1
|
Xu J, Chen Y, Shi Y, Sun A, Yang Y, Boustani M, Su J, Zhang P. Associations Between Neuroinflammation-Related Conditions and Alzheimer's Disease: A Study of US Insurance Claims Data. J Alzheimers Dis 2024; 99:739-752. [PMID: 38701142 DOI: 10.3233/jad-231286] [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: 05/05/2024]
Abstract
Background Early detection of Alzheimer's disease (AD) is a key component for the success of the recently approved lecanemab and aducanumab. Patients with neuroinflammation-related conditions are associated with a higher risk for developing AD. Objective Investigate the incidence of AD among patients with neuroinflammation-related conditions including epilepsy, hemorrhage stroke, multiple sclerosis (MS), and traumatic brain injury (TBI). Methods We used Optum's de-identified Clinformatics Data Mart Database (CDM). We derived covariate-matched cohorts including patients with neuroinflammation-related conditions and controls without the corresponding condition. The matched cohorts were: 1) patients with epilepsy and controls (N = 67,825 matched pairs); 2) patients with hemorrhage stroke and controls (N = 81,510 matched pairs); 3) patients with MS and controls (N = 9,853 matched pairs); and 4) patients TBI and controls (N = 104,637 matched pairs). We used the Cox model to investigate the associations between neuroinflammation-related conditions and AD. Results We identified that epilepsy, hemorrhage stroke, and TBI were associated with increased risks of AD in both males and females (hazard ratios [HRs]≥1.74, p < 0.001), as well as in gender- and race-conscious subpopulations (HRs≥1.64, p < 0.001). We identified that MS was associated with increased risks of AD in both males and females (HRs≥1.47, p≤0.004), while gender- and race-conscious subgroup analysis shown mixed associations. Conclusions Patients with epilepsy, hemorrhage stroke, MS, and/or TBI are associated with a higher risk of developing AD. More attention on cognitive status should be given to older patients with these conditions.
Collapse
Affiliation(s)
- Jing Xu
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Yao Chen
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Yi Shi
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Anna Sun
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Yuedi Yang
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Malaz Boustani
- Indiana University Center for Health Innovation and Implementation Science, School of Medicine, Indianapolis, IN, USA
| | - Jing Su
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Pengyue Zhang
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
2
|
Hanrahan JG, Burford C, Nagappan P, Adegboyega G, Rajkumar S, Kolias A, Helmy A, Hutchinson PJ. Is dementia more likely following traumatic brain injury? A systematic review. J Neurol 2023; 270:3022-3051. [PMID: 36810827 DOI: 10.1007/s00415-023-11614-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The association between traumatic brain injury (TBI) and dementia is controversial, and of growing importance considering the ageing demography of TBI. OBJECTIVE To review the scope and quality of the existing literature investigating the relationship between TBI and dementia. METHODS We conducted a systematic review following PRISMA guidelines. Studies that compared TBI exposure and dementia risk were included. Studies were formally assessed for quality with a validated quality-assessment tool. RESULTS 44 studies were included in the final analysis. 75% (n = 33) were cohort studies and data collection was predominantly retrospective (n = 30, 66.7%). 25 studies (56.8%) found a positive relationship between TBI and dementia. Clearly defined and valid measures of assessing TBI history were lacking (case-control studies-88.9%, cohort studies-52.9%). Most studies failed to justify a sample size (case-control studies-77.8%, cohort studies-91.2%), blind assessors to exposure (case-control-66.7%) or blind assessors to exposure status (cohort-3.00%). Studies that identified a relationship between TBI and dementia had a longer median follow-up time (120 months vs 48 months, p = 0.022) and were more likely to use validated TBI definitions (p = 0.01). Studies which clearly defined TBI exposure (p = 0.013) and accounted for TBI severity (p = 0.036) were also more likely to identify an association between TBI and dementia. There was no consensus method by which studies diagnosed dementia and neuropathological confirmation was only available in 15.5% of studies. CONCLUSIONS Our review suggests a relationship between TBI and dementia, but we are unable to predict the risk of dementia for an individual following TBI. Our conclusions are limited by heterogeneity in both exposure and outcome reporting and by poor study quality. Future studies should; (a) use validated methods to define TBI, accounting for TBI severity; (b) follow consensus agreement on criteria for dementia diagnosis; and (c) undertake follow-up that is both longitudinal, to determine if there is a progressive neurodegenerative change or static post-traumatic deficit, and of sufficient duration.
Collapse
Affiliation(s)
- John Gerrard Hanrahan
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Charlotte Burford
- Department of General Surgery, East Kent University Hospitals NHS Foundation Trust, Ashford, UK.
| | - Palani Nagappan
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Gideon Adegboyega
- Bart's and the London Medical School, Queen Mary University of London, London, UK
| | - Shivani Rajkumar
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Angelos Kolias
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Adel Helmy
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Peter John Hutchinson
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| |
Collapse
|
3
|
Gibbons LE, Power MC, Walker RL, Kumar RG, Murphy A, Latimer CS, Nolan AL, Melief EJ, Beller A, Bogdani M, Keene CD, Larson EB, Crane PK, Dams-O'Connor K. Association of Traumatic Brain Injury with Late Life Neuropathological Outcomes in a Community-Based Cohort. J Alzheimers Dis 2023; 93:949-961. [PMID: 37125552 DOI: 10.3233/jad-221224] [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] [Indexed: 05/02/2023]
Abstract
BACKGROUND Prior studies into the association of head trauma with neuropathology have been limited by incomplete lifetime neurotrauma exposure characterization. OBJECTIVE To investigate the neuropathological sequelae of traumatic brain injury (TBI) in an autopsy sample using three sources of TBI ascertainment, weighting findings to reflect associations in the larger, community-based cohort. METHODS Self-reported head trauma with loss of consciousness (LOC) exposure was collected in biennial clinic visits from 780 older adults from the Adult Changes in Thought study who later died and donated their brain for research. Self-report data were supplemented with medical record abstraction, and, for 244 people, structured interviews on lifetime head trauma. Neuropathology outcomes included Braak stage, CERAD neuritic plaque density, Lewy body distribution, vascular pathology, hippocampal sclerosis, and cerebral/cortical atrophy. Exposures were TBI with or without LOC. Modified Poisson regressions adjusting for age, sex, education, and APOE ɛ4 genotype were weighted back to the full cohort of 5,546 participants. RESULTS TBI with LOC was associated with the presence of cerebral cortical atrophy (Relative Risk 1.22, 95% CI 1.02, 1.42). None of the other outcomes was associated with TBI with or without LOC. CONCLUSION TBI with LOC was associated with increased risk of cerebral cortical atrophy. Despite our enhanced TBI ascertainment, we found no association with the Alzheimer's disease-related neuropathologic outcomes among people who survived to at least age 65 without dementia. This suggests the pathophysiological processes underlying post-traumatic neurodegeneration are distinct from the hallmark pathologies of Alzheimer's disease.
Collapse
Affiliation(s)
- Laura E Gibbons
- General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Melinda C Power
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Rod L Walker
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Raj G Kumar
- Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alia Murphy
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Caitlin S Latimer
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Amber L Nolan
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Erica J Melief
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Allison Beller
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Marika Bogdani
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - C Dirk Keene
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Eric B Larson
- General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Paul K Crane
- General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
4
|
Yarns BC, Holiday KA, Carlson DM, Cosgrove CK, Melrose RJ. Pathophysiology of Alzheimer's Disease. Psychiatr Clin North Am 2022; 45:663-676. [PMID: 36396271 DOI: 10.1016/j.psc.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Alzheimer's disease (AD) is the most common neurodegenerative disease leading to dementia worldwide. While neuritic plaques consisting of aggregated amyloid-beta proteins and neurofibrillary tangles of accumulated tau proteins represent the pathophysiologic hallmarks of AD, numerous processes likely interact with risk and protective factors and one's culture to produce the cognitive loss, neuropsychiatric symptoms, and functional impairments that characterize AD dementia. Recent biomarker and neuroimaging research has revealed how the pathophysiology of AD may lead to symptoms, and as the pathophysiology of AD gains clarity, more potential treatments are emerging that aim to modify the disease and relieve its burden.
Collapse
Affiliation(s)
- Brandon C Yarns
- Psychiatry/Mental Health Service, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Building 401, Mail Code 116AE, Los Angeles, CA 90073, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza #4, Los Angeles, CA 90095, USA.
| | - Kelsey A Holiday
- Psychiatry/Mental Health Service, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Building 401, Mail Code 116AE, Los Angeles, CA 90073, USA
| | - David M Carlson
- Psychiatry/Mental Health Service, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Building 401, Mail Code 116AE, Los Angeles, CA 90073, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza #4, Los Angeles, CA 90095, USA
| | - Coleman K Cosgrove
- Department of Psychiatry, University at Buffalo, 462 Grider Street, Buffalo, NY 14215, USA
| | - Rebecca J Melrose
- Psychiatry/Mental Health Service, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Building 401, Mail Code 116AE, Los Angeles, CA 90073, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza #4, Los Angeles, CA 90095, USA
| |
Collapse
|
5
|
Rosselli M, Uribe IV, Ahne E, Shihadeh L. Culture, Ethnicity, and Level of Education in Alzheimer's Disease. Neurotherapeutics 2022; 19:26-54. [PMID: 35347644 PMCID: PMC8960082 DOI: 10.1007/s13311-022-01193-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2022] [Indexed: 12/15/2022] Open
Abstract
Alzheimer's disease (AD) is the most frequent cause of dementia, where the abnormal accumulation of beta-amyloid (Aβ) and tau lead to neurodegeneration as well as loss of cognitive, behavioral, and functional abilities. The present review analyzes AD from a cross-cultural neuropsychological perspective, looking at differences in culture-associated variables, neuropsychological test performance and biomarkers across ethnic and racial groups. Studies have found significant effects of culture, preferred language, country of origin, race, and ethnicity on cognitive test performance, although the definition of those grouping terms varies across studies. Together, with the substantial underrepresentation of minority groups in research, the inconsistent classification might conduce to an inaccuratte diagnosis that often results from biases in testing procedures that favor the group to which test developers belong. These biases persist even after adjusting for variables related to disadvantageous societal conditions, such as low level of education, unfavorable socioeconomic status, health care access, or psychological stressors. All too frequently, educational level is confounded with culture. Minorities often have lower educational attainment and lower quality of education, causing differences in test results that are then attributed to culture. Higher levels of education are also associated with increased cognitive reserve, a protective factor against cognitive decline in the presence of neurodegeneration. Biomarker research suggests there might be significant differences in specific biomarker profiles for each ethnicity/race in need of accurate cultural definitions to adequately predict risk and disease progression across ethnic/racial groups. Overall, this review highlights the need for diversity in all domains of AD research that lack inclusion and the collection of relevant information from these groups.
Collapse
Affiliation(s)
- Mónica Rosselli
- Department of Psychology, Florida Atlantic University, Charles E. Schmidt College of Science 3200 College Av, Davie, FL, 33314, USA.
- 1Florida Alzheimer's Disease Research Center, Miami Beach, FL, USA.
| | - Idaly Vélez Uribe
- Department of Psychology, Florida Atlantic University, Charles E. Schmidt College of Science 3200 College Av, Davie, FL, 33314, USA
- 1Florida Alzheimer's Disease Research Center, Miami Beach, FL, USA
| | - Emily Ahne
- Department of Psychology, Florida Atlantic University, Charles E. Schmidt College of Science 3200 College Av, Davie, FL, 33314, USA
| | - Layaly Shihadeh
- Department of Psychology, Florida Atlantic University, Charles E. Schmidt College of Science 3200 College Av, Davie, FL, 33314, USA
| |
Collapse
|
6
|
Chen J, Kouts J, Rippee MA, Lauer S, Smith D, McDonald T, Kurylo M, Filardi T. Developing a Comprehensive, Interdisciplinary Concussion Program. Health Serv Insights 2020; 13:1178632920938674. [PMID: 32782428 PMCID: PMC7385849 DOI: 10.1177/1178632920938674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/03/2020] [Indexed: 11/17/2022] Open
Abstract
There has been a growing trend of local and national coverage of and interest in concussion injuries over the past 2 decades. Increasing public concern over potential catastrophic and unknown long-term effects of sports-related concussion injuries has led to an acknowledgment of the strong public health need for addressing all concussion injuries, regardless of mechanism of injury. In efforts to address this need for concussion prevention and management, both in sports and nonsports, The University of Kansas Health System initiated the interdisciplinary Center for Concussion Management program in 2012. The program was created as a virtual clinic concept and includes voluntary participation from various providers across the institution, limited budget, and space obstacles. Since its inception, the program has continued to operate as its initial design of a multidisciplinary team model outside the sole ownership of 1 department, and has expanded to include education and outreach to local and regional schools and groups.
Collapse
Affiliation(s)
- Jamie Chen
- Center for Concussion Management, The University of Kansas Health System, Kansas City, KS, USA
| | - Jill Kouts
- Center for Concussion Management, The University of Kansas Health System, Kansas City, KS, USA
| | - Michael A Rippee
- Department of Neurology, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Stephen Lauer
- Department of Pediatrics, The University of Kansas Medical Center, Kansas City, KS, USA
| | - David Smith
- Department of Family Medicine, Department of Sports Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Tracy McDonald
- Department of Trauma/Acute Care Surgery, Burn, and Concussion Administration, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Monica Kurylo
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Tanya Filardi
- Department of Neurosurgery, The University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
7
|
Pharmacogenomics of Cognitive Dysfunction and Neuropsychiatric Disorders in Dementia. Int J Mol Sci 2020; 21:ijms21093059. [PMID: 32357528 PMCID: PMC7246738 DOI: 10.3390/ijms21093059] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 02/07/2023] Open
Abstract
Symptomatic interventions for patients with dementia involve anti-dementia drugs to improve cognition, psychotropic drugs for the treatment of behavioral disorders (BDs), and different categories of drugs for concomitant disorders. Demented patients may take >6–10 drugs/day with the consequent risk for drug–drug interactions and adverse drug reactions (ADRs >80%) which accelerate cognitive decline. The pharmacoepigenetic machinery is integrated by pathogenic, mechanistic, metabolic, transporter, and pleiotropic genes redundantly and promiscuously regulated by epigenetic mechanisms. CYP2D6, CYP2C9, CYP2C19, and CYP3A4/5 geno-phenotypes are involved in the metabolism of over 90% of drugs currently used in patients with dementia, and only 20% of the population is an extensive metabolizer for this tetragenic cluster. ADRs associated with anti-dementia drugs, antipsychotics, antidepressants, anxiolytics, hypnotics, sedatives, and antiepileptic drugs can be minimized by means of pharmacogenetic screening prior to treatment. These drugs are substrates, inhibitors, or inducers of 58, 37, and 42 enzyme/protein gene products, respectively, and are transported by 40 different protein transporters. APOE is the reference gene in most pharmacogenetic studies. APOE-3 carriers are the best responders and APOE-4 carriers are the worst responders; likewise, CYP2D6-normal metabolizers are the best responders and CYP2D6-poor metabolizers are the worst responders. The incorporation of pharmacogenomic strategies for a personalized treatment in dementia is an effective option to optimize limited therapeutic resources and to reduce unwanted side-effects.
Collapse
|