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Reuter-Lorenz PA, Park DC. Cognitive aging and the life course: A new look at the Scaffolding theory. Curr Opin Psychol 2024; 56:101781. [PMID: 38278087 DOI: 10.1016/j.copsyc.2023.101781] [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: 09/16/2023] [Revised: 11/21/2023] [Accepted: 12/06/2023] [Indexed: 01/28/2024]
Abstract
Our understanding of human neurocognitive aging, its developmental roots, and life course influences has been transformed by brain imaging technologies, increasing availability of longitudinal data sets, and analytic advances. The Scaffolding Theory of Aging and Cognition is a life course model, proposed originally in 2009, featuring adaptivity and compensatory potential as lifelong mechanisms for meeting neurocognitive challenges posed by the environment and by developing or declining brain circuitry. Here, we review the scaffolding theory in relation to new evidence addressing when during the life course potentially enriching and depleting factors exert their effects on brain health and scaffolding, and we consider the implications for separable, and potentially reciprocal, influences on the level of cognitive function and the rate of decline in later life.
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Brosnan M, Pearce DJ, O'Neill MH, Loughnane GM, Fleming B, Zhou SH, Chong T, Nobre AC, O Connell RG, Bellgrove MA. Evidence Accumulation Rate Moderates the Relationship between Enriched Environment Exposure and Age-Related Response Speed Declines. J Neurosci 2023; 43:6401-6414. [PMID: 37507230 PMCID: PMC10500991 DOI: 10.1523/jneurosci.2260-21.2023] [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: 11/15/2021] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Older adults exposed to enriched environments (EEs) maintain relatively higher levels of cognitive function, even in the face of compromised markers of brain health. Response speed (RS) is often used as a simple proxy to measure the preservation of global cognitive function in older adults. However, it is unknown which specific selection, decision, and/or motor processes provide the most specific indices of neurocognitive health. Here, using a simple decision task with electroencephalography (EEG), we found that the efficiency with which an individual accumulates sensory evidence was a critical determinant of the extent to which RS was preserved in older adults (63% female, 37% male). Moreover, the mitigating influence of EE on age-related RS declines was most pronounced when evidence accumulation rates were shallowest. These results suggest that the phenomenon of cognitive reserve, whereby high EE individuals can better tolerate suboptimal brain health to facilitate the preservation of cognitive function, is not just applicable to neuroanatomical indicators of brain aging but can be observed in markers of neurophysiology. Our results suggest that EEG metrics of evidence accumulation may index neurocognitive vulnerability of the aging brain.Significance Statement Response speed in older adults is closely linked with trajectories of cognitive aging. Here, by recording brain activity while individuals perform a simple computer task, we identify a neural metric that is a critical determinant of response speed. Older adults exposed to greater cognitive and social stimulation throughout a lifetime could maintain faster responding, even when this neural metric was impaired. This work suggests EEG is a useful technique for interrogating how a lifetime of stimulation benefits brain health in aging.
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Affiliation(s)
- Méadhbh Brosnan
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria 3800, Australia
- Department of Experimental Psychology, University of Oxford, Oxford OX2 6GG, United Kingdom
- Oxford Centre for Human Brain Activity, University of Oxford, Oxford OX3 7JX, United Kingdom
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford OX3 9DU, United Kingdom
- School of Psychology, University College Dublin, Dublin 2, Ireland
| | - Daniel J Pearce
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria 3800, Australia
| | - Megan H O'Neill
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria 3800, Australia
| | - Gerard M Loughnane
- School of Business, National College of Ireland, Dublin 1, Ireland
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin 2, Ireland
| | - Bryce Fleming
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria 3800, Australia
| | - Shou-Han Zhou
- Department of Psychology, James Cook University, Brisbane, Queensland 4000, Australia
| | - Trevor Chong
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria 3800, Australia
| | - Anna C Nobre
- Department of Experimental Psychology, University of Oxford, Oxford OX2 6GG, United Kingdom
- Oxford Centre for Human Brain Activity, University of Oxford, Oxford OX3 7JX, United Kingdom
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Redmond G O Connell
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria 3800, Australia
- School of Business, National College of Ireland, Dublin 1, Ireland
| | - Mark A Bellgrove
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria 3800, Australia
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Dzwiza-Ohlsen EN, Kempermann G. The embodied mind in motion: a neuroscientific and philosophical perspective on prevention and therapy of dementia. Front Psychol 2023; 14:1174424. [PMID: 37663337 PMCID: PMC10471310 DOI: 10.3389/fpsyg.2023.1174424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/24/2023] [Indexed: 09/05/2023] Open
Abstract
The embodied mind in motion is a concept in which health and well-being, prevention and therapy, as well as lifestyle and habits meet. The mind changes profoundly in the course of dementias, affecting daily living and resulting in reduced quality of life. Interdisciplinary approaches are required for a holistic understanding of how the mind is affected by dementia. We here explore what such a holistic theory of dementia might look like and propose the idea of "embodied mind in motion". The paradigm is biopsychosocial or biocultural, the theoretical anchor point is the lifeworld, and the guiding concept is "embodiment," as body and mind are constantly in motion. Physical activity is, hence, central for the experience of health and well-being, beyond being "exercise" and "health behavior". We discuss the embodied mind in motion referring to phenomenology, enactivism and (philosophical) anthropology. In our view, habits are embodied long-term memories and a philosophical equivalent to lifestyle. They unfold the meaningfulness of moving the body, complementing the objectifiable benefits of physical exercise. Empirical studies on "holistic activities" like hiking, yoga, music and dance illustrate improved integration into everyday life. Their meaningfulness enhances compliance and increases the preventive and even therapeutic potential. A crucial factor for this is the emotional dimension of lifestyle, exemplified by the virally popularized performance of "Swan Lake" by wheel-chair bound ex-ballerina Marta Cinta González Saldaña, suffering from Alzheimer's disease. A number of epistemological and ontological consequences anchor "embodied movement" as a valuable principle for dementia research.
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Affiliation(s)
- Erik N. Dzwiza-Ohlsen
- Faculty of Arts and Humanities, Husserl Archives Cologne, University of Cologne, Cologne, Germany
| | - Gerd Kempermann
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
- CRTD – Center for Regenerative Therapies, TU Dresden, Dresden, Germany
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4
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van der Flier WM, de Vugt ME, Smets EMA, Blom M, Teunissen CE. Towards a future where Alzheimer's disease pathology is stopped before the onset of dementia. NATURE AGING 2023; 3:494-505. [PMID: 37202515 DOI: 10.1038/s43587-023-00404-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/21/2023] [Indexed: 05/20/2023]
Abstract
Alzheimer's disease (AD) is a major healthcare challenge with no curative treatment at present. To address this challenge, we need a paradigm shift, where we focus on pre-dementia stages of AD. In this Perspective, we outline a strategy to move towards a future with personalized medicine for AD by preparing for and investing in effective and patient-orchestrated diagnosis, prediction and prevention of the dementia stage. While focusing on AD, this Perspective also discusses studies that do not specify the cause of dementia. Future personalized prevention strategies encompass multiple components, including tailored combinations of disease-modifying interventions and lifestyle. By empowering the public and patients to be more actively engaged in the management of their health and disease and by developing improved strategies for diagnosis, prediction and prevention, we can pave the way for a future with personalized medicine, in which AD pathology is stopped to prevent or delay the onset of dementia.
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Affiliation(s)
- Wiesje M van der Flier
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, the Netherlands.
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands.
- Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, the Netherlands.
| | - Marjolein E de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Ellen M A Smets
- Medical Psychology, Amsterdam UMC location AMC, Amsterdam, the Netherlands
| | - Marco Blom
- Alzheimer Nederland, Amersfoort, Utrecht, the Netherlands
| | - Charlotte E Teunissen
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands
- Neurochemistry Laboratory, Clinical Chemistry, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
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5
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Stiernman L, Grill F, McNulty C, Bahrd P, Panes Lundmark V, Axelsson J, Salami A, Rieckmann A. Widespread fMRI BOLD Signal Overactivations during Cognitive Control in Older Adults Are Not Matched by Corresponding Increases in fPET Glucose Metabolism. J Neurosci 2023; 43:2527-2536. [PMID: 36868855 PMCID: PMC10082451 DOI: 10.1523/jneurosci.1331-22.2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/14/2023] [Accepted: 01/20/2023] [Indexed: 03/05/2023] Open
Abstract
A common observation in fMRI studies using the BOLD signal is that older adults, compared with young adults, show overactivations, particularly during less demanding tasks. The neuronal underpinnings of such overactivations are not known, but a dominant view is that they are compensatory in nature and involve recruitment of additional neural resources. We scanned 23 young (20-37 years) and 34 older (65-86 years) healthy human adults of both sexes with hybrid positron emission tomography/MRI. The radioligand [18F]fluoro-deoxyglucose was used to assess dynamic changes in glucose metabolism as a marker of task-dependent synaptic activity, along with simultaneous fMRI BOLD imaging. Participants performed two verbal working memory (WM) tasks: one involving maintenance (easy) and one requiring manipulation (difficult) of information in WM. Converging activations to the WM tasks versus rest were observed for both imaging modalities and age groups in attentional, control, and sensorimotor networks. Upregulation of activity to WM-demand, comparing the more difficult to the easier task, also converged between both modalities and age groups. For regions in which older adults showed task-dependent BOLD overactivations compared with the young adults, no corresponding increases in glucose metabolism were found. To conclude, findings from the current study show that task-induced changes in the BOLD signal and synaptic activity as measured by glucose metabolism generally converge, but overactivations observed with fMRI in older adults are not coupled with increased synaptic activity, which suggests that these overactivations are not neuronal in origin.SIGNIFICANCE STATEMENT Findings of increased fMRI activations in older compared with younger adults have been suggested to reflect increased use of neuronal resources to cope with reduced brain function. The physiological underpinnings of such compensatory processes are poorly understood, however, and rest on the assumption that vascular signals accurately reflect neuronal activity. Comparing fMRI and simultaneously acquired functional positron emission tomography as an alternative index of synaptic activity, we show that age-related overactivations do not appear to be neuronal in origin. This result is important because mechanisms underlying compensatory processes in aging are potential targets for interventions aiming to prevent age-related cognitive decline.
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Affiliation(s)
- Lars Stiernman
- Department of Integrative Medical Biology, Umeå University, 901 87 Umeå, Sweden
- Umeå Center for Functional Brain Imaging, Umeå University, 901 87 Umeå, Sweden
| | - Filip Grill
- Umeå Center for Functional Brain Imaging, Umeå University, 901 87 Umeå, Sweden
- Department of Radiation Sciences, Umeå University, 901 87 Umeå, Sweden
| | - Charlotte McNulty
- Department of Integrative Medical Biology, Umeå University, 901 87 Umeå, Sweden
- Umeå Center for Functional Brain Imaging, Umeå University, 901 87 Umeå, Sweden
| | - Philip Bahrd
- Department of Integrative Medical Biology, Umeå University, 901 87 Umeå, Sweden
- Umeå Center for Functional Brain Imaging, Umeå University, 901 87 Umeå, Sweden
| | - Vania Panes Lundmark
- Department of Integrative Medical Biology, Umeå University, 901 87 Umeå, Sweden
- Umeå Center for Functional Brain Imaging, Umeå University, 901 87 Umeå, Sweden
| | - Jan Axelsson
- Umeå Center for Functional Brain Imaging, Umeå University, 901 87 Umeå, Sweden
- Department of Radiation Sciences, Umeå University, 901 87 Umeå, Sweden
| | - Alireza Salami
- Department of Integrative Medical Biology, Umeå University, 901 87 Umeå, Sweden
- Umeå Center for Functional Brain Imaging, Umeå University, 901 87 Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, 901 87 Umeå, Sweden
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, 171 65 Solna, Sweden
| | - Anna Rieckmann
- Department of Integrative Medical Biology, Umeå University, 901 87 Umeå, Sweden
- Umeå Center for Functional Brain Imaging, Umeå University, 901 87 Umeå, Sweden
- Department of Radiation Sciences, Umeå University, 901 87 Umeå, Sweden
- Munich Center for the Economics of Aging, Max Planck Institute for Social Law and Social Policy, Munich, 80799 München, Germany
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6
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Lopes JB, Małz M, Senko AN, Zocher S, Kempermann G. Loss of individualized behavioral trajectories in adult neurogenesis-deficient cyclin D2 knockout mice. Hippocampus 2023; 33:360-372. [PMID: 36880417 DOI: 10.1002/hipo.23522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/14/2023] [Accepted: 02/19/2023] [Indexed: 03/08/2023]
Abstract
There is still limited mechanistic insight into how the interaction of individuals with their environment results in the emergence of individuality in behavior and brain structure. Nevertheless, the idea that personal activity shapes the brain is implicit in strategies for healthy cognitive aging as well as in the idea that individuality is reflected in the brain's connectome. We have shown that even isogenic mice kept in a shared enriched environment (ENR) developed divergent and stable social and exploratory trajectories. As these trajectories-measured as roaming entropy (RE)-positively correlated with adult hippocampal neurogenesis, we hypothesized that a feedback between behavioral activity and adult hippocampal neurogenesis might be a causal factor in brain individualization. We used cyclin D2 knockout mice with constitutively extremely low levels of adult hippocampal neurogenesis and their wild-type littermates. We housed them for 3 months in a novel ENR paradigm, consisting of 70 connected cages equipped with radio frequency identification antennae for longitudinal tracking. Cognitive performance was evaluated in the Morris Water Maze task (MWM). With immunohistochemistry we confirmed that adult neurogenesis correlated with RE in both genotypes and that D2 knockout mice had the expected impaired performance in the reversal phase of the MWM. But whereas the wild-type animals developed stable exploratory trajectories with increasing variance, correlating with adult neurogenesis, this individualizing phenotype was absent in D2 knockout mice. Here the behaviors started out more random and revealed less habituation and low variance. Together, these findings suggest that adult neurogenesis contributes to experience-dependent brain individualization.
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Affiliation(s)
- Jadna Bogado Lopes
- German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
- CRTD - Center for Regenerative Therapies TU Dresden, Dresden, Germany
| | - Monika Małz
- German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
- CRTD - Center for Regenerative Therapies TU Dresden, Dresden, Germany
| | - Anna N Senko
- German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
- CRTD - Center for Regenerative Therapies TU Dresden, Dresden, Germany
| | - Sara Zocher
- German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
- CRTD - Center for Regenerative Therapies TU Dresden, Dresden, Germany
| | - Gerd Kempermann
- German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
- CRTD - Center for Regenerative Therapies TU Dresden, Dresden, Germany
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7
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Torenvliet C, Groenman AP, Radhoe TA, Agelink van Rentergem JA, Van der Putten WJ, Geurts HM. A longitudinal study on cognitive aging in autism. Psychiatry Res 2023; 321:115063. [PMID: 36709700 DOI: 10.1016/j.psychres.2023.115063] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023]
Abstract
Longitudinal studies on cognitive aging in autism are scarce, and largely underpowered, yet essential to obtain more conclusive results on cognitive changes in autism during adulthood. In the largest longitudinal study on cognition thus far, we aimed to get more insight into cognitive aging in autism. As pre-registered, we computed reliable change indices (RCIs) and multilevel models to estimate cognitive changes in 128 autistic, and 112 non-autistic adults (range: 24-85 yrs.) over two to three timepoints (average interval: 3.5 yrs.). Participants were tested on 15 outcome measures, covering verbal memory, visual (working) memory, prospective memory, theory of mind, fluency, response speed, inhibition, planning, and switching. RCIs showed no significant differences between groups (autism/no-autism) in changes over time. Using multilevel models, most tasks showed sensitivity to cross-sectional age-related effects, and/or longitudinal changes, with worse performance at older age, and later timepoints. However, effects were not significantly different between the autism and no-autism group. This lack of group differences was substantiated by additional Bayesian analyses. In sum, the current study provides evidence for parallel (similar) cognitive aging in autism. Specifically, autistic individuals diagnosed in adulthood, without intellectual disability, do not seem at risk for accelerated cognitive decline.
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Affiliation(s)
- C Torenvliet
- Dutch Autism and ADHD Research Center, Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.
| | - A P Groenman
- Dutch Autism and ADHD Research Center, Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Research Institute Child Development and Education, University of Amsterdam, the Netherlands
| | - T A Radhoe
- Dutch Autism and ADHD Research Center, Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - J A Agelink van Rentergem
- Dutch Autism and ADHD Research Center, Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - W J Van der Putten
- Dutch Autism and ADHD Research Center, Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Leo Kannerhuis, autism clinic (Youz/Parnassia Group), Amsterdam, the Netherlands
| | - H M Geurts
- Dutch Autism and ADHD Research Center, Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Leo Kannerhuis, autism clinic (Youz/Parnassia Group), Amsterdam, the Netherlands
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8
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Clinical Trials of New Drugs for Vascular Cognitive Impairment and Vascular Dementia. Int J Mol Sci 2022; 23:ijms231911067. [PMID: 36232368 PMCID: PMC9569827 DOI: 10.3390/ijms231911067] [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: 08/22/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 12/03/2022] Open
Abstract
Population aging has challenged the treatment of cognitive impairment or dementia. Vascular dementia is the second leading cause of dementia after Alzheimer’s disease. Cognitive consequences after ischemic brain injury have been recognized as a preferred target for therapeutic strategies, prompting the search for potential agents. The keyword “vascular dementia” was used to search ClinicalTrials.gov to determine agents represented in phases I, II, III, and IV. The agents were classified on the basis of their mechanisms. Of the 17 randomized controlled trials meeting our inclusion criteria, 9 were completed in the past 10 years, and 8 are ongoing or in the planning stages. We also identified one trial in phase I, nine in phase II, six in phase III, and one in phase IV. Fewer trials of new drugs for improving cognition or ameliorating the behavioral and psychological symptoms of dementia target vascular dementia than Alzheimer’s dementia. Drug trials on vascular dementia overlap with drug trials targeting functional outcomes in cerebrovascular disease. International pharmaceutical companies’ investment in new drugs targeting VCI and vascular dementia remains insufficient.
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9
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Bernard JA. Don't forget the little brain: A framework for incorporating the cerebellum into the understanding of cognitive aging. Neurosci Biobehav Rev 2022; 137:104639. [PMID: 35346747 PMCID: PMC9119942 DOI: 10.1016/j.neubiorev.2022.104639] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/28/2022] [Accepted: 03/23/2022] [Indexed: 12/22/2022]
Abstract
With the rapidly growing population of older adults, an improved understanding of brain and cognitive aging is critical, given the impacts on health, independence, and quality of life. To this point, we have a well-developed literature on the cortical contributions to cognition in advanced age. However, while this work has been foundational for our understanding of brain and behavior in older adults, subcortical contributions, particularly those from the cerebellum, have not been integrated into these models and frameworks. Incorporating the cerebellum into models of cognitive aging is an important step for moving the field forward. There has also been recent interest in this structure in Alzheimer's dementia, indicating that such work may be beneficial to our understanding of neurodegenerative disease. Here, I provide an updated overview of the cerebellum in advanced age and propose that it serves as a critical source of scaffolding or reserve for cortical function. Age-related impacts on cerebellar function further impact cortical processing, perhaps resulting in many of the activation patterns commonly seen in aging.
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Affiliation(s)
- Jessica A Bernard
- Department of Psychological and Brain Sciences, USA; Texas A&M Institute for Neuroscience, Texas A&M University, USA.
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10
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Kremen WS, Elman JA, Panizzon MS, Eglit GML, Sanderson-Cimino M, Williams ME, Lyons MJ, Franz CE. Cognitive Reserve and Related Constructs: A Unified Framework Across Cognitive and Brain Dimensions of Aging. Front Aging Neurosci 2022; 14:834765. [PMID: 35711905 PMCID: PMC9196190 DOI: 10.3389/fnagi.2022.834765] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/03/2022] [Indexed: 01/27/2023] Open
Abstract
Cognitive reserve and related constructs are valuable for aging-related research, but consistency and clarification of terms is needed as there is still no universally agreed upon nomenclature. We propose a new set of definitions for the concepts of reserve, maintenance, and resilience, and we invoke parallel concepts for each that are applicable to cognition and to brain. Our definitions of reserve and resilience correspond reasonably well to dictionary definitions of these terms. We demonstrate logical/methodological problems that arise from incongruence between commonly used conceptual and operational definitions. In our view, cognitive reserve should be defined conceptually as one's total cognitive resources at a given point in time. IQ and education are examples of common operational definitions (often referred to as proxies) of cognitive reserve. Many researchers define cognitive reserve conceptually as a property that allows for performing better than expected cognitively in the face of aging or pathology. Performing better than expected is demonstrated statistically by interactions in which the moderator is typically IQ or education. The result is an irreconcilable situation in which cognitive reserve is both the moderator and the moderation effect itself. Our proposed nomenclature resolves this logical inconsistency by defining performing better than expected as cognitive resilience. Thus, in our usage, we would test the hypothesis that high cognitive reserve confers greater cognitive resilience. Operational definitions (so-called proxies) should not conflate factors that may influence reserve-such as occupational complexity or engagement in cognitive activities-with cognitive reserve itself. Because resources may be depleted with aging or pathology, one's level of cognitive reserve may change over time and will be dependent on when assessment takes place. Therefore, in addition to cognitive reserve and cognitive resilience, we introduce maintenance of cognitive reserve as a parallel to brain maintenance. If, however, education is the measure of reserve in older adults, it precludes assessing change or maintenance of reserve. Finally, we discuss consideration of resistance as a subcategory of resilience, reverse causation, use of residual scores to assess performing better than expected given some adverse factor, and what constitutes high vs. low cognitive reserve across different studies.
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Affiliation(s)
- William S. Kremen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, United States
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, United States
| | - Jeremy A. Elman
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, United States
| | - Matthew S. Panizzon
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, United States
| | - Graham M. L. Eglit
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, United States
| | - Mark Sanderson-Cimino
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, United States
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - McKenna E. Williams
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, United States
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Michael J. Lyons
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, United States
| | - Carol E. Franz
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, United States
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11
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Brosnan MB, Shalev N, Ramduny J, Sotiropoulos SN, Chechlacz M. Right fronto-parietal networks mediate the neurocognitive benefits of enriched environments. Brain Commun 2022; 4:fcac080. [PMID: 35474852 PMCID: PMC9035529 DOI: 10.1093/braincomms/fcac080] [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: 09/06/2021] [Revised: 01/10/2022] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
Exposure to enriched environments throughout a lifetime, providing so-called reserve, protects against cognitive decline in later years. It has been hypothesized that high levels of alertness necessitated by enriched environments might strengthen the right fronto-parietal networks to facilitate this neurocognitive resilience. We have previously shown that enriched environments offset age-related deficits in selective attention by preserving grey matter within right fronto-parietal regions. Here, using neurite orientation dispersion and density imaging, we examined the relationship between enriched environments, microstructural properties of fronto-parietal white matter association pathways (three branches of the superior longitudinal fasciculus), structural brain health (atrophy), and attention (alertness, orienting and executive control) in a group of older adults. We show that exposure to enriched environments is associated with a lower orientation dispersion index within the right superior longitudinal fasciculus 1 which in turn mediates the relationship between enriched environments and alertness, as well as grey and white matter atrophy. This suggests that enriched environments may induce white matter plasticity (and prevent age-related dispersion of axons) within the right fronto-parietal networks to facilitate the preservation of neurocognitive health in later years.
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Affiliation(s)
- Méadhbh B. Brosnan
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Oxford Centre for Human Brain Activity, University of Oxford, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Nir Shalev
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Oxford Centre for Human Brain Activity, University of Oxford, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Jivesh Ramduny
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Stamatios N. Sotiropoulos
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Queen’s Medical Centre, Nottingham, UK
| | - Magdalena Chechlacz
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK
- School of Psychology, University of Birmingham, Birmingham, UK
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12
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Buchman AS, Bennett DA. Mixed Neuropathologies, Neural Motor Resilience and Target Discovery for Therapies of Late-Life Motor Impairment. Front Hum Neurosci 2022; 16:853330. [PMID: 35399360 PMCID: PMC8987574 DOI: 10.3389/fnhum.2022.853330] [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: 01/12/2022] [Accepted: 02/21/2022] [Indexed: 01/14/2023] Open
Abstract
By age 85, most adults manifest some degree of motor impairment. However, in most individuals a specific etiology for motor decline and treatment to modify its inexorable progression cannot be identified. Recent clinical-pathologic studies provide evidence that mixed-brain pathologies are commonly associated with late-life motor impairment. Yet, while nearly all older adults show some degree of accumulation of Alzheimer's disease and related dementias (ADRD) pathologies, the extent to which these pathologies contribute to motor decline varies widely from person to person. Slower or faster than expected motor decline in the presence of brain injury and/or pathology has been conceptualized as more or less "resilience" relative to the average person This suggests that other factors, such as lifestyles or other neurobiologic indices may offset or exacerbate the negative effects of pathologies via other molecular pathways. The mechanisms underlying neural motor resilience are just beginning to be illuminated. Unlike its cousin, cognitive resilience which is restricted to neural mechanisms above the neck, the motor system extends the total length of the CNS and beyond the CNS to reach muscle and musculoskeletal structures, all of which are crucial for motor function. Building on prior work, we propose that by isolating motor decline unrelated to neuropathologies and degeneration, investigators can identify genes and proteins that may provide neural motor resilience. Elucidating these molecular mechanisms will advance our understanding of the heterogeneity of late-life motor impairment. This approach will also provide high value therapeutic targets for drug discovery of therapies that may offset the negative motor consequences of CNS pathologies that are currently untreatable.
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Affiliation(s)
- Aron S. Buchman
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States,*Correspondence: Aron S. Buchman,
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
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13
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Overview of (f)MRI Studies of Cognitive Aging for Non-Experts: Looking through the Lens of Neuroimaging. Life (Basel) 2022; 12:life12030416. [PMID: 35330167 PMCID: PMC8953678 DOI: 10.3390/life12030416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/21/2022] [Accepted: 03/11/2022] [Indexed: 11/20/2022] Open
Abstract
This special issue concerning Brain Functional and Structural Connectivity and Cognition aims to expand our understanding of brain connectivity. Herein, I review related topics including the principle and concepts of functional MRI, brain activation, and functional/structural connectivity in aging for uninitiated readers. Visuospatial attention, one of the well-studied functions in aging, is discussed from the perspective of neuroimaging.
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14
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Saboo KV, Hu C, Varatharajah Y, Przybelski SA, Reid RI, Schwarz CG, Graff-Radford J, Knopman DS, Machulda MM, Mielke MM, Petersen RC, Arnold PM, Worrell GA, Jones DT, Jack Jr CR, Iyer RK, Vemuri P. Deep learning identifies brain structures that predict cognition and explain heterogeneity in cognitive aging. Neuroimage 2022; 251:119020. [PMID: 35196565 PMCID: PMC9045384 DOI: 10.1016/j.neuroimage.2022.119020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/20/2022] [Accepted: 02/17/2022] [Indexed: 12/02/2022] Open
Abstract
Specific brain structures (gray matter regions and white matter tracts) play a dominant role in determining cognitive decline and explain the heterogeneity in cognitive aging. Identification of these structures is crucial for screening of older adults at risk of cognitive decline. Using deep learning models augmented with a model-interpretation technique on data from 1432 Mayo Clinic Study of Aging participants, we identified a subset of brain structures that were most predictive of individualized cognitive trajectories and indicative of cognitively resilient vs. vulnerable individuals. Specifically, these structures explained why some participants were resilient to the deleterious effects of elevated brain amyloid and poor vascular health. Of these, medial temporal lobe and fornix, reflective of age and pathology-related degeneration, and corpus callosum, reflective of inter-hemispheric disconnection, accounted for 60% of the heterogeneity explained by the most predictive structures. Our results are valuable for identifying cognitively vulnerable individuals and for developing interventions for cognitive decline.
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15
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Kremen WS, Elman JA, Panizzon MS, Eglit GML, Sanderson-Cimino M, Williams ME, Lyons MJ, Franz CE. Cognitive Reserve and Related Constructs: A Unified Framework Across Cognitive and Brain Dimensions of Aging. Front Aging Neurosci 2022. [PMID: 35711905 DOI: 10.3389/fnagi.2022.834765fda] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Cognitive reserve and related constructs are valuable for aging-related research, but consistency and clarification of terms is needed as there is still no universally agreed upon nomenclature. We propose a new set of definitions for the concepts of reserve, maintenance, and resilience, and we invoke parallel concepts for each that are applicable to cognition and to brain. Our definitions of reserve and resilience correspond reasonably well to dictionary definitions of these terms. We demonstrate logical/methodological problems that arise from incongruence between commonly used conceptual and operational definitions. In our view, cognitive reserve should be defined conceptually as one's total cognitive resources at a given point in time. IQ and education are examples of common operational definitions (often referred to as proxies) of cognitive reserve. Many researchers define cognitive reserve conceptually as a property that allows for performing better than expected cognitively in the face of aging or pathology. Performing better than expected is demonstrated statistically by interactions in which the moderator is typically IQ or education. The result is an irreconcilable situation in which cognitive reserve is both the moderator and the moderation effect itself. Our proposed nomenclature resolves this logical inconsistency by defining performing better than expected as cognitive resilience. Thus, in our usage, we would test the hypothesis that high cognitive reserve confers greater cognitive resilience. Operational definitions (so-called proxies) should not conflate factors that may influence reserve-such as occupational complexity or engagement in cognitive activities-with cognitive reserve itself. Because resources may be depleted with aging or pathology, one's level of cognitive reserve may change over time and will be dependent on when assessment takes place. Therefore, in addition to cognitive reserve and cognitive resilience, we introduce maintenance of cognitive reserve as a parallel to brain maintenance. If, however, education is the measure of reserve in older adults, it precludes assessing change or maintenance of reserve. Finally, we discuss consideration of resistance as a subcategory of resilience, reverse causation, use of residual scores to assess performing better than expected given some adverse factor, and what constitutes high vs. low cognitive reserve across different studies.
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Affiliation(s)
- William S Kremen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, United States
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, United States
| | - Jeremy A Elman
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, United States
| | - Matthew S Panizzon
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, United States
| | - Graham M L Eglit
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, United States
| | - Mark Sanderson-Cimino
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, United States
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - McKenna E Williams
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, United States
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Michael J Lyons
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, United States
| | - Carol E Franz
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, United States
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16
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Don HJ, Davis T, Ray KL, McMahon MC, Cornwall AC, Schnyer DM, Worthy DA. Neural regions associated with gain-loss frequency and average reward in older and younger adults. Neurobiol Aging 2021; 109:247-258. [PMID: 34818618 DOI: 10.1016/j.neurobiolaging.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022]
Abstract
Research on the biological basis of reinforcement-learning has focused on how brain regions track expected value based on average reward. However, recent work suggests that humans are more attuned to reward frequency. Furthermore, older adults are less likely to use expected values to guide choice than younger adults. This raises the question of whether brain regions assumed to be sensitive to average reward, like the medial and lateral PFC, also track reward frequency, and whether there are age-based differences. Older (60-81 years) and younger (18-30 years) adults performed the Soochow Gambling task, which separates reward frequency from average reward, while undergoing fMRI. Overall, participants preferred options that provided negative net payoffs, but frequent gains. Older adults improved less over time, were more reactive to recent negative outcomes, and showed greater frequency-related activation in several regions, including DLPFC. We also found broader recruitment of prefrontal and parietal regions associated with frequency value and reward prediction errors in older adults, which may indicate compensation. The results suggest greater reliance on average reward for younger adults than older adults.
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Affiliation(s)
- Hilary J Don
- Texas A&M University, Department of Psychological & Brain Sciences, College Station, Texas, USA.
| | - Tyler Davis
- Texas Tech University, Department of Psychological Sciences, Lubbock, Texas, USA
| | - Kimberly L Ray
- University of Texas at Austin, Department of Psychology, Austin, Texas, USA
| | - Megan C McMahon
- University of Texas at Austin, Department of Psychology, Austin, Texas, USA
| | - Astin C Cornwall
- Texas A&M University, Department of Psychological & Brain Sciences, College Station, Texas, USA
| | - David M Schnyer
- University of Texas at Austin, Department of Psychology, Austin, Texas, USA
| | - Darrell A Worthy
- Texas A&M University, Department of Psychological & Brain Sciences, College Station, Texas, USA
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17
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Gallo F, Kalpouzos G, Laukka EJ, Wang R, Qiu C, Bäckman L, Marseglia A, Fratiglioni L, Dekhtyar S. Cognitive Trajectories and Dementia Risk: A Comparison of Two Cognitive Reserve Measures. Front Aging Neurosci 2021; 13:737736. [PMID: 34512313 PMCID: PMC8424183 DOI: 10.3389/fnagi.2021.737736] [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: 07/07/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Cognitive reserve (CR) is meant to account for the mismatch between brain damage and cognitive decline or dementia. Generally, CR has been operationalized using proxy variables indicating exposure to enriching activities (activity-based CR). An alternative approach defines CR as residual variance in cognition, not explained by the brain status (residual-based CR). The aim of this study is to compare activity-based and residual-based CR measures in their association with cognitive trajectories and dementia. Furthermore, we seek to examine if the two measures modify the impact of brain integrity on cognitive trajectories and if they predict dementia incidence independent of brain status. Methods We used data on 430 older adults aged 60+ from the Swedish National Study on Aging and Care in Kungsholmen, followed for 12 years. Residual-based reserve was computed from a regression predicting episodic memory with a brain-integrity index incorporating six structural neuroimaging markers (white-matter hyperintensities volume, whole-brain gray matter volume, hippocampal volume, lateral ventricular volume, lacunes, and perivascular spaces), age, and sex. Activity-based reserve incorporated education, work complexity, social network, and leisure activities. Cognition was assessed with a composite of perceptual speed, semantic memory, letter-, and category fluency. Dementia was clinically diagnosed in accordance with DSM-IV criteria. Linear mixed models were used for cognitive change analyses. Interactions tested if reserve measures modified the association between brain-integrity and cognitive change. Cox proportional hazard models, adjusted for brain-integrity index, assessed dementia risk. Results Both reserve measures were associated with cognitive trajectories [β × time (top tertile, ref.: bottom tertile) = 0.013; 95% CI: –0.126, –0.004 (residual-based) and 0.011; 95% CI: –0.001, 0.024, (activity-based)]. Residual-based, but not activity-based reserve mitigated the impact of brain integrity on cognitive decline [β (top tertile × time × brain integrity) = –0.021; 95% CI: –0.043, 0.001] and predicted 12-year dementia incidence, after accounting for the brain-integrity status [HR (top tertile) = 0.23; 95% CI: 0.09, 0.58]. Interpretation The operationalization of reserve based on residual cognitive performance may represent a more direct measure of CR than an activity-based approach. Ultimately, the two models of CR serve largely different aims. Accounting for brain integrity is essential in any model of reserve.
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Affiliation(s)
- Federico Gallo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow, Russia.,Centre for Neurolinguistics and Psycholinguistics, Vita-Salute San Raffaele University, Milan, Italy
| | - Grégoria Kalpouzos
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Erika J Laukka
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Rui Wang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,The Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden.,Department of Medicine and Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Chengxuan Qiu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Lars Bäckman
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Anna Marseglia
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Serhiy Dekhtyar
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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18
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Soto-Añari M, López N, Rivera-Fernández C, Belón-Hercilla V, Fernández-Guinea S. Literacy Level and Executive Control in Healthy Older Peruvian Adults. Front Neurol 2021; 12:629048. [PMID: 34512496 PMCID: PMC8426511 DOI: 10.3389/fneur.2021.629048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 07/30/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Early-life educational experiences are associated with cognitive performance in aging. Early literacy seems to improve executive control mechanisms, however, it is not clear whether early education would still be an advantage in countries like Peru, where access to and quality of education is highly variable. Aim: Our objective was to analyze the association of literacy level with executive control factors. Method: We evaluated 93 healthy older adults with a clinical protocol that included the Mini-Mental State Examination, the Geriatric Depression Scale and Global Dementia Staging. We also used a neuropsychological executive function battery which included the Trail-Making Test parts A and B, the Stroop Test, phonological and semantic verbal fluency tasks, Forward and Backward Digits, Numbers and Letters of the Wechsler Scale, and the Go/No-Go task. We used a principal component analysis for the dimensional reduction of the variables. To measure the level of literacy we used the word accentuation test (WAT). Results: We observed statistically significant correlations between the principal components (PCs) of working memory, cognitive flexibility and inhibitory control with the WAT scores. Furthermore, we observed that processing speed and WAT predict the scores on PCs factors better than years of education and age. Conclusions: Literacy level correlates more closely with better cognitive performance than years of education and thus, might improve executive control factors that could compensate and protect against brain changes in cognitive decline and dementia.
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Affiliation(s)
- Marcio Soto-Añari
- Laboratorio de Neurociencia, Departamento de Psicología, Universidad Católica San Pablo, Arequipa, Peru
| | | | | | - Verónica Belón-Hercilla
- Laboratorio de Neurociencia, Departamento de Psicología, Universidad Católica San Pablo, Arequipa, Peru
| | - Sara Fernández-Guinea
- Departamento de Psicología Experimental, Facultad de Psicología, Universidad Complutense de Madrid, Madrid, Spain
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19
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Chen Q, Baran TM, Turnbull A, Zhang Z, Rebok GW, Lin FV. Increased segregation of structural brain networks underpins enhanced broad cognitive abilities of cognitive training. Hum Brain Mapp 2021; 42:3202-3215. [PMID: 33955088 PMCID: PMC8193523 DOI: 10.1002/hbm.25428] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/26/2021] [Accepted: 03/08/2021] [Indexed: 12/11/2022] Open
Abstract
A major challenge in the cognitive training field is inducing broad, far-transfer training effects. Thus far, little is known about the neural mechanisms underlying broad training effects. Here, we tested a set of competitive hypotheses regarding the role of brain integration versus segregation underlying the broad training effect. We retrospectively analyzed data from a randomized controlled trial comparing neurocognitive effects of vision-based speed of processing training (VSOP) and an active control consisting of mental leisure activities (MLA) in older adults with MCI. We classified a subset of participants in the VSOP as learners, who showed improvement in executive function and episodic memory. The other participants in the VSOP (i.e., VSOP non-learners) and a subset of participants in the MLA (i.e., MLA non-learners) served as controls. Structural brain networks were constructed from diffusion tensor imaging. Clustering coefficients (CCs) and characteristic path lengths were computed as measures of segregation and integration, respectively. Learners showed significantly greater global CCs after intervention than controls. Nodal CCs were selectively enhanced in cingulate cortex, parietal regions, striatum, and thalamus. Among VSOP learners, those with more severe baseline neurodegeneration had greater improvement in segregation after training. Our findings suggest broad training effects are related to enhanced segregation in selective brain networks, providing insight into cognitive training related neuroplasticity.
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Affiliation(s)
- Quanjing Chen
- Elaine C. Hubbard Center for Nursing Research on Aging, School of NursingUniversity of Rochester Medical CenterRochesterNew YorkUSA
- Department of Psychiatry, School of Medicine and DentistryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Timothy M. Baran
- Department of Biomedical EngineeringUniversity of RochesterRochesterNew YorkUSA
- Department of Imaging SciencesUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Adam Turnbull
- Elaine C. Hubbard Center for Nursing Research on Aging, School of NursingUniversity of Rochester Medical CenterRochesterNew YorkUSA
- Department of Imaging SciencesUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Zhengwu Zhang
- Department of Biostatistics and Computational BiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - George W. Rebok
- Department of Mental HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Feng Vankee Lin
- Elaine C. Hubbard Center for Nursing Research on Aging, School of NursingUniversity of Rochester Medical CenterRochesterNew YorkUSA
- Department of Psychiatry, School of Medicine and DentistryUniversity of Rochester Medical CenterRochesterNew YorkUSA
- Department of Brain and Cognitive SciencesUniversity of RochesterRochesterNew YorkUSA
- Department of Neuroscience, School of Medicine and DentistryUniversity of Rochester Medical CenterRochesterNew YorkUSA
- Department of Neurology, School of Medicine and DentistryUniversity of Rochester Medical CenterRochesterNew YorkUSA
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20
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Zhao Y, Liu P, Turner MP, Abdelkarim D, Lu H, Rypma B. The neural-vascular basis of age-related processing speed decline. Psychophysiology 2021; 58:e13845. [PMID: 34115388 DOI: 10.1111/psyp.13845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 12/12/2022]
Abstract
Most studies examining neurocognitive aging are based on the blood-oxygen level-dependent signal obtained during functional magnetic resonance imaging (fMRI). The physiological basis of this signal is neural-vascular coupling, the process by which neurons signal cerebrovasculature to dilate in response to an increase in active neural metabolism due to stimulation. These fMRI studies of aging rely on the hemodynamic equivalence assumption that this process is not disrupted by physiologic deterioration associated with aging. Studies of neural-vascular coupling challenge this assumption and show that neural-vascular coupling is closely related to cognition. In this review, we put forward a theory of processing speed decline in aging and how it is related to age-related neural-vascular coupling changes based on the results of studies elucidating the relationships between cognition, cerebrovascular dynamics, and aging.
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Affiliation(s)
- Yuguang Zhao
- School of Behavioral and Brain Sciences, Center for Brain Health, University of Texas at Dallas, Richardson, TX, USA
| | - Peiying Liu
- School of Medicine, Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Monroe P Turner
- School of Behavioral and Brain Sciences, Center for Brain Health, University of Texas at Dallas, Richardson, TX, USA
| | - Dema Abdelkarim
- School of Behavioral and Brain Sciences, Center for Brain Health, University of Texas at Dallas, Richardson, TX, USA
| | - Hanzhang Lu
- School of Medicine, Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Bart Rypma
- School of Behavioral and Brain Sciences, Center for Brain Health, University of Texas at Dallas, Richardson, TX, USA
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21
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Mather M. How Do Cognitively Stimulating Activities Affect Cognition and the Brain Throughout Life? Psychol Sci Public Interest 2021; 21:1-5. [PMID: 32772802 DOI: 10.1177/1529100620941808] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Mara Mather
- Leonard Davis School of Gerontology and Department of Psychology, University of Southern California
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22
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Paraskevopoulos E, Chalas N, Karagiorgis A, Karagianni M, Styliadis C, Papadelis G, Bamidis P. Aging Effects on the Neuroplastic Attributes of Multisensory Cortical Networks as Triggered by a Computerized Music Reading Training Intervention. Cereb Cortex 2021; 31:123-137. [PMID: 32794571 DOI: 10.1093/cercor/bhaa213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 12/24/2022] Open
Abstract
The constant increase in the graying population is the result of a great expansion of life expectancy. A smaller expansion of healthy cognitive and brain functioning diminishes the gains achieved by longevity. Music training, as a special case of multisensory learning, may induce restorative neuroplasticity in older ages. The current study aimed to explore aging effects on the cortical network supporting multisensory cognition and to define aging effects on the network's neuroplastic attributes. A computer-based music reading protocol was developed and evaluated via electroencephalography measurements pre- and post-training on young and older adults. Results revealed that multisensory integration is performed via diverse strategies in the two groups: Older adults employ higher-order supramodal areas to a greater extent than lower level perceptual regions, in contrast to younger adults, indicating an age-related shift in the weight of each processing strategy. Restorative neuroplasticity was revealed in the left inferior frontal gyrus and right medial temporal gyrus, as a result of the training, while task-related reorganization of cortical connectivity was obstructed in the group of older adults, probably due to systemic maturation mechanisms. On the contrary, younger adults significantly increased functional connectivity among the regions supporting multisensory integration.
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Affiliation(s)
- Evangelos Paraskevopoulos
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Nikolas Chalas
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.,Institute for Biomagnetism and Biosignal Analysis, University of Münster, D-48149 Münster, Germany
| | - Alexandros Karagiorgis
- School of Music Studies, Faculty of Fine Arts, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Maria Karagianni
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Charis Styliadis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Georgios Papadelis
- School of Music Studies, Faculty of Fine Arts, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Panagiotis Bamidis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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23
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Farina M, Polidoro Lima M, Machado WDL, Moret-Tatay C, Fernandes Lopes RM, Argimon IIDL, Irigaray TQ. Components of an indirect cognitive reserve: a longitudinal assessment of community-dwelling older adults. AGING NEUROPSYCHOLOGY AND COGNITION 2020; 28:907-920. [PMID: 33249955 DOI: 10.1080/13825585.2020.1839377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Cognitive reserve enables individuals to preserve their cognition, despite a possible underlying brain pathology. The objective was to verify which components contribute to an indirect measurement of cognitive reserve in older adults, assessed longitudinally within a four-year interval. The sample was comprised of 64 older adults from the community. The following instruments were used: sociodemographic form; Mini-Mental State Examination; subtests from the Wechsler Adult Intelligence Scale - Third Edition; Trail Making Test; Verbal Fluency Test (animal category); Rey Auditory-Verbal Learning Test; Beck Anxiety Inventory; and the Geriatric Depression Scale 15-item version. Multiple linear regression analyses were performed for the data analysis. The sample was predominantly composed of women (81.3%) and the mean age of the sample was 73.19 years (SD = 6.12). With respect to the variables related to cognitive reserve, it was found that anxiety was the predictor variable of more cognitive components: It was found that poorer cognitive performance is associated with anxiety, and this variable is negatively related to cognitive reserve, as well as to the age variable. Engaging in cognitively stimulating activities, education level and living with someone were deemed to be factors that help build cognitive reserve in older adults. Keywords: cognitive reserve; older adults; longitudinal.
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Affiliation(s)
- Marianne Farina
- Psychology Department, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Manuela Polidoro Lima
- Psychology Department, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Wagner De Lara Machado
- Psychology Department, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Carmen Moret-Tatay
- Psychology Department, Universidad Catolica De Valencia San Vicente Martir, Valencia, Spain
| | | | | | - Tatiana Quarti Irigaray
- Psychology Department, Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
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Yang T, Zhang F. Targeting Transcription Factor Nrf2 (Nuclear Factor Erythroid 2-Related Factor 2) for the Intervention of Vascular Cognitive Impairment and Dementia. Arterioscler Thromb Vasc Biol 2020; 41:97-116. [PMID: 33054394 DOI: 10.1161/atvbaha.120.314804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Vascular cognitive impairment and dementia (VCID) is an age-related, mild to severe mental disability due to a broad panel of cerebrovascular disorders. Its pathobiology involves neurovascular dysfunction, blood-brain barrier disruption, white matter damage, microRNAs, oxidative stress, neuroinflammation, and gut microbiota alterations, etc. Nrf2 (Nuclear factor erythroid 2-related factor 2) is the master regulator of redox status and controls the transcription of a panel of antioxidative and anti-inflammatory genes. By interacting with NF-κB (nuclear factor-κB), Nrf2 also fine-tunes the cellular oxidative and inflammatory balance. Aging is associated with Nrf2 dysfunction, and increasing evidence has proved the role of Nrf2 in mitigating the VCID process. Based on VCID pathobiologies and Nrf2 studies from VCID and other brain diseases, we point out several hypothetical Nrf2 targets for VCID management, including restoration of endothelial function and neurovascular coupling, preservation of blood-brain barrier integrity, reduction of amyloidopathy, promoting white matter integrity, and mitigating oxidative stress and neuroinflammation. Collectively, the Nrf2 pathway could be a promising direction for future VCID research. Targeting Nrf2 would shed light on VCID managing strategies.
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Affiliation(s)
- Tuo Yang
- Department of Neurology, Pittsburgh Institute of Brain Disorders and Recovery, University of Pittsburgh, PA
| | - Feng Zhang
- Department of Neurology, Pittsburgh Institute of Brain Disorders and Recovery, University of Pittsburgh, PA
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Lövdén M, Fratiglioni L, Glymour MM, Lindenberger U, Tucker-Drob EM. Education and Cognitive Functioning Across the Life Span. Psychol Sci Public Interest 2020; 21:6-41. [PMID: 32772803 PMCID: PMC7425377 DOI: 10.1177/1529100620920576] [Citation(s) in RCA: 348] [Impact Index Per Article: 87.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cognitive abilities are important predictors of educational and occupational performance, socioeconomic attainment, health, and longevity. Declines in cognitive abilities are linked to impairments in older adults' everyday functions, but people differ from one another in their rates of cognitive decline over the course of adulthood and old age. Hence, identifying factors that protect against compromised late-life cognition is of great societal interest. The number of years of formal education completed by individuals is positively correlated with their cognitive function throughout adulthood and predicts lower risk of dementia late in life. These observations have led to the propositions that prolonging education might (a) affect cognitive ability and (b) attenuate aging-associated declines in cognition. We evaluate these propositions by reviewing the literature on educational attainment and cognitive aging, including recent analyses of data harmonized across multiple longitudinal cohort studies and related meta-analyses. In line with the first proposition, the evidence indicates that educational attainment has positive effects on cognitive function. We also find evidence that cognitive abilities are associated with selection into longer durations of education and that there are common factors (e.g., parental socioeconomic resources) that affect both educational attainment and cognitive development. There is likely reciprocal interplay among these factors, and among cognitive abilities, during development. Education-cognitive ability associations are apparent across the entire adult life span and across the full range of education levels, including (to some degree) tertiary education. However, contrary to the second proposition, we find that associations between education and aging-associated cognitive declines are negligible and that a threshold model of dementia can account for the association between educational attainment and late-life dementia risk. We conclude that educational attainment exerts its influences on late-life cognitive function primarily by contributing to individual differences in cognitive skills that emerge in early adulthood but persist into older age. We also note that the widespread absence of educational influences on rates of cognitive decline puts constraints on theoretical notions of cognitive aging, such as the concepts of cognitive reserve and brain maintenance. Improving the conditions that shape development during the first decades of life carries great potential for improving cognitive ability in early adulthood and for reducing public-health burdens related to cognitive aging and dementia.
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Affiliation(s)
- Martin Lövdén
- Aging Research Center, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Ulman Lindenberger
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, Berlin, Germany, and London, United Kingdom
| | - Elliot M. Tucker-Drob
- Department of Psychology and Population Research Center, University of Texas at Austin
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Elshiekh A, Subramaniapillai S, Rajagopal S, Pasvanis S, Ankudowich E, Rajah MN. The association between cognitive reserve and performance-related brain activity during episodic encoding and retrieval across the adult lifespan. Cortex 2020; 129:296-313. [DOI: 10.1016/j.cortex.2020.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/26/2020] [Accepted: 05/02/2020] [Indexed: 01/23/2023]
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Iadecola C, Duering M, Hachinski V, Joutel A, Pendlebury ST, Schneider JA, Dichgans M. Vascular Cognitive Impairment and Dementia: JACC Scientific Expert Panel. J Am Coll Cardiol 2020; 73:3326-3344. [PMID: 31248555 DOI: 10.1016/j.jacc.2019.04.034] [Citation(s) in RCA: 346] [Impact Index Per Article: 86.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/09/2019] [Accepted: 04/23/2019] [Indexed: 02/07/2023]
Abstract
Cognitive impairment associated with aging has emerged as one of the major public health challenges of our time. Although Alzheimer's disease is the leading cause of clinically diagnosed dementia in Western countries, cognitive impairment of vascular etiology is the second most common cause and may be the predominant one in East Asia. Furthermore, alterations of the large and small cerebral vasculature, including those affecting the microcirculation of the subcortical white matter, are key contributors to the clinical expression of cognitive dysfunction caused by other pathologies, including Alzheimer's disease. This scientific expert panel provides a critical appraisal of the epidemiology, pathobiology, neuropathology, and neuroimaging of vascular cognitive impairment and dementia, and of current diagnostic and therapeutic approaches. Unresolved issues are also examined to shed light on new basic and clinical research avenues that may lead to mitigating one of the most devastating human conditions.
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Affiliation(s)
- Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York.
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-Universität LMU, Munich, Germany
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Anne Joutel
- Institute of Psychiatry and Neurosciences of Paris, INSERM U1266, Université Paris Descartes, Paris, France
| | - Sarah T Pendlebury
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and the University of Oxford, Oxford, United Kingdom
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-Universität LMU, Munich, Germany; German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Neth BJ, Graff-Radford J, Mielke MM, Przybelski SA, Lesnick TG, Schwarz CG, Reid RI, Senjem ML, Lowe VJ, Machulda MM, Petersen RC, Jr. CRJ, Knopman DS, Vemuri P. Relationship Between Risk Factors and Brain Reserve in Late Middle Age: Implications for Cognitive Aging. Front Aging Neurosci 2020; 11:355. [PMID: 31998113 PMCID: PMC6962238 DOI: 10.3389/fnagi.2019.00355] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 12/05/2019] [Indexed: 12/16/2022] Open
Abstract
Background Brain reserve can be defined as the individual variation in the brain structural characteristics that later in life are likely to modulate cognitive performance. Late midlife represents a point in aging where some structural brain imaging changes have become manifest but the effects of cognitive aging are minimal, and thus may represent an ideal opportunity to determine the relationship between risk factors and brain imaging biomarkers of reserve. Objective We aimed to assess neuroimaging measures from multiple modalities to broaden our understanding of brain reserve, and the late midlife risk factors that may make the brain vulnerable to age related cognitive disorders. Methods We examined multimodal [structural and diffusion Magnetic Resonance Imaging (MRI), FDG PET] neuroimaging measures in 50-65 year olds to examine the associations between risk factors (Intellectual/Physical Activity: education-occupation composite, physical, and cognitive-based activity engagement; General Health Factors: presence of cardiovascular and metabolic conditions (CMC), body mass index, hemoglobin A1c, smoking status (ever/never), CAGE Alcohol Questionnaire (>2, yes/no), Beck Depression Inventory score), brain reserve measures [Dynamic: genu corpus callosum fractional anisotropy (FA), posterior cingulate cortex FDG uptake, superior parietal cortex thickness, AD signature cortical thickness; Static: intracranial volume], and cognition (global, memory, attention, language, visuospatial) from a population-based sample. We quantified dynamic proxies of brain reserve (cortical thickness, glucose metabolism, microstructural integrity) and investigated various protective/risk factors. Results Education-occupation was associated with cognition and total intracranial volume (static measure of brain reserve), but was not associated with any of the dynamic neuroimaging biomarkers. In contrast, many general health factors were associated with the dynamic neuroimaging proxies of brain reserve, while most were not associated with cognition in this late middle aged group. Conclusion Brain reserve, as exemplified by the four dynamic neuroimaging features studied here, is itself at least partly influenced by general health status in midlife, but may be largely independent of education and occupation.
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Affiliation(s)
- Bryan J. Neth
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | | | - Michelle M. Mielke
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Scott A. Przybelski
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Timothy G. Lesnick
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | | | - Robert I. Reid
- Department of Information Technology, Mayo Clinic, Rochester, MN, United States
| | - Matthew L. Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
- Department of Information Technology, Mayo Clinic, Rochester, MN, United States
| | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | | | | | - David S. Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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