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Torres JM, Flores Romero KR, Kotwal AA, Chen R, Hill‐Jarrett T, Mitchell UA, Glymour MM. Spouses of individuals living with mild cognitive impairment or dementia in the United States: A descriptive, population-based study. Alzheimers Dement 2024; 20:1562-1572. [PMID: 38041823 PMCID: PMC10984471 DOI: 10.1002/alz.13555] [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: 07/18/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Little is known about the population of individuals who live with a spouse with cognitive impairment (CI) or dementia. METHODS Using the US Health and Retirement Study, 2000 to 2018, we estimated the population of adults ≥ 50 years old co-residing with a spouse with probable CI/dementia. We described their socio-demographic and health characteristics and quantified socio-demographic inequities. RESULTS Among community-dwelling adults ≥ 50 years old, 6% of women and 4% of men co-resided with a spouse with probable CI/dementia. Among those who were married/partnered, the prevalence of spousal dementia was greater for Black and Hispanic adults compared to their White counterparts, and for those with lower versus higher educational attainment. Among spouses, activities of daily living disability, depression, and past 2-year hospitalization was common. DISCUSSION Millions of older adults, disproportionately Black and Hispanic people and people with lower levels of educational attainment, live with a spouse with CI while also facing their own major health challenges.
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Affiliation(s)
- Jacqueline M. Torres
- Department of Epidemiology & BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Karla Renata Flores Romero
- Department of Epidemiology & BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Ashwin A. Kotwal
- Division of GeriatricsDepartment of MedicineUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Geriatrics, Palliative, and Extended Care Service LineSan Francisco Veterans Affairs Medical CenterSan FranciscoCaliforniaUSA
| | - Ruijia Chen
- Department of EpidemiologySchool of Public HealthBoston UniversityBostonMassachusettsUSA
| | - Tanisha Hill‐Jarrett
- Memory and Aging CenterDepartment of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Uchechi A. Mitchell
- Division of Community Health SciencesSchool of Public HealthUniversity of IllinoisChicagoIllinoisUSA
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Ciesla M, Pobst J, Gomes-Osman J, Lamar M, Barnes LL, Banks R, Jannati A, Libon D, Swenson R, Tobyne S, Bates D, Showalter J, Pascual-Leone A. Estimating dementia risk in an African American population using the DCTclock. Front Aging Neurosci 2024; 15:1328333. [PMID: 38274984 PMCID: PMC10810014 DOI: 10.3389/fnagi.2023.1328333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
The prevalence of Alzheimer's disease (AD) and related dementias (ADRD) is increasing. African Americans are twice as likely to develop dementia than other ethnic populations. Traditional cognitive screening solutions lack the sensitivity to independently identify individuals at risk for cognitive decline. The DCTclock is a 3-min AI-enabled adaptation of the well-established clock drawing test. The DCTclock can estimate dementia risk for both general cognitive impairment and the presence of AD pathology. Here we performed a retrospective analysis to assess the performance of the DCTclock to estimate future conversion to ADRD in African American participants from the Rush Alzheimer's Disease Research Center Minority Aging Research Study (MARS) and African American Clinical Core (AACORE). We assessed baseline DCTclock scores in 646 participants (baseline median age = 78.0 ± 6.4, median years of education = 14.0 ± 3.2, 78% female) and found significantly lower baseline DCTclock scores in those who received a dementia diagnosis within 3 years. We also found that 16.4% of participants with a baseline DCTclock score less than 60 were significantly more likely to develop dementia in 5 years vs. those with the highest DCTclock scores (75-100). This research demonstrates the DCTclock's ability to estimate the 5-year risk of developing dementia in an African American population. Early detection of elevated dementia risk using the DCTclock could provide patients, caregivers, and clinicians opportunities to plan and intervene early to improve cognitive health trajectories. Early detection of dementia risk can also enhance participant selection in clinical trials while reducing screening costs.
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Affiliation(s)
| | | | - Joyce Gomes-Osman
- Linus Health, Boston, MA, United States
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Melissa Lamar
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Russell Banks
- Linus Health, Boston, MA, United States
- Department of Communicative Sciences and Disorders, College of Arts and Sciences, Michigan State University, East Lansing, MI, United States
| | - Ali Jannati
- Linus Health, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - David Libon
- Linus Health, Boston, MA, United States
- Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ, United States
| | - Rodney Swenson
- Linus Health, Boston, MA, United States
- University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States
| | | | | | | | - Alvaro Pascual-Leone
- Linus Health, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, United States
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Bachand AM, Dell LD. Can Incorrect Analysis of Time-Dependent Exposure Explain Associations between PM2.5 Exposure and Risk of Dementia? J Alzheimers Dis 2024; 97:1931-1937. [PMID: 38339933 DOI: 10.3233/jad-231046] [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] [Indexed: 02/12/2024]
Abstract
Background Epidemiological studies have reported positive associations between long-term exposure to particulate matter of 2.5 microns or less in diameter (PM2.5) and risk of Alzheimer's disease and other clinical dementia. Many of these studies have analyzed data using Cox Proportional Hazards (PH) regression, which estimates a hazard ratio (HR) for the treatment (in this case, exposure) effect on the time-to-event outcome while adjusting for influential covariates. PM2.5 levels vary over time. As air quality standards for PM2.5 have become more stringent over time, average outdoor PM2.5 levels have decreased substantially. Objective Investigate whether a Cox PH analysis that does not properly account for exposure that varies over time could produce a biased HR of similar magnitude to the HRs reported in recent epidemiological studies of PM2.5 and dementia risk. Methods Simulation analysis. Results We found that the biased HR can affect statistical analyses that consider exposure levels at event times only, especially if PM2.5 levels decreased consistently over time. Furthermore, the direction of such bias is away from the null and of a magnitude that is consistent with the reported estimates of dementia risk in several epidemiological studies of PM2.5 exposure (HR≈1.2 to 2.0). Conclusions This bias can be avoided by correctly assigning exposure to study subjects throughout the entire follow-up period. We recommend that investigators provide a detailed description of how time-dependent exposure variables were accounted for in their Cox PH analyses when they report their results.
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Atilano-Barbosa D, Barrios FA. Brain morphological variability between whites and African Americans: the importance of racial identity in brain imaging research. Front Integr Neurosci 2023; 17:1027382. [PMID: 38192686 PMCID: PMC10773238 DOI: 10.3389/fnint.2023.1027382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 04/14/2023] [Indexed: 01/10/2024] Open
Abstract
In a segregated society, marked by a historical background of inequalities, there is a consistent under-representation of ethnic and racial minorities in biomedical research, causing disparities in understanding genetic and acquired diseases as well as in the effectiveness of clinical treatments affecting different groups. The repeated inclusion of small and non-representative samples of the population in neuroimaging research has led to generalization bias in the morphological characterization of the human brain. A few brain morphometric studies between Whites and African Americans have reported differences in orbitofrontal volumetry and insula cortical thickness. Nevertheless, these studies are mostly conducted in small samples and populations with cognitive impairment. For this reason, this study aimed to identify brain morphological variability due to racial identity in representative samples. We hypothesized that, in neurotypical young adults, there are differences in brain morphometry between participants with distinct racial identities. We analyzed the Human Connectome Project (HCP) database to test this hypothesis. Brain volumetry, cortical thickness, and cortical surface area measures of participants identified as Whites (n = 338) or African Americans (n = 56) were analyzed. Non-parametrical permutation analysis of covariance between these racial identity groups adjusting for age, sex, education, and economic income was implemented. Results indicated volumetric differences in choroid plexus, supratentorial, white matter, and subcortical brain structures. Moreover, differences in cortical thickness and surface area in frontal, parietal, temporal, and occipital brain regions were identified between groups. In this regard, the inclusion of sub-representative minorities in neuroimaging research, such as African American persons, is fundamental for the comprehension of human brain morphometric diversity and to design personalized clinical brain treatments for this population.
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Affiliation(s)
| | - Fernando A. Barrios
- Institute of Neurobiology, National Autonomous University of Mexico, Juriquilla, Mexico
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Koenigsberg SH, Chang CJ, Ish J, Xu Z, Kresovich JK, Lawrence KG, Kaufman JD, Sandler DP, Taylor JA, White AJ. Air pollution and epigenetic aging among Black and White women in the US. ENVIRONMENT INTERNATIONAL 2023; 181:108270. [PMID: 37890265 PMCID: PMC10872847 DOI: 10.1016/j.envint.2023.108270] [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: 07/17/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND DNA methylation-based measures of biological aging have been associated with air pollution and may link pollutant exposures to aging-related health outcomes. However, evidence is inconsistent and there is little information for Black women. OBJECTIVE We examined associations of ambient particulate matter <2.5 μm and <10 μm in diameter (PM2.5 and PM10) and nitrogen dioxide (NO2) with DNA methylation, including epigenetic aging and individual CpG sites, and evaluated whether associations differ between Black and non-Hispanic White (NHW) women. METHODS Validated models were used to estimate annual average outdoor residential exposure to PM2.5, PM10, and NO2 in a sample of self-identified Black (n=633) and NHW (n=3493) women residing in the contiguous US. We used sampling-weighted generalized linear regression to examine the effects of pollutants on six epigenetic aging measures (primary: DunedinPACE, GrimAgeAccel, and PhenoAgeAccel; secondary: Horvath intrinsic epigenetic age acceleration [EAA], Hannum extrinsic EAA, and skin & blood EAA) and epigenome-wide associations for individual CpG sites. Wald tests of nested models with and without interaction terms were used to examine effect measure modification by race/ethnicity. RESULTS Black participants had higher median air pollution exposure than NHW participants. GrimAgeAccel was associated with both PM10 and NO2 among Black participants, (Q4 versus Q1, PM10: β=1.09, 95% CI: 0.16-2.03; NO2: β=1.01, 95% CI 0.08-1.94) but not NHW participants (p-for-heterogeneity: PM10=0.10, NO2=0.20). In Black participants, we also observed a monotonic exposure-response relationship between NO2 and DunedinPACE (Q4 versus Q1, NO2: β=0.029, 95% CI: 0.004-0.055; p-for-trend=0.03), which was not observed in NHW participants (p-for-heterogeneity=0.09). In the EWAS, pollutants were significantly associated with differential methylation at 19 CpG sites in Black women and one in NHW women. CONCLUSIONS In a US-wide cohort study, our findings suggest that air pollution is associated with DNA methylation alterations consistent with higher epigenetic aging among Black, but not NHW, women.
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Affiliation(s)
- Sarah H Koenigsberg
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 123 W. Franklin St., Chapel Hill, NC 27517, USA; Epidemiology Branch, National Institute of Environmental Health Sciences, 111 TW Alexander Dr, Research Triangle Park, NC 27709, USA.
| | - Che-Jung Chang
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 TW Alexander Dr, Research Triangle Park, NC 27709, USA
| | - Jennifer Ish
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 TW Alexander Dr, Research Triangle Park, NC 27709, USA
| | - Zongli Xu
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 TW Alexander Dr, Research Triangle Park, NC 27709, USA
| | - Jacob K Kresovich
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 TW Alexander Dr, Research Triangle Park, NC 27709, USA; Departments of Cancer Epidemiology and Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Kaitlyn G Lawrence
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 TW Alexander Dr, Research Triangle Park, NC 27709, USA
| | - Joel D Kaufman
- Departments of Environmental & Occupational Health Sciences, Medicine, and Epidemiology University of Washington, 4225 Roosevelt Way NE, Seattle, WA 98105, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 TW Alexander Dr, Research Triangle Park, NC 27709, USA
| | - Jack A Taylor
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 TW Alexander Dr, Research Triangle Park, NC 27709, USA
| | - Alexandra J White
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 TW Alexander Dr, Research Triangle Park, NC 27709, USA.
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Doumatey AP, Bentley AR, Akinyemi R, Olanrewaju TO, Adeyemo A, Rotimi C. Genes, environment, and African ancestry in cardiometabolic disorders. Trends Endocrinol Metab 2023; 34:601-621. [PMID: 37598069 PMCID: PMC10548552 DOI: 10.1016/j.tem.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/21/2023]
Abstract
The past two decades have been characterized by a substantial global increase in cardiometabolic diseases, but the prevalence and incidence of these diseases and related traits differ across populations. African ancestry populations are among the most affected yet least included in research. Populations of African descent manifest significant genetic and environmental diversity and this under-representation is a missed opportunity for discovery and could exacerbate existing health disparities and curtail equitable implementation of precision medicine. Here, we discuss cardiometabolic diseases and traits in the context of African descent populations, including both genetic and environmental contributors and emphasizing novel discoveries. We also review new initiatives to include more individuals of African descent in genomics to address current gaps in the field.
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Affiliation(s)
- Ayo P Doumatey
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Amy R Bentley
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Rufus Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training and Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Timothy O Olanrewaju
- Division of Nephrology, Department of Medicine, University of Ilorin & University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Charles Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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Lim AC, Barnes LL, Weissberger GH, Lamar M, Nguyen AL, Fenton L, Herrera J, Han SD. Quantification of race/ethnicity representation in Alzheimer's disease neuroimaging research in the USA: a systematic review. COMMUNICATIONS MEDICINE 2023; 3:101. [PMID: 37491471 PMCID: PMC10368705 DOI: 10.1038/s43856-023-00333-6] [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: 03/09/2023] [Accepted: 07/05/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Racial and ethnic minoritized groups are disproportionately at risk for Alzheimer's Disease (AD), but are not sufficiently recruited in AD neuroimaging research in the United States. This is important as sample composition impacts generalizability of findings, biomarker cutoffs, and treatment effects. No studies have quantified the breadth of race/ethnicity representation in the AD literature. METHODS This review identified median race/ethnicity composition of AD neuroimaging US-based research samples available as free full-text articles on PubMed. Two types of published studies were analyzed: studies that directly report race/ethnicity data (i.e., direct studies), and studies that do not report race/ethnicity but used data from a cohort study/database that does report this information (i.e., indirect studies). RESULTS Direct studies (n = 719) have median representation of 88.9% white or 87.4% Non-Hispanic white, 7.3% Black/African American, and 3.4% Hispanic/Latino ethnicity, with 0% Asian American, Native Hawaiian/Pacific Islander, and American Indian/Alaska Native, Multiracial, and Other Race participants. Cohort studies/databases (n = 44) from which indirect studies (n = 1745) derived are more diverse, with median representation of 84.2% white, 83.7% Non-Hispanic white, 11.6% Black/African American, 4.7% Hispanic/Latino, and 1.75% Asian American participants. Notably, 94% of indirect studies derive from just 10 cohort studies/databases. Comparisons of two time periods using a median split for publication year, 1994-2017 and 2018-2022, indicate that sample diversity has improved recently, particularly for Black/African American participants (3.39% from 1994-2017 and 8.29% from 2018-2022). CONCLUSIONS There is still underrepresentation of all minoritized groups relative to Census data, especially for Hispanic/Latino and Asian American individuals. The AD neuroimaging literature will benefit from increased representative recruitment of ethnic/racial minorities. More transparent reporting of race/ethnicity data is needed.
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Affiliation(s)
- Aaron C Lim
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Gali H Weissberger
- The Interdisciplinary Department of Social Sciences, Bar-Ilan University, Raman Gat, Israel
| | - Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Annie L Nguyen
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA
| | - Laura Fenton
- Department of Psychology, USC Dornsife College of Letters, Arts, and Sciences, Los Angeles, CA, USA
| | - Jennifer Herrera
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA
| | - S Duke Han
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA.
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.
- Department of Psychology, USC Dornsife College of Letters, Arts, and Sciences, Los Angeles, CA, USA.
- USC School of Gerontology, Los Angeles, CA, USA.
- Department of Neurology, Keck School of Medicine of USC, Los Angeles, CA, USA.
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Yannatos I, Stites S, Brown RT, McMillan CT. Contributions of neighborhood social environment and air pollution exposure to Black-White disparities in epigenetic aging. PLoS One 2023; 18:e0287112. [PMID: 37405974 PMCID: PMC10321643 DOI: 10.1371/journal.pone.0287112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 05/29/2023] [Indexed: 07/07/2023] Open
Abstract
Racial disparities in many aging-related health outcomes are persistent and pervasive among older Americans, reflecting accelerated biological aging for Black Americans compared to White, known as weathering. Environmental determinants that contribute to weathering are poorly understood. Having a higher biological age, measured by DNA methylation (DNAm), than chronological age is robustly associated with worse age-related outcomes and higher social adversity. We hypothesize that individual socioeconomic status (SES), neighborhood social environment, and air pollution exposures contribute to racial disparities in DNAm aging according to GrimAge and Dunedin Pace of Aging methylation (DPoAm). We perform retrospective cross-sectional analyses among 2,960 non-Hispanic participants (82% White, 18% Black) in the Health and Retirement Study whose 2016 DNAm age is linked to survey responses and geographic data. DNAm aging is defined as the residual after regressing DNAm age on chronological age. We observe Black individuals have significantly accelerated DNAm aging on average compared to White individuals according to GrimAge (239%) and DPoAm (238%). We implement multivariable linear regression models and threefold decomposition to identify exposures that contribute to this disparity. Exposure measures include individual-level SES, census-tract-level socioeconomic deprivation and air pollution (fine particulate matter, nitrogen dioxide, and ozone), and perceived neighborhood social and physical disorder. Race and gender are included as covariates. Regression and decomposition results show that individual-level SES is strongly associated with and accounts for a large portion of the disparity in both GrimAge and DPoAm aging. Higher neighborhood deprivation for Black participants significantly contributes to the disparity in GrimAge aging. Black participants are more vulnerable to fine particulate matter exposure for DPoAm, perhaps due to individual- and neighborhood-level SES, which may contribute to the disparity in DPoAm aging. DNAm aging may play a role in the environment "getting under the skin", contributing to age-related health disparities between older Black and White Americans.
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Affiliation(s)
- Isabel Yannatos
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Shana Stites
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Rebecca T. Brown
- Division of Geriatric Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Geriatrics and Extended Care, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, United States of America
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, United States of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Corey T. McMillan
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Wilker EH, Osman M, Weisskopf MG. Ambient air pollution and clinical dementia: systematic review and meta-analysis. BMJ 2023; 381:e071620. [PMID: 37019461 PMCID: PMC10498344 DOI: 10.1136/bmj-2022-071620] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE To investigate the role of air pollutants in risk of dementia, considering differences by study factors that could influence findings. DESIGN Systematic review and meta-analysis. DATA SOURCES EMBASE, PubMed, Web of Science, Psycinfo, and OVID Medline from database inception through July 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies that included adults (≥18 years), a longitudinal follow-up, considered US Environmental Protection Agency criteria air pollutants and proxies of traffic pollution, averaged exposure over a year or more, and reported associations between ambient pollutants and clinical dementia. Two authors independently extracted data using a predefined data extraction form and assessed risk of bias using the Risk of Bias In Non-randomised Studies of Exposures (ROBINS-E) tool. A meta-analysis with Knapp-Hartung standard errors was done when at least three studies for a given pollutant used comparable approaches. RESULTS 2080 records identified 51 studies for inclusion. Most studies were at high risk of bias, although in many cases bias was towards the null. 14 studies could be meta-analysed for particulate matter <2.5 µm in diameter (PM2.5). The overall hazard ratio per 2 μg/m3 PM2.5 was 1.04 (95% confidence interval 0.99 to 1.09). The hazard ratio among seven studies that used active case ascertainment was 1.42 (1.00 to 2.02) and among seven studies that used passive case ascertainment was 1.03 (0.98 to 1.07). The overall hazard ratio per 10 μg/m3 nitrogen dioxide was 1.02 ((0.98 to 1.06); nine studies) and per 10 μg/m3 nitrogen oxide was 1.05 ((0.98 to 1.13); five studies). Ozone had no clear association with dementia (hazard ratio per 5 μg/m3 was 1.00 (0.98 to 1.05); four studies). CONCLUSION PM2.5 might be a risk factor for dementia, as well as nitrogen dioxide and nitrogen oxide, although with more limited data. The meta-analysed hazard ratios are subject to limitations that require interpretation with caution. Outcome ascertainment approaches differ across studies and each exposure assessment approach likely is only a proxy for causally relevant exposure in relation to clinical dementia outcomes. Studies that evaluate critical periods of exposure and pollutants other than PM2.5, and studies that actively assess all participants for outcomes are needed. Nonetheless, our results can provide current best estimates for use in burden of disease and regulatory setting efforts. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021277083.
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Affiliation(s)
- Elissa H Wilker
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Environmental Heath, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Marwa Osman
- Department of Environmental Heath, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Marc G Weisskopf
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Environmental Heath, Harvard TH Chan School of Public Health, Boston, MA, USA
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10
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Arce Rentería M, Mobley TM, Evangelista ND, Medina LD, Deters KD, Fox‐Fuller JT, Minto LR, Avila‐Rieger J, Bettcher BM. Representativeness of samples enrolled in Alzheimer's disease research centers. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12450. [PMID: 37287650 PMCID: PMC10242202 DOI: 10.1002/dad2.12450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/16/2023] [Accepted: 05/02/2023] [Indexed: 06/09/2023]
Abstract
To generalize findings on the mechanisms and prognosis in Alzheimer's disease and related dementias (ADRD), it is critical for ADRD research to be representative of the population. Sociodemographic and health characteristics across ethnoracial groups included in the National Alzheimer's Coordinating Center sample (NACC) were compared to the nationally representative Health and Retirement Study (HRS). Baseline NACC data (n = 36,639) and the weighted 2010 HRS wave (N = 52,071,840) were included. We assessed covariate balance by calculating standardized mean differences across harmonized covariates (i.e., sociodemographic, health). NACC participants were older, more educated, with worse subjective memory and hearing, but endorsed fewer depressive symptoms compared to HRS participants. While all racial and ethnic groups in NACC differed from HRS participants in the same way overall, these differences were further amplified between racial and ethnic groups. NACC participants do not represent the U.S. population in key demographic and health factors, which differed by race and ethnicity. HIGHLIGHTS We examined selection factors included in NACC studies compared to a nationally representative sample.Selection factors included demographic and health factors and self-reported memory concerns.Results suggest that NACC participants are not representative of the U.S. population.Importantly, selection factors differed across racial and ethnic groups.Findings are suggestive of selection bias within NACC studies.
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Affiliation(s)
- Miguel Arce Rentería
- Department of NeurologyTaub Institute for Research on Alzheimer's Disease and the Aging BrainColumbia University College of Physicians and SurgeonsColumbia University Medical CenterNew York CityNew YorkUSA
| | - Taylor M. Mobley
- Department of EpidemiologyUniversity of CaliforniaLos Angeles Fielding School of Public HealthLos AngelesCaliforniaUSA
| | - Nicole D. Evangelista
- Department of Clinical and Health Psychology, Center for Cognitive Aging and MemoryCollege of Public Health and Health Professions, McKnight Brain InstituteUniversity of FloridaGainesvilleFloridaUSA
| | - Luis D. Medina
- Department of PsychologyUniversity of HoustonHoustonTexasUSA
| | - Kacie D. Deters
- Department of Integrative Biology & PhysiologyUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Joshua T. Fox‐Fuller
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA
| | - Lex R. Minto
- Department of PsychologyGeorgia State UniversityAtlantaGeorgiaUSA
| | - Justina Avila‐Rieger
- Department of NeurologyTaub Institute for Research on Alzheimer's Disease and the Aging BrainColumbia University College of Physicians and SurgeonsColumbia University Medical CenterNew York CityNew YorkUSA
| | - Brianne M. Bettcher
- Behavioral Neurology SectionDepartment of NeurologyUniversity of Colorado Alzheimer's and Cognition CenterUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
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11
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Findley CA, Cox MF, Lipson AB, Bradley R, Hascup KN, Yuede C, Hascup ER. Health disparities in aging: Improving dementia care for Black women. Front Aging Neurosci 2023; 15:1107372. [PMID: 36845663 PMCID: PMC9947560 DOI: 10.3389/fnagi.2023.1107372] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
In the United States, 80% of surveyed Black patients report experiencing barriers to healthcare for Alzheimer's disease and related dementias (ADRD), delaying the time-sensitive treatment of a progressive neurodegenerative disease. According to the National Institute on Aging, Black study participants are 35% less likely to be given a diagnosis of ADRD than white participants, despite being twice as likely to suffer from ADRD than their white counterparts. Prior analysis of prevalence for sex, race, and ethnicity by the Centers for Disease Control indicated the highest incidence of ADRD in Black women. Older (≥65 years) Black women are at a disproportionately high risk for ADRD and yet these patients experience distinct inequities in obtaining clinical diagnosis and treatment for their condition. To that end, this perspective article will review a current understanding of biological and epidemiological factors that underlie the increased risk for ADRD in Black women. We will discuss the specific barriers Black women face in obtaining access to ADRD care, including healthcare prejudice, socioeconomic status, and other societal factors. This perspective also aims to evaluate the performance of intervention programs targeted toward this patient population and offer possible solutions to promote health equity.
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Affiliation(s)
- Caleigh A Findley
- Department of Neurology, Dale and Deborah Smith Center for Alzheimer's Research and Treatment, Neuroscience Institute, Southern Illinois University School of Medicine, Springfield, IL, United States.,Department of Pharmacology, Southern Illinois University School of Medicine, Springfield, IL, United States
| | - MaKayla F Cox
- Department of Neurology, Washington University, St. Louis, MO, United States
| | - Adam B Lipson
- Department of Neurology, Dale and Deborah Smith Center for Alzheimer's Research and Treatment, Neuroscience Institute, Southern Illinois University School of Medicine, Springfield, IL, United States.,Division of Neurosurgery, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, United States
| | - RaTasha Bradley
- Department of Neurology, Dale and Deborah Smith Center for Alzheimer's Research and Treatment, Neuroscience Institute, Southern Illinois University School of Medicine, Springfield, IL, United States
| | - Kevin N Hascup
- Department of Neurology, Dale and Deborah Smith Center for Alzheimer's Research and Treatment, Neuroscience Institute, Southern Illinois University School of Medicine, Springfield, IL, United States.,Department of Pharmacology, Southern Illinois University School of Medicine, Springfield, IL, United States.,Medical Microbiology, Immunology and Cell Biology, Southern Illinois University School of Medicine, Springfield, IL, United States
| | - Carla Yuede
- Department of Psychiatry, Washington University, St. Louis, MO, United States
| | - Erin R Hascup
- Department of Neurology, Dale and Deborah Smith Center for Alzheimer's Research and Treatment, Neuroscience Institute, Southern Illinois University School of Medicine, Springfield, IL, United States.,Department of Pharmacology, Southern Illinois University School of Medicine, Springfield, IL, United States
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12
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Long-term particulate matter 2.5 exposure and dementia: a systematic review and meta-analysis. Public Health 2022; 212:33-41. [DOI: 10.1016/j.puhe.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/26/2022] [Accepted: 08/16/2022] [Indexed: 11/11/2022]
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13
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Parra KL, Alexander GE, Raichlen DA, Klimentidis YC, Furlong MA. Exposure to air pollution and risk of incident dementia in the UK Biobank. ENVIRONMENTAL RESEARCH 2022; 209:112895. [PMID: 35149105 PMCID: PMC8976829 DOI: 10.1016/j.envres.2022.112895] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/14/2022] [Accepted: 02/02/2022] [Indexed: 05/03/2023]
Abstract
BACKGROUND Air pollution may cause inflammatory and oxidative stress damage to the brain, leading to neurodegenerative disease. The association between air pollution and dementia, and modification by apolipoprotein E genotype 4 (APOE-ε4) has yet to be fully investigated. OBJECTIVES To examine associations of air pollution with three types of incident dementias (Alzheimer's disease (AD), frontotemporal dementia (FTD), and vascular dementia (VAD)), and their potential modification by APOE-ε4 genotype. METHODS The UK Biobank enrolled >500,000 participants (2006-2010) with ongoing follow-up. We used annual averages of air pollution (PM2.5, PM10, PM2.5-10, PM2.5absorbance, NO2, NOX) for 2010 scaled to interquartile ranges (IQR). We included individuals aged ≥60 years, with no dementia diagnosis prior to January 1, 2010. Time to incident dementia and follow-up time were reported from baseline (January 01, 2010) to last censor event (death, last hospitalization, or loss to follow-up). Cox proportional hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated to estimate the association of air pollutants and incident dementia, and modification of these associations by APOE-ε4. RESULTS Our sample included 187,194 individuals (including N = 680 AD, N = 377 VAD, N = 63 FTD) with a mean follow-up of 7.04 years. We observed consistent associations of PM2.5 with greater risk of all-cause dementia (HR = 1.17, 95% CI: 1.10, 1.24) and AD (HR = 1.17, 95% CI: 1.06, 1.29). NO2 was also associated with greater risk of any incident dementia (HR = 1.18, 95% CI: 1.10, 1.25), AD (HR = 1.15, 95% CI: 1.04, 1.28) and VAD (HR = 1.18, 95% CI: 1.03, 1.35). APOE-ε4 did not modify the association between any air pollutants and dementia. DISCUSSION PM2.5 and NO2 levels were associated with several types of dementia, and these associations were not modified by APOE-ε4. Findings from the UK Biobank support and extend to other epidemiological evidence for the potential association of air pollutants with detrimental brain health during aging.
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Affiliation(s)
- Kimberly L Parra
- Department of Epidemiology & Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA.
| | - Gene E Alexander
- Departments of Psychology and Psychiatry, Neuroscience and Physiological Sciences Graduate Interdisciplinary Programs, BIO5 Institute, and Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA; Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - David A Raichlen
- Department of Biological Sciences, Human and Evolutionary Biology Section, University of Southern California, Los Angeles, CA, USA
| | - Yann C Klimentidis
- Department of Epidemiology & Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Melissa A Furlong
- Department of Community, Environment, and Policy, Division of Environmental Health Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
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14
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Escobar YNH, O’Piela D, Wold LE, Mackos AR. Influence of the Microbiota-Gut-Brain Axis on Cognition in Alzheimer’s Disease. J Alzheimers Dis 2022; 87:17-31. [PMID: 35253750 PMCID: PMC10394502 DOI: 10.3233/jad-215290] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The gut microbiota is made up of trillions of microbial cells including bacteria, viruses, fungi, and other microbial bodies and is greatly involved in the maintenance of proper health of the host body. In particular, the gut microbiota has been shown to not only be involved in brain development but also in the modulation of behavior, neuropsychiatric disorders, and neurodegenerative diseases including Alzheimer’s disease. The precise mechanism by which the gut microbiota can affect the development of Alzheimer’s disease is unknown, but the gut microbiota is thought to communicate with the brain directly via the vagus nerve or indirectly through signaling molecules such as cytokines, neuroendocrine hormones, bacterial components, neuroactive molecules, or microbial metabolites such as short-chain fatty acids. In particular, interventions such as probiotic supplementation, fecal microbiota transfer, and supplementation with microbial metabolites have been used not only to study the effects that the gut microbiota has on behavior and cognitive function, but also as potential therapeutics for Alzheimer’s disease. A few of these interventions, such as probiotics, are promising candidates for the improvement of cognition in Alzheimer ’s disease and are the focus of this review.
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Affiliation(s)
- Yael-Natalie H. Escobar
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Devin O’Piela
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Loren E. Wold
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
- College of Nursing, The Ohio State University, Columbus, OH, USA
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Amy R. Mackos
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
- College of Nursing, The Ohio State University, Columbus, OH, USA
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15
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The pathogenic effects of particulate matter on neurodegeneration: a review. J Biomed Sci 2022; 29:15. [PMID: 35189880 PMCID: PMC8862284 DOI: 10.1186/s12929-022-00799-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 02/16/2022] [Indexed: 12/15/2022] Open
Abstract
The increasing amount of particulate matter (PM) in the ambient air is a pressing public health issue globally. Epidemiological studies involving data from millions of patients or volunteers have associated PM with increased risk of dementia and Alzheimer’s disease in the elderly and cognitive dysfunction and neurodegenerative pathology across all age groups, suggesting that PM may be a risk factor for neurodegenerative diseases. Neurodegenerative diseases affect an increasing population in this aging society, putting a heavy burden on economics and family. Therefore, understanding the mechanism by which PM contributes to neurodegeneration is essential to develop effective interventions. Evidence in human and animal studies suggested that PM induced neurodenegerative-like pathology including neurotoxicity, neuroinflammation, oxidative stress, and damage in blood–brain barrier and neurovascular units, which may contribute to the increased risk of neurodegeneration. Interestingly, antagonizing oxidative stress alleviated the neurotoxicity of PM, which may underlie the essential role of oxidative stress in PM’s potential effect in neurodegeneration. This review summarized up-to-date epidemiological and experimental studies on the pathogenic role of PM in neurodegenerative diseases and discussed the possible underlying mechanisms.
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Gary KM, Hoque M, Yashkin AP, Yashin AI, Akushevich I. Does the Chronic Stress of Everyday Discrimination or Race Itself Better Predict AD Onset Risk? Gerontol Geriatr Med 2022; 8:23337214221142944. [PMID: 36544849 PMCID: PMC9761247 DOI: 10.1177/23337214221142944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/21/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
Using evidence from the Health and Retirement Study, we explore racial disparities in Alzheimer's Disease (AD) onset risk. From a stress process perspective, there is substantial evidence in the literature that everyday discrimination is a chronic strain for Black individuals that acts as a social determinant of illness. However, few studies have examined specific relationships between this social stressor, race, and AD onset risk. Using Cox Proportional Hazard Models, we examined racial differences in exposure and vulnerability to everyday discrimination. Findings suggest that everyday discrimination predicts AD onset risk, and Black individuals experience more frequent exposure to everyday discrimination as a chronic strain. However, contrary to the stress process model, Black respondents were not more vulnerable to the effect of everyday discrimination on AD onset risk. Racial bias from medical professionals during the diagnostic process and mortality selection bias may explain this effect. Overall, the results of this study provide further evidence that discrimination is a key factor in predicting AD while also considering that many racial minorities with high rates of this type of social stress may not receive an unbiased diagnosis and/or survive to late life to develop AD.
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Affiliation(s)
- Katharine M. Gary
- Duke University, Durham, NC, USA
- Katharine Gary, Duke University, Erwin Mill
Building, 2024 W. Main Street, Durham, NC 27705, USA.
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