handen B, Plante DT, Hartley SL. Sleep and White Matter in Adults with Down Syndrome. Brain Sci 2021; 11:1322. [PMID: 34679387 PMCID: PMC8533851 DOI: 10.3390/brainsci11101322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022] Open
Abstract
Adults with Down syndrome are at a high risk for disordered sleep. These sleep problems could have marked effects on aging and Alzheimer's disease, potentially altering white matter integrity. This study examined the associations between disordered sleep assessed via an actigraph accelerometer worn on 7 consecutive nights, presence of diagnosis of obstructive sleep apnea, and diffusion tensor imaging indices of white matter integrity in 29 non-demented adults with Down Syndrome (48% female, aged 33-54 years). Average total sleep time was associated with lower mean diffusivity in the left superior longitudinal fasciculus (r = -0.398, p = 0.040). Average sleep efficiency, length of awakenings, and movement index were related to fractional anisotropy in the right inferior longitudinal fasciculus (r = -0.614 to 0.387, p ≤ 0.050). Diagnosis of obstructive sleep apnea was associated with fractional anisotropy in the right inferior longitudinal fasciculus (r = -0.373, p = 0.050). Findings suggest that more disrupted sleep is associated with lower white matter integrity in the major association tracts in middle-aged adults with Down syndrome. Longitudinal work is needed to confirm the directionally of associations. Sleep interventions could be an important component for promoting optimal brain aging in the Down syndrome population.
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Affiliation(s)
- Victoria Fleming
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (V.F.); (B.P.-G.); (A.B.); (M.Z.); (A.L.A.); (B.T.C.)
- School of Human Ecology, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Brianna Piro-Gambetti
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (V.F.); (B.P.-G.); (A.B.); (M.Z.); (A.L.A.); (B.T.C.)
- School of Human Ecology, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Austin Bazydlo
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (V.F.); (B.P.-G.); (A.B.); (M.Z.); (A.L.A.); (B.T.C.)
- Department of Medical Physics, University of Wisconsin-Madison, WI 53705, USA
| | - Matthew Zammit
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (V.F.); (B.P.-G.); (A.B.); (M.Z.); (A.L.A.); (B.T.C.)
- Department of Medical Physics, University of Wisconsin-Madison, WI 53705, USA
| | - Andrew L. Alexander
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (V.F.); (B.P.-G.); (A.B.); (M.Z.); (A.L.A.); (B.T.C.)
- Department of Medical Physics, University of Wisconsin-Madison, WI 53705, USA
- Department of Psychiatry, University of Wisconsin-Madison, WI 53719, USA;
| | - Bradley T. Christian
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (V.F.); (B.P.-G.); (A.B.); (M.Z.); (A.L.A.); (B.T.C.)
- Department of Medical Physics, University of Wisconsin-Madison, WI 53705, USA
- Department of Psychiatry, University of Wisconsin-Madison, WI 53719, USA;
| | - Benjamin Handen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA;
| | - David T. Plante
- Department of Psychiatry, University of Wisconsin-Madison, WI 53719, USA;
| | - Sigan L. Hartley
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (V.F.); (B.P.-G.); (A.B.); (M.Z.); (A.L.A.); (B.T.C.)
- School of Human Ecology, University of Wisconsin-Madison, Madison, WI 53706, USA
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14
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Montal V, Barroeta I, Bejanin A, Pegueroles J, Carmona-Iragui M, Altuna M, Benejam B, Videla L, Fernández S, Padilla C, Aranha MR, Iulita MF, Vidal-Piñeiro D, Alcolea D, Blesa R, Lleó A, Fortea J. Metabolite Signature of Alzheimer's Disease in Adults with Down Syndrome. Ann Neurol 2021; 90:407-416. [PMID: 34309066 DOI: 10.1002/ana.26178] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the Alzheimer's disease metabolite signature through magnetic resonance spectroscopy in adults with Down syndrome and its relation with Alzheimer's disease biomarkers and cortical thickness. METHODS We included 118 adults with Down syndrome from the Down Alzheimer Barcelona Imaging Initiative and 71 euploid healthy controls from the Sant Pau Initiative on Neurodegeneration cohort. We measured the levels of myo-inositol (a marker of neuroinflammation) and N-acetyl-aspartate (a marker of neuronal integrity) in the precuneus using magnetic resonance spectroscopy. We investigated the changes with age and along the disease continuum (asymptomatic, prodromal Alzheimer's disease, and Alzheimer's disease dementia stages). We assessed the relationship between these metabolites and Aβ42 /Aβ40 ratio, phosphorylated tau-181, neurofilament light (NfL), and YKL-40 cerebrospinal fluid levels as well as amyloid positron emission tomography uptake using Spearman correlations controlling for multiple comparisons. Finally, we computed the relationship between cortical thickness and metabolite levels using Freesurfer. RESULTS Asymptomatic adults with Down syndrome had a 27.5% increase in the levels of myo-inositol, but equal levels of N-acetyl-aspartate compared to euploid healthy controls. With disease progression, myo-inositol levels increased, whereas N-acetyl-aspartate levels decreased in symptomatic stages of the disease. Myo-inositol was associated with amyloid, tau, and neurodegeneration markers, mainly at symptomatic stages of the disease, whereas N-acetyl-aspartate was related to neurodegeneration biomarkers in symptomatic stages. Both metabolites were significantly associated with cortical thinning, mainly in symptomatic participants. INTERPRETATION Magnetic resonance spectroscopy detects Alzheimer's disease related inflammation and neurodegeneration, and could be a good noninvasive disease-stage biomarker in Down syndrome. ANN NEUROL 2021.
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Affiliation(s)
- Victor Montal
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Isabel Barroeta
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Alexandre Bejanin
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Jordi Pegueroles
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - María Carmona-Iragui
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Barcelona Down Medical Center. Fundació Catalana Síndrome de Down, Barcelona, Spain
| | - Miren Altuna
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Barcelona Down Medical Center. Fundació Catalana Síndrome de Down, Barcelona, Spain
| | - Bessy Benejam
- Barcelona Down Medical Center. Fundació Catalana Síndrome de Down, Barcelona, Spain
| | - Laura Videla
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Barcelona Down Medical Center. Fundació Catalana Síndrome de Down, Barcelona, Spain
| | - Susana Fernández
- Barcelona Down Medical Center. Fundació Catalana Síndrome de Down, Barcelona, Spain
| | - Concepcion Padilla
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mateus Rozalem Aranha
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Florencia Iulita
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Didac Vidal-Piñeiro
- Department of Psychology, Centre for Lifespan Changes in Brain and Cognition, University of Oslo, Oslo, Norway
| | - Daniel Alcolea
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Rafael Blesa
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Alberto Lleó
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Juan Fortea
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Barcelona Down Medical Center. Fundació Catalana Síndrome de Down, Barcelona, Spain
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15
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A Comparative Analysis of Machine Learning Algorithms to Predict Alzheimer's Disease. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:9917919. [PMID: 34336171 PMCID: PMC8289609 DOI: 10.1155/2021/9917919] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/29/2021] [Accepted: 06/23/2021] [Indexed: 02/06/2023]
Abstract
Alzheimer's disease has been one of the major concerns recently. Around 45 million people are suffering from this disease. Alzheimer's is a degenerative brain disease with an unspecified cause and pathogenesis which primarily affects older people. The main cause of Alzheimer's disease is Dementia, which progressively damages the brain cells. People lost their thinking ability, reading ability, and many more from this disease. A machine learning system can reduce this problem by predicting the disease. The main aim is to recognize Dementia among various patients. This paper represents the result and analysis regarding detecting Dementia from various machine learning models. The Open Access Series of Imaging Studies (OASIS) dataset has been used for the development of the system. The dataset is small, but it has some significant values. The dataset has been analyzed and applied in several machine learning models. Support vector machine, logistic regression, decision tree, and random forest have been used for prediction. First, the system has been run without fine-tuning and then with fine-tuning. Comparing the results, it is found that the support vector machine provides the best results among the models. It has the best accuracy in detecting Dementia among numerous patients. The system is simple and can easily help people by detecting Dementia among them.
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16
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Fleming V, Litzelman K. Caregiver resource utilization: Intellectual and development disability and dementia. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:1468-1476. [PMID: 34124823 DOI: 10.1111/jar.12889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/03/2021] [Accepted: 04/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adults with intellectual and developmental disabilities and their families have high need for support services. This study assessed resource utilization among caregivers of intellectual and developmental disabilities and other conditions. METHODS We assessed 366 caregivers of adults with intellectual and developmental disabilities, dementia or other conditions Regressions assessed group differences in number of agency contacts and frequency of service use. A secondary analysis assessed reasons for underutilization of services. RESULTS Caregivers of individuals with dementia contacted twice as many agencies as other caregivers and were more likely to report using suggested services. Agency contact and service utilization were similar among caregivers of adults with intellectual and developmental disabilities compared to other caregivers. Caregivers of adults with intellectual and developmental indicated that suggested services were unavailable to them. CONCLUSION The findings of this study shed light on challenges with access to and utilization of support services.
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Affiliation(s)
- Victoria Fleming
- Department of Human Development & Family Studies, University of Wisconsin-Madison, Madison, WI, USA
| | - Kristin Litzelman
- Department of Human Development & Family Studies, University of Wisconsin-Madison, Madison, WI, USA
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17
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Bazydlo A, Zammit M, Wu M, Dean D, Johnson S, Tudorascu D, Cohen A, Cody K, Ances B, Laymon C, Klunk W, Zaman S, Handen B, Alexander A, Christian B, Hartley S. White matter microstructure associations with episodic memory in adults with Down syndrome: a tract-based spatial statistics study. J Neurodev Disord 2021; 13:17. [PMID: 33879062 PMCID: PMC8059162 DOI: 10.1186/s11689-021-09366-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/08/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Nearly all persons with Down syndrome will show pathology of Alzheimer's disease in their 40s. There is a critical need for studies to identify early biomarkers of these various pathological changes of Alzheimer's disease in the Down syndrome population and understand the relationship of these biomarkers to cognitive symptoms in order to inform clinical trials. Although Alzheimer's disease is often considered a disease of gray matter, white matter degeneration has been documented during the preclinical stage of Alzheimer's disease. The current study examined the association between diffusion tensor imaging (DTI) measures of white matter microstructure and episodic memory performance in 52 adults with Down syndrome. METHODS Seventy (N = 70) participants (M = 40.13, SD = 7.77 years) received baseline scans as part of the Neurodegeneration in Aging Down Syndrome (NiAD) study at two imaging facilities (36 at the University of Wisconsin-Madison [UW-Madison] and 34 at the University of Pittsburgh Medical Center [UPMC]). All participants had genetically confirmed trisomy 21. Fifty-two (N = 52) participants remained after QC. The DTI measures, fractional anisotropy (FA) and mean diffusivity (MD), were calculated for each participant. A combined measure of episodic memory was generated by summing the z-scores of (1) Free and Cued Recall test and (2) Rivermead Behavioural Memory Test for Children Picture Recognition. The DTI data were projected onto a population-derived FA skeleton and tract-based spatial statistics analysis was conducted using the FSL tool PALM to calculate Pearson's r values between FA and MD with episodic memory. RESULTS A positive correlation of episodic memory with FA and a negative correlation of episodic memory and MD in the major association white matter tracts were observed. Results were significant (p < 0.05) after correction for chronological age, imaging site, and premorbid cognitive ability. CONCLUSION These findings suggest that white matter degeneration may be implicated in early episodic memory declines prior to the onset of dementia in adults with Down syndrome. Further, our findings suggest a coupling of episodic memory and white matter microstructure independent of chronological age.
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Affiliation(s)
- Austin Bazydlo
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
| | - Matthew Zammit
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Minjie Wu
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Douglas Dean
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Sterling Johnson
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, WI, USA
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Dana Tudorascu
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ann Cohen
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Karly Cody
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Beau Ances
- Washington University of St. Louis, St. Louis, MO, USA
| | - Charles Laymon
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - William Klunk
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Shahid Zaman
- Cambridge Intellectual and Developmental Disabilities Research Group, University of Cambridge, Cambridge, UK
| | - Benjamin Handen
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrew Alexander
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Bradley Christian
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison, Madison, WI, USA
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Sigan Hartley
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
- School of Human Ecology, University of Wisconsin-Madison, Madison, WI, USA
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18
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Chicoine B, Rivelli A, Fitzpatrick V, Chicoine L, Jia G, Rzhetsky A. Prevalence of Common Disease Conditions in a Large Cohort of Individuals With Down Syndrome in the United States. J Patient Cent Res Rev 2021; 8:86-97. [PMID: 33898640 DOI: 10.17294/2330-0698.1824] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Given the current life expectancy and number of individuals living with Down syndrome (DS), it is important to learn common occurrences of disease conditions across the developmental lifespan. This study analyzed data from a large cohort of individuals with DS in an effort to better understand these disease conditions, inform future screening practices, tailor medical care guidelines, and improve utilization of health care resources. Methods This retrospective, descriptive study incorporated up to 28 years of data, compiled from 6078 individuals with DS and 30,326 controls matched on age and sex. Data were abstracted from electronic medical records within a large Midwestern health system. Results In general, individuals with DS experienced higher prevalence of testicular cancer, leukemias, moyamoya disease, mental health conditions, bronchitis and pneumonia, gastrointestinal conditions, thyroid disorder, neurological conditions, atlantoaxial subluxation, osteoporosis, dysphagia, diseases of the eyes/adnexa and of the ears/mastoid process, and sleep apnea, relative to matched controls. Individuals with DS experienced lower prevalence of solid tumors, heart disease conditions, sexually transmitted diseases, HIV, influenza, sinusitis, urinary tract infections, and diabetes. Similar rates of prevalence were seen for lymphomas, skin melanomas, stroke, acute myocardial infarction, hepatitis, cellulitis, and osteoarthritis. Conclusions While it is challenging to draw a widespread conclusion about comorbidities in individuals with Down syndrome, it is safe to conclude that care for individuals with DS should not automatically mirror screening, prevention, or treatment guidelines for the general U.S. population. Rather, care for those with DS should reflect the unique needs and common comorbidities of this population.
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Affiliation(s)
- Brian Chicoine
- Advocate Aurora Health, Downers Grove, IL.,Advocate Medical Group Adult Down Syndrome Center, Park Ridge, IL
| | - Anne Rivelli
- Advocate Aurora Health, Downers Grove, IL.,Advocate Aurora Research Institute, Downers Grove, IL
| | - Veronica Fitzpatrick
- Advocate Aurora Health, Downers Grove, IL.,Advocate Aurora Research Institute, Downers Grove, IL
| | - Laura Chicoine
- Advocate Aurora Health, Downers Grove, IL.,Advocate Medical Group Adult Down Syndrome Center, Park Ridge, IL
| | - Gengjie Jia
- Department of Medicine, University of Chicago, Chicago, IL.,Institute of Genomics and Systems Biology, University of Chicago, Chicago, IL
| | - Andrey Rzhetsky
- Department of Medicine, University of Chicago, Chicago, IL.,Institute of Genomics and Systems Biology, University of Chicago, Chicago, IL
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19
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De Vreese LP, Gomiero T, De Bastiani E, Marangoni A, Weger E, Mantesso U. Short forms of Prudhoe Cognitive Function Test in adults and aging people with intellectual disabilities: Italian validation study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:162-172. [PMID: 33230890 DOI: 10.1111/jir.12799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 09/22/2020] [Accepted: 10/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND We aimed to validate the Italian version of the two parallel short forms of the Prudhoe Cognitive Function Test (s-PCFT-I) in adults and seniors with intellectual disabilities (ID) of any aetiology and level of severity. METHODS Our validation is a multicentre study attended by 211 subjects with ID, 125 male and 86 female, aged 40 years and above for people with Down syndrome and aged 50 years for people with other forms of disabilities. RESULTS The s-PCFT-I shows a wide range of scores in the absence of floor effects with minimal ceiling effects. A Cronbach's α coefficient of 0.85 and a mean inter-item correlation of 0.21 indicate high internal consistency. The tool demonstrates good agreement between testers and near excellent temporal stability with intraclass correlation coefficients respectively of 0.85 and 0.90. s-PCFT-I total scores do not differ by sex or age, while statistically significant differences are observed between people with different levels of severity of ID. Moderate to good and highly significant correlations (-0.40 to -0.66) among the s-PCFT-I total scores and subscores and the Sum of Cognitive Score of the informant-based Dementia Questionnaire for Persons with Intellectual Disabilities suggest an acceptable level of concurrent criterion validity. Cognitive decliners according to Prasher's Dementia Questionnaire for Persons with Intellectual Disabilities cut-off scores perform significantly lower on s-PCFT-I than non-decliners. CONCLUSIONS The s-PCFT-I has good psychometric properties and user friendliness and may therefore be a valuable addition to the current informant-rated tools for screening and assessment of cognition in aging people with ID.
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Affiliation(s)
- L P De Vreese
- Fondazione Luigi Boni Onlus, Health Director Geriatric Center, Suzzara, Italy
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino, Trento, Italy
| | - T Gomiero
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino, Trento, Italy
| | - E De Bastiani
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino, Trento, Italy
| | - A Marangoni
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino, Trento, Italy
- Fondazione Trentina per l'Autismo, Mezzolombardo, Italy
| | - E Weger
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino, Trento, Italy
| | - U Mantesso
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino, Trento, Italy
- Azienda Provinciale per i Servizi Sanitari, Public health general practitioner, Trento, Italy
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20
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Figueroa-Jimenez MD, Cañete-Massé C, Carbó-Carreté M, Zarabozo-Hurtado D, Peró-Cebollero M, Salazar-Estrada JG, Guàrdia-Olmos J. Resting-state default mode network connectivity in young individuals with Down syndrome. Brain Behav 2021; 11:e01905. [PMID: 33179859 PMCID: PMC7821605 DOI: 10.1002/brb3.1905] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/24/2020] [Accepted: 10/02/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Down syndrome (DS) is a chromosomal disorder that causes intellectual disability. Few studies have been conducted on functional connectivity using resting-state fMRI (functional magnetic resonance imaging) signals or more specifically, on the relevant structure and density of the default mode network (DMN). Although data on this issue have been reported in adult DS individuals (age: >45 years), the DMN properties in young DS individuals have not been studied. The aim of this study was to describe the density and structure of the DMN network from fMRI signals in young DS (age: <36 years). METHOD A sample of 22 young people with DS between the ages of 16 and 35 (M = 25.5 and SD = 5.1) was recruited in various centers for people with intellectual disability (ID). In addition to sociodemographic data, a six-minute fMRI session was recorded with a 3. T Philips Ingenia scanner. A control group of 22 young people, matched by age and gender, was obtained from the Human Connectome Project (to compare the networks properties between groups). RESULTS The values of the 48 ROIs that configured the DMN were obtained, and the connectivity graphs for each subject, the average connectivity graph for each group, the clustering and degree values for each ROI, and the average functional connectivity network were estimated. CONCLUSIONS A higher density of overactivation was identified in DS group in the ventral, sensorimotor, and visual DMN networks, although within a framework of a wide variability of connectivity patterns in comparison with the control group network. These results extend our understanding of the functional connectivity networks pattern and intrasubject variability in DS.
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Affiliation(s)
| | - Cristina Cañete-Massé
- Department of Social Psychology & Quantitative Psychology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,UB Institute of Complex Systems, University of Barcelona, Barcelona, Spain
| | - María Carbó-Carreté
- Institute of Neuroscience, University of Barcelona, Barcelona, Spain.,Department of Cognition, Developmental Psychology and Education, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Daniel Zarabozo-Hurtado
- RIO Group Clinical Laboratory, Center for Research in Advanced Functional Neuro-Diagnosis CINDFA, Guadalajara, México
| | - Maribel Peró-Cebollero
- Department of Social Psychology & Quantitative Psychology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,UB Institute of Complex Systems, University of Barcelona, Barcelona, Spain.,Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | | | - Joan Guàrdia-Olmos
- Department of Social Psychology & Quantitative Psychology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,UB Institute of Complex Systems, University of Barcelona, Barcelona, Spain.,Institute of Neuroscience, University of Barcelona, Barcelona, Spain
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21
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Hartley SL, Handen BL, Devenny D, Tudorascu D, Piro-Gambetti B, Zammit MD, Laymon CM, Klunk WE, Zaman S, Cohen A, Christian BT. Cognitive indicators of transition to preclinical and prodromal stages of Alzheimer's disease in Down syndrome. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12096. [PMID: 32995465 PMCID: PMC7507534 DOI: 10.1002/dad2.12096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION There is a critical need to identify measures of cognitive functioning sensitive to early Alzheimer's disease (AD) pathophysiology in Down syndrome to advance clinical trial research in this at-risk population. The objective of the study was to longitudinally track performance on cognitive measures in relation to neocortical and striatal amyloid beta (Aβ) in non-demented Down syndrome. METHODS The study included 118 non-demented adults with Down syndrome who participated in two to five points of data collection, spanning 1.5 to 8 years. Episodic memory, visual attention and executive functioning, and motor planning and coordination were assessed. Aβ was measured via [C-11] Pittsburgh Compound-B (PiB) PET. RESULTS PiB was associated with level and rate of decline in cognitive performance in episodic memory, visual attention, executive functioning, and visuospatial ability in models controlling for chronological age. DISCUSSION The Cued Recall Test emerged as a promising indicator of transition from preclinical to prodromal AD.
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Affiliation(s)
- Sigan L Hartley
- Waisman Center University of Wisconsin-Madison Madison Wisconsin USA
- Department of Human Development & Family Studies University of Wisconsin-Madison Madison Wisconsin USA
| | - Benjamin L Handen
- Department of Psychiatry University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Darlynne Devenny
- New York State Institute for Basic Research in Developmental Disabilities Albany New York USA
| | - Dana Tudorascu
- Department of Psychiatry University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Brianna Piro-Gambetti
- Waisman Center University of Wisconsin-Madison Madison Wisconsin USA
- Department of Human Development & Family Studies University of Wisconsin-Madison Madison Wisconsin USA
| | - Matthew D Zammit
- Waisman Center University of Wisconsin-Madison Madison Wisconsin USA
- Department of Medical Physics University of Wisconsin-Madison Madison Wisconsin USA
| | - Charles M Laymon
- Department of Psychiatry University of Pittsburgh Pittsburgh Pennsylvania USA
| | - William E Klunk
- Department of Psychiatry University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Shahid Zaman
- Department of Psychiatry University of Cambridge Cambridge UK
| | - Annie Cohen
- Department of Psychiatry University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Bradley T Christian
- Waisman Center University of Wisconsin-Madison Madison Wisconsin USA
- Department of Medical Physics University of Wisconsin-Madison Madison Wisconsin USA
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22
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Rafii MS. Alzheimer's Disease in Down Syndrome: Progress in the Design and Conduct of Drug Prevention Trials. CNS Drugs 2020; 34:785-794. [PMID: 32506291 PMCID: PMC7395870 DOI: 10.1007/s40263-020-00740-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Individuals with Down syndrome (DS) are at high risk for developing Alzheimer's disease (AD) pathology and this has provided significant insights into our understanding of the genetic basis of AD. The present review summarizes recent clinical, neuropathologic, imaging, and fluid biomarker studies of AD in DS (DSAD), highlighting the striking similarities, as well as some notable differences, between DSAD and the more common late-onset form of AD (LOAD) in the general population, as well as the much rarer, autosomal-dominant form of AD (ADAD). There has been significant progress in our understanding of the natural history of AD biomarkers in DS and their relationship to clinically meaningful changes. Additional work is needed to clearly define the continuum of AD that has been described in the general population, such as the preclinical, prodromal, and dementia stages of AD. Multiple therapeutic approaches, including those targeting not only β-amyloid but also tau and the amyloid precursor protein itself, require consideration. Recent developments in the field are presented within the context of such efforts to conduct clinical trials to treat and potentially prevent AD in DS.
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23
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Mihaila I, Handen BL, Christian BT, Hartley SL. Leisure activity in middle-aged adults with Down syndrome: Initiators, social partners, settings and barriers. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:865-875. [PMID: 31994249 DOI: 10.1111/jar.12706] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 12/06/2019] [Accepted: 01/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Leisure activity has been linked to optimal ageing outcomes, yet little is known about the type and level of leisure activity adults with Down syndrome currently engage in, and the factors that promote and hinder their leisure activities. MATERIALS AND METHODS A daily diary was utilized to provide an in-depth description of the average daily leisure activity of 44 adults with Down syndrome (aged 25-56 years) across a typical 7-day period. Factors related to participation, including initiators, social partners, settings and barriers, were examined. RESULTS Findings indicated that the majority of adults with Down syndrome did not meet established physical leisure activity intensity recommendations (i.e., 150 min/week moderately active activity) and did not exceed levels of passive leisure (e.g., watching television) found in the general population (i.e., 2-3 hr/day). Adults with Down syndrome self-initiated and self-engaged in the majority of their leisure activity. Family members and paid staff allocated resources towards initiating and engaging as social partners in social and physical leisure, respectively. CONCLUSIONS Interventions and support services should partner with family members and paid staff to foster participation in adaptive leisure activity, perhaps through the establishment of leisure activity as part of daily routines.
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Affiliation(s)
- Iulia Mihaila
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA
| | - Benjamin L Handen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bradley T Christian
- University of Wisconsin-Madison Waisman Center, Madison, WI, USA.,Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Sigan L Hartley
- University of Wisconsin-Madison Waisman Center, Madison, WI, USA.,Department of Human Development and Family Studies, University of Wisconsin-Madison, Madison, WI, USA
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24
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An P, Zhou X, Du Y, Zhao J, Song A, Liu H, Ma F, Huang G. Association of Neutrophil-Lymphocyte Ratio with Mild Cognitive Impairment in Elderly Chinese Adults: A Case-control Study. Curr Alzheimer Res 2020; 16:1309-1315. [DOI: 10.2174/1567205017666200103110521] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 11/15/2019] [Accepted: 12/29/2019] [Indexed: 02/04/2023]
Abstract
Background:
Inflammation plays a significant role in the pathophysiology of cognitive impairment
in previous studies. Neutrophil-lymphocyte ratio (NLR) is a reliable measure of systemic inflammation.
Objective:
The aim of this study was to investigate the association between NLR and mild cognitive
impairment (MCI), and further to explore the diagnostic potential of the inflammatory markers NLR for
the diagnosis of MCI in elderly Chinese individuals.
Methods:
186 MCI subjects and 153 subjects with normal cognitive function were evaluated consecutively
in this study. Neutrophil (NEUT) count and Lymphocyte (LYM) count were measured in fasting
blood samples. The NLR was calculated by dividing the absolute NEUT count by the absolute LYM
count. Multivariable logistic regression was used to evaluate the potential association between NLR and
MCI. NLR for predicting MCI was analyzed using Receiver Operating Characteristic (ROC) curve
analysis.
Results:
The NLR of MCI group was significantly higher than that of subjects with normal cognitive
function (2.39 ± 0.55 vs. 1.94 ± 0.51, P < 0.001). Logistic regression analysis showed that higher NLR
was an independent risk factor for MCI (OR: 4.549, 95% CI: 2.623-7.889, P < 0.001). ROC analysis
suggested that the optimum NLR cut-off point for MCI was 2.07 with 73.66% sensitivity, 69.28% specificity,
74.48% Positive Predictive Values (PPV) and 68.36% negative predictive values (NPV). Subjects
with NLR ≥ 2.07 showed higher risk relative to NLR < 2.07 (OR: 5.933, 95% CI: 3.467-10.155, P <
0.001).
Conclusion:
The elevated NLR is significantly associated with increased risk of MCI. In particular,
NLR level higher than the threshold of 2.07 was significantly associated with the probability of MCI.
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Affiliation(s)
- Peilin An
- Department of Nutrition & Food Science, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xuan Zhou
- Department of Nutrition & Food Science, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yue Du
- Department of Social Medicine and Health Management, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jiangang Zhao
- Community Health Service Center, Sanhuailu Street, Binhai New District, Tianjin, China
| | - Aili Song
- Community Health Service Center, Sanhuailu Street, Binhai New District, Tianjin, China
| | - Huan Liu
- Department of Nutrition & Food Science, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Fei Ma
- Department of Epidemiology & Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Guowei Huang
- Department of Nutrition & Food Science, School of Public Health, Tianjin Medical University, Tianjin, China
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