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Dabiri S, Ramírez Ruiz MI, Jean-Louis G, Ntekim OE, Obisesan TO, Campbell AL, Mwendwa DT. The Mediating Role of Inflammation in the Relationship Between α-Synuclein and Cognitive Functioning. J Gerontol A Biol Sci Med Sci 2023; 78:206-212. [PMID: 36269624 DOI: 10.1093/gerona/glac217] [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: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Accumulating evidence suggests that α-synuclein plays a role in the pathophysiology of Alzheimer's disease (AD). This study examined whether α-synuclein level in cerebrospinal fluid (CSF) was associated with cognitive functioning among older adults. We also explored whether this relationship was mediated by proinflammatory cytokines TNF-α and IL-6, along with sIL-6R and vascular endothelial growth factor (VEGF). Using a cross-sectional Alzheimer's Disease Neuroimaging Initiative (ADNI; N = 148) sample, we examined the relationship between α-synuclein and participants' performance on Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-Cog 13) at baseline. Mediation analyses were utilized, adjusting for age, education, APOEe4, and Geriatric Depression Scale scores. All biological markers were measured in CSF. Participants in the current sample were 58.3% males, 41.7% females, and Caucasian (95.5%); their average education and age were 15.5 (standard deviation [SD] = 2.97) and 74.4 (SD = 7.51) years, respectively. Higher accumulation of α-synuclein was associated with poorer MMSE scores (β = -0.41, standard error [SE] = 1.54, p < .001). This relationship appeared to be mediated by VEGF (β = 0.27, SE = 2.15, p = .025) and IL-6r (β = 0.22, SE = 1.66, p < .026). In addition, α-synuclein was associated with poorer performance on the ADAS-Cog 13 (β = 0.34, p = .005) and mediated by VEGF (β = -0.19, SE = 4.13, p = .025) after adjusting for age, education, APOEe4, and depressive symptoms. α-Synuclein may serve as an additional biomarker for determining poor cognitive functioning. VEGF and IL-6 soluble receptors were significant mediators of the relationship between α-synuclein and cognitive functioning. If confirmed in prospective analyses, these findings can further inform the pathologic cascade and early diagnosis of AD.
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Affiliation(s)
- Sanaz Dabiri
- Department of Psychology, Howard University, Washington, District of Columbia, Washington, DC, USA
| | - Mara I Ramírez Ruiz
- Department of Psychology, Howard University, Washington, District of Columbia, Washington, DC, USA
| | - Girardin Jean-Louis
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Oyonumo E Ntekim
- Department of Graduate Nutritional Sciences, Howard University, Washington, District of Columbia, Washington, DC, USA
| | - Thomas O Obisesan
- Division of Geriatrics, Department of Medicine, Howard University Hospital, Washington, District of Columbia, Washington, DC, USA
| | - Alfonso L Campbell
- Department of Psychology, Howard University, Washington, District of Columbia, Washington, DC, USA
| | - Denée T Mwendwa
- Department of Psychology, Howard University, Washington, District of Columbia, Washington, DC, USA
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Feng L, Wang Y, Zeng D, Wang M, Duan X. Predictors of cognitive decline in older individuals without dementia: An updated meta-analysis. Ann Clin Transl Neurol 2023; 10:497-506. [PMID: 36705073 PMCID: PMC10109353 DOI: 10.1002/acn3.51740] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To evaluate the effect of overall peripheral inflammatory levels on cognitive function, we explored the relationship between established biomarkers of peripheral inflammation (circulating C-reactive protein [CRP], interleukin-6 [IL-6], and tumor necrosis factor-α [TNF-α]) and cognitive decline by performing a review of observational studies and creating an updated summary. METHODS We included literatures exploring the relationship between peripheral levels of CRP, IL-6, and TNF-α and subsequent cognitive decline, published until July 2022, by searching the following databases: PubMed, Embase, Web of Science, the Cochrane Library, ClinicalTrials, CNKI, and VIP databases. We used random-effects models to pool the odds ratios (ORs) for the risks of subsequent cognitive decline in older adults with high levels of peripheral inflammation. We initially screened out 501 literatures, of which only 17 were ultimately eligible. Overall, there were 19,516 older individuals included in our meta-analysis, and 2134 of them experienced subsequent cognitive change. RESULTS Individuals with high levels of peripheral inflammation may have 14% more chance to develop subsequent cognitive decline than those with low levels (OR = 1.14, 95% CI: 1.03-1.27; p < 0.00001). In the subgroup analysis, the incidence of cognitive decline was higher in individuals with high levels of IL-6. This study further demonstrates the link between systemic inflammation and cognitive status. INTERPRETATION Detecting CRP, IL-6, and TNF-α in peripheral blood is necessary, as they may become effective indicators for forthcoming cognitive performance.
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Affiliation(s)
- Lan Feng
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China.,Department of Anesthesiology, Southwest Medical University, Luzhou, China
| | - Yuhao Wang
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China.,Department of Anesthesiology, Southwest Medical University, Luzhou, China
| | - Daojun Zeng
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China.,Department of Anesthesiology, Southwest Medical University, Luzhou, China
| | - Maohua Wang
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China.,Department of Anesthesiology, Southwest Medical University, Luzhou, China
| | - Xiaoxia Duan
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China.,Department of Anesthesiology, Southwest Medical University, Luzhou, China
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Farina MP, Kim JK, Hayward MD, Crimmins EM. Links between inflammation and immune functioning with cognitive status among older Americans in the Health and Retirement Study. Brain Behav Immun Health 2022; 26:100559. [PMID: 36439057 PMCID: PMC9694056 DOI: 10.1016/j.bbih.2022.100559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022] Open
Abstract
Elevated inflammation and poor immune functioning are tied to worse cognitive health. Both processes are fundamental to aging and are strongly implicated in the development of age-related health outcomes, including cognitive status. However, results from prior studies evaluating links between indicators of inflammation and immune function and cognitive impairment have been inconsistent due to biomarker selection, sample selection, and cognitive outcome. Using the Health and Retirement Study (HRS), a nationally representative study of older adults in the United States, we assessed how indicators of inflammation (neutrophil-lymphocyte ratio (NLR), albumin, CRP, IL6, IL10, IL-1Ra, sTNFR1, and TGFβ1) and immune functioning (CMV, CD4+ TN/TM, and CD8+ TN/TM) are associated with cognitive status. First, to examine the association between each biomarker and cognitive status, we tested whether markers of inflammation and immune functioning varied across cognitive status categories. We found that dementia and cognitive impairment without dementia (CIND) were associated with elevated inflammation and poorer immune functioning across biomarkers except for CD4+ TN/TM. Next, we estimated multinomial logistic regression models to assess which biomarkers would continue to be associated with dementia and CIND, net of each other. In these models, albumin, cytokines, CMV, CD4+ TN/TM, and CD8+ TN/TM are associated with cognitive status. Because poor immune functioning and increased inflammation are associated with cognitive impairment, improving immune functioning and reducing inflammation may provide a mechanism for reducing ADRD risk in the population.
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Affiliation(s)
- Mateo P. Farina
- Leonard Davis School of Gerontology, University of Southern California, USA
| | - Jung Ki Kim
- Leonard Davis School of Gerontology, University of Southern California, USA
| | - Mark D. Hayward
- Population Research Center and Department of Sociology, University of Texas at Austin, USA
| | - Eileen M. Crimmins
- Leonard Davis School of Gerontology, University of Southern California, USA
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Cross sectional association between cytomegalovirus seropositivity, inflammation and cognitive impairment in elderly cancer survivors. Cancer Causes Control 2021; 33:81-90. [PMID: 34637066 DOI: 10.1007/s10552-021-01504-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The higher prevalence of cognitive impairment/ dementia among cancer survivors is likely multifactorial. Since both exposures to cytomegalovirus (CMV) and inflammation are common among elderly cancer survivors, we evaluated their contribution towards dementia. METHODS Data from 1387 cancer survivors and 7004 participants without cancer in the 2016 wave of the Health and Retirement Study (HRS) was used in this study. Two inflammatory biomarkers, C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR), were used to create an inflammation score. We used survey logistic regression adjusted for survey design parameters. RESULTS CMV seropositivity was not associated with cognitive impairment among cancer survivors (p = 0.2). In addition, inflammation was associated with elevated odds of cognitive impairment (OR = 2.2, 95% CI [1.2, 4.2]). Cancer survivors who were both CMV seropositive and had increased inflammation had the highest odds of cognitive impairment compared to those who were CMV seronegative and had low inflammation (OR = 3.8, 95% CI [1.5, 9.4]). The stratified analysis among cancer survivors showed this association was seen only among cancer survivors in whom the cancer was diagnosed within three years of measurement of inflammation score and CMV serostatus (OR = 18.5; 95% CI [6.1, 56.1]). CONCLUSION The CMV seropositivity and high inflammation was associated with higher cognitive impairment among cancer survivors. The stronger associations seen among cancer survivors diagnosed within the last three years suggest that strategies to reduce CMV activation and inflammation during or immediately after cancer treatment may be important in reducing the prevalence of cognitive impairment/ dementia among cancer survivors.
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Bettcher BM, Tansey MG, Dorothée G, Heneka MT. Peripheral and central immune system crosstalk in Alzheimer disease - a research prospectus. Nat Rev Neurol 2021; 17:689-701. [PMID: 34522039 PMCID: PMC8439173 DOI: 10.1038/s41582-021-00549-x] [Citation(s) in RCA: 152] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 02/08/2023]
Abstract
Dysregulation of the immune system is a cardinal feature of Alzheimer disease (AD), and a considerable body of evidence indicates pathological alterations in central and peripheral immune responses that change over time. Considering AD as a systemic immune process raises important questions about how communication between the peripheral and central compartments occurs and whether this crosstalk represents a therapeutic target. We established a whitepaper workgroup to delineate the current status of the field and to outline a research prospectus for advancing our understanding of peripheral-central immune crosstalk in AD. To guide the prospectus, we begin with an overview of seminal clinical observations that suggest a role for peripheral immune dysregulation and peripheral-central immune communication in AD, followed by formative animal data that provide insights into possible mechanisms for these clinical findings. We then present a roadmap that defines important next steps needed to overcome conceptual and methodological challenges, opportunities for future interdisciplinary research, and suggestions for translating promising mechanistic studies into therapeutic interventions.
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Affiliation(s)
- Brianne M. Bettcher
- grid.430503.10000 0001 0703 675XBehavioral Neurology Section, Department of Neurology, University of Colorado Alzheimer’s and Cognition Center, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Malú G. Tansey
- grid.15276.370000 0004 1936 8091Department of Neuroscience, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL USA
| | - Guillaume Dorothée
- grid.412370.30000 0004 1937 1100Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, CRSA, Team “Immune System and Neuroinflammation”, Hôpital Saint-Antoine, Paris, France
| | - Michael T. Heneka
- grid.15090.3d0000 0000 8786 803XDepartment of Neurodegenerative Diseases & Geropsychiatry/Neurology, University of Bonn Medical Center, Bonn, Germany ,grid.168645.80000 0001 0742 0364Department of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA USA
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West NA, Kullo IJ, Morris MC, Mosley TH. Sex-specific associations of inflammation markers with cognitive decline. Exp Gerontol 2020; 138:110986. [PMID: 32497552 DOI: 10.1016/j.exger.2020.110986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/16/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND/OBJECTIVE Inflammation is implicated in cognitive decline; however, there is a paucity of data for African American populations and for sex-specific associations. DESIGN Prospective cohort study. SETTING Genetic Epidemiology Network of Arteriopathy/Genetics of Microangiopathic Brain Injury studies. PARTICIPANTS African-American sibships (N = 1010). MEASUREMENTS Neurocognitive tests assessed global cognition and four cognitive domains: processing speed, memory, language, and executive function at two time points over seven years. Circulating levels of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor receptor (TNFR)-1 and TNFR2 were measured at study baseline. Linear mixed models were used to investigate the association between inflammation markers and cognitive decline. RESULTS Among men, a one SD increase in CRP was associated with an increased rate of decline over 7 years in global cognitive Z-score (adjusted difference in slopes = -0.31, p = 0.006) and in processing speed Z-score (adjusted difference in slopes = -0.10, p = 0.02), but not declines in memory, language, or executive function Z-scores. Also among men, a one SD increase in IL-6 was associated with an increased decline rate in global cognitive Z-score (adjusted difference in slopes = -0.33, p = 0.002) and in processing speed Z-score (adjusted difference in slopes = -0.12, p = 0.007). There was no difference in decline rates by CRP or IL-6 level in adjusted analyses among women for any cognitive scores. Among men and women combined, a one SD increase in baseline sTNFR1 was associated with a faster rate of decline in memory Z-score (adjusted difference in slopes = -0.09, p = 0.02). Baseline sTNFR2 levels did not significantly predict rate of cognitive decline in any cognitive domains. CONCLUSIONS Circulating markers of CRP and IL-6 may be differential risk factors for men and women in relation to cognitive decline. A novel inflammation marker, sTNFR1, may be a useful predictor of memory decline in older adults.
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Affiliation(s)
- Nancy A West
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, United States of America.
| | - Iftikhar J Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - M Caroline Morris
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Thomas H Mosley
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, MS, United States of America
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Gross AL, Walker KA, Moghekar AR, Pettigrew C, Soldan A, Albert MS, Walston JD. Plasma Markers of Inflammation Linked to Clinical Progression and Decline During Preclinical AD. Front Aging Neurosci 2019; 11:229. [PMID: 31555121 PMCID: PMC6742958 DOI: 10.3389/fnagi.2019.00229] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/12/2019] [Indexed: 01/31/2023] Open
Abstract
Objective To examine the prospective association between blood biomarkers of immune functioning (i.e., innate immune activation, adaptive immunity, and inflammation) and subsequent cognitive decline and clinical progression to mild cognitive impairment (MCI) in cognitively normal individuals. Methods The BIOCARD study is an observational cohort study of N = 191 initially cognitively healthy participants (mean age 65.2 years). Blood plasma samples were assayed for markers of chronic inflammation (TNFR1, IL-6), adaptive immunity (CD25), and innate immune activation (CD14 and CD163). Participants were followed annually for ongoing clinical assessment and cognitive testing for up to 7.3 years. Primary study outcomes were progression to MCI and cognitive change over time, as measured by a global factor score encompassing multiple cognitive domains. Results Higher levels of plasma TNFR1 were associated with greater risk of progression from normal cognition to MCI (HR: 3.27; 95% confidence interval, CI: 1.27, 8.40). Elevated levels of TNFR1 were also associated with steeper rate of cognitive decline on follow-up but not with baseline cognitive performance. Baseline IL-6 levels and markers of innate and adaptive immune activation showed no relationship with MCI risk or cognitive decline. Conclusion Inflammation, mediated by TNF signaling, may play a selective role in the early phase of AD. Accordingly, plasma TNFR1 may facilitate improved prediction of disease progression for individuals in the preclinical stage of AD.
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Affiliation(s)
- Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Keenan A Walker
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Abhay R Moghekar
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Corinne Pettigrew
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Anja Soldan
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Marilyn S Albert
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Jeremy D Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD, United States
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Xue QL, Buta B, Ma L, Ge M, Carlson M. Integrating Frailty and Cognitive Phenotypes: Why, How, Now What? CURRENT GERIATRICS REPORTS 2019; 8:97-106. [PMID: 31815092 PMCID: PMC6897328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE OF REVIEW This review elucidates the concept of frailty in relationship to reserve and resilience, the relationships and shared pathophysiology between physical frailty and cognitive impairment, the theoretical underpinnings of three integrated phenotypes of physical and cognitive impairments, and the potential of incorporating biomarkers into phenotype refinement and validation. RECENT FINDINGS The fact that frailty and cognitive impairment are associated and often coexist in older adults has led to the popular view of expanding the definition of frailty to include cognitive impairment. However, there is great variability in approaches to and assumptions regarding the integrated phenotypes of physical frailty and cognitive impairment. SUMMARY The development of integrated frailty and cognitive phenotypes should explicate the types of frailty and cognitive impairment they intend to capture and prioritize the incorporation of biological theories that help determine shared and distinct pathways in the progression to physical and cognitive impairments.
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Affiliation(s)
- Qian-Li Xue
- Department of Medicine Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Brian Buta
- Department of Medicine Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Lina Ma
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Meiling Ge
- The Center of Gerontology and Geriatrics (National Clinical Research Center for Geriatrics), West China Hospital, Sichuan University, Chengdu, China
| | - Michelle Carlson
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Xue QL, Buta B, Ma L, Ge M, Carlson M. Integrating Frailty and Cognitive Phenotypes: Why, How, Now What? CURRENT GERIATRICS REPORTS 2019. [DOI: 10.1007/s13670-019-0279-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Walker KA, Windham BG, Power MC, Hoogeveen RC, Folsom AR, Ballantyne CM, Knopman DS, Selvin E, Jack CR, Gottesman RF. The association of mid-to late-life systemic inflammation with white matter structure in older adults: The Atherosclerosis Risk in Communities Study. Neurobiol Aging 2018; 68:26-33. [PMID: 29702373 DOI: 10.1016/j.neurobiolaging.2018.03.031] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/15/2018] [Accepted: 03/28/2018] [Indexed: 01/03/2023]
Abstract
We examined whether the pattern of middle- to late-life systemic inflammation was associated with white matter (WM) structural abnormalities in older adults. A total of 1532 participants (age = 76.5; standard deviations = 5.4) underwent 3T brain magnetic resonance imaging to quantify white matter hyperintensity volume and whole-brain WM microstructural integrity (fractional anisotropy, mean diffusivity). High-sensitivity C-reactive protein (CRP), a marker of systemic inflammation, was measured at 3 visits (21 and 14 years before, and concurrent with, neuroimaging). Participants were categorized into 1 of 6 groups based on their 21-year pattern of low (<3 mg/L) versus elevated (≥3 mg/L) CRP. Compared to the group with low CRP at all 3 visits, the group that transitioned from low to elevated CRP during midlife demonstrated greatest white matter hyperintensity volume and poorest WM microstructural integrity, after adjusting for demographic variables and cardiovascular risk factors. Participants with high CRP at all visits also demonstrated greater WM structural abnormalities, but only after accounting for differential attrition. These results suggest that increasing and persistent inflammation in the decades spanning middle-to late-life may promote WM disease in older adults.
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Affiliation(s)
- Keenan A Walker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - B Gwen Windham
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Melinda C Power
- Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Ron C Hoogeveen
- Section of Cardiology, Baylor College of Medicine, Houston, TX, USA; Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Christie M Ballantyne
- Section of Cardiology, Baylor College of Medicine, Houston, TX, USA; Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | | | - Elizabeth Selvin
- Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Duarte PDO, Duarte MGF, Pelichek A, Pfrimer K, Ferriolli E, Moriguti JC, Lima NK. Cardiovascular risk factors and inflammatory activity among centenarians with and without dementia. Aging Clin Exp Res 2017; 29:411-417. [PMID: 27377066 DOI: 10.1007/s40520-016-0603-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
Abstract
A better knowledge of the differences existing between individuals who maintain cognition up to 100 years of age or more and those of the same age who present dementia syndrome may be of help in understanding the dementia of the very elderly people. The aim of this study was to assess cardiovascular risk factors and inflammatory markers among centenarians with and without dementia. A population-based cross-sectional study was conducted on centenarians residing in a middle-size city. Volunteers were evaluated by comprehensive geriatric assessment at home. General laboratory examinations were performed and cardiovascular risk and inflammatory activity markers were determined. Mean subject age was 101 ± 2 years, and 82 % were women. Assessment of dementia syndrome revealed that 36.4 % of the centenarians had preserved cognition. Centenarians with dementia had lower schooling (p < 0.01), lower body mass index (p = 0.02) and higher homocysteine levels (p < 0.01) and tended to have a lower systolic blood pressure (p = 0.05). Regarding the markers of inflammatory activity, demented subjects had high levels of interleukin-6 (p < 0.01), high-sensitivity C-reactive protein (p = 0.02), and erythrocyte sedimentation rate (p = 0.01) and lower albumin levels (p = 0.02) compared to centenarians without dementia. Concluding, centenarians with preserved cognition had better nutritional status, lower homocysteinemia, tendency to higher blood pressure and lower inflammatory activity compared to demented subjects.
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LeBlanc ES, Rizzo JH, Pedula KL, Yaffe K, Ensrud KE, Cauley J, Cawthon PM, Cummings S, Hillier TA. Weight Trajectory over 20 Years and Likelihood of Mild Cognitive Impairment or Dementia Among Older Women. J Am Geriatr Soc 2017; 65:511-519. [PMID: 27991654 PMCID: PMC5685172 DOI: 10.1111/jgs.14552] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The association between weight change and cognition is controversial. We examined the association between 20-year weight change and cognitive function in late life. DESIGN Cohort study. SETTING Study of Osteoporotic Fractures (SOF). PARTICIPANTS One thousand two hundred eighty-nine older, community-dwelling women (mean baseline age 68 (65-81) and 88 (82-102) at cognitive testing). MEASUREMENTS Study of Osteoporotic Fractures participants had body weight measured repeatedly over 20 years (mean 8 weights). Adjudicated cognitive status was classified as normal (n = 775) or mild cognitive impairment (MCI)/dementia (n = 514) at Year 20. Logistic models were used to evaluate whether absolute weight change, rate of weight loss per year, presence of abrupt, unrecovered weight loss, and weight variability were associated with MCI or dementia. RESULTS Women with greater rate of weight loss over 20 years had increased chance of developing MCI or dementia. In age/education/clinic-adjusted "base" models, each 0.5 kg/yr decrease resulted in 30% increased odds of MCI/dementia (OR = 1.30 [95% CI: 1.14, 1.49]). After adjustment for age, education, clinic, depression, and walking speed, there was 17% (OR = 1.17 [95% CI: 1.02, 1.35]) increased odds of MCI/dementia for each 0.5 kg/yr decrease in weight. In base models, variability in weight was significant. Each 1% average deviation from each woman's predicted weight curve was associated with 11% increased odds of MCI/dementia (OR = 1.11 [95% CI: 1.04, 1.18]). The estimate was attenuated after full adjustment (OR = 1.06 [95% CI: 0.99, 1.14]). The presence of an abrupt weight decline was not associated with MCI/dementia. CONCLUSIONS Rate of weight loss over 20 years was associated with development of MCI or dementia in women surviving past 80 years, suggesting that nutritional status, social-environmental factors, and/or adipose tissue function and structure may affect cognitive function with aging.
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Affiliation(s)
- Erin S. LeBlanc
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Joanne H. Rizzo
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Kathryn L. Pedula
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Kristine Yaffe
- Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California San Francisco School of Medicine and San Francisco VA Medical Center, San Francisco, CA, USA
| | - Kristine E. Ensrud
- Department of Medicine, University of Minnesota; University of Epidemiology & Community Health, University of Minnesota; Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN University of Minnesota, USA
| | - Jane Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peggy M. Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Steven Cummings
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Teresa A. Hillier
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
- Center for Health Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
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Tay L, Lim WS, Chan M, Ye RJ, Chong MS. The Independent Role of Inflammation in Physical Frailty among Older Adults with Mild Cognitive Impairment and Mild-to-Moderate Alzheimer's Disease. J Nutr Health Aging 2016; 20:288-99. [PMID: 26892578 DOI: 10.1007/s12603-015-0617-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the independent and combined effects of inflammation and endocrine dysregulation on (i) baseline frailty status and (ii) frailty progression at one year, among cognitively impaired community dwelling older adults. DESIGN Prospective cohort study. SETTING Tertiary Memory Clinic. METHODS We recruited patients with mild cognitive impairment and mild-moderate Alzheimer's disease. Physical frailty status was assessed at baseline and 1-year. Blood biomarkers of systemic inflammation [interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α)] and anabolic hormones [insulin-like growth factor-1 (IGF-1), dehydroepiandrosterone sulphate (DHEAS)] were measured at baseline and examined in relation to physical frailty status at baseline and progression at 1-year. Each subject was categorized as (i) neither pro-inflammatory nor endocrine deficient, (ii) pro-inflammatory (IL-6 or TNF-α, or both, being in highest quartile) but not endocrine deficient, (iii) endocrine deficient (IGF-1 or DHEAS, or both, being in lowest quartile) but not pro-inflammatory and (iv) both pro-inflammatory and endocrine deficient. RESULTS Twenty (20.2%) of 99 subjects were physically frail at baseline. There was no association between severity of cognitive impairment and baseline frailty status, but the frail group had significantly greater hippocampal atrophy (median MTA: 2 (2-3) vs 1 (1-2), p=0.010). TNF-α was significantly higher in subjects who were physically frail at baseline (median TNF-α: 1.30 (0.60-1.40) vs 0.60 (0.50-1.30) pg/mL, p=0.035). In multiple logistic regression adjusted for age and gender, a pro-inflammatory state in the absence of concomitant endocrine deficiency was significantly associated with physical frailty at baseline (OR=4.99, 95% C.I 1.25-19.88, p=0.023); this was no longer significant when MTA score was included in the model. Isolated pro-inflammatory state (without endocrine deficiency) significantly increased the odds of frailty progression (OR=4.06, 95% CI 1.09-15.10, p=0.037) at 1-year. The combination pro-inflammatory and endocrine deficient state was not significantly associated with either baseline or progressive physical frailty. CONCLUSION A pro-inflammatory state exerts differential effects on physical frailty, contributing to the increased risk of baseline and progressive frailty only in the absence of a concomitant endocrine deficient state, with potential mediation via neurodegeneration.
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Affiliation(s)
- L Tay
- Dr Laura Tay, Department of Geriatric Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. Phone: 65-6359 6474, Fax: 65-6359 6294, E-Mail:
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Gao Q, Camous X, Lu YX, Lim ML, Larbi A, Ng TP. Novel inflammatory markers associated with cognitive performance: Singapore Longitudinal Ageing Studies. Neurobiol Aging 2015; 39:140-6. [PMID: 26923410 DOI: 10.1016/j.neurobiolaging.2015.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
We identified and validated several novel inflammatory markers of cognitive performance in community-living older persons. An exploratory study (n = 83) correlated 177 inflammatory markers assayed by Luminex with the Mini-Mental State Examination (MMSE) and identified 8 inflammatory markers for enzyme-linked immunosorbent assay (ELISA) and correlations with MMSE, Montreal Cognitive Assessment (MoCA), and cognitive impairment in the validation study (n = 139). The validation study replicated the significant associations of soluble interleukin-2 receptor alpha chain (sIL-2Rα; p = 0.050), soluble tumor necrosis factor receptor 2 (sTNFR2; p = 0.002) and soluble glycoprotein 130 (sgp130; p = 0.026) with MMSE, and sIL-2Rα (p = 0.019) and sgp130 (p < 0.001) with MoCA. Significant trends of associations of tertiles of sgp130, sIL-2Rα, and sTNFR2 were found with cognitive impairment. Highly elevated estimates of association of high versus low tertiles were obtained for sgp130 (odds ratio [OR] = 4.24, 95% confidence interval [CI] 0.96-18.8), sIL-2Rα (OR = 3.94, 95% CI 0.83-18.7), and sTNFR2 (OR = 7.58, 95% CI 1.19-48.1). sgp130, sTNFR2, and sIL-2Rα are promising inflammatory markers of low cognitive performance for further investigation.
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Affiliation(s)
- Qi Gao
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xavier Camous
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A∗STAR), Singapore
| | - Yan-Xia Lu
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A∗STAR), Singapore
| | - May-Li Lim
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Anis Larbi
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A∗STAR), Singapore
| | - Tze-Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Abstract
Reports from recent studies suggest that diabetes confers a higher risk of cardiovascular disease in women compared to men. Larger studies, including meta-analyses, report that women with diabetes have a 44 % greater risk of incident coronary heart disease and a 27 % greater risk of incident stroke compared to men with diabetes. In this article, we summarize results from longitudinal studies that examine sex differences in risk factors for and rates of macrovascular complications from diabetes. We also discuss possible mechanisms for increased cardiovascular risk associated with diabetes in women compared to men, including the clustering of hypertension, obesity, and elevated triglycerides, the possible contribution of hormonal differences, and sex differences in the prescription of and adherence to pharmacologic treatment. In conclusion, diabetes is associated with a slightly higher risk of cardiovascular disease in women compared to men. Future studies should further explore the reasons underlying imperfect use of medications that lower cardiovascular risk in both women and men with diabetes.
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Affiliation(s)
- Amanda Lyon
- Department of Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Elizabeth A Jackson
- Department of Medicine, Division of Cardiovascular Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, MI, 48106, USA.
| | - Rita R Kalyani
- Department of Medicine, Johns Hopkins University, 1830 E Monument St # 333, Baltimore, MD, 21287, USA.
| | - Dhananjay Vaidya
- Department of Medicine, Johns Hopkins University, 1830 E Monument St # 333, Baltimore, MD, 21287, USA.
| | - Catherine Kim
- Departments of Medicine, Obstetrics & Gynecology, and Epidemiology, University of Michigan, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI, 48109, USA.
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Ansah JP, Malhotra R, Lew N, Chiu CT, Chan A, Bayer S, Matchar DB. Projection of young-old and old-old with functional disability: does accounting for the changing educational composition of the elderly population make a difference? PLoS One 2015; 10:e0126471. [PMID: 25974069 PMCID: PMC4431717 DOI: 10.1371/journal.pone.0126471] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 04/02/2015] [Indexed: 11/18/2022] Open
Abstract
This study compares projections, up to year 2040, of young-old (aged 60-79) and old-old (aged 80+) with functional disability in Singapore with and without accounting for the changing educational composition of the Singaporean elderly. Two multi-state population models, with and without accounting for educational composition respectively, were developed, parameterized with age-gender-(education)-specific transition probabilities (between active, functional disability and death states) estimated from two waves (2009 and 2011) of a nationally representative survey of community-dwelling Singaporeans aged ≥60 years (N=4,990). Probabilistic sensitivity analysis with the bootstrap method was used to obtain the 95% confidence interval of the transition probabilities. Not accounting for educational composition overestimated the young-old with functional disability by 65 percent and underestimated the old-old by 20 percent in 2040. Accounting for educational composition, the proportion of old-old with functional disability increased from 40.8 percent in 2000 to 64.4 percent by 2040; not accounting for educational composition, the proportion in 2040 was 49.4 percent. Since the health profiles, and hence care needs, of the old-old differ from those of the young-old, health care service utilization and expenditure and the demand for formal and informal caregiving will be affected, impacting health and long-term care policy.
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Affiliation(s)
- John P. Ansah
- Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
- * E-mail:
| | - Rahul Malhotra
- Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Nicola Lew
- Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Chi-Tsun Chiu
- Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Angelique Chan
- Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Sociology, National University of Singapore, Singapore, Singapore
| | - Steffen Bayer
- Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - David B. Matchar
- Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
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Licastro F, Carbone I, Raschi E, Porcellini E. The 21st century epidemic: infections as inductors of neuro-degeneration associated with Alzheimer's Disease. Immun Ageing 2014; 11:22. [PMID: 25516763 PMCID: PMC4266955 DOI: 10.1186/s12979-014-0022-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 11/22/2014] [Indexed: 01/18/2023]
Abstract
Alzheimer's disease (AD) is a complex disease resulting in neurodegeneration and cognitive impairment. Investigations on environmental factors implicated in AD are scarce and the etiology of the disease remains up to now obscure. The disease's pathogenesis may be multi-factorial and different etiological factors may converge during aging and induce an activation of brain microglia and macrophages. This microglia priming will result in chronic neuro-inflammation under chronic antigen activation. Infective agents may prime and drive iper-activation of microglia and be partially responsible of the induction of brain inflammation and decline of cognitive performances. Age-associated immune dis-functions induced by chronic sub-clinical infections appear to substantially contribute to the appearance of neuro-inflammation in the elderly. Individual predisposition to less efficient immune responses is another relevant factor contributing to impaired regulation of inflammatory responses and accelerated cognitive decline. Life-long virus infection may play a pivotal role in activating peripheral and central inflammatory responses and in turn contributing to increased cognitive impairment in preclinical and clinical AD.
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Affiliation(s)
- Federico Licastro
- />Department of Experimental, Diagnostic and Specialty Medicine, School of Medicine, University of Bologna, Bologna, 40100 Italy
- />Laboratory of Immunopathology and Immunogenetics, Department of Experimental, Diagnostic and Specialty Medicine, School of Medicine, University of Bologna, Via S. Giacomo 14, 40126 Bologna, Italy
| | - Ilaria Carbone
- />Department of Experimental, Diagnostic and Specialty Medicine, School of Medicine, University of Bologna, Bologna, 40100 Italy
| | - Elena Raschi
- />Department of Experimental, Diagnostic and Specialty Medicine, School of Medicine, University of Bologna, Bologna, 40100 Italy
| | - Elisa Porcellini
- />Department of Experimental, Diagnostic and Specialty Medicine, School of Medicine, University of Bologna, Bologna, 40100 Italy
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Declines in inflammation predict greater white matter microstructure in older adults. Neurobiol Aging 2014; 36:948-54. [PMID: 25554492 DOI: 10.1016/j.neurobiolaging.2014.11.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/29/2014] [Accepted: 11/05/2014] [Indexed: 12/14/2022]
Abstract
Protracted systemic inflammation has been associated with adverse effects on cognition and brain structure and may accelerate neurodegenerative disease processes; however, it is less clear whether changes in inflammation are associated with brain structure. We studied 276 black and white older adults (mean age = 83 years at time of imaging) enrolled in a prospective study of aging. Inflammation (measured with c-reactive protein, CRP) was assessed repeatedly over 6 years (i.e., year 2, 4, 6, and 8). Brain magnetic resonance imaging (MRIs) were obtained at years 10-11 with diffusion tensor imaging; regions of interest included late-myelinating areas vulnerable to aging, including frontal-parietal (superior longitudinal fasciculus [SLF]-dorsal) and temporal (SLF-temporal; uncinate) white matter tracts. Mean CRP values significantly declined (t = -5.54, p < 0.0001) over 6 years, and subject-specific slopes (best linear unbiased predictors of slopes) all showed a decline (mean = -0.57, standard deviation = 0.53) for our participant sample. More than 50% of study participants were still in the moderate to high cardiovascular risk range based on CRP values at year 8. After controlling for demographics, vascular risk factors and MRI white matter hyperintensities, larger decreases in CRP values over time were significantly associated with higher fractional anisotropy in the SLF-dorsal (beta = -0.0052, standard error [SE] = 0.003; 95% confidence interval [CI] = -0.0103 to -0.0025, p = 0.04), SLF-temporal (beta = -0.0109, SE = 0.004; 95% CI = -0.0189 to -0.0029, p = 0.008), and uncinate (beta = -0.0067, SE = 0.003; 95% CI = -0.0132 to -0.0001, p = 0.05) fasciculi. Results suggest that in a prospective cohort of older individuals, faster declines in inflammation over time are related to indicators of white matter health, even after accounting for vascular risk factors.
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Bettcher BM, Kramer JH. Longitudinal inflammation, cognitive decline, and Alzheimer's disease: a mini-review. Clin Pharmacol Ther 2014; 96:464-9. [PMID: 25009982 DOI: 10.1038/clpt.2014.147] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 07/02/2014] [Indexed: 01/06/2023]
Abstract
The role of inflammation in cognitive decline has generated considerable interest, although few longitudinal evaluations have been conducted. A review of the literature yields mixed findings but suggests that inflammatory dysregulation is evident and may be related to clinical outcomes. The directionality, magnitude, and progression of these associations remain unclear. Future studies employing multiple time points of inflammatory data along with Alzheimer's disease (AD) biomarkers are critical for explication of longitudinal inflammation in cognitive decline.
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Affiliation(s)
- B M Bettcher
- Neurology Department, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - J H Kramer
- Neurology Department, Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
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Thambisetty M, Ferrucci L. Soluble interleukin-6 receptor levels and risk of dementia: one more signpost on a long road ahead. J Am Geriatr Soc 2014; 62:772-4. [PMID: 24731027 DOI: 10.1111/jgs.12737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Madhav Thambisetty
- Clinical and Translational Neuroscience Unit, Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
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