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Chang HT, Chan PC, Chiu PY. Non-linear relationship between serum cholesterol levels and cognitive change among older people in the preclinical and prodromal stages of dementia: a retrospective longitudinal study in Taiwan. BMC Geriatr 2024; 24:474. [PMID: 38816835 DOI: 10.1186/s12877-024-05030-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Adverse effects of rigorously lowering low-density lipoprotein cholesterol on cognition have been reported; therefore, we aimed to study the contribution of serum cholesterol in cognitive decline in older people with or without dementia. METHODS Cognitive function was assessed by the Cognitive Abilities Screening Instrument (CASI). We investigated associations between serum cholesterol with cognitive decline using multiple regressions controlling for the effects of demographics, vascular risk factors, and treatments. RESULTS Most associations between cholesterol and CASI scores could be explained by non-linear and inverted U-shaped relationships (R2 = 0.003-0.006, p < 0.016, Šidákcorrection). The relationships were most evident between changes in cholesterol and CASI scores in older people at the preclinical or prodromal stages of dementia (R2 = 0.02-0.064, p values < 0.016). There were no differences in level of changes in CASI scores between individuals in 1st decile and 10th decile groups of changes in cholesterol (p = 0.266-0.972). However, individuals in the 1st decile of triglyceride changes and with stable and normal cognitive functions showed significant improvement in CASI scores compared to those in the 10th decile (t(202) = 2.275, p values < 0.05). CONCLUSION These findings could implicate that rigorously lowering cholesterol may not be suitable for the prevention of cognitive decline among older people, especially among individuals in preclinical or prodromal stages of dementia.
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Affiliation(s)
- Hsin-Te Chang
- Department of Psychology, College of Science, Chung Yuan Christian University, Taoyuan, Taiwan
- Research Assistant Center, Show Chwan Memorial Hospital, Changhua City, Changhua, Taiwan
| | - Po-Chi Chan
- Department of Neurology, Show Chwan Memorial Hospital, Changhua City, Changhua, Taiwan
| | - Pai-Yi Chiu
- Department of Neurology, Show Chwan Memorial Hospital, Changhua City, Changhua, Taiwan.
- Department of Applied Mathematics, College of Science, Tunghai University, Taichung, Taiwan.
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Pang KS, Peng HB, Li BP, Wen B, Noh K, Xia R, Toscan A, Serson S, Fraser PE, Tirona RG, de Lannoy IAM. Aging and brain free cholesterol concentration on amyloid-β peptide accumulation in guinea pigs. Biopharm Drug Dispos 2024; 45:93-106. [PMID: 38488691 DOI: 10.1002/bdd.2386] [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: 04/22/2023] [Revised: 01/21/2024] [Accepted: 02/08/2024] [Indexed: 04/19/2024]
Abstract
Alzheimer's disease is a complex multifactorial neurodegenerative disorder wherein age is a major risk factor. The appropriateness of the Hartley guinea pig (GP), which displays high sequence homologies of its amyloid-β (Aβ40 and Aβ42) peptides, Mdr1 and APP (amyloid precursor protein) and similarity in lipid handling to humans, was appraised among 9-40 weeks old guinea pigs. Protein expression levels of P-gp (Abcb1) and Cyp46a1 (24(S)-hydroxylase) for Aβ40, and Aβ42 efflux and cholesterol metabolism, respectively, were decreased with age, whereas those for Lrp1 (low-density lipoprotein receptor related protein 1), Rage (receptor for advanced glycation endproducts) for Aβ efflux and influx, respectively, and Abca1 (the ATP binding cassette subfamily A member 1) for cholesterol efflux, were unchanged among the ages examined. There was a strong, negative correlation of the brain Aβ peptide concentrations and Abca1 protein expression levels with free cholesterol. The correlation of Aβ peptide concentrations with Cyp46a1 was, however, not significant, and concentrations of the 24(S)-hydroxycholesterol metabolite revealed a decreasing trend from 20 weeks old toward 40 weeks old guinea pigs. The composite data suggest a role for free cholesterol on brain Aβ accumulation. The decreases in P-gp and Lrp1 protein levels should further exacerbate the accumulation of Aβ peptides in guinea pig brain.
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Affiliation(s)
- K Sandy Pang
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - H Benson Peng
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Betty P Li
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Binyu Wen
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Keumhan Noh
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Runyu Xia
- Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anja Toscan
- Transpharmation Canada, Mississauga, Ontario, Canada
| | - Sylvia Serson
- Transpharmation Canada, Mississauga, Ontario, Canada
| | - Paul E Fraser
- Tanz Centre for Research in Neurodegenerative Diseases and Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Rommel G Tirona
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Pan Y, Liang J, Zhang W, Gao D, Li C, Xie W, Zheng F. Association between Age at Diagnosis of Hyperlipidemia and Subsequent Risk of Dementia. J Am Med Dir Assoc 2024:104960. [PMID: 38453136 DOI: 10.1016/j.jamda.2024.01.029] [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: 11/07/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES The relationship between age at diagnosis of hyperlipidemia and dementia remains unclear. We examined whether younger age at diagnosis of hyperlipidemia is associated with higher risk of subsequent dementia. DESIGN A longitudinal population-based study with a median follow-up of 12.8 years. SETTING AND PARTICIPANTS We analyzed data on a sample of 489,642 participants in the United Kingdom. METHODS This study was based on the UK Biobank. Information on hyperlipidemia and dementia diagnoses was collected at baseline (2006-2010) and follow-up [median = 12.8 years, interquartile range (IQR): 12.1-13.6 years]. Propensity score matching method and Cox proportional hazards models were used to assess the association between age at diagnosis of hyperlipidemia and dementia. RESULTS Among 489,642 participants (mean age: 56.9 ± 8.1 years; female: 54.7%), 114,112 (23.3%) were diagnosed with hyperlipidemia. Younger age at diagnosis of hyperlipidemia (per 10-year decrease) was significantly associated with higher risks of all-cause dementia [hazard ratio (HR), 1.12; 95% CI, 1.07-1.18; P < .001], Alzheimer's disease (AD) (HR, 1.22; 95% CI, 1.14-1.31; P < .001), and vascular dementia (VD) (HR, 1.16; 95% CI, 1.05-1.27; P < .001). After propensity score matching, patients with hyperlipidemia diagnosed before 50 years had the highest HR for all-cause dementia (HR, 1.46; 95% CI, 1.15-1.86; P = .002), followed by patients diagnosed between 50 and 69 years (HR, 1.21; 95% CI, 1.12-1.31; P < .001) and then patients diagnosed aged 70 years and older (HR, 0.94; 95% CI, 0.84-1.06; P = .302). Similar results were observed for AD and VD. CONCLUSIONS AND IMPLICATIONS A dose-response relationship between age at hyperlipidemia diagnosis and risk of dementia was found in the longitudinal cohort study, with younger age at diagnosis of hyperlipidemia being associated with higher subsequent risk.
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Affiliation(s)
- Yang Pan
- School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Liang
- School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenya Zhang
- School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Darui Gao
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Chenglong Li
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Wuxiang Xie
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China.
| | - Fanfan Zheng
- School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Hassen CB, Machado‐Fragua MD, Landré B, Fayosse A, Dumurgier J, Kivimaki M, Sabia S, Singh‐Manoux A. Change in lipids before onset of dementia, coronary heart disease, and mortality: A 28-year follow-up Whitehall II prospective cohort study. Alzheimers Dement 2023; 19:5518-5530. [PMID: 37243914 PMCID: PMC10679471 DOI: 10.1002/alz.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/07/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION The association of lipids with dementia remains a subject of debate. Using data from 7,672 participants of the Whitehall II prospective cohort study, we examined whether timing of exposure, length of follow-up, or sex modifies this association. METHODS Twelve markers of lipid levels were measured from fasting blood and eight among them a further five times. We performed time-to-event as well as trajectory analyses. RESULTS No associations were observed in men; in women most lipids were associated with the risk of dementia, but only for events occurring after the first 20 years of follow-up. Differences in lipid trajectories in men emerged only in the years immediately before diagnosis whereas in women total cholesterol (TC), LDL-cholesterol (LDL-C), non-HDL-cholesterol (non-HDL-C), TC/HDL-C, and LDL-C/HDL-C were higher in midlife among dementia cases before declining progressively. DISCUSSION Abnormal lipid levels in midlife seem to be associated with a higher risk of dementia in women.
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Affiliation(s)
- Céline Ben Hassen
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseasesParisFrance
| | - Marcos D Machado‐Fragua
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseasesParisFrance
| | - Benjamin Landré
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseasesParisFrance
| | - Aurore Fayosse
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseasesParisFrance
| | - Julien Dumurgier
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseasesParisFrance
- Cognitive Neurology Center, Lariboisière – Fernand Widal Hospital, AP‐HPUniversité Paris CitéParisFrance
| | - Mika Kivimaki
- Department of Mental Health of Older People, Faculty of Brain SciencesUniversity College LondonLondonUK
| | - Séverine Sabia
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseasesParisFrance
- Department of Mental Health of Older People, Faculty of Brain SciencesUniversity College LondonLondonUK
| | - Archana Singh‐Manoux
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseasesParisFrance
- Department of Mental Health of Older People, Faculty of Brain SciencesUniversity College LondonLondonUK
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Chen Y, Yang K, Huang Y, Wang X, Zhao Y, Ping P, Guan S, Fu S. Associations between lipid profiles and late-life cognitive impairment among oldest-old and centenarian adults. MedComm (Beijing) 2023; 4:e362. [PMID: 37692108 PMCID: PMC10484073 DOI: 10.1002/mco2.362] [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: 03/01/2023] [Revised: 07/23/2023] [Accepted: 08/06/2023] [Indexed: 09/12/2023] Open
Abstract
Dyslipidemia and cognitive impairment are common among old adults and the occurrence of them rises exponentially with increasing age. Evidences of the relationships between serum lipids and cognitive impairment are inconsistent or equivocal among older adults. This study aimed to investigate the associations between lipid profiles and late-life cognitive impairment among oldest-old and centenarian adults. In this cross-sectional study, serum lipids were biochemically measured among 606 oldest-old adults and 653 centenarians, and cognitive function was evaluated using mini-mental state examination (MMSE). Multivariate linear and logistic regression analyses were performed to explore the associations between serum lipids and cognitive impairment. Results showed participants with cognitive impairment had lower total cholesterol (TC) levels compared with those without cognitive impairment (p < 0.05). TC levels were positively associated with MMSE (p < 0.05). Furthermore, a negative association was observed between TC levels and cognitive impairment (p for trend = 0.002). This negative association remained statistically significant after adjusting for confounders (p for trend = 0.028). These results suggested that older adults with higher TC levels were likely to have better cognitive function. Taking immoderate cholesterol-lowering drugs among older adults is questionable and requires investigation, and cognitive performance of old adults with lower TC levels deserves more attention.
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Affiliation(s)
- Yujian Chen
- Central LaboratoryHainan Hospital of Chinese People's Liberation Army General HospitalSanyaChina
| | - Kaidi Yang
- Oncology DepartmentHainan Hospital of Chinese People's Liberation Army General HospitalSanyaChina
| | - Ya Huang
- Blood Transfusion DepartmentHainan Hospital of Chinese People's Liberation Army General HospitalSanyaChina
| | - Xuejiao Wang
- Pediatric DepartmentHainan Hospital of Chinese People's Liberation Army General HospitalSanyaChina
| | - Yali Zhao
- Central LaboratoryHainan Hospital of Chinese People's Liberation Army General HospitalSanyaChina
| | - Ping Ping
- General Station for Drug and Instrument Supervision and ControlJoint Logistic Support Force of Chinese People's Liberation ArmyBeijingChina
| | - Shasha Guan
- Oncology DepartmentHainan Hospital of Chinese People's Liberation Army General HospitalSanyaChina
| | - Shihui Fu
- Department of CardiologyHainan Hospital of Chinese People's Liberation Army General HospitalSanyaChina
- Department of Geriatric CardiologyChinese People's Liberation Army General HospitalBeijingChina
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Moser ED, Manemann SM, Larson NB, St Sauver JL, Takahashi PY, Mielke MM, Rocca WA, Olson JE, Roger VL, Remaley AT, Decker PA, Killian JM, Bielinski SJ. Association Between Fluctuations in Blood Lipid Levels Over Time With Incident Alzheimer Disease and Alzheimer Disease-Related Dementias. Neurology 2023; 101:e1127-e1136. [PMID: 37407257 PMCID: PMC10513892 DOI: 10.1212/wnl.0000000000207595] [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: 12/05/2022] [Accepted: 05/12/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Prevention strategies for Alzheimer disease and Alzheimer disease-related dementias (AD/ADRDs) are urgently needed. Lipid variability, or fluctuations in blood lipid levels at different points in time, has not been examined extensively and may contribute to the risk of AD/ADRD. Lipid panels are a part of routine screening in clinical practice and routinely available in electronic health records (EHR). Thus, in a large geographically defined population-based cohort, we investigated the variation of multiple lipid types and their association to the development of AD/ADRD. METHODS All residents living in Olmsted County, Minnesota on the index date January 1, 2006, aged 60 years or older without an AD/ADRD diagnosis were identified. Persons with ≥3 lipid measurements including total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), or high-density lipoprotein cholesterol (HDL-C) in the 5 years before index date were included. Lipid variation was defined as any change in individual's lipid levels over time regardless of direction and was measured using variability independent of the mean (VIM). Associations between lipid variation quintiles and incident AD/ADRD were assessed using Cox proportional hazards regression. Participants were followed through 2018 for incident AD/ADRD. RESULTS The final analysis included 11,571 participants (mean age 71 years; 54% female). Median follow-up was 12.9 years with 2,473 incident AD/ADRD cases. After adjustment for confounding variables including sex, race, baseline lipid measurements, education, BMI, and lipid-lowering treatment, participants in the highest quintile of total cholesterol variability had a 19% increased risk of incident AD/ADRD, and those in highest quintile of triglycerides, variability had a 23% increased risk. DISCUSSION In a large EHR derived cohort, those in the highest quintile of variability for total cholesterol and triglyceride levels had an increased risk of incident AD/ADRD. Further studies to identify the mechanisms behind this association are needed.
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Affiliation(s)
- Ethan D Moser
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Sheila M Manemann
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Nicholas B Larson
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Jennifer L St Sauver
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Paul Y Takahashi
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Michelle M Mielke
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Walter A Rocca
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Janet E Olson
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Véronique L Roger
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Alan T Remaley
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Paul A Decker
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Jill M Killian
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Suzette J Bielinski
- From the Department of Quantitative Health Sciences (E.D.M., S.M.M., N.B.L., J.L.S.S., M.M.M., W.A.R., J.E.O., V.L.R., P.A.D., J.M.K., S.J.B.); Division of Community Internal Medicine (P.Y.T.), Department of Medicine, Mayo Clinic; Department of Neurology (M.M.M., W.A.R.), Rochester, MN; Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Mayo Clinic Women's Health Research Center (W.A.R.); Department of Cardiovascular Medicine (V.L.R.), Mayo Clinic, Rochester, MN; Epidemiology and Community Branch (V.L.R.), National Heart, Lung, and Blood Institute, National Institutes of Health; and Lipoprotein Metabolism Laboratory (A.T.R.), Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD.
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Aggarwal NT, Mielke MM. Sex Differences in Alzheimer's Disease. Neurol Clin 2023; 41:343-358. [PMID: 37030962 PMCID: PMC10321561 DOI: 10.1016/j.ncl.2023.01.001] [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: 04/10/2023]
Abstract
Reviewing the research presented in this article, it is evident that from an epidemiological perspective, it is important to evaluate the extent to which findings of sex and gender differences in Alzheimer's dementia (AD) are due to differences in longevity, survival bias, and comorbidities. Medical, genetic, psychosocial, and behavioral factors, in addition to hormonal factors, can differentially affect the risk and progression of AD in women versus men. Further, evaluation of sex differences in AD progression and the trajectory of change in cognitive function, neuroimaging, cerebrospinal fluid (CSF), and blood-based biomarkers of AD is needed. Finally, identifying sex differences in AD biomarkers and change across the lifespan is critical for the planning of prevention trials to reduce the risk of developing AD.
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Affiliation(s)
- Neelum T Aggarwal
- Department of Neurological Sciences, Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 West Harrison Street, Suite 1000, Chicago, IL 60612, USA.
| | - Michelle M Mielke
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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8
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Wee J, Sukudom S, Bhat S, Marklund M, Peiris NJ, Hoyos CM, Patel S, Naismith SL, Dwivedi G, Misra A. The relationship between midlife dyslipidemia and lifetime incidence of dementia: A systematic review and meta-analysis of cohort studies. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12395. [PMID: 36911359 PMCID: PMC9993469 DOI: 10.1002/dad2.12395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 03/14/2023]
Abstract
Introduction We conducted a systematic review and meta-analysis to review the relationship between midlife dyslipidemia and lifetime incident dementia. Methods The databases Medline, Embase, Scopus, Web of Science, and Cochrane were searched from inception to February 20, 2022. Longitudinal studies examining the relationship between midlife lipid levels on dementia, dementia subtypes, and/or cognitive impairment were pooled using inverse-variance weighted random-effects meta-analysis. Results Seventeen studies (1.2 million participants) were included. Midlife hypercholesterolemia was associated with increased incidence of mild cognitive impairment (effect size [ES] = 2.01; 95% confidence interval [CI] 1.19 to 2.84; I2 = 0.0%) and all-cause dementia (ES = 1.14; 95% CI: 1.07 to 1.21; I2 = 0.0%). Each 1 mmol/L increase in low-density lipoprotein was associated with an 8% increase (ES = 1.08, 95% CI: 1.03 to 1.14; I2 = 0.3%) in incidence of all-cause dementia. Discussion Midlife dyslipidemia is associated with an increased risk of cognitive impairment in later life.
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Affiliation(s)
- Jason Wee
- Fiona Stanley Hospital South Metropolitan Health Service Perth Western Australia Australia
| | - Sara Sukudom
- University of Western Australia Perth Western Australia Australia.,Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Saiuj Bhat
- Royal Perth Hospital Perth Western Australia Australia
| | - Matti Marklund
- The George Institute for Global Health University of New South Wales Sydney New South Wales Australia.,Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA.,Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden
| | - Niridu Jude Peiris
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Camilla M Hoyos
- Faculty of Science and School of Psychology and Centre for Sleep and Chronobiology Woolcock Institute of Medical Research The University of Sydney Sydney New South Wales Australia
| | - Sanjay Patel
- Heart Research Institute Sydney New South Wales Australia
| | - Sharon L Naismith
- Faculty of Science and School of Psychology Charles Perkins Centre University of Sydney Sydney New South Wales Australia
| | - Girish Dwivedi
- University of Western Australia Perth Western Australia Australia
| | - Ashish Misra
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia.,Heart Research Institute Sydney New South Wales Australia
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9
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Kodishala C, Hulshizer CA, Kronzer VL, Davis JM, Ramanan VK, Vassilaki M, Mielke MM, Crowson CS, Myasoedova E. Risk Factors for Dementia in Patients With Incident Rheumatoid Arthritis: A Population-Based Cohort Study. J Rheumatol 2023; 50:48-55. [PMID: 35840149 PMCID: PMC9812854 DOI: 10.3899/jrheum.220200] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Growing evidence suggests that patients with rheumatoid arthritis (RA) have increased risk for dementia. We assessed risk factors for incident dementia in an inception cohort of patients with RA. METHODS This retrospective population-based cohort study included residents of 8 counties in Minnesota who were ≥ 50 years of age when they met 1987 American College of Rheumatology criteria for incident RA between 1980 and 2014 and were followed until death/migration or December 31, 2019. Patients with dementia before RA incidence were excluded. Incident dementia was defined as 2 relevant International Classification of Diseases, 9th or 10th revision codes at least 30 days apart. Data on sociodemographics, disease characteristics, cardiovascular/cerebrovascular disease (CVD) risk factors, and comorbidities were abstracted from medical records. RESULTS The study included 886 patients with RA (mean age 65.1 yrs, 65.2% female). During the follow-up period (median 8.5 yrs), 103 patients developed dementia. After adjusting for age, sex, and calendar year of RA incidence, older age at RA incidence (HR 1.14 per 1 year increase, 95% CI 1.12-1.17), rheumatoid nodules (HR 1.76, 95% CI 1.05-2.95), hypertension (HR 1.84, 95% CI 1.19-2.85), presence of large joint swelling (HR 2.03, 95% CI 1.14-3.60), any CVD (HR 2.25, 95% CI 1.38-3.66), particularly ischemic stroke (HR 3.16, 95% CI 1.84-5.43) and heart failure (HR 1.82, 95% CI 1.10-3.00), anxiety (HR 1.86, 95% CI 1.16-2.97), and depression (HR 2.63, 95% CI 1.76-3.93) were associated with increased risk of dementia. After adjusting for CVD risk factors and any CVD, all covariates listed above were still significantly associated with risk of dementia. CONCLUSION Apart from age, hypertension, depression, and anxiety, all of which are universally recognized risk factors for dementia, clinically active RA and presence of CVD were associated with an elevated risk of dementia incidence among patients with RA.
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Affiliation(s)
- Chanakya Kodishala
- C. Kodishala, MBBS, DM, V.L. Kronzer, MD, MSCI, J.M. Davis III, MD, Division of Rheumatology, Mayo Clinic
| | | | - Vanessa L Kronzer
- C. Kodishala, MBBS, DM, V.L. Kronzer, MD, MSCI, J.M. Davis III, MD, Division of Rheumatology, Mayo Clinic
| | - John M Davis
- C. Kodishala, MBBS, DM, V.L. Kronzer, MD, MSCI, J.M. Davis III, MD, Division of Rheumatology, Mayo Clinic
| | | | - Maria Vassilaki
- M. Vassilaki, MD, PhD, Department of Quantitative Health Sciences, Mayo Clinic
| | - Michelle M Mielke
- M.M. Mielke, PhD, Department of Quantitative Health Sciences, Department of Neurology, Mayo Clinic
| | - Cynthia S Crowson
- C.S. Crowson, PhD, Division of Rheumatology, Department of Quantitative Health Sciences, Mayo Clinic
| | - Elena Myasoedova
- E. Myasoedova, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.
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10
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Wang ZT, Fu Y, Zhang YR, Chen SD, Huang SY, Yang L, Li HQ, Ou YN, Feng JF, Dong Q, Cheng W, Tan L, Wang HF, Yu JT. Modified dementia risk score as a tool for the prediction of dementia: a prospective cohort study of 239745 participants. Transl Psychiatry 2022; 12:509. [PMID: 36496374 PMCID: PMC9741578 DOI: 10.1038/s41398-022-02269-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
Based on risk profiles, several approaches for predicting dementia risk have been developed. Predicting the risk of dementia with accuracy is a significant clinical challenge. The goal was to create a modified dementia risk score (MDRS) based on a big sample size. A total of 239,745 participants from UK Biobank were studied (mean follow-up of 8.7 years). The score value of each risk factor was estimated according to the β coefficient in the logistic regression model. The total dementia risk score was the sum of each risk score. Kaplan Meier survival curves and Cox proportional hazards analyses were used to assess the associations between total score and dementia. Among all participants included, 3531 incident cases of all-cause dementia (ACD), 1729 cases of Alzheimer's disease (AD), and 925 cases of vascular dementia (VD) were identified. Several vascular risk factors (physical activity, current smoking status, and glycemic status) and depressive symptoms were found to be significantly related to dementia risk. The modified dementia risk scores predicted dementia well (model 1, area under curve 0.810; model 2, area under curve 0.832). In model 1, the cut-off value for high risk (HR) was 81 or higher, and in model 2 (including the APOE4), it was 98 or higher. According to Kaplan-Meier survival analyses, patients in the HR group had faster clinical progression (p < 0.0001) in either model 1 or 2. Cox regression analyses for HR versus low risk (LR) revealed that the Hazard radio for ACD was 7.541 (6.941 to 8.193) in model 1 and 8.348 (7.727 to 9.019) in model 2. MDRS is appropriate for dementia primary prevention, and may help quickly identify individuals with elevated risk of dementia.
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Affiliation(s)
- Zuo-Teng Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Yan Fu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ya-Ru Zhang
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shi-Dong Chen
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shu-Yi Huang
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Liu Yang
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hong-Qi Li
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ya-Nan Ou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jian-Feng Feng
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Cheng
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
| | - Hui-Fu Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China.
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China.
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11
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Association between cholesterol levels and dementia risk according to the presence of diabetes and statin use: a nationwide cohort study. Sci Rep 2022; 12:19383. [PMID: 36371594 PMCID: PMC9653412 DOI: 10.1038/s41598-022-24153-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/10/2022] [Indexed: 11/13/2022] Open
Abstract
We explored the association between cholesterol levels and dementia risk according to the presence of diabetes and statin use. In this population-based longitudinal cohort study, the Korean National Health Insurance Service datasets (2002-2017) were used. Among individuals aged ≥ 40 years who underwent health examinations in 2009 (N = 6,883,494), the hazard of dementia was evaluated according to cholesterol levels. During a median 8.33 years, 263,185 dementia cases were detected. In statin non-users with or without diabetes, the hazards of all-cause dementia were highest for those in the lowest quartile or quintile of low-density lipoprotein-cholesterol (LDL-C) level, showing an inverted J-shaped relationship. Among statin users with or without diabetes, an advance in LDL-C group was associated with an increase in hazards of all-cause dementia. In statin users with diabetes, even very low LDL-C level was not associated with an increased risk of all-cause dementia. Although there was a seemingly paradoxical association between low LDL-C level and dementia risk in statin non-users, the trend was not observed in statin users and is not likely to be clinically relevant. Rather, an advance in LDL-C levels was associated with an increase in the hazard of all-cause dementia in statin users, regardless of the presence of diabetes.
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12
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Wang K, Xu L, Liu L, Zhan S, Wang S, Song Y. Sex differences in the association between the change in triglyceride‑glucose index and cognitive decline: A population-based cohort study. J Affect Disord 2022; 316:42-49. [PMID: 35952934 DOI: 10.1016/j.jad.2022.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/14/2022] [Accepted: 08/06/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous studies indicated that insulin resistance (IR) was related to cognitive decline. This study aimed to investigate whether triglyceride-glucose (TyG) as a surrogate marker of IR can detect the association between IR and cognitive decline, and explore sex-specific association between the longitudinal change in TyG index and cognitive decline in the middle-aged and elderly population in China. METHODS Data from the China Health and Retirement Longitudinal Study, which include 2358 females and 2062 males, were used. The TyG index was calculated as ln (fasting triglyceride [mg/dL] × fasting blood glucose [mg/dL] / 2). Cognitive score was measured by word recall test and mental status test. Logistic regression was used to assess the association between change in TyG index and cognitive decline in men and women from 2011 to 2015, respectively. Subgroup analysis by age was also performed. RESULTS The fourth quartile of change in TyG index was significantly associated with the increased risk of decline in global cognition compared with the first quartile in men [odds ratio (OR) 1.32, 95 % CI 1.03 to 1.71]. Stratified by age groups, the significant association between TyG index and cognitive decline was only found in men aged under 60 years old (OR 1.51, 95 % CI 1.07 to 2.13). LIMITATIONS We only observed the association between TyG index and cognitive decline, but not the severity of the decline. CONCLUSIONS The increased TyG index is related to the risk of cognitive decline in men. This study provided new evidence for formulating sex-specific prevention and treatment strategies for cognitive decline.
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Affiliation(s)
- Kai Wang
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China; Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, China; Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, China; Shandong Institute of Endocrine & Metabolic Diseases, Jinan, China
| | - Lu Xu
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Lili Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Siyan Zhan
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China.
| | - Shengfeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
| | - Yongfeng Song
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China; Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, China; Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, China; Shandong Institute of Endocrine & Metabolic Diseases, Jinan, China.
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13
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Zhu Y, Liu X, Zhu R, Zhao J, Wang Q. Lipid levels and the risk of dementia: A dose-response meta-analysis of prospective cohort studies. Ann Clin Transl Neurol 2022; 9:296-311. [PMID: 35202496 PMCID: PMC8935316 DOI: 10.1002/acn3.51516] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/18/2022] [Accepted: 01/23/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES We performed a dose-response meta-analysis to estimate the association between lipid profiles with the risk of dementia and the potential differences according to the subtype of dementia based on prospective studies. METHODS We searched PubMed, Embase and Web of Science for relevant articles and performed a meta-analysis. We applied fixed or random-effects models to calculate pooled relative risk (RR) with their 95% confidence intervals (CI). The dose-response relationship was assessed by restricted cubic spline. RESULTS Twenty-five prospective studies comprising 362,443 participants and 20,121 cases were included in the final analysis. We found that increased risk of all-cause dementia could be predicted by elevated total cholesterol (TC) (RR = 1.13, 95% CI 1.04-1.22). When looking at dementia subtypes, we also observed high TC and triglycerides (TG) may increase the future risk of Alzheimer's disease (AD), with a pooled RR of 1.13 (95% CI: 1.06-1.21) and 1.10 (95% CI: 1.04-1.15) respectively. Moreover, a dose-response analysis revealed a linear association between TC or TG and the risk of AD, with a pooled RR of 1.09 (95% CI: 1.02-1.16) and 1.12 (95% CI: 1.05-1.21) for per 3-mmol/L increment in TC and TG, respectively. CONCLUSIONS Current evidence suggest that every 3-mmol/L increase in blood TC or TG is linearly associated with a 9% or 12% increase in RR of AD, supporting the notion that high TC and TG levels appear to play a causal role in the development of AD.
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Affiliation(s)
- Ying Zhu
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Xu Liu
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Ruixia Zhu
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Jingjing Zhao
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Qianwen Wang
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
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14
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El-Tallawy HN, Saadeldin HM, Ezzeldin AM, Tohamy AM, Eltellawy S, Bathalath AM, Shehab MM. Genetic, clinical, and biochemical aspects of patients with Alzheimer disease. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00455-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Abstract
Background
The most common form of dementia is Alzheimer’s disease (AD). The clinical manifestations of AD are loss of memory that is progressive and deterioration in cognitive function. The objective of this study is to find patterns of AD among patients regarding clinical aspects, psychological aspects, and laboratory aspects, as well as to determine the role of some genes (APOE1, APOE2, and TMEM106B) in the pathogenesis of AD. In this case–control study, 40 patients with AD were recruited from the inpatient neurology departments and outpatient neurology clinics of the university hospitals in the period of January 1 to December 31, 2017. Furthermore, 40 cross-matched control patients underwent a complete history taking, neurological examination, brain MRI or CT, psychometric tests, thyroid function, and lipid profile measurements. Extracted DNA was quantified using a nanodrop analyzer (ND-1OOO) spectrophotometer for TMEM106B (rs1990622), APOE2 (rs429358), and APOE1 (rs7412).
Results
All subtypes of lipid profiles were significantly higher in patients with AD than the controls. There was a significant difference between the two groups regarding TMEM106B. There was an insignificant difference regarding thyroid hormones T3, T4, and TSH between patients and controls. There was no significant difference between AD patients and the control group regarding APOE-1 and APOE-2. Patients were worse than controls in tests of cognition, such as The Cognitive Abilities Screening Instrument (CASI) and auditory number and letter span test. In addition, AD patients had more depression than controls.
Conclusion
There may be a significant role of a high lipid profile and TMEM106B expression in the pathogenesis of AD.
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15
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Huo N, Vemuri P, Graff-Radford J, Syrjanen J, Machulda M, Knopman DS, Jack CR, Petersen R, Mielke MM. Sex Differences in the Association Between Midlife Cardiovascular Conditions or Risk Factors With Midlife Cognitive Decline. Neurology 2022; 98:e623-e632. [PMID: 34987078 PMCID: PMC8829960 DOI: 10.1212/wnl.0000000000013174] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/16/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The prevalence of midlife cardiovascular conditions and risk factors is higher in men than women. Associations between midlife cardiovascular conditions or risk factors and midlife cognitive decline have been reported, but few studies have assessed sex differences in these associations. METHODS We included 1,857 participants enrolled in the population-based Mayo Clinic Study of Aging who were 50 to 69 years of age at baseline. Participants were evaluated every 15 months by a coordinator, including neurologic evaluation and neuropsychological testing. The neuropsychological testing used 9 tests to calculate global cognitive and domain-specific (memory, language, executive function, and visuospatial skills) z scores. Nurse abstractors reviewed participant medical records to determine the presence of cardiovascular conditions (coronary heart disease, arrhythmias, congestive heart failure) and risk factors (hypertension, diabetes, dyslipidemia, obesity, ever smoking). Linear mixed-effect models evaluated the association between baseline cardiovascular conditions or risk factors and global and domain-specific cognitive decline. Multivariable models adjusted for demographics, APOE genotype, depression, and other medical conditions. Interactions between sex and each cardiovascular condition or risk factor were examined, and results were stratified by sex. RESULTS Overall, 1,465 (78.9%) participants had at least 1 cardiovascular condition or risk factor; the proportion of men was higher than women (767 [83.4%] vs 698 [74.5%], p < 0.0001). Cross-sectionally, coronary heart disease and ever smoking were associated with a lower visuospatial z score in multivariable models. Longitudinally, several cardiovascular conditions and risk factors were associated with declines in global and domain-specific z scores but not visuospatial z scores. Most cardiovascular conditions were more strongly associated with cognition among women: coronary heart disease and other cardiovascular conditions were associated with global cognitive decline only in women (all p < 0.05). In addition, diabetes, dyslipidemia, and coronary heart disease were associated with language z score decline only in women (all p < 0.05). However, congestive heart failure was associated with language z score decline only in men (all p < 0.05). DISCUSSION Midlife cardiovascular conditions and risk factors are associated with midlife cognitive decline. Moreover, specific cardiovascular conditions and risk factors have stronger associations with cognitive decline in midlife for women than men despite the higher prevalence of those conditions in men.
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Affiliation(s)
- Nan Huo
- From the Mayo Clinic, Rochester, MN
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16
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Ryan MC, Hong LE, Hatch KS, Gao S, Chen S, Haerian K, Wang J, Goldwaser EL, Du X, Adhikari BM, Bruce H, Hare S, Kvarta MD, Jahanshad N, Nichols TE, Thompson PM, Kochunov P. The additive impact of cardio-metabolic disorders and psychiatric illnesses on accelerated brain aging. Hum Brain Mapp 2022; 43:1997-2010. [PMID: 35112422 PMCID: PMC8933252 DOI: 10.1002/hbm.25769] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 11/28/2021] [Accepted: 12/28/2021] [Indexed: 12/24/2022] Open
Abstract
Severe mental illnesses (SMI) including major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia spectrum disorder (SSD) elevate accelerated brain aging risks. Cardio‐metabolic disorders (CMD) are common comorbidities in SMI and negatively impact brain health. We validated a linear quantile regression index (QRI) approach against the machine learning “BrainAge” index in an independent SSD cohort (N = 206). We tested the direct and additive effects of SMI and CMD effects on accelerated brain aging in the N = 1,618 (604 M/1,014 F, average age = 63.53 ± 7.38) subjects with SMI and N = 11,849 (5,719 M/6,130 F; 64.42 ± 7.38) controls from the UK Biobank. Subjects were subdivided based on diagnostic status: SMI+/CMD+ (N = 665), SMI+/CMD− (N = 964), SMI−/CMD+ (N = 3,765), SMI−/CMD− (N = 8,083). SMI (F = 40.47, p = 2.06 × 10−10) and CMD (F = 24.69, p = 6.82 × 10−7) significantly, independently impacted whole‐brain QRI in SMI+. SSD had the largest effect (Cohen’s d = 1.42) then BD (d = 0.55), and MDD (d = 0.15). Hypertension had a significant effect on SMI+ (d = 0.19) and SMI− (d = 0.14). SMI effects were direct, independent of MD, and remained significant after correcting for effects of antipsychotic medications. Whole‐brain QRI was significantly (p < 10−16) associated with the volume of white matter hyperintensities (WMH). However, WMH did not show significant association with SMI and was driven by CMD, chiefly hypertension (p < 10−16). We used a simple and robust index, QRI, the demonstrate additive effect of SMI and CMD on accelerated brain aging. We showed a greater effect of psychiatric illnesses on QRI compared to cardio‐metabolic illness. Our findings suggest that subjects with SMI should be among the targets for interventions to protect against age‐related cognitive decline.
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Affiliation(s)
- Meghann C Ryan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - L Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kathryn S Hatch
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Si Gao
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Shuo Chen
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Division of Biostatistics and Bioinformatics, Department of Public Health and Epidemiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Krystl Haerian
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA
| | - Jingtao Wang
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Eric L Goldwaser
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Xiaoming Du
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Bhim M Adhikari
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Heather Bruce
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Stephanie Hare
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mark D Kvarta
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Neda Jahanshad
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Thomas E Nichols
- Nuffield Department of Population Health of the University of Oxford, Oxford, UK
| | - Paul M Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
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17
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Peters R, Xu Y, Antikainen R, Beckett N, Gussekloo J, Jagger C, Jukema JW, Keinanen-Kiukaanniemi S, Rydén L, Skoog I, Staessen JA, Thijs L, Trompet S, Tully PJ, Tzourio C, Anstey KJ. Evaluation of High Cholesterol and Risk of Dementia and Cognitive Decline in Older Adults Using Individual Patient Meta-Analysis. Dement Geriatr Cogn Disord 2021; 50:318-325. [PMID: 34700321 DOI: 10.1159/000519452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Although increased cholesterol level has been acknowledged as a risk factor for dementia, evidence synthesis based on published data has yielded mixed results. This is especially relevant in older adults where individual studies report non-linear relationships between cholesterol and cognition and, in some cases, find higher cholesterol associated with a lower risk of subsequent cognitive decline or dementia. Prior evidence synthesis based on published results has not allowed us to focus on older adults or to standardize analyses across studies. Given our ageing population, an increased risk of dementia in older adults, and the need for proportionate treatment in this age group, an individual participant data (IPD) meta-analysis is timely. METHOD We combined data from 8 studies and over 21,000 participants aged 60 years and over in a 2-stage IPD to examine the relationship between total, high-density, and low-density lipoprotein (HDL and LDL) cholesterol and subsequent incident dementia or cognitive decline, with the latter categorized using a reliable change index method. RESULTS Meta-analyses found no relationship between total, HDL, or LDL cholesterol (per millimoles per litre increase) and risk of cognitive decline in this older adult group averaging 76 years of age. For total cholesterol and cognitive decline: odds ratio (OR) 0.93 (95% confidence interval [CI] 0.86: 1.01) and for incident dementia: OR 1.01 [95% CI 0.89: 1.13]. This was not altered by rerunning the analyses separately for statin users and non-users or by the presence of an APOE e4 allele. CONCLUSION There were no clear consistent relationships between cholesterol and cognitive decline or dementia in this older adult group, nor was there evidence of effect modification by statin use. Further work is needed in younger populations to understand the role of cholesterol across the life-course and to identify any relevant intervention points. This is especially important if modification of cholesterol is to be further evaluated for its potential influence on risk of cognitive decline or dementia.
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Affiliation(s)
- Ruth Peters
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Ying Xu
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Nigel Beckett
- Guys and St Thomas' NHS Trust, London, United Kingdom
| | | | - Carol Jagger
- Faculty of Medical Sciences, University of Newcastle, Newcastle upon Tyne, United Kingdom
| | - Johan Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | | | - Lina Rydén
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden.,Department of Psychiatry Cognition and Old Age Psychiatry, Sahlgrenska University Hospital, Region Västra Götaland, Mölndal, Sweden
| | - Ingmar Skoog
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
| | - Jan A Staessen
- Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium.,Biomedical Sciences Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Lutgarde Thijs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - Stella Trompet
- Leiden University Medical Center, Leiden, The Netherlands
| | - Philip J Tully
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Christophe Tzourio
- Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Kaarin J Anstey
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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18
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Nilsson NIV, Picard C, Labonté A, Köbe T, Meyer PF, Villeneuve S, Auld D, Poirier J. Association of a Total Cholesterol Polygenic Score with Cholesterol Levels and Pathological Biomarkers across the Alzheimer's Disease Spectrum. Genes (Basel) 2021; 12:genes12111805. [PMID: 34828411 PMCID: PMC8623969 DOI: 10.3390/genes12111805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 01/16/2023] Open
Abstract
Midlife hypercholesterolemia is a well-known risk factor for sporadic Alzheimer's disease (AD), and like AD, it is highly influenced by genetics with heritability estimates of 32-63%. We thus hypothesized that genetics underlying peripheral blood total cholesterol (TC) levels could influence the risk of developing AD. We created a weighted polygenic score (TC-PGS) using summary data from a meta-analysis of TC genome-wide association studies for evaluation in three independent AD-related cohorts spanning pre-clinical, clinical, and pathophysiologically proved AD. APOE-ε4 variant was purposely included in the analysis as it represents an already well-established genetic risk factor for both AD and circulating TC. We could vastly improve the performance of the score when considering p-value thresholds for inclusion in the score, sex, and statin use. This optimized score (p-value threshold of 1 × 10-6 for inclusion in the score) explained 18.2% of the variance in TC levels in statin free females compared to 6.9% in the entire sample and improved prediction of hypercholesterolemia (receiver operator characteristics analysis revealed area under the curve increase from 70.8% to 80.5%). The TC-PGS was further evaluated for association with AD risk and pathology. We found no association between the TC-PGS and either of the AD hallmark pathologies, assessed by cerebrospinal fluid levels of Aβ-42, p-Tau, and t-Tau, and 18F-NAV4694 and 18F-AV-1451 positron emission tomography. Similarly, we found no association with the risk of developing amyloid pathology or becoming cognitively impaired in individuals with amyloid pathology.
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Affiliation(s)
- Nathalie I. V. Nilsson
- Department of Psychiatry, McGill University, Montreal, QC H3A 0G4, Canada; (N.I.V.N.); (T.K.); (P.-F.M.); (S.V.)
- Douglas Research Centre, Montreal, QC H4H 1R3, Canada; (C.P.); (A.L.)
- Centre for the Studies in the Prevention of Alzheimer’s Disease, Montreal, QC H4H 1R3, Canada
| | - Cynthia Picard
- Douglas Research Centre, Montreal, QC H4H 1R3, Canada; (C.P.); (A.L.)
- Centre for the Studies in the Prevention of Alzheimer’s Disease, Montreal, QC H4H 1R3, Canada
| | - Anne Labonté
- Douglas Research Centre, Montreal, QC H4H 1R3, Canada; (C.P.); (A.L.)
- Centre for the Studies in the Prevention of Alzheimer’s Disease, Montreal, QC H4H 1R3, Canada
| | - Theresa Köbe
- Department of Psychiatry, McGill University, Montreal, QC H3A 0G4, Canada; (N.I.V.N.); (T.K.); (P.-F.M.); (S.V.)
- Centre for the Studies in the Prevention of Alzheimer’s Disease, Montreal, QC H4H 1R3, Canada
| | - Pierre-François Meyer
- Department of Psychiatry, McGill University, Montreal, QC H3A 0G4, Canada; (N.I.V.N.); (T.K.); (P.-F.M.); (S.V.)
- Centre for the Studies in the Prevention of Alzheimer’s Disease, Montreal, QC H4H 1R3, Canada
| | - Sylvia Villeneuve
- Department of Psychiatry, McGill University, Montreal, QC H3A 0G4, Canada; (N.I.V.N.); (T.K.); (P.-F.M.); (S.V.)
- Douglas Research Centre, Montreal, QC H4H 1R3, Canada; (C.P.); (A.L.)
- Centre for the Studies in the Prevention of Alzheimer’s Disease, Montreal, QC H4H 1R3, Canada
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montreal, QC H3A 0G4, Canada
- McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, QC H3A 0G4, Canada
| | - Daniel Auld
- Genome Centre, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Judes Poirier
- Department of Psychiatry, McGill University, Montreal, QC H3A 0G4, Canada; (N.I.V.N.); (T.K.); (P.-F.M.); (S.V.)
- Douglas Research Centre, Montreal, QC H4H 1R3, Canada; (C.P.); (A.L.)
- Centre for the Studies in the Prevention of Alzheimer’s Disease, Montreal, QC H4H 1R3, Canada
- Department of Medicine, McGill University, Montreal, QC H3A 0G4, Canada
- Correspondence:
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19
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Dounavi ME, Low A, McKiernan EF, Mak E, Muniz-Terrera G, Ritchie K, Ritchie CW, Su L, O’Brien JT. Evidence of cerebral hemodynamic dysregulation in middle-aged APOE ε4 carriers: The PREVENT-Dementia study. J Cereb Blood Flow Metab 2021; 41:2844-2855. [PMID: 34078163 PMCID: PMC8543665 DOI: 10.1177/0271678x211020863] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 11/22/2022]
Abstract
Accumulating evidence suggests vascular dysregulation in preclinical Alzheimer's disease. In this study, cerebral hemodynamics and their coupling with cognition in middle-aged apolipoprotein ε4 carriers (APOEε4+) were investigated. Longitudinal 3 T T1-weighted and arterial spin labelling MRI data from 158 participants (40-59 years old) in the PREVENT-Dementia study were analysed (125 two-year follow-up). Cognition was evaluated using the COGNITO battery. Cerebral blood flow (CBF) and cerebrovascular resistance index (CVRi) were quantified for the flow territories of the anterior, middle and posterior cerebral arteries. CBF was corrected for underlying atrophy and individual hematocrit. Hemodynamic measures were the dependent variables in linear regression models, with age, sex, years of education and APOEε4 carriership as predictors. Further analyses were conducted with cognitive outcomes as dependent variables, using the same model as before with additional APOEε4 × hemodynamics interactions. At baseline, APOEε4+ showed increased CBF and decreased CVRi compared to non-carriers in the anterior and middle cerebral arteries, suggestive of potential vasodilation. Hemodynamic changes were similar between groups. Interaction analysis revealed positive associations between CBF changes and performance changes in delayed recall (for APOEε4 non-carriers) and verbal fluency (for APOEε4 carriers) cognitive tests. These observations are consistent with neurovascular dysregulation in middle-aged APOEε4+.
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Affiliation(s)
- Maria-Eleni Dounavi
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Audrey Low
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Elizabeth F McKiernan
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Elijah Mak
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Karen Ritchie
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
- INSERM, Montpellier, France
| | - Craig W Ritchie
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Li Su
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - John T. O’Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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20
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Whiteley WN, Gupta AK, Godec T, Rostamian S, Whitehouse A, Mackay J, Sever PS. Long-Term Incidence of Stroke and Dementia in ASCOT. Stroke 2021; 52:3088-3096. [PMID: 34192893 PMCID: PMC8478091 DOI: 10.1161/strokeaha.120.033489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/17/2021] [Accepted: 04/12/2021] [Indexed: 11/16/2022]
Abstract
Background and Purpose Management of stroke risk factors might reduce later dementia. In ASCOT (Anglo-Scandinavian Outcome Trial), we determined whether dementia or stroke were associated with different blood pressure (BP)–lowering regimens; atorvastatin or placebo; and mean BP, BP variability, and mean cholesterol levels. Methods Participants with hypertension and ≥3 cardiovascular disease risk factors were randomly allocated to amlodipine- or atenolol-based BP-lowering regimen targeting BP <140/90 mm Hg for 5.5 years. Participants with total cholesterol ≤6.5 mmol/L were also randomly allocated to atorvastatin 10 mg or placebo for 3.3 years. Mean and LDL (low-density lipoprotein) cholesterol, BP, and SD of BP were calculated from 6 months to end of trial. UK participants were linked to electronic health records to ascertain deaths and hospitalization in general and mental health hospitals. Dementia and stroke were ascertained by validated code lists and within-trial ascertainment. Results Of 8580 UK participants, 7300 were followed up to 21 years from randomization. Atorvastatin for 3.3 years had no measurable effect on stroke (264 versus 272; adjusted hazard ratio [HR], 0.92 [95% CI, 0.78–1.09]; P=0.341) or dementia (238 versus 227; adjusted HR, 0.98 [95% CI, 0.82–1.18]; P=0.837) compared with placebo. Mean total cholesterol was not associated with later stroke or dementia. An amlodipine-based compared with an atenolol-based regimen for 5.5 years reduced stroke (443 versus 522; adjusted HR, 0.82 [95% CI, 0.72–0.93]; P=0.003) but not dementia (450 versus 465; adjusted HR, 0.94 [95% CI, 0.82–1.07]; P=0.334) over follow-up. BP variability (SD mean BP) was associated with a higher risk of dementia (per 5 mm Hg HR, 1.14 [95% CI, 1.06–1.24]; P<0.001) and stroke (HR, 1.21 [95% CI, 1.12–1.32]; P<0.001) adjusted for mean BP. Conclusions An amlodipine-based BP regimen reduced the long-term incidence of stroke compared with an atenolol-based regimen but had no measurable effect on dementia. Atorvastatin had no effect on either stroke or dementia. Higher BP variability was associated with a higher incidence of later dementia and stroke.
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Affiliation(s)
- William N. Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh (W.N.W.)
- Nuffield Department of Population Health, University of Oxford (W.N.W.)
| | - Ajay K. Gupta
- William Harvey Research Institute, Queen Mary University of London (A.K.G.)
- National Heart and Lung Institute, Imperial College London (A.G., S.R., A.W., J.M., P.S.S.)
| | - Thomas Godec
- London School of Hygiene and Tropical Medicine, University of London (T.G.)
| | - Somayeh Rostamian
- National Heart and Lung Institute, Imperial College London (A.G., S.R., A.W., J.M., P.S.S.)
| | - Andrew Whitehouse
- National Heart and Lung Institute, Imperial College London (A.G., S.R., A.W., J.M., P.S.S.)
| | - Judy Mackay
- National Heart and Lung Institute, Imperial College London (A.G., S.R., A.W., J.M., P.S.S.)
| | - Peter S. Sever
- National Heart and Lung Institute, Imperial College London (A.G., S.R., A.W., J.M., P.S.S.)
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21
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Ozawa H, Miyazawa T, Miyazawa T. Effects of Dietary Food Components on Cognitive Functions in Older Adults. Nutrients 2021; 13:2804. [PMID: 34444965 PMCID: PMC8398286 DOI: 10.3390/nu13082804] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 12/21/2022] Open
Abstract
Population aging has recently been an important issue as the number of elderly people is growing worldwide every year, and the extension of social security costs is financially costly. The increase in the number of elderly people with cognitive decline is a serious problem related to the aging of populations. Therefore, it is necessary to consider not only physical care but also cognitive patterns in the future care of older adults. Since food contains a variety of bioactive substances, dietary patterns may help improve age-related cognitive decline. However, the relationship between cognitive function and individual food components remains ambiguous as no clear efficacy or mechanism has been confirmed. Against this background, this review summarizes previous reports on the biological process of cognitive decline in the elderly and the relationship between individual compounds in foods and cognitive function, as well as the role of individual components of food in cognitive function, in the following order: lipids, carotenoids, vitamins, phenolic compounds, amino acids, peptides, and proteins. Based on the research presented in this review, a proper diet that preserves cognitive function has the potential to improve age-related cognitive decline, Alzheimer's disease, and Parkinson's disease. Hopefully, this review will help to trigger the development of new foods and technologies that improve aging and cognitive functions and extend the healthy life span.
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Affiliation(s)
| | | | - Teruo Miyazawa
- New Industry Creation Hatchery Center (NICHe), Tohoku University, Sendai 980-8579, Japan; (H.O.); (T.M.)
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22
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Liu H, Zou L, Zhou R, Zhang M, Gu S, Zheng J, Hukportie DN, Wu K, Huang Z, Yuan Z, Wu X. Long-Term Increase in Cholesterol Is Associated With Better Cognitive Function: Evidence From a Longitudinal Study. Front Aging Neurosci 2021; 13:691423. [PMID: 34220488 PMCID: PMC8248815 DOI: 10.3389/fnagi.2021.691423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/18/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Higher visit-to-visit cholesterol has been associated with cognitive decline. However, the association between long-term increase or decrease in cholesterol and cognitive decline remains unclear. Methods: A total of 4,915 participants aged ≥45 years with normal cognition in baseline were included. The participants were divided into four groups, namely low-low, low-high, high-low, and high-high, according to the diagnostic thresholds of total cholesterol (TC), non-high-density lipoprotein cholesterol (NHDL-C), low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol (HDL-C) after 4 years of follow-up. Cognitive function was assessed by episodic memory and mental intactness. Binary logistic regression was used to analyse the association of cholesterol variation with cognitive decline. Results: Among the participants, 979 (19.9%) experienced global cognitive decline. The odds ratio (OR) of global cognitive and memory function decline were remarkably lower in participants in the low-high NHDL-C group than those in the low-low group [OR and 95% confidence interval (CI): 0.50 [0.26-0.95] for global cognitive decline, 0.45 [0.25-0.82] for memory function decline]. The lower OR was also significant in females (OR [95% CI]: 0.38 [0.17-0.87] for global cognitive decline; 0.44 [0.19-0.97] for memory function decline) and participants without cardiovascular disease (OR [95% CI]: 0.31 [0.11-0.87] for global cognitive decline; 0.34 [0.14-0.83] for memory function decline). The increases in other cholesterol were also negatively associated with the risk of cognitive decline although not significantly. Conclusions: A longitudinal increase in NHDL-C may be protective for cognition in females or individuals without cardiovascular disease.
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Affiliation(s)
- Huamin Liu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Lianwu Zou
- Department of Psychiatry, Baiyun Psychiatric Rehabilitation Hospital, Guangzhou, China
| | - Rui Zhou
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Minyi Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Shanyuan Gu
- Inpatient Department, Baiyun Psychiatric Rehabilitation Hospital, Guangzhou, China
| | - Jiazhen Zheng
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Daniel Nyarko Hukportie
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Keyi Wu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Zhiwei Huang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Zelin Yuan
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Xianbo Wu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
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23
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Litke R, Garcharna LC, Jiwani S, Neugroschl J. Modifiable Risk Factors in Alzheimer Disease and Related Dementias: A Review. Clin Ther 2021; 43:953-965. [PMID: 34108080 DOI: 10.1016/j.clinthera.2021.05.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Although Alzheimer disease and related dementias (ADRDs) have long been considered nonpreventable and even an inevitable consequence of aging, recent findings from longitudinal studies indicate a downtrend in age-adjusted incidence and prevalence of ADRDs in Western countries. This remarkable trend might be the result of improved management of so-called modifiable risk factors. The aim of this review is to present evidence of modifiable factors of ADRDs in a life-course approach. METHODS A PubMed database search was conducted between November and December 2020 to identify relevant studies evaluating the role of modifiable risk factors in the development of ADRDs. Key words (Alzheimer's disease and modifiable risk factors) were used and specific inclusion and exclusion criteria applied. FINDINGS This review identifies modifiable factors for ADRDs divided into early-life, middle-life, and late-life risk factors, depending on the available window of preventive action. According to life course exposure, factors can be protective or deleterious for ADRDs that participate in the underlying pathophysiologic complexity of these diseases as well as the complexity for public health measures implementations. IMPLICATIONS The available evidence derived from epidemiologic, preclinical, interventional studies suggest that modifiable risk factors for ADRDs offer opportunities for therapeutic and preventive actions.
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Affiliation(s)
- Rachel Litke
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York.
| | | | - Salima Jiwani
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Judith Neugroschl
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.
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24
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Duong MT, Nasrallah IM, Wolk DA, Chang CCY, Chang TY. Cholesterol, Atherosclerosis, and APOE in Vascular Contributions to Cognitive Impairment and Dementia (VCID): Potential Mechanisms and Therapy. Front Aging Neurosci 2021; 13:647990. [PMID: 33841127 PMCID: PMC8026881 DOI: 10.3389/fnagi.2021.647990] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/08/2021] [Indexed: 12/18/2022] Open
Abstract
Vascular contributions to cognitive impairment and dementia (VCID) are a common cause of cognitive decline, yet limited therapies exist. This cerebrovascular disease results in neurodegeneration via acute, chronic, local, and systemic mechanisms. The etiology of VCID is complex, with a significant impact from atherosclerosis. Risk factors including hypercholesterolemia and hypertension promote intracranial atherosclerotic disease and carotid artery stenosis (CAS), which disrupt cerebral blood flow and trigger ischemic strokes and VCID. Apolipoprotein E (APOE) is a cholesterol and phospholipid carrier present in plasma and various tissues. APOE is implicated in dyslipidemia and Alzheimer disease (AD); however, its connection with VCID is less understood. Few experimental models for VCID exist, so much of the present information has been drawn from clinical studies. Here, we review the literature with a focus on the clinical aspects of atherosclerotic cerebrovascular disease and build a working model for the pathogenesis of VCID. We describe potential intermediate steps in this model, linking cholesterol, atherosclerosis, and APOE with VCID. APOE4 is a minor isoform of APOE that promotes lipid dyshomeostasis in astrocytes and microglia, leading to chronic neuroinflammation. APOE4 disturbs lipid homeostasis in macrophages and smooth muscle cells, thus exacerbating systemic inflammation and promoting atherosclerotic plaque formation. Additionally, APOE4 may contribute to stromal activation of endothelial cells and pericytes that disturb the blood-brain barrier (BBB). These and other risk factors together lead to chronic inflammation, atherosclerosis, VCID, and neurodegeneration. Finally, we discuss potential cholesterol metabolism based approaches for future VCID treatment.
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Affiliation(s)
- Michael Tran Duong
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Ilya M Nasrallah
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David A Wolk
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Ta-Yuan Chang
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
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25
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Ding D, Zhou F, Cao Y, Liang X, Wu W, Xiao Z, Zhao Q, Deng W. Cholesterol profiles and incident cognitive decline among older adults: the Shanghai Aging Study. Age Ageing 2021; 50:472-479. [PMID: 32766741 DOI: 10.1093/ageing/afaa140] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND the association between cholesterol profiles and risk of cognitive decline among older adults was inconclusive. OBJECTIVE to examine the association between cholesterol profiles and risk of cognitive decline in older adults with or without vascular risk factors (VRFs) in the prospective phase of the Shanghai Aging Study. DESIGN a prospective community-based cohort study. SETTING Shanghai, China. PARTICIPANTS we prospectively followed 1,556 dementia-free participants aged ≥60 years with a baseline cholesterol profile for 5.2 years on average. Participants with at least one of obesity, diabetes, hypertension, stroke, and coronary artery disease were categorised to the VRFs group, and those free of any VRFs were categorised to the non-VRFs group. METHODS total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol in serum were measured at baseline. At follow-up, consensus diagnosis of incident dementia and Alzheimer's disease (AD) were established based on medical, neurological, and neuropsychological examinations. Cox regression was used to assess the association between cholesterol and incident dementia/AD; multivariate linear regression was used to examine the relationship between cholesterol and an annual rate of Mini Mental State Examination (MMSE) score decline in participants with or without VRFs. RESULTS among VRFs-free participants, TC (HR 0.62, 95%CI 0.40-0.95) and LDL-C (HR 0.47, 95%CI 0.28-0.80) were inversely associated with incident dementia, LDL-C was inversely associated with incident AD (HR 0.50, 95%CI 0.28-0.90). A significant correlation was found between incremental TC (β = 0.08), LDL-C (β = 0.09), and a slower annual decline of MMSE score. CONCLUSIONS effect of cholesterol on cognitive decline may be modified by VRFs.
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Affiliation(s)
- Ding Ding
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Fen Zhou
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
- Key Lab of Health Technology Assessment, National Health and Family Planning Commission of the People's Republic of China (Fudan University), Shanghai, China
- Key Laboratory of Public Health Safety of Ministry of Education (Fudan University), Shanghai, China
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro 70182, Sweden
| | - Xiaoniu Liang
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Wanqing Wu
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhenxu Xiao
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qianhua Zhao
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei Deng
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
- Key Lab of Health Technology Assessment, National Health and Family Planning Commission of the People's Republic of China (Fudan University), Shanghai, China
- Key Laboratory of Public Health Safety of Ministry of Education (Fudan University), Shanghai, China
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Krivanek TJ, Gale SA, McFeeley BM, Nicastri CM, Daffner KR. Promoting Successful Cognitive Aging: A Ten-Year Update. J Alzheimers Dis 2021; 81:871-920. [PMID: 33935078 PMCID: PMC8293659 DOI: 10.3233/jad-201462] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
A decade has passed since we published a comprehensive review in this journal addressing the topic of promoting successful cognitive aging, making this a good time to take stock of the field. Because there have been limited large-scale, randomized controlled trials, especially following individuals from middle age to late life, some experts have questioned whether recommendations can be legitimately offered about reducing the risk of cognitive decline and dementia. Despite uncertainties, clinicians often need to at least make provisional recommendations to patients based on the highest quality data available. Converging lines of evidence from epidemiological/cohort studies, animal/basic science studies, human proof-of-concept studies, and human intervention studies can provide guidance, highlighting strategies for enhancing cognitive reserve and preventing loss of cognitive capacity. Many of the suggestions made in 2010 have been supported by additional research. Importantly, there is a growing consensus among major health organizations about recommendations to mitigate cognitive decline and promote healthy cognitive aging. Regular physical activity and treatment of cardiovascular risk factors have been supported by all of these organizations. Most organizations have also embraced cognitively stimulating activities, a heart-healthy diet, smoking cessation, and countering metabolic syndrome. Other behaviors like regular social engagement, limiting alcohol use, stress management, getting adequate sleep, avoiding anticholinergic medications, addressing sensory deficits, and protecting the brain against physical and toxic damage also have been endorsed, although less consistently. In this update, we review the evidence for each of these recommendations and offer practical advice about behavior-change techniques to help patients adopt brain-healthy behaviors.
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Affiliation(s)
- Taylor J. Krivanek
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Seth A. Gale
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Brittany M. McFeeley
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Casey M. Nicastri
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Kirk R. Daffner
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
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Thelen M, Brown-Borg HM. Does Diet Have a Role in the Treatment of Alzheimer's Disease? Front Aging Neurosci 2020; 12:617071. [PMID: 33424583 PMCID: PMC7785773 DOI: 10.3389/fnagi.2020.617071] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/30/2020] [Indexed: 12/23/2022] Open
Abstract
The aging process causes many changes to the brain and is a major risk factor for the development of neurodegenerative diseases such as Alzheimer's Disease (AD). Despite an already vast amount of research on AD, a greater understanding of the disease's pathology and therapeutic options are desperately needed. One important distinction that is also in need of further study is the ability to distinguish changes to the brain observed in early stages of AD vs. changes that occur with normal aging. Current FDA-approved therapeutic options for AD patients have proven to be ineffective and indicate the need for alternative therapies. Aging interventions including alterations in diet (such as caloric restriction, fasting, or methionine restriction) have been shown to be effective in mediating increased health and lifespan in mice and other model organisms. Because aging is the greatest risk factor for the development of neurodegenerative diseases, certain dietary interventions should be explored as they have the potential to act as a future treatment option for AD patients.
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Affiliation(s)
- Mitchell Thelen
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, United States
| | - Holly M Brown-Borg
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, United States
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Liu L, Zhang C, Lv X, Lai X, Xu L, Feng J, Song Y, Wang S, Zhan S. Sex-specific associations between lipids and cognitive decline in the middle-aged and elderly: a cohort study of Chinese adults. ALZHEIMERS RESEARCH & THERAPY 2020; 12:164. [PMID: 33287901 PMCID: PMC7722300 DOI: 10.1186/s13195-020-00731-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/23/2020] [Indexed: 11/19/2022]
Abstract
Background Studies regarding the lipid-cognition relationship have increasingly gained popularity but have generated much mixed results. To date, few studies have focused on the difference between sexes. Methods This study included 6792 Chinese adults aged over 45 years (women, 48.56%; mean age, 57.28 years), who were free of severe conditions known to affect cognitive function at the baseline (2011). Blood concentrations of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), and triglycerides (TG) were assessed at baseline, and both continuous and categorical values were used in final analyses. Global cognitive functions were assessed by the word recall test and the mental status test in 2011, 2013, and 2015, respectively. We graded participants into three groups according to the cognitive change slopes: no decline (≥ 0), moderate decline (median to 0), and severe decline (< median). Sex-specific associations between blood lipids and cognitive decline were analyzed using ordinal logistic models, adjusting for sociodemographic information, lifestyle behaviors, and health status. Results Higher baseline TC and LDL-C concentrations exhibited no significant association with 5-year cognitive decline in men but were significantly associated with greater 5-year cognitive decline in women [odds ratio (OR) 1.026, 95% confidence interval (CI) 1.003, 1.050; OR 1.026, CI 1.002, 1.051, respectively]. For higher serum HDL-c levels, a significantly protective effect on cognition was observed in men, but a slightly adverse effect was found in women (not significant after Bonferroni correction). TG presented almost no effect on later cognition in either sex. Conclusion Different associations between sexes were observed for the lipid-cognition relationship, and maintaining serum cholesterol levels at an appropriate range may have a positive effect on cognitive health.
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Affiliation(s)
- Lili Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Chen Zhang
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jing 5 road, Huaiyin District, Jinan, 250021, China
| | - Xiaozhen Lv
- Beijing Dementia Key Laboratory, National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital (Institute of Mental Health), 51 Huayuanbei Road, Haidian District, Beijing, 100191, China
| | - Xuefeng Lai
- School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Lu Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Jingnan Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Yongfeng Song
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jing 5 road, Huaiyin District, Jinan, 250021, China.
| | - Shengfeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China. .,Research Center of Clinical Epidemiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China. .,Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, 100191, China.
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Moazzami K, Power MC, Gottesman R, Mosley T, Lutsey PL, Jack CR, Hoogeveen RC, West N, Knopman DS, Alonso A. Association of mid-life serum lipid levels with late-life brain volumes: The atherosclerosis risk in communities neurocognitive study (ARICNCS). Neuroimage 2020; 223:117324. [PMID: 32882383 PMCID: PMC9006082 DOI: 10.1016/j.neuroimage.2020.117324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/20/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Limited information exists regarding the association between midlife lipid levels and late-life total and regional brain volumes. METHODS We studied 1872 participants in the longitudinal community-based Atherosclerosis Risk in Communities Neurocognitive Study. Serum lipid levels were measured in 1987-1989 (mean age, 53 ± 5 years). Participants underwent 3T brain MRI scans in 2011-2013. Brain volumes were measured using FreeSurfer image analysis software. Linear regression models were used to assess the associations between serum lipids and brain volumes modeled in standard deviation (SD) units, adjusting for potential confounders. RESULTS In adjusted analyses, one SD higher low-density lipoprotein cholesterol (LDL) levels were associated with larger total brain volumes (β 0.033, 95% CI 0.006-0.060) as well as larger volumes of the temporal (β 0.038, 95% CI 0.003-0.074) and parietal lobes (β 0.044, 95% CI 0.009-0.07) and Alzheimer disease-related region (β 0.048, 95% CI 0.048-0.085). Higher triglyceride levels were associated with smaller total brain volumes (β -0.033, 95% CI -0.060, -0.007). The associations between LDL levels and brain volumes were modified by age (P for interaction <0.001), with higher LDL levels associated with larger total and regional brain volumes only among adults >53 years at baseline, and were attenuated after application of weights to account for informative attrition, although associations with the parietal and Alzheimer's disease-related region remained significant. High-density lipoprotein cholesterol was not associated with brain volumes. CONCLUSION Higher LDL levels in late midlife were associated with larger brain volumes later in life, while higher triglyceride levels were associated with smaller brain volumes. These associations were driven by adults >53 years at baseline.
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Affiliation(s)
- Kasra Moazzami
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
| | - Melinda C Power
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, United States
| | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Thomas Mosley
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS, United States
| | - Pamela L Lutsey
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, United States
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Ron C Hoogeveen
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Nancy West
- Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, United States
| | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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30
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Perera G, Rijnbeek PR, Alexander M, Ansell D, Avillach P, Duarte-Salles T, Gordon MF, Lapi F, Mayer MA, Pasqua A, Pedersen L, van Der Lei J, Visser PJ, Stewart R. Vascular and metabolic risk factor differences prior to dementia diagnosis: a multidatabase case-control study using European electronic health records. BMJ Open 2020; 10:e038753. [PMID: 33191253 PMCID: PMC7668358 DOI: 10.1136/bmjopen-2020-038753] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/16/2020] [Accepted: 09/17/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE The objective of the study is to compare body mass index (BMI), systolic/diastolic blood pressure (SBP/DBP) and serum total cholesterol levels between dementia cases and controls at multiple time intervals prior to dementia onset, and to test time interval as a modifying factor for these associations. DESIGN Case-control study. SETTING Six European electronic health records databases. PARTICIPANTS 291 780 cases at the date of first-recorded dementia diagnosis, compared with 29 170 549 controls randomly selected from the same databases, age matched and sex matched at this index date. EXPOSURE The following measures were extracted whenever recorded within each dataset: BMI (kg/m2), SBP and DBP (mm Hg) and serum total cholesterol (mmol/L). Levels for each of these variables were defined within six 2-year time intervals over the 12 years prior to the index date. MAIN OUTCOMES Case-control differences in exposures of interest were modelled for each time period and adjusted for demographic and clinical factors (ischaemic/unspecified stroke, type 2 diabetes mellitus, acute myocardial infarction, hypertension diagnosis, antihypertensive medication, cholesterol-lowering medication). Coefficients and interactions with time period were meta-analysed across the six databases. RESULTS Mean BMI (coefficient -1.16 kg/m2; 95% CI -1.38 to 0.93) and SBP (-2.83 mm Hg; 95% CI -4.49 to -1.16) were lower in cases at diagnosis, and case-control differences were greater in more recent time periods, as indicated by significant case-x-time interaction and case-x-time-squared interaction terms. Time variations in coefficients for cholesterol levels were less consistent between databases and those for DBP were largely not significant. CONCLUSION Routine clinical data show emerging divergence in levels of BMI and SBP prior to the diagnosis of dementia but less evidence for DBP or total cholesterol levels. These divergences should receive at least some consideration in routine dementia risk screening, although underlying mechanisms still require further investigation.
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Affiliation(s)
- Gayan Perera
- Psychological Medicine, King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | - P R Rijnbeek
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - David Ansell
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Avillach
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Aarhus University, Aarhus, Denmark
| | | | - Mark Forrest Gordon
- Specialty Clinical Development, Neurology and Psychiatry, Teva Pharmaceuticals USA Inc, North Wales, Pennsylvania, USA
| | - Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | | | - Alessandro Pasqua
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Johan van Der Lei
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
- Department of Neurology, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Neurobiology, Karolinska Institutet, Stockholm, Sweden
| | - Robert Stewart
- Psychological Medicine, King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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31
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Kaur D, Bucholc M, Finn DP, Todd S, Wong-Lin K, McClean PL. Multi-time-point data preparation robustly reveals MCI and dementia risk factors. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2020; 12:e12116. [PMID: 33088897 PMCID: PMC7560502 DOI: 10.1002/dad2.12116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/05/2020] [Accepted: 09/16/2020] [Indexed: 12/25/2022]
Abstract
Introduction Conflicting results on dementia risk factors have been reported across studies. We hypothesize that variation in data preparation methods may partially contribute to this issue. Methods We propose a comprehensive data preparation approach comparing individuals with stable diagnosis over time to those who progress to mild cognitive impairment (MCI)/dementia. This was compared to the often-used "baseline" analysis. Multivariate logistic regression was used to evaluate both methods. Results The results obtained from sensitivity analyses were consistent with those from our multi-time-point data preparation approach, exhibiting its robustness. Compared to analysis using only baseline data, the number of significant risk factors identified in progression analyses was substantially lower. Additionally, we found that moderate depression increased healthy-to-MCI/dementia risk, while hypertension reduced MCI-to-dementia risk. Discussion Overall, multi-time-point-based data preparation approaches may pave the way for a better understanding of dementia risk factors, and address some of the reproducibility issues in the field.
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Affiliation(s)
- Daman Kaur
- Northern Ireland Centre for Stratified Medicine Biomedical Sciences Research Institute Clinical Translational Research and Innovation Centre (C-TRIC) Altnagelvin Hospital Site Ulster University Derry/Londonderry Northern Ireland UK
| | - Magda Bucholc
- Intelligent Systems Research Centre School of Computing Engineering and Intelligent Systems Ulster University Derry/Londonderry Northern Ireland UK
| | - David P Finn
- Pharmacology and Therapeutics School of Medicine Galway Neuroscience Centre National University of Ireland Galway University Road Galway Republic of Ireland
| | - Stephen Todd
- Altnagelvin Area Hospital Western Health and Social Care Trust Derry/Londonderry Northern Ireland UK
| | - KongFatt Wong-Lin
- Intelligent Systems Research Centre School of Computing Engineering and Intelligent Systems Ulster University Derry/Londonderry Northern Ireland UK
| | - Paula L McClean
- Northern Ireland Centre for Stratified Medicine Biomedical Sciences Research Institute Clinical Translational Research and Innovation Centre (C-TRIC) Altnagelvin Hospital Site Ulster University Derry/Londonderry Northern Ireland UK
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Rosa G, Giannotti C, Martella L, Massa F, Serafini G, Pardini M, Nobili FM, Monacelli F. Brain Aging, Cardiovascular Diseases, Mixed Dementia, and Frailty in the Oldest Old: From Brain Phenotype to Clinical Expression. J Alzheimers Dis 2020; 75:1083-1103. [DOI: 10.3233/jad-191075] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Gianmarco Rosa
- Department of Internal Medicine and Medical Specialties, DIMI, Section of Cardiovascular Diseases, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Giannotti
- Department of Internal Medicine and Medical Specialties, DIMI, Section of Geriatrics, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucia Martella
- Department of Internal Medicine and Medical Specialties, DIMI, Section of Geriatrics, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federico Massa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health DINOGMI, Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health DINOGMI, Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health DINOGMI, Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Flavio Mariano Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health DINOGMI, Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fiammetta Monacelli
- Department of Internal Medicine and Medical Specialties, DIMI, Section of Geriatrics, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Abstract
Population-based clinic-pathological studies have established that the most common pathological substrate of dementia in community-dwelling elderly people is mixed, especially Alzheimer's disease (AD) and cerebrovascular ischemic disease (CVID), rather than pure AD. While these could be just two frequent unrelated comorbidities in the elderly, epidemiological research has reinforced the idea that mid-life (age <65 years) vascular risk factors increase the risk of late-onset (age ≥ 65 years) dementia, and specifically AD. By contrast, healthy lifestyle choices such as leisure activities, physical exercise, and Mediterranean diet are considered protective against AD. Remarkably, several large population-based longitudinal epidemiological studies have recently indicated that the incidence and prevalence of dementia might be decreasing in Western countries. Although it remains unclear whether these positive trends are attributable to neuropathologically definite AD versus CVID, based on these epidemiological data it has been estimated that a sizable proportion of AD cases could be preventable. In this review, we discuss the current evidence about modifiable risk factors for AD derived from epidemiological, preclinical, and interventional studies, and analyze the opportunities for therapeutic and preventative interventions.
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Affiliation(s)
- Alberto Serrano-Pozo
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - John H Growdon
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Causal association of circulating cholesterol levels with dementia: a mendelian randomization meta-analysis. Transl Psychiatry 2020; 10:145. [PMID: 32398686 PMCID: PMC7217910 DOI: 10.1038/s41398-020-0822-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 12/23/2022] Open
Abstract
Prospective studies have shown that abnormally circulating cholesterol is associated with the risk of dementia. However, whether the association is causal or not remains unclear. We attempt to infer the causal association in a MR meta-analysis by using ApoE gene polymorphisms as instrument variables. Studies with dementia risk (27 studies) or circulating lipid levels (7 studies) were included, with totally 3136 dementia patients and 3103 healthy controls. The analyses showed that carriers of ε2 allele significantly were of decreased risk of AD (OR = 0.70; 95% CI: 0.58-0.84; P < 0.01), whereas carriers of ε4 allele were of increased risk of AD (OR = 3.62; 95% CI: 3.03-4.32; P < 0.05), compared to these of ε3 allele. Circulating TC was significantly reduced in carriers of ε2 allele (WMD = - 0.29 mmol/L; 95% CI: -0.54 to -0.03; P < 0.05) and increased in carriers of ε4 allele (WMD = 0.42 mmol/l; 95% CI: 0.001-0.84; P < 0.05). In addition, carriers of ε4 allele had reduction in circulating HDL-C (WMD = - 0.04 mmol/L; 95% CI: - 0.07 to -0.001; P < 0.05). In comparing allele ε2 with ε3, the predicted OR of having AD for 1 mg/dL increment in circulating TC was 0.97 (95% CI: 0.86-0.98; P < 0.05). Comparing allele ε4 with ε3, the predicted OR for a 1 mg/dL increment in TC was 1.08 (95% CI: 1.05-17.58; P < 0.05), and reduction in HDL-C was 2.30 (95% CI: 1.51-43.99; P < 0.05). Our findings demonstrate that high circulating TC and reduced HDL-C levels might be potential risk factors of the development of AD.
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35
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Effect of Combined Antihypertensive and Lipid-Lowering Therapies on Cognitive Function: A New Treatment Strategy? Cardiol Res Pract 2020; 2020:1484357. [PMID: 32351732 PMCID: PMC7178519 DOI: 10.1155/2020/1484357] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/03/2020] [Accepted: 03/19/2020] [Indexed: 01/06/2023] Open
Abstract
Risk factors for cardiovascular disease such as hypertension and hyperlipidemia are associated with cognitive decline. However, there is still no clear evidence that the use of antihypertensive or lipid-lowering therapy can prevent or delay cognitive decline or development of dementia. To provide a reference for clinical treatment, we analyzed the potential mechanisms of cognitive dysfunction induced by hypertension and hyperlipidemia, the clinical research and controversy of antihypertensive and lipid-lowering therapies on cognitive function, and the clinical value of combined antihypertensive and lipid-lowering therapy. It is currently believed that hypertension and elevated blood cholesterol levels in middle-aged people may be related to cognitive impairment or dementia in the elderly. Some studies suggest that intensive antihypertensive or lipid-lowering therapies are better than standard antihypertensive or lipid-lowering therapy, yet further tests are needed to confirm their effects on cognitive function. Actively controlling potential risk factors from middle age may be important for Alzheimer's disease (AD) prevention.
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36
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Yang FN, Stanford M, Jiang X. Low Cholesterol Level Linked to Reduced Semantic Fluency Performance and Reduced Gray Matter Volume in the Medial Temporal Lobe. Front Aging Neurosci 2020; 12:57. [PMID: 32300296 PMCID: PMC7142997 DOI: 10.3389/fnagi.2020.00057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/19/2020] [Indexed: 11/29/2022] Open
Abstract
Hyperlipidemia has been proposed as a risk factor of dementia and cognitive decline. However, the findings of the relationship between cholesterol level and cognitive/brain function have been inconsistent. Here, using a well-controlled sample from the Parkinson's Progression Markers Initiative (PPMI), we investigated the probable non-linear relationship between plasma total cholesterol (TC) level, gray matter volume (GMv), and cognitive performance in 117 non-demented subjects (mean age, 61.5 ± 8.9 years), including 67 Parkinson's disease (PD) patients and 50 demographically matched controls. A quadratic relationship between semantic fluency (SF) performance and TC levels was identified. Within the subjects with a desirable TC level (TC < 200 mg/dl), low TC (lTC) levels were associated with reduced SF performance, as well as reduced GMv in three medial temporal regions [including bilateral anterior hippocampus (HIP)]. In contrast, no significant relationship between TC and cognition performance/GMv was found in individuals with a high cholesterol level (i.e., TC ≥ 200 mg/dl). Further region of interest (ROI)-based analysis showed that individuals with TC levels ranging from 100 to 160 mg/dl had the lowest GMv in the medial temporal regions. These findings suggest that low-normal TC level may be associated with reduced cognitive function and brain atrophy in regions implicated in neurodegenerative diseases, adding to a growing body of literature supporting a probable non-linear relationship between cholesterol level and brain health. However, this finding needs to be verified with other large public cohort data that do not include PD patients.
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Affiliation(s)
- Fan Nils Yang
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC, United States
| | - Macdonell Stanford
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC, United States
- School of Medicine, Georgetown University Medical Center, Washington, DC, United States
| | - Xiong Jiang
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC, United States
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Vu M, Koponen M, Taipale H, Tanskanen A, Tiihonen J, Kettunen R, Hartikainen S, Tolppanen AM. Prevalence of cardiovascular drug use before and after diagnosis of Alzheimer's disease. Int J Cardiol 2020; 300:221-225. [PMID: 31810814 DOI: 10.1016/j.ijcard.2019.09.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Both cardiovascular diseases and Alzheimer's disease (AD) are common in aging populations. We investigated the prevalence of cardiovascular (CV) drug use in relation to AD diagnosis, and compared the prevalence to a matched cohort without AD. METHODS Point prevalence of CV drugs was counted every six months, from five years before to five years after AD diagnosis in the register-based Medication Use and Alzheimer's disease (MEDALZ) study, including community dwellers who received a clinically verified AD diagnosis during 2005-2011 in Finland, and compared to a matched cohort without AD. Data on drugs purchases was extracted from the Prescription Register by Anatomical Therapeutic Chemical-classification system codes C* (excluding C04 and C05) and modelled to use periods with PRE2DUP method. RESULTS Before AD diagnosis, the prevalence of CV drug use was higher in persons with AD (RR 1.04; confidence interval (CI) 1.02-1.06). At the index date (AD diagnosis date), the prevalence of CV drug use was similarly among persons with AD (75.8%), in comparison to matched cohort without AD (73.4%). However, after that, the prevalence of CV drug use started decline in persons with AD. CONCLUSIONS The decline in use of CV drugs after AD diagnosis likely reflects discontinued need for treatment due to weight loss, frailty, decline in blood pressure and serum lipid levels. It may also reflect the change in prescribing due to adverse events and priorities of care to improve the quality of end-of-life.
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Affiliation(s)
- Mai Vu
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
| | - Marjaana Koponen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Heidi Taipale
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland; Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Raimo Kettunen
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Tolppanen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland
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Changes in Metabolic Syndrome Status and Risk of Dementia. J Clin Med 2020; 9:jcm9010122. [PMID: 31906539 PMCID: PMC7019689 DOI: 10.3390/jcm9010122] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/17/2019] [Accepted: 12/30/2019] [Indexed: 12/19/2022] Open
Abstract
This study investigated the effects of changes in metabolic syndrome (MS) status and each component on subsequent dementia occurrence. The study population was participants of a biennial National Health Screening Program in 2009–2010 and 2011–2012 in Korea. Participants were divided into four groups according to change in MS status during the two-year interval screening: sustained normal, worsened (normal to MS), improved (MS to normal), and sustained MS group. Risk of dementia among the groups was estimated from the second screening date to 31 December 2016 using a Cox proportional hazards model. A total of 4,106,590 participants were included. The mean follow-up was 4.9 years. Compared to the sustained normal group, adjusted hazard ratios (aHR) (95% confidence interval) were 1.11 (1.08–1.13) for total dementia, 1.08 (1.05–1.11) for Alzheimer’s disease, and 1.20 (1.13–1.28) for vascular dementia in the worsened group; 1.12 (1.10–1.15), 1.10 (1.07–1.13), and 1.19 (1.12–1.27) for the improved group; and 1.18 (1.16–1.20), 1.13 (1.11–1.15), and 1.38 (1.32–1.44) for the sustained MS group. Normalization of MS lowered the risk of all dementia types; total dementia (aHR 1.18 versus 1.12), Alzheimer’s disease (1.13 versus 1.10), and vascular dementia (1.38 versus 1.19). Among MS components, fasting glucose and blood pressure showed more impact. In conclusion, changes in MS status were associated with the risk of dementia. Strategies to improve MS, especially hyperglycemia and blood pressure, may help to prevent dementia.
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Liu L, Huang X, Feng L, Wu Y. Internal Lipid Profile and Body Lipid Profile in Relation to Cognition: A Cross-Sectional Study in Southern China. Am J Alzheimers Dis Other Demen 2020; 35:1533317520962660. [PMID: 33089704 PMCID: PMC10624072 DOI: 10.1177/1533317520962660] [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: 11/16/2022]
Abstract
AIM There are currently no established, clinically relevant, non-invasive markers of cognitive impairment, except for age and APOE genotype. METHODS A cross-sectional study of 1,296 participants from Nanchang, China, has been conducted. We collected data from Mini-Mental State Examination (MMSE) scores, internal lipid profiles and body lipid profiles, age and other factors that may have an effect on cognitive impairment. RESULTS Internal lipid profiles (OR = 1.03 [95%CI, 1.00-1.06], P = 0.024), body lipid profiles (OR = 1.05 [95%CI, 1.01-1.09], P = 0.014), and age (OR = 1.03 [95%CI, 1.01-1.05], P < 0.001) were all positively correlated with cognitive impairment. CONCLUSIONS Cognitive impairment was more frequent in female patients with high internal lipid profiles or body lipid profiles, and these characteristics were related to age and education.
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Affiliation(s)
- Lian Liu
- Department Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
- Department Health Care Centre, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Xiao Huang
- Department Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Liang Feng
- Department Health Care Centre, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Yanqing Wu
- Department Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
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Peters R, Peters J, Booth A, Anstey KJ. Trajectory of blood pressure, body mass index, cholesterol and incident dementia: systematic review. Br J Psychiatry 2020; 216:16-28. [PMID: 31368428 DOI: 10.1192/bjp.2019.156] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The global ageing population and the long prodromal period for the development of cognitive decline and dementia brings a need to understand the antecedents of both successful and impaired cognitive ageing. It is increasingly apparent that the trajectory of risk-factor change, as well as the level of the risk factor, may be associated with an increased or decreased risk of cognitive decline or dementia. AIMS Our aim was to summarise the published evidence and to generate hypotheses related to risk-factor trajectories and risk of incident cognitive decline or dementia. METHOD We collated data from longitudinal observational studies relating to trajectory of blood pressure, obesity and cholesterol and later cognitive decline or dementia using standard systematic review methodology. The databases MEDLINE, Embase and PsycINFO were searched from inception to 26 April 2018. RESULTS Thirteen articles were retained for inclusion. Analytical methods varied. Our summary of the current evidence base suggests that first body mass index and then blood pressure rises and then falls more steeply in those who go on to develop dementia. The evidence for cholesterol was less consistent. CONCLUSION Based on our review we present the hypothesis that weight falls around 10 years and blood pressure around 5 years before diagnosis. Confirmatory work is required. However, characterisation of risk according to combinations and patterns of risk factors may ultimately be integrated into the assessments used to identify those at risk of receiving a diagnosis of cognitive decline or dementia in late life.
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Affiliation(s)
- Ruth Peters
- Senior Lecturer and Senior Research Scientist, Psychology, University of New South Wales; Neuroscience Research Australia, Australia; and Imperial College London, UK
| | - Jean Peters
- Honorary Senior Lecturer, School of Health and Related Research, University of Sheffield, UK
| | - Andrew Booth
- Reader, School of Health and Related Research, University of Sheffield, UK
| | - Kaarin J Anstey
- Professor, Psychology, University of New South Wales; and Neuroscience Research Australia, Australia
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Khan MA, Alam Q, Haque A, Ashafaq M, Khan MJ, Ashraf GM, Ahmad M. Current Progress on Peroxisome Proliferator-activated Receptor Gamma Agonist as an Emerging Therapeutic Approach for the Treatment of Alzheimer's Disease: An Update. Curr Neuropharmacol 2019; 17:232-246. [PMID: 30152284 PMCID: PMC6425074 DOI: 10.2174/1570159x16666180828100002] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/14/2018] [Accepted: 08/21/2018] [Indexed: 01/24/2023] Open
Abstract
Alzheimer’s disease (AD) is an age-related progressive neurodegenerative disorder, characterized by the deposition of amyloid-β within the brain parenchyma resulting in a significant decline in cognitive functions. The pathophysiological conditions of the disease are recognized by the perturbation of synaptic function, energy and lipid metabolism. In Addition deposition of amyloid plaques also triggers inflammation upon the induction of microglia. Peroxisome proliferator-activated receptors (PPARs) are ligand-activated transcription factors known to play important role in the regulation of glucose ab-sorption, homeostasis of lipid metabolism and are further known to involved in repressing the expression of genes related to inflammation. Therefore, agonists of this receptor represent an attractive therapeutic target for AD. Recently, both clinical and preclinical studies showed that use of Peroxisome proliferator-activated receptor gamma (PPARγ) agonist improves both learning and memory along with other AD related pathology. Thus, PPARγ signifies a significant new therapeutic target in treating AD. In this review, we have shed some light on the recent progress of how, PPARγ agonist selectively modulated different cellular targets in AD and its amazing potential in the treatment of AD.
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Affiliation(s)
- Mahmood Ahmad Khan
- Department of Biochemistry, University College of Medical Sciences and GTB Hospital, University of Delhi, Dilshad Garden, Delhi 110095, India
| | - Qamre Alam
- King Fahd Medical Research Center, King Abdulaziz University, P.O. Box 80216, Jeddah 21589, Saudi Arabia
| | - Absarul Haque
- King Fahd Medical Research Center, King Abdulaziz University, P.O. Box 80216, Jeddah 21589, Saudi Arabia
| | - Mohammad Ashafaq
- Department of Pharmacology and Toxicology, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Mohd Jahir Khan
- School of Biotechnology, Jawaharlal Nehru University, New Delhi 110067, India
| | - Ghulam Md Ashraf
- King Fahd Medical Research Center, King Abdulaziz University, P.O. Box 80216, Jeddah 21589, Saudi Arabia
| | - Mahboob Ahmad
- Department of Biochemistry, Hind Institute of Medical Sciences, Sitapur-2613013, India
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Pokharel Y, Mouhanna F, Nambi V, Virani SS, Hoogeveen R, Alonso A, Heiss G, Coresh J, Mosley T, Gottesman RF, Ballantyne CM, Power MC. ApoB, small-dense LDL-C, Lp(a), LpPLA 2 activity, and cognitive change. Neurology 2019; 92:e2580-e2593. [PMID: 31043469 PMCID: PMC6556082 DOI: 10.1212/wnl.0000000000007574] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 01/29/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To examine the association of specific lipoproteins/inflammatory enzyme with cognitive change. METHODS We examined the association of apolipoprotein B (ApoB), small-dense low-density lipoprotein cholesterol (sdLDL-C), lipoprotein (a) (Lp[a]), and lipoprotein-associated phospholipase A2 (LpPLA2) activity with 15-year change in Delayed Word Recall Test, Digit Symbol Substitution Test (DSST), Word Fluency Test (WFT), and overall summary score in 9,350 participants in the Atherosclerosis Risk in Communities study. We assessed interaction by race, sex, education, APOE ε4 status, and statin use. We also addressed questions of informative missingness, the role of stroke, and the influence of fasting status. RESULTS The mean (SD) age was 63.4 (5.7) years; 56.4% were women and 17.4% were black. We observed faster cognitive decline on DSST and global z scores with every 10-mg/dL higher sdLDL-C level (Δ DSST z score, -0.010; 95% confidence interval [CI] -0.017, -0.002 and Δ global z score, -0.011; -0.021, -0.001) and the highest vs the lowest ApoB quintiles (Δ DSST z score, -0.092; -0.0164, -0.019 and Δ global z score, -0.101; -0.200, -0.002). Association for the ApoB quintiles with Δ global z score (-0.10) was comparable with that of having 1 APOE ε4 allele (-0.11). Higher Lp(a) was associated with slower decline in DSST, WFT, and global z scores. LpPLA2 activity was not associated with cognitive change. Results were similar in sensitivity analyses. The associations of sdLDL-C or Lp(a) on cognitive change were more pronounced in statin users. CONCLUSIONS Optimal control of atherogenic lipoproteins such as ApoB and sdLDL-C in midlife for cardiovascular health may also benefit late-life cognitive health.
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Affiliation(s)
- Yashashwi Pokharel
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD.
| | - Farah Mouhanna
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Vijay Nambi
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Salim S Virani
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Ron Hoogeveen
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Alvaro Alonso
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Gerardo Heiss
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Josef Coresh
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Thomas Mosley
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Rebecca F Gottesman
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Christie M Ballantyne
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Melinda C Power
- From Saint Luke's Mid-America Heart Institute (Y.P.), University of Missouri-Kansas City; Department of Epidemiology and Biostatistics (F.M., M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Epidemiology (F.M., A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Section of Cardiology (V.N., S.S.V.), Michael E. DeBakey Veterans Affairs Medical Center; Section of Cardiology (V.N., S.S.V., R.H., C.M.B.), Baylor College of Medicine; Center for Cardiovascular Disease Prevention (V.N., S.S.V., R.H., C.M.B.), Houston Methodist DeBakey Heart and Vascular Center, TX; Department of Epidemiology (G.H.), Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Epidemiology (J.C., R.F.G.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD
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Chung HS, Lee JS, Kim JA, Roh E, Lee YB, Hong SH, Kim NH, Yoo HJ, Seo JA, Kim SG, Kim NH, Baik SH, Choi KM. Variability in Total Cholesterol Concentration Is Associated With the Risk of Dementia: A Nationwide Population-Based Cohort Study. Front Neurol 2019; 10:441. [PMID: 31133961 PMCID: PMC6513975 DOI: 10.3389/fneur.2019.00441] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/10/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction: Although total cholesterol (TC) variability is suggested as a risk factor for cardiovascular and cerebrovascular disease, there is no previous study to evaluate the association between TC variability and the development of dementia. Methods: Using the Korean National Health Insurance Service-Health Screening Cohort (NHIS-HEALS), the main outcomes were newly diagnosed all-cause dementia, Alzheimer's disease (AD), or vascular dementia (VaD) between January 1, 2008, and December 31, 2015. Visit-to-visit TC variability was measured as variability independent of the mean (TC-VIM), coefficient variance (TC-CV), and standard deviation (TC-SD). Results: In a total of 131,965 Koreans, there were 3,722 all-cause dementia (2.82%), 2,776 AD (2.10%), and 488 VaD (0.37%) during the median follow-up of 8.4 years. Kaplan-Meier curves showed increased cumulative incidences for all in the group of the highest quartiles of TC variability compared to the others. Regression using the Fine and Gray hazards model showed a steadily increasing risk of all-cause dementia with higher quartiles of TC variability. After adjusting for confounders including mean TC level and comparing the highest and lowest TC-VIM quartiles, the hazard ratios (HRs) for all-cause dementia and AD were 1.15 [95% confidence interval (CI) = 1.05-1.27; P = 0.003] and 1.12 (95% CI = 1.00-1.25; P = 0.040), respectively. The incidence of VaD was not significantly higher in the higher-quartile groups compared to that in the lowest-quartile group in TC-VIM variability (HR 1.22; 95% CI = 0.95-1.59; P = 0.122). These associations were consistent with TC variability defined by TC-CV or TC-SD. Conclusions: For the first time, we have demonstrated that a higher visit-to-visit variability in TC independent of mean TC is associated with an increased risk of all-cause dementia and AD in the general population.
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Affiliation(s)
- Hye Soo Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Hallym University, Seoul, South Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea
| | - Jung A Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Eun Roh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - You Bin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - So Hyeon Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Ji A Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, South Korea
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Abstract
AbstractIn recent decades, clinical trials in Alzheimer’s disease (AD) have failed at an unprecedented rate. The etiology of AD has since come under renewed scrutiny, both to elucidate the underlying pathologies and to identify novel therapeutic strategies. Here, diet has emerged as a potential causative/protective agent. A variety of nutrients, including lipids, minerals, vitamins, antioxidants and sugars as well as broader dietary patterns and microbiotal interactions have demonstrated associations with AD. Although clinical trials have yet to definitively implicate any singular dietary element as therapeutic or causative, it is apparent that dietary preferences, likely in complex synergies, may influence the risk, onset and course of AD. This review catalogs the impact of major dietary elements on AD. It further examines an unexplored reciprocal association where AD may modulate diet, as well as how potential therapeutics may complicate these interactions. In doing so, we observe diet may have profound effects on the outcome of a clinical trial, either as a confounder of a drug/disease interaction or as a generally disruptive covariate. We therefore conclude that future clinical trials in AD should endeavor to control for diet, either in study design or subsequent analyses.
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Marcum ZA, Walker R, Bobb JF, Sin MK, Gray SL, Bowen JD, McCormick W, McCurry SM, Crane PK, Larson EB. Serum Cholesterol and Incident Alzheimer's Disease: Findings from the Adult Changes in Thought Study. J Am Geriatr Soc 2018; 66:2344-2352. [PMID: 30289959 DOI: 10.1111/jgs.15581] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate associations between high-density lipoprotein cholesterol (HDL) and non-HDL-C levels at specific ages and subsequent Alzheimer's disease (AD) risk. DESIGN Prospective population-based cohort study. SETTING Adult Changes in Thought (ACT) Study. PARTICIPANTS Individuals aged 65 and older with no dementia at ACT Study entry. We identified separate, partially overlapping subcohorts of ACT participants who were eligible for each age band-specific analysis (50-59, n = 1,088; 60-69, n = 2,852; 70-79, n = 2,344; 80-89, n = 537). MEASUREMENTS Exposure consisted of clinical measures of total cholesterol (TC) and HDL-C from laboratory data during a given age band. Outcomes of incident AD were assessed post-age band using standard research diagnostic criteria. Statistical analyses used adjusted Cox proportional hazards regression models for each exposure and outcome pair within an age band. Cholesterol exposures were modeled using cubic splines. RESULTS For non-HDL-C, we found a statistically significant association with AD risk in the 60 to 69 (omnibus p = .005) and 70 to 79 (omnibus p = .04) age bands, suggesting a potential U-shaped relationship (greater risk at low and high levels). For example, in people aged 60 to 69, those with an average non-HDL-C level of 120 mg/DL had a 29% greater AD hazard (hazard ratio (HR)=1.29, 95% confidence interval (CI)=1.04-1.61) than those with an average non-HDL-C level of 160 mg/dL, whereas those with an average non-HDL-C level of 210 mg/dL had a 16% greater hazard (HR=1.16, 95% CI=1.01-1.33). We did not find a statistically significant association between HDL-C and AD risk. CONCLUSION People with low (120 mg/dL) and high (210 mg/dL) non-HDL-C levels during their 60s and 70s had modestly higher risk of AD than those with intermediate (160 mg/dL) levels. The extreme age bands (50s and 80s) had small sample sizes. J Am Geriatr Soc 66:2344-2352, 2018.
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Affiliation(s)
- Zachary A Marcum
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington
| | - Rod Walker
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
| | - Mo-Kyung Sin
- Seattle University, College of Nursing, Seattle, Washington
| | - Shelly L Gray
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington
| | | | - Wayne McCormick
- Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington
| | - Susan M McCurry
- School of Nursing, University of Washington, Seattle, Washington
| | - Paul K Crane
- Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle, Washington
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
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Wagner M, Helmer C, Tzourio C, Berr C, Proust-Lima C, Samieri C. Evaluation of the Concurrent Trajectories of Cardiometabolic Risk Factors in the 14 Years Before Dementia. JAMA Psychiatry 2018; 75:1033-1042. [PMID: 30043038 PMCID: PMC6233804 DOI: 10.1001/jamapsychiatry.2018.2004] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
IMPORTANCE Cardiometabolic risk factors have been associated with an increased risk of dementia; yet, the optimal targets and time window for the management of cardiometabolic health to prevent dementia remain unknown. OBJECTIVES To model concurrently and compare the trajectories of cardiometabolic risk factors up to 14 years preceding diagnosis in individuals with dementia and matched controls free of dementia. DESIGN, SETTING, AND PARTICIPANTS A case-control study nested within the Three-City study, a French population-based cohort of older persons (≥65 years), included 6 home visits with neuropsychological testing between 1999 and 2014. Data analysis was performed in September 2017. A total of 785 incident dementia cases and 3140 controls matched by sex, age, educational level, and cohort center at the time of diagnosis were evaluated. EXPOSURES Repeated measures of body mass index (BMI) and systolic (SBP) and diastolic (DBP) blood pressure, high-density lipoprotein (HDL-C) and low-density lipoprotein cholesterol (LDL-C), triglycerides, and glycemia levels between 1999 and 2014. MAIN OUTCOMES AND MEASURES Incidence of dementia based on systematic detection and validated diagnosis. RESULTS A total of 785 cases and 3140 controls (2530 [65%] women; mean [SD] age, 76 [5] years) were included in the study. Cases presented a faster decline in BMI, slower increase of SBP and constantly lower DBP. Mean values (95% CI) 14 years before diagnosis (-14 years) and at diagnosis (year 0) for the most common profile were BMI, 26.1 (25.6-26.5) and 24.8 (24.5-25.1) for a case, and 25.7 (25.4-26.1) and 25.3 (25.0-25.5) for a control; for SBP, 135.2 (131.8-138.7) and 142.1 (140.3-143.9) mm Hg for a case, and 135.8 (132.9-138.6) and 144.9 (143.7-146.1) mm Hg for a control; for DBP, 76.5 (74.7-78.5) and 74.0 (73.1-74.9) mm Hg for a case, and 76.7 (75.1-78.3) and 75.0 (74.2-75.7) mm Hg for a control. In contrast, glycemia was higher among cases (mean fasting glucose values [95% CI] at -14 years and year 0: 89.4 [86.9-92.1] and 96.4 [93.7-99.3] mg/dL for a case, and 87.1 [85.1-89.2] and 95.3 [93.5-97.1] mg/dL for a control), with a significant case-control difference from -1.6 to -14 years prior to diagnosis. There were no significant case-control differences in trajectories of blood lipid levels (mean values [95% CI] at -14 years and year 0: for HDL-C, 70.6 [67.6-73.9] and 61.3 [58.9-63.8] mg/dL for a case, and 70.4 [67.5-73.3] and 62.3 [60.2-64.3] mg/dL for a control; for LDL-C: 147.2 [140.5-154.5] and 141.6 [136.6-146.7] mg/dL for a case, and 144.3 [138.7-150.4] and 141.2 [137.5-145.2] mg/dL for a control; for triglycerides: 115.5 [103.6-149.1] and 112.6 [104.8-120.9] mg/dL for a case, and 112.5 [103.8-144.4] and 109.7 [105.0-114.8] mg/dL for a control). CONCLUSIONS AND RELEVANCE In this large cohort of older persons, BMI declined in prodromal dementia, possibly reflecting early preclinical changes. Lower BP prior to dementia may reflect both a consequence and a contributing factor for the disease, whereas higher blood glucose levels may constitute a risk factor for dementia in the older age range. Overall, these findings suggest that elevated glycemia, low BP, and weight loss may be primary targets for the management of cardiometabolic health for primary and secondary prevention of dementia in the older age range.
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Affiliation(s)
- Maude Wagner
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR U1219, F-33000 Bordeaux, France
| | - Catherine Helmer
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR U1219, F-33000 Bordeaux, France
| | - Christophe Tzourio
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR U1219, CHU, F-33000 Bordeaux, France
| | - Claudine Berr
- University of Montpellier, Inserm, Neuropsychiatry: Epidemiological and Clinical Research, UMR U1061, F-34000 Montpellier, France
| | - Cécile Proust-Lima
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR U1219, F-33000 Bordeaux, France
| | - Cécilia Samieri
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR U1219, F-33000 Bordeaux, France
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McCartney DL, Stevenson AJ, Walker RM, Gibson J, Morris SW, Campbell A, Murray AD, Whalley HC, Porteous DJ, McIntosh AM, Evans KL, Deary IJ, Marioni RE. Investigating the relationship between DNA methylation age acceleration and risk factors for Alzheimer's disease. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2018; 10:429-437. [PMID: 30167451 PMCID: PMC6111045 DOI: 10.1016/j.dadm.2018.05.006] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction The “epigenetic clock” is a DNA methylation–based estimate of biological age and is correlated with chronological age—the greatest risk factor for Alzheimer's disease (AD). Genetic and environmental risk factors exist for AD, several of which are potentially modifiable. In this study, we assess the relationship between the epigenetic clock and AD risk factors. Methods Multilevel models were used to assess the relationship between age acceleration (the residual of biological age regressed onto chronological age) and AD risk factors relating to cognitive reserve, lifestyle, disease, and genetics in the Generation Scotland study (n = 5100). Results We report significant associations between age acceleration and body mass index, total cholesterol to high-density lipoprotein cholesterol ratios, socioeconomic status, high blood pressure, and smoking behavior (Bonferroni-adjusted P < .05). Discussion Associations are present between environmental risk factors for AD and age acceleration. Measures to modify such risk factors might improve the risk profile for AD and the rate of biological ageing. Future longitudinal analyses are therefore warranted.
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Affiliation(s)
- Daniel L McCartney
- Medical Genetics Section, Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, Scotland
| | - Anna J Stevenson
- Medical Genetics Section, Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, Scotland
| | - Rosie M Walker
- Medical Genetics Section, Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, Scotland
| | - Jude Gibson
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, Scotland
| | - Stewart W Morris
- Medical Genetics Section, Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, Scotland
| | - Archie Campbell
- Medical Genetics Section, Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, Scotland
| | - Alison D Murray
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen, Scotland
| | - Heather C Whalley
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, Scotland
| | - David J Porteous
- Medical Genetics Section, Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, Scotland.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, Scotland
| | - Andrew M McIntosh
- Medical Genetics Section, Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, Scotland.,Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, Scotland.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, Scotland
| | - Kathryn L Evans
- Medical Genetics Section, Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, Scotland.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, Scotland
| | - Ian J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, Scotland.,Department of Psychology, University of Edinburgh, Edinburgh, Scotland
| | - Riccardo E Marioni
- Medical Genetics Section, Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, Scotland.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, Scotland
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PCSK9 and neurocognitive function: Should it be still an issue after FOURIER and EBBINGHAUS results? J Clin Lipidol 2018; 12:1123-1132. [PMID: 30318062 DOI: 10.1016/j.jacl.2018.05.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 12/20/2022]
Abstract
The serine protease proprotein convertase subtilisin/kexin type 9 (PCSK9) modulates the levels of low-density lipoprotein cholesterol and cardiovascular risk. Potential risks of adverse neurological effects of intensive lipid-lowering treatment have been hypothesized, as cholesterol is a component of the central nervous system. Moreover, several observations suggest that PCSK9 might play a role in neurogenesis, neuronal migration and apoptosis. In rodents, increased expression of PCSK9 has been detected in specific areas of the central nervous system during embryonic development; also, PCSK9 modulates low-density lipoprotein receptor levels in the ischemic brain areas. Despite a putative participation of PCSK9 in nervous system physiology, the absence of PCSK9 in knockout mice or in humans with loss-of-function mutations of PCSK9 gene has not been linked to neurological alterations. In recent years, some concerns have been raised about the potential neurological side effects of cholesterol-lowering treatments and, more specifically of PCSK9 inhibitors. In this review, the evidence regarding the function of PCSK9 in neuron differentiation, apoptosis, and migration and in nervous system development and latest clinical trials evaluating the effects of PCSK9 inhibitors on neurocognitive function will be described.
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50
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Ong KL, Morris MJ, McClelland RL, Hughes TM, Maniam J, Fitzpatrick AL, Martin SS, Luchsinger JA, Rapp SR, Hayden KM, Sandfort V, Allison MA, Rye KA. Relationship of Lipids and Lipid-Lowering Medications With Cognitive Function: The Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol 2018; 187:767-776. [PMID: 29617947 DOI: 10.1093/aje/kwx329] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 10/03/2017] [Indexed: 12/23/2022] Open
Abstract
Studies on the relationship of cholesterol concentrations and lipid-lowering medications with dementia risk have yielded inconsistent findings. Therefore, we investigated the association of lipid concentrations and lipid-lowering medications with cognitive function in the Multi-Ethnic Study of Atherosclerosis across 3 different cognitive domains assessed by means of the Cognitive Abilities Screening Instrument (CASI; version 2), the Digit Symbol Coding (DSC) Test, and the Digit Span (DS) Test in 2010-2012. After adjustment for sociodemographic and confounding factors, including concentrations of other lipids and use of lipid-lowering medication, higher total cholesterol, low-density lipoprotein cholesterol, and non-high-density-lipoprotein cholesterol concentrations were modestly associated with higher DS Test scores. None of the lipid parameters were associated with CASI or DSC Test scores. Similarly, changes in lipid concentrations were not associated with any cognitive function test score. Using treatment effects model analysis and after adjusting for confounding factors, including lipid concentrations, the use of any lipid-lowering medication, especially statins, was associated with higher scores on the CASI and backward DS tests but not on the DSC and forward DS tests. Our study does not support a robust association between lipid concentrations and cognitive function or between the use of lipid-lowering medication, especially statins, and worse cognitive function.
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Affiliation(s)
- Kwok Leung Ong
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Margaret J Morris
- Department of Pharmacology, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Robyn L McClelland
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Timothy M Hughes
- Department of Internal Medicine, Division of Gerontology and Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Jayanthi Maniam
- Department of Pharmacology, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Annette L Fitzpatrick
- Department of Family Medicine, School of Medicine, University of Washington, Seattle, Washington
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
- Department of Global Health, Schools of Public Health and Medicine, University of Washington, Seattle, Washington
| | - Seth S Martin
- Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - José A Luchsinger
- Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, New York
| | - Stephen R Rapp
- Department of Psychiatry and Behavioral Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Kathleen M Hayden
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Veit Sandfort
- Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, Maryland
| | - Matthew A Allison
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
| | - Kerry-Anne Rye
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
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