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Mullin DS, Stirland LE, Buchanan E, Convery CA, Cox SR, Deary IJ, Giuntoli C, Greer H, Page D, Robertson E, Shenkin SD, Szalek A, Taylor A, Weatherdon G, Wilkinson T, Russ TC. Identifying dementia using medical data linkage in a longitudinal cohort study: Lothian Birth Cohort 1936. BMC Psychiatry 2023; 23:303. [PMID: 37127606 PMCID: PMC10152609 DOI: 10.1186/s12888-023-04797-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/18/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The Lothian Birth Cohort 1936 (LBC1936) is a longitudinal study of ageing with well-characterised assessments, but until now, it has relied on self-report or proxies for dementia such as cognitive tests. Our aims were twofold: a) to describe a framework for identifying dementia in a cohort study. b) to report the age-specific incidence and prevalence of all-cause dementia and dementia subtypes in 865 individuals in the LBC1936. METHODS Electronic Health Records (EHR) of all participants were reviewed, and relevant information was extracted to form case vignettes for everyone with any record of cognitive dysfunction. The EHR data sources include hospital and clinic letters, general practitioner and hospital referrals, prescribed medications, imaging and laboratory results. Death certificate data were obtained separately. Clinician assessments were performed when there was concern about a participant's cognition. A diagnosis of probable dementia, possible dementia, or no dementia was agreed upon by a consensus diagnostic review board, comprised of a multidisciplinary team of clinical dementia experts who reviewed case vignettes and clinician assessment letters. For those with probable dementia, a subtype was also determined, where possible. We compared the agreement between our newly ascertained dementia diagnoses with the existing self-reported dementia diagnoses. RESULTS Self-reported dementia diagnoses were positive in only 17.8% of ascertained dementia diagnoses. The EHR review identified 163/865 (18.8%) individuals as having cognitive dysfunction. At the consensus diagnostic review board, 118/163 were diagnosed with probable all-cause dementia, a prevalence of 13.6%. Age-specific dementia prevalence increased with age from 0.8% (65-74.9 years) to 9.93% (85-89.9 years). Prevalence rates for women were higher in nearly all age groups. The most common subtype was dementia due to Alzheimer disease (49.2%), followed by mixed Alzheimer and cerebrovascular disease (17.0%), dementia of unknown or unspecified cause (16.1%), and dementia due to vascular disease (8.5%). CONCLUSIONS We present a robust systematic framework and guide for other cohort teams wanting to ascertain dementia diagnoses. The newly ascertained dementia diagnosis provides vital data for further analyses of LBC1936 to allow exploration of lifecourse predictors of dementia.
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Affiliation(s)
- Donncha S Mullin
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK.
- Division of Psychiatry, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh, EH10 5HF, UK.
| | - Lucy E Stirland
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Global Brain Health Institute, University of California San Francisco, San Francisco, UK
| | - Emily Buchanan
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | - Catherine-Anne Convery
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | - Simon R Cox
- Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
| | - Cinzia Giuntoli
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | - Holly Greer
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | - Danielle Page
- Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
| | - Elizabeth Robertson
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | | | - Anna Szalek
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | - Adele Taylor
- Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
| | - Georgina Weatherdon
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | - Tim Wilkinson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Tom C Russ
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
- Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
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Matsuzono K, Suzuki M, Anan Y, Ozawa T, Mashiko T, Koide R, Tanaka R, Fujimoto S. Spontaneous Echo Contrast in the Left Atrium and Aortic-Arch Atheroma, Detected by Transesophageal Echocardiography, Was Negatively Correlated with Cognitive Function. J Alzheimers Dis 2023; 91:673-681. [PMID: 36463447 DOI: 10.3233/jad-220763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND The relationship between transesophageal echocardiography findings and cognitive function. OBJECTIVE This study aimed to establish an association between transesophageal echocardiography findings and cognitive function in stroke survivors. METHODS A single-center study was conducted between April 1, 2017 and March 31, 2022. All subjects that were included had a past history of ischemic stroke and were admitted after >21 days from onset. The participants underwent cognitive function tests including a Mini-Mental State Examination, Revised Hasegawa Dementia Scale, Frontal Assessment Battery, and transesophageal echocardiography. RESULTS The results of 126 participants were analyzed. The cognitive function of participants with a spontaneous echo contrast (+) in the left atrium including appendage or of those with an aorta-arch plaque with a maximum thickness ≥4 mm significantly worse while neither the patent foramen ovale nor the branch extending plaque influenced cognitive function (The median cognitive scores of the spontaneous echo contrast (-) versus (+) were 26 versus 22, p < 0.01**, 26 versus 21, p < 0.001***, and 14 versus 11, p < 0.01**. Those of the aortic-arch plaque max thickness (<4 mm) versus (≥4 mm) were 26 versus 25, p < 0.05*, 27 versus 24, p < 0.05*, and 15 versus 13, p < 0.05*). CONCLUSION Our findings show that spontaneous echo contrast in the left atrium and aortic-arch atheroma detected by transesophageal echocardiography, were negatively associated with cognitive function.
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Affiliation(s)
- Kosuke Matsuzono
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Masayuki Suzuki
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Yuhei Anan
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Tadashi Ozawa
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Takafumi Mashiko
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Reiji Koide
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Ryota Tanaka
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Shigeru Fujimoto
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
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Xi Y, Zhang Y, Zhou Y, Liu Q, Chen X, Liu X, Grune T, Shi L, Hou M, Liu Z. Effects of methionine intake on cognitive function in mild cognitive impairment patients and APP/PS1 Alzheimer's Disease model mice: Role of the cystathionine-β-synthase/H 2S pathway. Redox Biol 2022; 59:102595. [PMID: 36608589 PMCID: PMC9813720 DOI: 10.1016/j.redox.2022.102595] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
As a dietary intervention, methionine restriction (MR) has been reported to increase longevity and improve metabolism disorders. However, the effects of MR on alleviating neurodegenerative diseases such as Alzheimer's disease (AD) are largely unexplored. Here we sought to investigate the neuroprotective effects of low methionine intake in mild cognitive impairment (MCI) patients and APP/PS1 AD model mice, and to uncover the underlying mechanisms. In a cohort composed of 45 individuals diagnosed with MCI and 61 healthy controls without cognitive impairment, methionine intake was found to be positively associated with the increased risk of MCI, where no sex differences were observed. We further conducted a 16-week MR intervention (0.17% methionine, w/w) on APP/PS1 AD model mice. Although MR reduced Aβ accumulation in the brain of both male and female APP/PS1 mice, MR improved cognitive function only in male mice, as assessed by the Morris water maze test. Consistently, MR restored synapse ultrastructure and alleviated mitochondrial dysfunction by enhancing mitochondrial biogenesis in the brain of male APP/PS1 mice. Importantly, MR effectively balanced the redox status and activated cystathionine-β-synthase (CBS)/H2S pathway in the brain of male APP/PS1 mice. Together, our study indicated that lower dietary methionine intake is associated with improved cognitive function, in which CBS/H2S pathway plays an essential role. MR could be a promising nutritional intervention for preventing AD development.
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Affiliation(s)
- Yujia Xi
- Laboratory of Functional Chemistry and Nutrition of Food, College of Food Science and Engineering, Northwest A&F University, Yangling, Shaanxi, 712100, China
| | - Yuyu Zhang
- Laboratory of Functional Chemistry and Nutrition of Food, College of Food Science and Engineering, Northwest A&F University, Yangling, Shaanxi, 712100, China
| | - Yiwen Zhou
- School of Public Health, College of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China
| | - Qing Liu
- Laboratory of Functional Chemistry and Nutrition of Food, College of Food Science and Engineering, Northwest A&F University, Yangling, Shaanxi, 712100, China
| | - Xuhui Chen
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, 518000, China
| | - Xuebo Liu
- Laboratory of Functional Chemistry and Nutrition of Food, College of Food Science and Engineering, Northwest A&F University, Yangling, Shaanxi, 712100, China
| | - Tilman Grune
- German Institute of Human Nutrition (DIfE) Potsdam-Rehbruecke, Department of Molecular Toxicology, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
| | - Lin Shi
- College of Food Engineering and Nutritional Science, Shaanxi Normal University, Shaanxi, 710119, China.
| | - Min Hou
- School of Public Health, College of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China.
| | - Zhigang Liu
- Laboratory of Functional Chemistry and Nutrition of Food, College of Food Science and Engineering, Northwest A&F University, Yangling, Shaanxi, 712100, China; German Institute of Human Nutrition (DIfE) Potsdam-Rehbruecke, Department of Molecular Toxicology, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany; Northwest A&F University, Shenzhen Research Institute, Shenzen, Guangdong, 518000, China.
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Souza MA, Peres Bomfim LG, de Barros VL, Medeiros RC, Ginsicke DC, Colovati MES, Daly T, Zanesco A. The Differential Effect of Schooling and Physical Activity on Dementia in Older Women and Men from Brazil: Implications for Policymaking. J Alzheimers Dis 2022; 90:859-867. [DOI: 10.3233/jad-220517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Modifiable risk factors exert crucial impact on dementia. Objective: We sought to answer the question: do two modifiable risk factors, schooling level and physical activity (PA), affect cognitive function similarly in each sex? Methods: This cross-sectional study was conducted in 2019 and 2021, and the survey was applied to the residents of the metropolitan area of Santos, a seashore of Sao Paulo State. Four hundred and twenty-two participants (women = 254 and men = 168) were eligible. Baecke questionnaire for the elderly was applied for the classification as physically inactive (PI) or active (PA). Cognitive function was assessed by the Mini-Mental State Examination (MMSE) and the Clinical Dementia Rating (CDR). Participants were also stratified by schooling status for both sexes. Results: Higher education had a sex-independent positive influence on MMSE and CDR (p < 0.001). PA influences positively MMSE in older women (PI: 25±5 and PA: 27±3, p < 0.03), but has no effect in older men (26±5 and 25±5, p > 0.05). Concordantly, older women who were PA (1.7 and 0 %) showed a lower prevalence of dementia compared with PI (6.2 and 2.1%), for mild and moderate respectively. Active older women had higher odds of improving the MMSE score (OR: 1.093; 95% CI: 1.008–1.186) than men (OR: 0.97 (95% CI: 0.896–1.051). Conclusion: Education affects cognitive function equally in Brazilian elderly whereas older women are more responsive to the beneficial effects of PA for dementia than men.
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Affiliation(s)
- Melyssa Alves Souza
- Postgraduate Program in Environmental Health, Metropolitan University of Santos (UNIMES), Santos, SP, Brazil
- Department of Biosciences, Institute of Health and Society, Federal University of Sao Paulo (UNIFESP), Santos, SP, Brazil
| | - Larissa Gomes Peres Bomfim
- Postgraduate Program in Environmental Health, Metropolitan University of Santos (UNIMES), Santos, SP, Brazil
| | - Vinicius Lúcio de Barros
- Postgraduate Program in Environmental Health, Metropolitan University of Santos (UNIMES), Santos, SP, Brazil
| | - Ronaldo Coelho Medeiros
- Postgraduate Program in Environmental Health, Metropolitan University of Santos (UNIMES), Santos, SP, Brazil
| | - Danielle Cristine Ginsicke
- Postgraduate Program in Environmental Health, Metropolitan University of Santos (UNIMES), Santos, SP, Brazil
| | | | - Timothy Daly
- Sorbonne Université, Science Norms Democracy, UMR 8011, Paris, France
| | - Angelina Zanesco
- Postgraduate Program in Environmental Health, Metropolitan University of Santos (UNIMES), Santos, SP, Brazil
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Ding Y, Chu Y, Liu M, Ling Z, Wang S, Li X, Li Y. Fully automated discrimination of Alzheimer's disease using resting-state electroencephalography signals. Quant Imaging Med Surg 2022; 12:1063-1078. [PMID: 35111605 DOI: 10.21037/qims-21-430] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/24/2021] [Indexed: 12/29/2022]
Abstract
Background The Alzheimer's disease (AD) population increases worldwide, placing a heavy burden on the economy and society. Presently, there is no cure for AD. Developing a convenient method of screening for AD and mild cognitive impairment (MCI) could enable early intervention, thus slowing down the progress of the disease and enabling better overall disease management. Methods In the current study, resting-state electroencephalography (EEG) data were acquired from 113 normal cognition (NC) subjects, 116 amnestic MCI patients, and 72 probable AD patients. After preprocessing by an automatic algorithm, features including spectral power, complexity, and functional connectivity were extracted, and machine-learning classifiers were built to differentiate among the 3 groups. The classification performance was evaluated from multiple perspectives, including accuracy, specificity, sensitivity, area under the curve (AUC) with 95% confidence intervals, and compared to the empirical chance level by permutation tests. Results The analysis of variance results (P<0.05 with false discovery rate correction) confirmed the tendency to slow brain activity, reduced complexity, and connectivity with AD progress. By combining the features, the ability of the machine-learning classifiers, especially the ensemble trees, to differentiate among the 3 groups, was significantly better than that of the empirical chance level of the permutation test. The AUC of the classifier with the best performance was 80.08% for AD vs. NC, 70.82% for AD vs. MCI, and 63.95% for MCI vs. NC. Conclusions The current study presented a fully automatic procedure that could significantly distinguish NC, MCI, and AD subjects via resting-state EEG signals. The study was based on a large data set with evidence-based medical diagnosis and provided further evidence that resting-state EEG data could assist in the discrimination of AD patients.
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Affiliation(s)
- Yue Ding
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,iFLYTEK Research, iFLYTEK CO., LTD., Hefei, China
| | - Yinxue Chu
- iFLYTEK Research, iFLYTEK CO., LTD., Hefei, China
| | - Meng Liu
- Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhenhua Ling
- National Engineering Laboratory for Speech and Language Information Processing, University of Science and Technology of China, Hefei, China
| | - Shijin Wang
- iFLYTEK Research, iFLYTEK CO., LTD., Hefei, China.,State Key Laboratory of Cognitive Intelligence, Hefei, China
| | - Xin Li
- iFLYTEK Research, iFLYTEK CO., LTD., Hefei, China.,National Engineering Laboratory for Speech and Language Information Processing, University of Science and Technology of China, Hefei, China
| | - Yunxia Li
- Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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6
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Farfel JM, Leurgans SE, Capuano AW, de Moraes Sampaio MC, Wilson RS, Schneider JA, Bennett DA. Dementia and autopsy-verified causes of death in racially-diverse older Brazilians. PLoS One 2021; 16:e0261036. [PMID: 34910735 PMCID: PMC8673625 DOI: 10.1371/journal.pone.0261036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND While dementia has been associated with specific causes of death, previous studies were relatively small autopsy series or population-based studies lacking autopsy confirmation and were restricted to Non-Latinx Whites. Here, we examine the association of dementia with autopsy-verified causes of death in racially-diverse older Brazilians. METHODS As part of the Pathology, Alzheimer´s and Related Dementias Study (PARDoS), a community-based study in Brazil, we included 1941 racially-diverse deceased, 65 years or older at death. We conducted a structured interview with legal informants including the Clinical Dementia Rating (CDR) Scale for dementia proximate to death. Causes of death were assessed after full-body autopsy and macroscopic examination of the brain, thoracic and abdominal/pelvic organs. Up to four causes of death were reported for each decedent. Causes of death were classified as circulatory, infectious, cancer and other. Logistic regression was used to determine associations of dementia with cause of death, controlling for age, sex, race, and education. RESULTS Dementia was associated with a higher odds of an infectious cause of death (OR = 1.81, 95%CI:1.45-2.25), and with a lower odds of a circulatory disease as cause of death (OR = 0.69, 95%CI:0.54-0.86) and cancer as cause of death (OR = 0.41, 95%CI:0.24-0.71). Dementia was associated with a higher odds of pneumonia (OR = 1.92, 95%CI:1.53-2.40) and pulmonary embolism (OR = 2.31, 95%CI:1.75-3.05) as causes of death and with a lower odds of acute myocardial infarction (OR = 0.42, 95%CI:0.31-0.56) and arterial disease (OR = 0.76, 95%CI:0.61-0.94) as causes of death. CONCLUSION Racially-diverse older Brazilians with dementia had a higher odds of an infectious cause of death and a lower odds of cancer and circulatory disease as causes of death than those without dementia.
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Affiliation(s)
- Jose M. Farfel
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States of America
- Department of Pathology, Rush University Medical Center, Chicago, IL, United States of America
- Health Sciences Program, Instituto de Assistência Medica ao Servidor Público do Estado (IAMSPE), São Paulo, Brazil
| | - Sue E. Leurgans
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States of America
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, United States of America
| | - Ana W. Capuano
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States of America
- Health Sciences Program, Instituto de Assistência Medica ao Servidor Público do Estado (IAMSPE), São Paulo, Brazil
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, United States of America
| | | | - Robert S. Wilson
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States of America
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, United States of America
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, IL, United States of America
| | - Julie A. Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States of America
- Department of Pathology, Rush University Medical Center, Chicago, IL, United States of America
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, United States of America
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States of America
- Health Sciences Program, Instituto de Assistência Medica ao Servidor Público do Estado (IAMSPE), São Paulo, Brazil
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, United States of America
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Matsuzono K, Suzuki M, Miura K, Ozawa T, Mashiko T, Koide R, Tanaka R, Fujimoto S. Internal Jugular Vein Velocity and Spontaneous Echo Contrast Correlate with Alzheimer's Disease and Cognitive Function. J Alzheimers Dis 2021; 84:787-796. [PMID: 34602471 DOI: 10.3233/jad-210490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Many issues persist in the today's Alzheimer's disease (AD) screening and the breakthrough method is desired. OBJECTIVE We aim to validate the association between venous reflux and AD, and to develop a new method for AD screening. METHODS We examined spontaneous echo contrast, area, diameter, retrograde velocity, and anterograde velocity of the bilateral cervical internal jugular vein (IJV) using carotid ultrasonography. RESULTS A total of 112 patients participated in this study, with 26 diagnosed as AD. The proportion of both or either IJV spontaneous echo contrast (+) occupied 25 of total 26 AD patients, which showed 96.2%of sensitivity and 98.5%negative predictive value. The IJV velocities also showed significant correlation with AD diagnosis, although the IJV area or diameter did not. CONCLUSION Our results indicate that the validation of the spontaneous echo contrast or velocities of the IJV are convenient AD diagnosis screening methods and that the venous reflux disturbance correlates with AD development.
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Affiliation(s)
- Kosuke Matsuzono
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Masayuki Suzuki
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Kumiko Miura
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Tadashi Ozawa
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Takafumi Mashiko
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Reiji Koide
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Ryota Tanaka
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Shigeru Fujimoto
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
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8
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Chung Y, Lee H. Correlation between Alzheimer's disease and type 2 diabetes using non-negative matrix factorization. Sci Rep 2021; 11:15265. [PMID: 34315930 PMCID: PMC8316581 DOI: 10.1038/s41598-021-94048-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Abstract
Alzheimer's disease (AD) is a complex and heterogeneous disease that can be affected by various genetic factors. Although the cause of AD is not yet known and there is no treatment to cure this disease, its progression can be delayed. AD has recently been recognized as a brain-specific type of diabetes called type 3 diabetes. Several studies have shown that people with type 2 diabetes (T2D) have a higher risk of developing AD. Therefore, it is important to identify subgroups of patients with AD that may be more likely to be associated with T2D. We here describe a new approach to identify the correlation between AD and T2D at the genetic level. Subgroups of AD and T2D were each generated using a non-negative matrix factorization (NMF) approach, which generated clusters containing subsets of genes and samples. In the gene cluster that was generated by conventional gene clustering method from NMF, we selected genes with significant differences in the corresponding sample cluster by Kruskal-Wallis and Dunn-test. Subsequently, we extracted differentially expressed gene (DEG) subgroups, and candidate genes with the same regulation direction can be extracted at the intersection of two disease DEG subgroups. Finally, we identified 241 candidate genes that represent common features related to both AD and T2D, and based on pathway analysis we propose that these genes play a role in the common pathological features of AD and T2D. Moreover, in the prediction of AD using logistic regression analysis with an independent AD dataset, the candidate genes obtained better prediction performance than DEGs. In conclusion, our study revealed a subgroup of patients with AD that are associated with T2D and candidate genes associated between AD and T2D, which can help in providing personalized and suitable treatments.
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Affiliation(s)
- Yeonwoo Chung
- grid.61221.360000 0001 1033 9831School of Electrical Engineering and Computer Science, Gwangju Institute of Science and Technology, Gwangju, Korea
| | - Hyunju Lee
- School of Electrical Engineering and Computer Science, Gwangju Institute of Science and Technology, Gwangju, Korea.
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9
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Time trends in the relation between blood pressure and dementia in 85-year-olds. J Hypertens 2021; 39:1964-1971. [PMID: 34102663 DOI: 10.1097/hjh.0000000000002902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Blood pressure has decreased in the general population. We aimed to examine whether this is true also among the very old, and among persons with and without dementia. Further, we aimed to investigate how common undetected and untreated hypertension is in the very old, both among people with and without dementia. METHOD Blood pressure was measured in representative population samples of 85-year-olds living in Gothenburg, Sweden, examined 1986-1987 (n = 484) and 2008-2010 (n = 571). Dementia was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, edition 3 revised, by the same medical doctor at both examinations. RESULTS Both systolic and diastolic blood pressure were lower in 85-year-olds examined 2008-2010 than in those examined 1986-1987, both among those with and without dementia. Participants with dementia had lower systolic blood pressure than those without dementia in both cohorts, and blood pressure levels related to dementia severity. Despite this, hypertension (≥140/90 mmHg) was found in almost half (46.5%) of those with dementia in 2008-2010. CONCLUSION Our findings show that time-trends of lower blood pressure in western populations also applies to the very old, and that individuals with dementia continue to have lower blood pressure compared to the rest of the population. The latter finding suggests that the pathophysiological processes in dementia affect blood pressure regulating regions in the brain independent of time trends. Still, hypertension is common in dementia and needs to be detected and treated.
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Svob Strac D, Konjevod M, Sagud M, Nikolac Perkovic M, Nedic Erjavec G, Vuic B, Simic G, Vukic V, Mimica N, Pivac N. Personalizing the Care and Treatment of Alzheimer's Disease: An Overview. Pharmgenomics Pers Med 2021; 14:631-653. [PMID: 34093032 PMCID: PMC8169052 DOI: 10.2147/pgpm.s284615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/05/2021] [Indexed: 11/23/2022] Open
Abstract
Alzheimer's disease (AD) is a progressive, complex, and multifactorial neurodegenerative disorder, still without effective and stable therapeutic strategies. Currently, available medications for AD are based on symptomatic therapy, which include acetylcholinesterase (AChE) inhibitors and N-methyl-D-aspartate (NMDA) receptor antagonist. Additionally, medications such as antipsychotic drugs, antidepressants, sedative, and hypnotic agents, and mood stabilizers are used for the management of behavioral and psychological symptoms of dementia (BPSD). Clinical research has been extensively investigated treatments focusing on the hallmark pathology of AD, including the amyloid deposition, tau hyperphosphorylation, neuroinflammation, and vascular changes; however, so far without success, as all new potential drugs failed to show significant clinical benefit. The underlying heterogeneous etiology and diverse symptoms of AD suggest that a precision medicine strategy is required, which would take into account the complex genetic, epigenetic, and environmental landscape of each AD patient. The article provides a comprehensive overview of the literature on AD, the current and potential therapy of both cognitive symptoms as well as BPSD, with a special focus on gut microbiota and epigenetic modifications as new emerging drug targets. Their specific patterns could represent the basis for novel individually tailored approaches aimed to optimize precision medicine strategies for AD prevention and treatment. However, the successful application of precision medicine to AD demands a further extensive research of underlying pathological processes, as well as clinical and biological complexity of this multifactorial neurodegenerative disorder.
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Affiliation(s)
- Dubravka Svob Strac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Marcela Konjevod
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Marina Sagud
- Department of Psychiatry, Clinical Hospital Centre Zagreb, Zagreb, Croatia
- University of Zagreb Medical School, Zagreb, Croatia
| | - Matea Nikolac Perkovic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Gordana Nedic Erjavec
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Barbara Vuic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Goran Simic
- Department of Neuroscience, Croatian Institute for Brain Research, Zagreb, Croatia
| | - Vana Vukic
- Department of Neuroscience, Croatian Institute for Brain Research, Zagreb, Croatia
| | | | - Nela Pivac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
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11
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Cao Q, Tan CC, Xu W, Hu H, Cao XP, Dong Q, Tan L, Yu JT. The Prevalence of Dementia: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2021; 73:1157-1166. [PMID: 31884487 DOI: 10.3233/jad-191092] [Citation(s) in RCA: 178] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dementia is a severe neurodegenerative disorder and it can be categorized into several subtypes by different pathogenic causes. We sought to comprehensively analyzed the prevalence of dementia from perspectives of geographic region (Asia, Africa, South America, and Europe/North America), age, and gender. We searched PubMed and EMBASE for relevant articles on dementia published from January 1985 to August 2019. In these studies, analyses were stratified by geographic region, age, and gender. Meta-regression was conducted to identify if there were significant differences between groups. We included forty-seven studies. Among the individuals aged 50 and over in the community, the pooled prevalence for all-cause dementia, Alzheimer's disease, and vascular dementia were 697 (CI95%: 546-864) per 10,000 persons, 324 (CI95%: 228-460) per 10,000 persons, and 116 (CI95%: 86-157) per 10,000 persons, respectively. In our study, the prevalence of all-type dementia in individuals aged 100 years and older (6,592 per 10,000 cases) is 244 times higher than in those aged 50-59 (27 per 10,000 cases). The number of people living with dementia approximately doubles every five years. The prevalence was greater in women than in men (788 cases versus 561 cases per 10,000 persons) in overall analysis. In individuals aged 60 to 69 years, AD prevalence in females was 1.9 times greater than that in males (108 cases versus 56 cases per 10,000 persons), while the prevalence of VaD was 1.8 times greater in males than in females (56 cases versus 32 cases per 10,000 persons). Prevalence rate was higher in Europe and North America than in Asia, Africa, and South America.
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Affiliation(s)
- Qing Cao
- Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Nanjing, China
| | - Chen-Chen Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Wei Xu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Hao Hu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xi-Peng Cao
- Clinical Research Center, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Qiang Dong
- Department of Neurology & Institute of Neurology, WHO Collaborating Center for Research and Training in Neurosciences, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Nanjing, China
| | - Jin-Tai Yu
- Department of Neurology & Institute of Neurology, WHO Collaborating Center for Research and Training in Neurosciences, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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12
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Hou M, Xu G, Ran M, Luo W, Wang H. APOE-ε4 Carrier Status and Gut Microbiota Dysbiosis in Patients With Alzheimer Disease. Front Neurosci 2021; 15:619051. [PMID: 33732104 PMCID: PMC7959830 DOI: 10.3389/fnins.2021.619051] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/14/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Alternations in gut microbiota and a number of genes have been implicated as risk factors for the development of Alzheimer disease (AD). However, the interactions between the altered bacteria and risk genetic variants remain unclear. OBJECTIVE We aimed to explore associations of the risk genetic variants with altered gut bacteria in the onset of AD. METHODS We collected baseline data and stool and blood samples from 30 AD patients and 47 healthy controls in a case-control study. The rs42358/rs4512 (ApoE), rs3851179 (PICALM), rs744373 (BIN1), rs9331888 (CLU), rs670139 (MS4A4E), rs3764650 (ABCA7), rs3865444 (CD33), rs9349407 (CD2AP), rs11771145 (EPHA1), and rs3818361/rs6656401 (CR1) were sequenced, and microbiota composition was characterized using 16S rRNA gene sequencing. The associations of the altered gut bacteria with the risk genetics were analyzed. RESULTS Apolipoprotein ε4 allele and rs744373 were risk loci for the AD among 12 genetic variants. Phylum Proteobacteria; orders Enterobacteriales, Deltaproteobacteria, and Desulfovibrionales; families Enterobacteriaceae and Desulfovibrionaceae; and genera Escherichia-Shigella, Ruminococcaceae_UCG_002, Shuttleworthia, Anaerofustis, Morganelia, Finegoldia, and Anaerotruncus were increased in AD subjects, whereas family Enterococcaceae and genera Megamonas, Enterococcus, and Anaerostipes were more abundant in controls (P < 0.05). Among the altered microbiota, APOE ε4 allele was positively associated with pathogens: Proteobacteria. CONCLUSION The interaction of APOE ε4 gene and the AD-promoting pathogens might be an important factor requiring for the promotion of AD. Targeting to microbiota might be an effective therapeutic strategy for AD susceptible to APOE ε4 allele. This needs further investigation.
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Affiliation(s)
- Min Hou
- School of Public Health, College of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Gaolian Xu
- Nano Biomedical Research Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Maosheng Ran
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Wei Luo
- Xinjin No. 2 People’s Hospital, Chengdu, China
| | - Hui Wang
- School of Public Health, College of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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13
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Wang G, Li W. Sex as a Risk Factor for Developing Cognitive Impairments in National Alzheimer's Coordinating Center Participants. J Alzheimers Dis Rep 2021; 5:1-6. [PMID: 33681711 PMCID: PMC7902986 DOI: 10.3233/adr-200275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: It is inconclusive on how sex affects the risk of developing mild cognitive impairment (MCI) or dementia. Objective: To investigate how sex affects the risk of developing MCI or dementia. Methods: A secondary data analysis was performed on data collected from participants enrolled at Alzheimer’s Disease Research Centers funded by National Institute on Aging. There were two inclusion criteria: 1) participants were free of dementia at the baseline visit; 2) every participant must have at least one follow-up visit. A Cox proportional hazards model was used to investigate how sex affects the risk of developing cognitive impairments. Results: During a follow-up period of more than 10 years, male participants had a slightly higher incidence than female participants for either MCI or dementia. Not surprisingly, a higher prevalence was observed in male than female participants for either MCI or dementia. However, male participants had a higher mortality rate than their female counterparts. Conclusion: The male sex is associated with a higher risk for developing cognitive impairments along the aging process.
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Affiliation(s)
- Ge Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Li
- Physician Assistant Studies, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
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14
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Subramaniapillai S, Almey A, Natasha Rajah M, Einstein G. Sex and gender differences in cognitive and brain reserve: Implications for Alzheimer's disease in women. Front Neuroendocrinol 2021; 60:100879. [PMID: 33137359 DOI: 10.1016/j.yfrne.2020.100879] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 10/14/2020] [Accepted: 10/27/2020] [Indexed: 12/11/2022]
Abstract
Women represent ⅔ of the cases of Alzheimer's disease (AD). Current research has focused on differential risks to explain higher rates of AD in women. However, factors that reduce risk for AD, like cognitive/brain reserve, are less well explored. We asked: what is known about sex and gender differences in how reserve mitigates risk for AD? We conducted a narrative review of the literature, with keywords: "sex/gender differences", "cognitive/brain reserve", "Alzheimer's Disease", and the following cognitive reserve contributors: "education", "IQ", "occupation", "cognitive stimulation", "bilingualism", "socioeconomic status", "physical activity", "social support". Sixteen papers disaggregated their data by sex. Those papers observed sex and gender differences in reserve contributors. There is also evidence that greater reserve may be more beneficial in lowering AD risk in women, although more research is needed. We discuss how traditional reserve contributors are gendered and may not capture factors that support cognition in aging women.
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Affiliation(s)
- Sivaniya Subramaniapillai
- Department of Psychology, McGill University, 2001 Avenue McGill College, Montréal, QC H3A 1G1, Canada; Brain Imaging Centre, Douglas Institute Research Centre, 6875 LaSalle Blvd Verdun, Montréal, QC H4H 1R3, Canada.
| | - Anne Almey
- Department of Psychology, University of Toronto, 100 St. George Street, Toronto, ON M5S 3G3, Canada
| | - M Natasha Rajah
- Brain Imaging Centre, Douglas Institute Research Centre, 6875 LaSalle Blvd Verdun, Montréal, QC H4H 1R3, Canada; Department of Psychiatry, Faculty of Medicine, McGill University, 1033 Avenue des Pins, Montréal, QC H3A 1A1, Canada
| | - Gillian Einstein
- Department of Psychology, University of Toronto, 100 St. George Street, Toronto, ON M5S 3G3, Canada; Rotman Research Institute, Baycrest Hospital, 3560 Bathurst St, Toronto, ON M6A 2E1, Canada; Tema Genus, Linköping University, TEMA-huset, Entrance 37, Room E433, Campus Valla, Linköping, Sweden
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15
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Lee H, Cho H, Choe YS, Seo SW, Joo EY. Association Between Amyloid Accumulation and Sleep in Patients With Idiopathic REM Sleep Behavior Disorder. Front Neurol 2020; 11:547288. [PMID: 33343481 PMCID: PMC7744751 DOI: 10.3389/fneur.2020.547288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 11/03/2020] [Indexed: 01/06/2023] Open
Abstract
Background and Objectives: Amyloid-beta protein may lead to sleep disturbance and eventually develop cognitive impairment. Idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) is a predictor of neurodegeneration, yet there have been limited studies evaluating the relationship between cognitive decline and amyloid accumulation in iRBD patients. The aim of this study is to investigate the clinical and sleep characteristics of iRBD patients and its association with amyloid deposition. Methods: We enroll 23 iRBD patients (mean age, 65.8 years; male, 73.9%), and their mean history of clinically suspected RBD was 6.5 years. All underwent 18F-flutemetamol amyloid PET completed polysomnography (PSG) and questionnaires. Patients were classified into two groups according to amyloid deposition as amyloid positive and negative. Clinical and sleep parameters were compared between groups and were correlated with amyloid deposition, calculated as a standardized uptake value ratio (SUVR). Results: Four patients (17.4%) were revealed to be amyloid positive, and they showed increased percentage of wake after sleep onset (WASO), stage N1, and stage N2 sleep and worse on the Stroop Word Color Test compared to amyloid negative patients. Global SUVR was correlated with total sleep time, sleep efficiency, WASO, and N1 sleep, and these sleep parameters were associated with a part of default mode network of brains such as orbitofrontal, dorsolateral pre-frontal, and left temporal areas. Conclusion: iRBD patients with amyloid deposition have worse sleep quality than patients without amyloid. Relationship between fragmented sleep and amyloid deposition in the default mode network may be crucial to elucidate the disease progress of iRBD.
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Affiliation(s)
- Hanul Lee
- Department of Neurology, Neuroscience Center, School of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Hyunjin Cho
- Department of Neurology, Neuroscience Center, School of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Yeong Sim Choe
- Department of Neurology, Neuroscience Center, School of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| | - Sang Won Seo
- Department of Neurology, Neuroscience Center, School of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Eun Yeon Joo
- Department of Neurology, Neuroscience Center, School of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
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16
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Chang KH, Huang CC, Chen CM, Wu HC, Kuo HC. Differences in Clinical Presentation of Behavioral and Psychological Symptoms of Dementia in Alzheimer's Disease According to Sex and Education Level. J Alzheimers Dis 2020; 78:711-719. [PMID: 33044179 DOI: 10.3233/jad-200507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The behavioral and psychological symptoms of dementia (BPSD) seriously affect the quality of life of patients with Alzheimer's disease (AD) and their caregivers. OBJECTIVE We aimed to identify associations between demographic/genetic factors and clinical presentations of BPSD. METHODS In a cohort of 463 AD patients with BPSD, we retrospectively analyzed sex, education level, AD severity (assessed using the Clinical Dementia Rating and Mini-Mental Status Examination), and BPSD severity (assessed using the Neuropsychiatry Inventory, NPI). Severe BPSD was defined as NPI ≥10 for 3 consecutive years. RESULTS Among patients with severe BPSD (NPI ≥10), we observed more female patients (62.96%) and a lower level of education (6.03±4.77 years) as compared to those with mild BPSD (NPI <10) (female: 51.09%, p = 0.007; education years: 7.91±4.93, p < 0.001). Females had a lower level of education (5.72±4.50 years) and higher scores for depression/dysphoria (1.22±2.05) compared with males (education: 8.96±4.89 years, p < 0.001; depression/dysphoria: 0.78±1.42, p = 0.047). Patients with a high level of education (defined as ≥12 years) had higher scores for appetite/eating (0.90±2.02) than did those without (0.69±1.79; p = 0.001). Genetic analysis showed similar total and subscale NPI scores between patients with and without APOE4 and with and without the GRN rs5848 genotype. CONCLUSION Our findings indicate potential contributions of sex and education to the presentation of BPSD. Further study is warranted to provide models for tailoring therapeutic programs to individual AD patients according to these factors.
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Affiliation(s)
- Kuo-Hsuan Chang
- Department of Neurology, Chang Gung Memorial Hospital-Linkou Medical Center, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chin-Chang Huang
- Department of Neurology, Chang Gung Memorial Hospital-Linkou Medical Center, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chiung-Mei Chen
- Department of Neurology, Chang Gung Memorial Hospital-Linkou Medical Center, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Chuan Wu
- Department of Neurology, Chang Gung Memorial Hospital-Linkou Medical Center, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Chou Kuo
- Department of Neurology, Chang Gung Memorial Hospital-Linkou Medical Center, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
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17
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Liu D, Zhao D, Zhao Y, Wang Y, Zhao Y, Wen C. Inhibition of microRNA-155 Alleviates Cognitive Impairment in Alzheimer's Disease and Involvement of Neuroinflammation. Curr Alzheimer Res 2020; 16:473-482. [PMID: 31456514 DOI: 10.2174/1567205016666190503145207] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/25/2019] [Accepted: 04/30/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Neuroinflammation has important effects on cognitive functions in the pathophysiological process of Alzheimer's Disease (AD). In the current report, we determined the effects of microRNA-155 (miR-155) on the levels of IL-1β, IL-6 and TNF-α, and their respective receptors in the hippocampus using a rat model of AD. METHODS Real-time RT-PCR, ELISA and western blot analysis were used to examine the miR-155, PICs and PIC receptors. The Morris water maze and spatial working memory tests were used to assess cognitive functions. RESULTS miR-155 was increased in the hippocampus of AD rats, accompanied by amplification of IL-1β, IL-6 and TNF-α. Intracerebroventricular infusion of miR-155 inhibitor, but not its scramble attenuated the increases of IL-1β, IL-6 and TNF-α and upregulation of their receptors. MiR-155 inhibitor also attenuated upregulation of apoptotic Caspase-3 in the hippocampus of AD rats. Notably, inhibition of miR- 155 or PIC receptors largely recovered the impaired learning performance in AD rat. CONCLUSION We showed the critical role of miR-155 in regulating the memory impairment in AD rats likely via engagement of neuroinflammatory mechanisms, suggesting that miR-155 and its signaling molecules may present prospects in preventing and/or improving the development of the impaired cognitive functions in AD.
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Affiliation(s)
- Dandan Liu
- Center of Physical Examination, The First Hospital of Jilin University Changchun, Jilin 130021, China
| | - Dandan Zhao
- Department of Pediatric Gastroenterology, The First Hospital of Jilin University Changchun, Jilin 130021, China
| | - Yingkai Zhao
- Department of Gerontology, The First Hospital of Jilin University Changchun, Jilin 130021, China
| | - Yan Wang
- Department of Gerontology, The First Hospital of Jilin University Changchun, Jilin 130021, China
| | - Yong Zhao
- Department of Thoracic Surgery The First Hospital of Jilin University Changchun, Jilin 130021, China
| | - Chengfei Wen
- Department of Cardiology, The First Hospital (Eastern Division) of Jilin University, Changchun, Jilin 130031, China
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18
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Interaction between Cognitive Reserve and Biomarkers in Alzheimer Disease. Int J Mol Sci 2020; 21:ijms21176279. [PMID: 32872643 PMCID: PMC7503751 DOI: 10.3390/ijms21176279] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/11/2020] [Accepted: 08/22/2020] [Indexed: 12/22/2022] Open
Abstract
Patients with comparable degree of neuropathology could show different cognitive impairments. This could be explained with the concept of cognitive reserve (CR), which includes a passive and an active component. In particular, CR is used to explain the gap between tissue damage and clinical symptoms that has been observed in dementia and, in particular, in patients affected by Alzheimer disease (AD). Different studies confirm brain neuroplasticity. Our preliminary study demonstrated that AD patients with high education showed a CR inversely associated with glucose uptake measured in fluorodeoxyglucose positron emission tomography (FDG-PET), whereas the inverse correlation was observed in AD patients with low education. In other words, our findings suggest that CR compensates the neurodegeneration and allows the maintenance of patients’ cognitive performance. Best understanding of the concept of CR could lead to interventions to slow cognitive aging or reduce the risk of dementia.
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19
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Ding M, Qiu C, Rizzuto D, Grande G, Fratiglioni L. Tracing temporal trends in dementia incidence over 25 years in central Stockholm, Sweden. Alzheimers Dement 2020; 16:770-778. [DOI: 10.1002/alz.12073] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/31/2019] [Accepted: 01/13/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Mozhu Ding
- Aging Research Center Department of Neurobiology Care Sciences and Society Karolinska Institutet and Stockholm University Stockholm Sweden
| | - Chengxuan Qiu
- Aging Research Center Department of Neurobiology Care Sciences and Society Karolinska Institutet and Stockholm University Stockholm Sweden
| | - Debora Rizzuto
- Aging Research Center Department of Neurobiology Care Sciences and Society Karolinska Institutet and Stockholm University Stockholm Sweden
| | - Giulia Grande
- Aging Research Center Department of Neurobiology Care Sciences and Society Karolinska Institutet and Stockholm University Stockholm Sweden
| | - Laura Fratiglioni
- Aging Research Center Department of Neurobiology Care Sciences and Society Karolinska Institutet and Stockholm University Stockholm Sweden
- Stockholm Gerontology Research Center Stockholm Sweden
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20
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Bradfield NI, Ames D. Mild cognitive impairment: narrative review of taxonomies and systematic review of their prediction of incident Alzheimer's disease dementia. BJPsych Bull 2020; 44:67-74. [PMID: 31724527 PMCID: PMC7283119 DOI: 10.1192/bjb.2019.77] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/06/2019] [Accepted: 10/14/2019] [Indexed: 12/13/2022] Open
Abstract
Early detection of Alzheimer's disease is vital for developing novel treatments. Attempts to identify the intermediate state between normal cognition and dementia have evolved over the past 50 years. Current taxonomies of mild cognitive impairment (MCI) may be criticised for their imprecise operationalisation. With the advent of biomarkers such as amyloid-beta positron emission tomography imaging in established Alzheimer's disease, much research has focused on establishing which factors predict progression from MCI to Alzheimer's disease dementia. In this review, we discuss the historical context of MCI before reviewing the literature of MCI subtypes and their risk of progression to Alzheimer's disease dementia. Finally, we summarise the literature and discuss limitations and weaknesses of how the construct is operationalised and implemented, before offering suggestions for development of the concept of MCI. We conclude that MCI must be empirically defined for the sake of its predictive validity to identify Alzheimer's disease before dementia develops.
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21
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Sjöberg L, Fratiglioni L, Lövdén M, Wang HX. Low Mood and Risk of Dementia: The Role of Marital Status and Living Situation. Am J Geriatr Psychiatry 2020; 28:33-44. [PMID: 31522861 DOI: 10.1016/j.jagp.2019.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study aims to explore whether low mood is related to an increased dementia risk in two cohorts of older adults of different generations, and whether marital status and living situation modify this association. METHODS Participants (≥70 years), free from dementia and living at home, were identified from two population-based studies: the Kungsholmen Project (KP; n = 1,197) and the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K; n = 1,402). Low mood was obtained by self-report (KP and SNAC-K) at baseline in 1987-89 (KP) and 2001-04 (SNAC-K). Incident dementia cases were ascertained over 9 years, using the same diagnostic procedures and comparable criteria for the two cohorts (DSM-III-R in KP and DSM-IV-TR in SNAC-K). Hazard ratios (HR) were derived from Cox proportional hazards models. RESULTS Those having low mood at baseline were at higher risk of dementia in both cohorts combined (HR: 1.2, 95% confidence interval (CI): 1.0-1.4) than those without low mood. However, an increased risk was detected only in those who did not have a partner (HR: 1.5, 95% CI: 1.2-1.9), or lived alone (HR: 1.5, 95% CI: 1.2-1.9), but not among those who had a partner or lived with someone (HR: 0.8, 95% CI: 0.5-1.2). CONCLUSION Marital status and living situation have the potential to buffer the detrimental effects of low mood on dementia onset. Thus, specific attention from health care should target individuals having low mood and who do not have a partner or live alone.
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Affiliation(s)
- Linnea Sjöberg
- Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University (LS, LF. ML, H-XW), Stockholm, Sweden.
| | - Laura Fratiglioni
- Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University (LS, LF. ML, H-XW), Stockholm, Sweden; Stockholm Gerontology Research Center (LF), Stockholm, Sweden
| | - Martin Lövdén
- Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University (LS, LF. ML, H-XW), Stockholm, Sweden
| | - Hui-Xin Wang
- Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University (LS, LF. ML, H-XW), Stockholm, Sweden; Stress Research Institute, Stockholm University (H-XW), Stockholm, Sweden
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22
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Foroughan M, Jafari Z, Ghaemmagham Farahani I, Rashedi V. Validity and Reliability of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). GEROPSYCH 2019. [DOI: 10.1024/1662-9647/a000209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. This study examines the psychometric properties of the IQCODE and its applicability in the Iranian elderly population. A group of 95 elderly patients with at least 4 years of formal education who fulfilled the criteria of DSM-IV-TR for dementia were examined by the MMSE and the AMTs. The Farsi version of the IQCODE was subsequently administered to their primary caregivers. Results showed a significant correlation ( p = .01) between the score of the questionnaire and the results of the MMSE ( r = −0.647) and AMTs ( r = −0.641). A high internal reliability of the questionnaire was confirmed by Cronbach’s alpha coefficient (α = 0.927) and test-retest reliability by correlation coefficient ( r = 0.81). This study found that the IQCODE has acceptable psychometric properties and can be used for evaluating the cognitive state in the elderly population of Iran.
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Affiliation(s)
- Mahshid Foroughan
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Zahra Jafari
- Department of Basic Sciences in Rehabilitation, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | | | - Vahid Rashedi
- School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
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23
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Zarantonello L, Schiff S, Amodio P, Bisiacchi P. The effect of age, educational level, gender and cognitive reserve on visuospatial working memory performance across adult life span. AGING NEUROPSYCHOLOGY AND COGNITION 2019; 27:302-319. [PMID: 31046560 DOI: 10.1080/13825585.2019.1608900] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Working memory (WM) is a limited capacity cognitive system that temporarily holds information for processing. In the present study, we tested the effect of age, gender and cognitive reserve in terms of educational level, working and leisure time activities on an active visuospatial WM task. One-hundred thirty-four participants between 20 and 80 years old performed an n-back task with different degree of WM demanding. Reaction times (RTs) became slower and accuracy decreased with age; the former started to decline in participants that were 35 years old, the latter in participants that were 57 years old. Males were faster than females. Educational level (10 years in accuracy and 15 years in RTs) showed a positive effect on accuracy and RTs. Cognitive reserve had a positive effect on accuracy but no effect on RTs. In conclusion, age-related decline influenced earlier the speed and later the accuracy in a task that required active processes. While male was faster independently of WM demanding and age, middle school degree and an average cognitive reserve prevent errors during performance. Coherently, high school degree prevents slowing down but only in low demanding condition.
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Affiliation(s)
| | - Sami Schiff
- Department of Medicine, University of Padova, Padova, Italy
| | - Piero Amodio
- Department of Medicine, University of Padova, Padova, Italy
| | - Patrizia Bisiacchi
- Department of General Psychology, University of Padova, Padova, Italy.,Padua Neuroscience Center, Padova, Italy
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24
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Affiliation(s)
- N. N. Koberskaya
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | - G. R. Tabeeva
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
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25
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Elias A, Cummins T, Tyrrell R, Lamb F, Dore V, Williams R, Rosenfeld J, Hopwood M, Villemagne VL, Rowe CC. Risk of Alzheimer’s Disease in Obstructive Sleep Apnea Syndrome: Amyloid-β and Tau Imaging. J Alzheimers Dis 2018; 66:733-741. [DOI: 10.3233/jad-180640] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Alby Elias
- Department of Molecular Imaging and Therapy, Austin Health, The University of Melbourne, Victoria, Australia
- Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - Tia Cummins
- The Florey Institute of Neuroscience and Mental Health
| | - Regan Tyrrell
- Department of Molecular Imaging and Therapy, Austin Health, The University of Melbourne, Victoria, Australia
| | - Fiona Lamb
- Department of Molecular Imaging and Therapy, Austin Health, The University of Melbourne, Victoria, Australia
| | | | | | - J.V. Rosenfeld
- Department of Neurosurgery, Monash University, Victoria, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - Victor L. Villemagne
- Department of Molecular Imaging and Therapy, Austin Health, The University of Melbourne, Victoria, Australia
| | - Christopher C. Rowe
- Department of Molecular Imaging and Therapy, Austin Health, The University of Melbourne, Victoria, Australia
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26
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Zhu Y, Sabuncu MR. A Bayesian Disease Progression Model for Clinical Trajectories. GRAPHS IN BIOMEDICAL IMAGE ANALYSIS AND INTEGRATING MEDICAL IMAGING AND NON-IMAGING MODALITIES : SECOND INTERNATIONAL WORKSHOP, GRAIL 2018 AND FIRST INTERNATIONAL WORKSHOP, BEYOND MIC 2018, HELD IN CONJUNCTION WITH MICCAI 2018, GRANADA,... 2018; 11044:57-65. [PMID: 33842932 PMCID: PMC8034262 DOI: 10.1007/978-3-030-00689-1_6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In this work, we consider the problem of predicting the course of a progressive disease, such as cancer or Alzheimer's. Progressive diseases often start with mild symptoms that might precede a diagnosis, and each patient follows their own trajectory. Patient trajectories exhibit wild variability, which can be associated with many factors such as geno-type, age, or sex. An additional layer of complexity is that, in real life, the amount and type of data available for each patient can differ significantly. For example, for one patient we might have no prior history, whereas for another patient we might have detailed clinical assessments obtained at multiple prior time-points. This paper presents a probabilistic model that can handle multiple modalities (including images and clinical assessments) and variable patient histories with irregular timings and missing entries, to predict clinical scores at future time-points. We use a sigmoidal function to model latent disease progression, which gives rise to clinical observations in our generative model. We implemented an approximate Bayesian inference strategy on the proposed model to estimate the parameters on data from a large population of subjects. Furthermore, the Bayesian framework enables the model to automatically fine-tune its predictions based on historical observations that might be available on the test subject. We applied our method to a longitudinal Alzheimer's disease dataset with more than 3,000 subjects [1] with comparisons against several benchmarks.
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27
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Gene-gene interactions among coding genes of iron-homeostasis proteins and APOE-alleles in cognitive impairment diseases. PLoS One 2018. [PMID: 29518107 PMCID: PMC5843269 DOI: 10.1371/journal.pone.0193867] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cognitive impairments of different aetiology share alterations in iron and lipid homeostasis with mutual relationships. Since iron and cholesterol accumulation impact on neurodegenerative disease, the associated gene variants are appealing candidate targets for risk and disease progression assessment. In this light, we explored the role of common single nucleotide polymorphisms (SNPs) in the main iron homeostasis genes and in the main lipoprotein transporter gene (APOE) in a cohort of 765 patients with dementia of different origin: Alzheimer’s disease (AD) n = 276; vascular dementia (VaD), n = 255; mild cognitive impairment (MCI), n = 234; and in normal controls (n = 1086). In details, four genes of iron homeostasis (Hemochromatosis (HFE: C282Y, H63D), Ferroportin (FPN1: -8CG), Hepcidin (HAMP: -582AG), Transferrin (TF: P570S)), and the three major alleles of APOE (APOE2, APOE3, APOE4) were analyzed to explore causative interactions and synergies. In single analysis, HFE 282Y allele yielded a 3-fold risk reduction in the whole cohort of patients (P<0.0001), confirmed in AD and VaD, reaching a 5-fold risk reduction in MCI (P = 0.0019). The other iron SNPs slightly associated with risk reduction whereas APOE4 allele resulted in increased risk, reaching more than 7-fold increased risk in AD homozygotes (P = 0.001), confirmed to a lower extent in VaD and MCI (P = 0.038 and P = 0.013 respectively) as well as in the whole group (P<0.0001). Comparisons of Mini Mental State Examination (MMSE) among AD showed appreciable lowering in APOE4 carriers (P = 0.038), confirmed in the whole cohort of patients (P = 0.018). In interaction analysis, the HFE 282Y allele completely extinguished the APOE4 allele associated risk. Conversely, the coexistence in patients of a substantial number of iron SNPs accrued the APOE4 detrimental effect on MMSE. Overall, the analysis highlighted how a specific iron-allele burden, defined as different combinations of iron gene variants, might have different effects on cognitive impairment and might modulate the effects of established genetic risk factors such as APOE4. Our results suggest that established genetic risk factors might be affected by specific genetic backgrounds, making patients differently suited to manage iron accumulation adding new genetic insights in neurodegeneration. The recently recognized interconnections between iron and lipids, suggest that these pathways might share more than expected. We therefore extended to additional iron gene variants the newly proposed influencing mechanisms that HFE gene has on cholesterol metabolism. Our results have a strong translational potential promoting new pharmacogenetics studies on therapeutic target identification aimed at optimally tuning brain iron levels.
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Tisato V, Rimondi E, Brombo G, Volpato S, Zurlo A, Zauli G, Secchiero P, Zuliani G. Serum Soluble Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand Levels in Older Subjects with Dementia and Mild Cognitive Impairment. Dement Geriatr Cogn Disord 2018; 41:273-80. [PMID: 27304551 DOI: 10.1159/000446275] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) has been involved in both physiological and pathological conditions, including vascular pathologies and pathologies of the central nervous system. Nonetheless, the knowledge about the role of systemic TRAIL in patients affected by different types of dementia and mild cognitive impairment (MCI) is still limited. OBJECTIVE We assessed serum TRAIL levels in a large cohort of older individuals (n = 644) including patients with late-onset Alzheimer's disease (LOAD), vascular dementia (VAD), 'mixed' dementia (MIX), MCI, and healthy controls. METHODS Circulating TRAIL was measured by ELISA. RESULTS At univariate analysis, TRAIL levels were higher in VAD, MIX, and MCI patients compared with LOAD patients and controls. Using the multiple linear regression model, we found that TRAIL levels were associated with VAD and MCI, but not MIX, independent of potential confounding factors. CONCLUSION The finding of high levels of circulating TRAIL in VAD and MCI seems to suggest that both of these conditions are characterized by a significant vascular damage with respect to LOAD.
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Affiliation(s)
- Veronica Tisato
- Department of Morphology, Surgery and Experimental Medicine and LTTA Centre, University of Ferrara, Ferrara, Italy
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29
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Lee J, Park H, Chey J. Education as a Protective Factor Moderating the Effect of Depression on Memory Impairment in Elderly Women. Psychiatry Investig 2018; 15:70-77. [PMID: 29422928 PMCID: PMC5795034 DOI: 10.4306/pi.2018.15.1.70] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/25/2017] [Accepted: 08/31/2017] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The cognitive reserve theory explicates individual differences observed in the clinical manifestation of dementia despite similar brain pathology. Education, a popular proxy of the cognitive reserve, has been shown to have protective effects delaying the onset of clinical symptoms including memory. This study was conducted to test whether education can moderate the negative effect of depressive mood on memory performance in elderly women residing in the community. METHODS 29 elderly "unschooled" female (less than 6 years of formal education) and 49 "schooled" female (6 or more years) people were compared with regard to association between depressive mood and verbal memory functioning, which were measured by the Geriatric Depression Scale and the Elderly Verbal Learning Test, respectively. RESULTS The results showed that completing or receiving more than primary school education significantly reduced the negative association between depressive mood and memory performance. Participants who did not complete primary schooling showed a decline in memory test scores depending on the level of depressive mood; whereas participants who have completed or received more than primary education displayed relatively stable memory function despite varying level of depressive mood. CONCLUSION Our findings imply that education in early life may have protective effects against memory impairment related to elderly depression.
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Affiliation(s)
- Jiyoun Lee
- Department of Psychology, Seoul National University, Seoul, Republic of Korea
| | - Heyeon Park
- Department of Psychology, Seoul National University, Seoul, Republic of Korea
- Department of Public Health Medical Services, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeanyung Chey
- Department of Psychology, Seoul National University, Seoul, Republic of Korea
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30
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Christie GJ, Hamilton T, Manor BD, Farb NAS, Farzan F, Sixsmith A, Temprado JJ, Moreno S. Do Lifestyle Activities Protect Against Cognitive Decline in Aging? A Review. Front Aging Neurosci 2017; 9:381. [PMID: 29209201 PMCID: PMC5701915 DOI: 10.3389/fnagi.2017.00381] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/06/2017] [Indexed: 12/26/2022] Open
Abstract
The number of patients suffering from dementia is expected to more than triple by the year 2040, and this represents a major challenge to publicly-funded healthcare systems throughout the world. One of the most effective prevention mechanisms against dementia lies in increasing brain- and cognitive-reserve capacity, which has been found to reduce the behavioral severity of dementia symptoms as neurological degeneration progresses. To date though, most of the factors known to enhance this reserve stem from largely immutable history factors, such as level of education and occupational attainment. Here, we review the potential for basic lifestyle activities, including physical exercise, meditation and musical experience, to contribute to reserve capacity and thus reduce the incidence of dementia in older adults. Relative to other therapies, these activities are low cost, are easily scalable and can be brought to market quickly and easily. Overall, although preliminary evidence is promising at the level of randomized control trials, the state of research on this topic remains underdeveloped. As a result, several important questions remain unanswered, including the amount of training required to receive any cognitive benefit from these activities and the extent to which this benefit continues following cessation. Future research directions are discussed for each lifestyle activity, as well as the potential for these and other lifestyle activities to serve as both a prophylactic and a therapeutic treatment for dementia.
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Affiliation(s)
- Gregory J Christie
- Digital Health Hub, Simon Fraser University, Surrey, BC, Canada.,Science and Technology for Aging Research Institute, Simon Fraser University, Surrey, BC, Canada
| | - Tara Hamilton
- Digital Health Hub, Simon Fraser University, Surrey, BC, Canada
| | - Bradley D Manor
- Institute for Aging Research, Harvard Medical School, Boston, MA, United States
| | - Norman A S Farb
- Department of Psychology, University of Toronto, Mississauga, ON, Canada
| | - Faranak Farzan
- Digital Health Hub, Simon Fraser University, Surrey, BC, Canada.,School of Mechatronics and Systems Engineering, Simon Fraser University, Surrey, BC, Canada
| | - Andrew Sixsmith
- Digital Health Hub, Simon Fraser University, Surrey, BC, Canada.,Science and Technology for Aging Research Institute, Simon Fraser University, Surrey, BC, Canada.,Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada
| | - Jean-Jacques Temprado
- Institut des Sciences du Mouvement, Faculté des Sciences du Sport, Aix-Marseille Université, Marseille, France
| | - Sylvain Moreno
- Digital Health Hub, Simon Fraser University, Surrey, BC, Canada.,Science and Technology for Aging Research Institute, Simon Fraser University, Surrey, BC, Canada.,School of Interactive Arts and Technology, Simon Fraser University, Surrey, BC, Canada
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31
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Marden JR, Tchetgen Tchetgen EJ, Kawachi I, Glymour MM. Contribution of Socioeconomic Status at 3 Life-Course Periods to Late-Life Memory Function and Decline: Early and Late Predictors of Dementia Risk. Am J Epidemiol 2017; 186:805-814. [PMID: 28541410 PMCID: PMC5859987 DOI: 10.1093/aje/kwx155] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 11/17/2016] [Accepted: 11/21/2016] [Indexed: 11/14/2022] Open
Abstract
Both early life and adult socioeconomic status (SES) predict late-life level of memory; however, evidence is mixed on the relationship between SES and rate of memory decline. Further, the relative importance of different life-course periods for rate of late-life memory decline has not been evaluated. We examined associations between life-course SES and late-life memory function and decline. Health and Retirement Study participants (n = 10,781) were interviewed biennially from 1998-2012 (United States). SES measurements for childhood (composite score including parents' educational attainment), early adulthood (high-school or college completion), and older adulthood (income, mean age 66 years) were all dichotomized. Word-list memory was modeled via inverse-probability weighted longitudinal models accounting for differential attrition, survival, and time-varying confounding, with nonrespondents retained via proxy assessments. Compared to low SES at all 3 points (referent), stable, high SES predicted the best memory function and slowest decline. High-school completion had the largest estimated effect on memory (β = 0.19; 95% confidence interval: 0.15, 0.22), but high late-life income had the largest estimated benefit for slowing declines (for 10-year memory change, β = 0.35; 95% confidence interval: 0.24, 0.46). Both early and late-life interventions are potentially relevant for reducing dementia risk by improving memory function or slowing decline.
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Affiliation(s)
- Jessica R. Marden
- Correspondence to Dr. Jessica R. Marden, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, Massachusetts 02115 (e-mail: )
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32
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Gerritsen L, Wang HX, Reynolds CA, Fratiglioni L, Gatz M, Pedersen NL. Influence of Negative Life Events and Widowhood on Risk for Dementia. Am J Geriatr Psychiatry 2017; 25:766-778. [PMID: 28433549 PMCID: PMC5474139 DOI: 10.1016/j.jagp.2017.02.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 12/19/2016] [Accepted: 02/09/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The aim of the current study was to examine the effect of negative life events and widowhood on the incidence of dementia. METHODS Data were from four Swedish longitudinal cohort studies with a total of nearly 2,000 participants and 8-25 years of follow-up. Seven stressful events were examined for which data were available in all cohorts. Clinical dementia diagnoses were made through medical and psychological examinations. Cox proportional hazards models were used to estimate the association between life events and dementia, adjusting for lifestyle and cardiovascular risk factors. RESULTS The experience of one stressful life event was not associated with dementia incidence, but two or more negative life events at baseline predicted higher risk for dementia (pooled HR: 2.00). This was most apparent for the incidence of vascular dementia (pooled HR: 3.60) but not for Alzheimer disease (pooled HR: 1.29). Moreover, persons who were widowed and had experienced one or more negative life events were found to have a threefold risk for dementia. CONCLUSION Widowhood augments the effect of negative life events on dementia incidence and negative life events specifically increase the risk for vascular dementia.
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Affiliation(s)
- Lotte Gerritsen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands.
| | - Hui-Xin Wang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
| | - Chandra A Reynolds
- Department of Psychology, University of California-Riverside, Riverside, CA
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Margaret Gatz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, University of Southern California, Los Angeles, CA
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, University of Southern California, Los Angeles, CA
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Abstract
Three neurodegenerative diseases [Amyotrophic Lateral Sclerosis (ALS), Parkinson's disease (PD) and Alzheimer's disease (AD)] have many characteristics like pathological mechanisms and genes. In this sense some researchers postulate that these diseases share the same alterations and that one alteration in a specific protein triggers one of these diseases. Analyses of gene expression may shed more light on how to discover pathways, pathologic mechanisms associated with the disease, biomarkers and potential therapeutic targets. In this review, we analyze four microarrays related to three neurodegenerative diseases. We will systematically examine seven genes (CHN1, MDH1, PCP4, RTN1, SLC14A1, SNAP25 and VSNL1) that are altered in the three neurodegenerative diseases. A network was built and used to identify pathways, miRNA and drugs associated with ALS, AD and PD using Cytoscape software an interaction network based on the protein interactions of these genes. The most important affected pathway is PI3K-Akt signalling. Thirteen microRNAs (miRNA-19B1, miRNA-107, miRNA-124-1, miRNA-124-2, miRNA-9-2, miRNA-29A, miRNA-9-3, miRNA-328, miRNA-19B2, miRNA-29B2, miRNA-124-3, miRNA-15A and miRNA-9-1) and four drugs (Estradiol, Acetaminophen, Resveratrol and Progesterone) for new possible treatments were identified.
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Affiliation(s)
| | - Marcelo Alarcón
- Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Universidad de Talca, Talca 3460000, Chile; Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), Universidad de Talca, Talca 3460000, Chile.
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Li Y, Liu Y, Wang P, Wang J, Xu S, Qiu M. Dependency criterion based brain pathological age estimation of Alzheimer's disease patients with MR scans. Biomed Eng Online 2017; 16:50. [PMID: 28438167 PMCID: PMC5404315 DOI: 10.1186/s12938-017-0342-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 04/19/2017] [Indexed: 12/20/2022] Open
Abstract
Objectives Traditional brain age estimation methods are based on the idea that uses the real age as the training label. However, these methods ignore that there is a deviation between the real age and the brain age due to the accelerated brain aging. Methods This paper considers this deviation and obtains it by maximizing the correlation between the estimated brain age and the class label rather than by minimizing the difference between the estimated brain age and the real age. Firstly, set the search range of the deviation as the deviation candidates according to the prior knowledge. Secondly, use the support vector regression as the age estimation model to minimize the difference between the estimated age and the real age plus deviation rather than the real age itself. Thirdly, design the fitness function based on the correlation criterion. Fourthly, conduct age estimation on the validation dataset using the trained age estimation model, put the estimated age into the fitness function, and obtain the fitness value of the deviation candidate. Fifthly, repeat the iteration until all the deviation candidates are involved and get the optimal deviation with maximum fitness values. The real age plus the optimal deviation is taken as the brain pathological age. Results The experimental results showed that the separability of the samples was apparently improved. For normal control- Alzheimer’s disease (NC-AD), normal control- mild cognition impairment (NC-MCI), and mild cognition impairment—Alzheimer’s disease (MCI-AD), the average improvements were 0.164 (31.66%), 0.1284 (34.29%), and 0.0206 (7.1%), respectively. For NC-MCI-AD, the average improvement was 0.2002 (50.39%). The estimated brain pathological age could be not only more helpful for the classification of AD but also more precisely reflect the accelerated brain aging. Conclusion In conclusion, this paper proposes a new kind of brain age—brain pathological age and offers an estimation method for it that can distinguish different states of AD, thereby better reflecting accelerated brain aging. Besides, the brain pathological age is most helpful for feature reduction, thereby simplifying the relevant classification algorithm.
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Affiliation(s)
- Yongming Li
- College of Communication Engineering, Chongqing University, Shapingba District, Chongqing, 400044, China. .,Department of Medical Image, College of Biomedical Engineering, Third Military Medical University, Chongqing, 400038, China. .,Collaborative Innovation Center for Brain Science, Chongqing University, Chongqing, 400044, China.
| | - Yuchuan Liu
- College of Communication Engineering, Chongqing University, Shapingba District, Chongqing, 400044, China
| | - Pin Wang
- College of Communication Engineering, Chongqing University, Shapingba District, Chongqing, 400044, China
| | - Jie Wang
- College of Communication Engineering, Chongqing University, Shapingba District, Chongqing, 400044, China
| | - Sha Xu
- College of Communication Engineering, Chongqing University, Shapingba District, Chongqing, 400044, China
| | - Mingguo Qiu
- Department of Medical Image, College of Biomedical Engineering, Third Military Medical University, Chongqing, 400038, China
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35
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Ribeiro AM, Monteiro S, Pereira AS. Leisure Activities as a Predictor of Cognitive Decline and Dementia in Old Age. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/jss.2017.53023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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36
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Villanueva G, López de Argumedo M, Elizondo I. Consumo de medicamentos para el tratamiento de la demencia en la Comunidad Autónoma Vasca durante el periodo 2006-2011. Neurologia 2016; 31:613-619. [DOI: 10.1016/j.nrl.2014.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 07/01/2014] [Accepted: 09/06/2014] [Indexed: 10/24/2022] Open
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37
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Dementia drug consumption in the Basque Country between 2006 and 2011. NEUROLOGÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.nrleng.2014.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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38
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Li Y, Li F, Wang P, Zhu X, Liu S, Qiu M, Zhang J, Zeng X. Estimating the brain pathological age of Alzheimer's disease patients from MR image data based on the separability distance criterion. Phys Med Biol 2016; 61:7162-7186. [PMID: 27649031 DOI: 10.1088/0031-9155/61/19/7162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Traditional age estimation methods are based on the same idea that uses the real age as the training label. However, these methods ignore that there is a deviation between the real age and the brain age due to accelerated brain aging. This paper considers this deviation and searches for it by maximizing the separability distance value rather than by minimizing the difference between the estimated brain age and the real age. Firstly, set the search range of the deviation as the deviation candidates according to prior knowledge. Secondly, use the support vector regression (SVR) as the age estimation model to minimize the difference between the estimated age and the real age plus deviation rather than the real age itself. Thirdly, design the fitness function based on the separability distance criterion. Fourthly, conduct age estimation on the validation dataset using the trained age estimation model, put the estimated age into the fitness function, and obtain the fitness value of the deviation candidate. Fifthly, repeat the iteration until all the deviation candidates are involved and get the optimal deviation with maximum fitness values. The real age plus the optimal deviation is taken as the brain pathological age. The experimental results showed that the separability was apparently improved. For normal control-Alzheimer's disease (NC-AD), normal control-mild cognition impairment (NC-MCI), and MCI-AD, the average improvements were 0.178 (35.11%), 0.033 (14.47%), and 0.017 (39.53%), respectively. For NC-MCI-AD, the average improvement was 0.2287 (64.22%). The estimated brain pathological age could be not only more helpful to the classification of AD but also more precisely reflect accelerated brain aging. In conclusion, this paper offers a new method for brain age estimation that can distinguish different states of AD and can better reflect the extent of accelerated aging.
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Affiliation(s)
- Yongming Li
- College of Communication Engineering, Chongqing University, Chongqing 400044, People's Republic of China. Department of Medical Image, College of Biomedical Engineering, Third Military Medical University, Chongqing 400038, People's Republic of China
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Tsolaki M, Fountoulakis C, Pavlopoulos I, Chatzi E, Kazis A. Prevalence and incidence of Alzheimers disease and other dementing disorders in Pylea, Greece. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153331759901400308] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We investigated the prevalence and incidence of dementing disorders in the city of Pylea, Greece, using a door-to-door three-phase approach, and explored the relationship between age and gender. From the initial cohort of 704-subjects, 112-subjects (15.9 percent) were excluded because they had moved out of town or could not be traced, 102-subjects (14.4 percent) died before the time of actual contact, and 110-subjects (15.6 percent) refused to be contacted. We were able to visit and examine 380-subjects (54 percent); each of them were administered the MMSE by one of three nurses and the CAMCOG by one of three physicians. We selected January 1, 1993, as the study prevalence day. Using specified diagnostic criteria, NINCDS-ADRDA and DSMIIIR, the study neurologists extensively investigated 118 from 380-subjects, who screened positive on MMSE (MMSE < 23) and CAMCOG (< 65). We found 35-subjects affected by dementia, 20 had Alzheimer's disease (AD), 11 had vascular or mixed dementia and four had secondary dementia (one Parkinson's disease, one Vitamin B12 deficiency, and two had Tumors). The estimated annual incidence rate for all forms of dementia, after correction for ageing of the samples was 57/1,000 persons aged > 70, made up of dementia of Alzheimer type (39.9/1,000), vascular dementia (13.9/1,000) and other forms (3.5/1,000). The prevalence of both dementia and AD increased steeply with advancing age and was consistently higher in women. The incidence of dementia increases with age, even in the oldest age groups and women have a higher risk of developing dementia than men. AD was the most common type of dementia. Our prevalence and incidence figures for dementia and AD are almost similar to those previously reported in Europe, the United States and Canada.
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Affiliation(s)
| | | | | | | | - A. Kazis
- 3rd Department of Neurology, Aristotle University of Thessaloniki, Macedonia, Greece
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Kim H, Jhoo JH, Jang JW. The effect of telemedicine on cognitive decline in patients with dementia. J Telemed Telecare 2016; 23:149-154. [PMID: 26541171 DOI: 10.1177/1357633x15615049] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Telemedicine has the advantage of providing medical resources in rural areas, but few studies have been conducted to investigate its efficacy in dementia care, compared to face-to-face care. This study evaluated the effectiveness of telemedicine in relation to cognitive changes in patients with dementia. Methods We evaluated cognitive changes over time, according to care modality, in 188 patients with dementia who were registered at our university-based dementia clinic. We followed 98 patients using telemedicine services and 90 patients who attended the dementia clinic in person. Patients in the telemedicine group also visited a public health center located in a rural area about 50 km from the dementia clinic. Results Changes in the mean annualized Mini-Mental State Examination (MMSE) score were not significantly different between the telemedicine group and the face-to-face dementia clinic group ( p = 0.291), with changes of 0.60 and 1.03 points, respectively. However, cognitive decline was significantly lower in the telemedicine group for the less severe initial cognitive performance subgroup than more severe cognitive performance subgroup ( p = 0.049), with changes of 0.62 and 1.59 points, respectively. Higher initial Clinical Dementia Rating (CDR) scores, MMSE scores, and age were found to be independent predictive factors of subsequent cognitive changes, as indicated by mean annualized MMSE scores. Discussion These findings suggest that telemedicine may be a useful alternative to face-to-face clinical visits for management of dementia in patients who are located in rural areas.
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Affiliation(s)
- Heeseok Kim
- 1 Department of Psychiatry, Kangwon National University Hospital, Korea
| | - Jin Hyeong Jhoo
- 1 Department of Psychiatry, Kangwon National University Hospital, Korea.,2 Department of Psychiatry, Kangwon National University School of Medicine, Korea
| | - Jae-Won Jang
- 3 Department of Neurology, Kangwon National University Hospital, Korea
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Launay CP, de Decker L, Kabeshova A, Annweiler C, Beauchet O. Risk of Unplanned Emergency Department Readmission after an Acute-Care Hospital Discharge among Geriatric Inpatients: Results from the Geriatric EDEN Cohort Study. J Nutr Health Aging 2016; 20:210-7. [PMID: 26812519 DOI: 10.1007/s12603-015-0624-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The study aims 1) to examine whether items of the brief geriatric assessment (BGA) or their combinations predicted the risk of unplanned emergency department readmission after an acute care hospital discharge among geriatric inpatients, and 2) to determine whether BGA could be used as a prognostic tool for unplanned emergency department readmission. METHODS A total of 312 older patients (mean age, 84.6 ± 5.4 years; 64.1% female) hospitalized in acute care wards after an emergency department visit were recruited in this observational prospective cohort study and separated into 2 groups based on the occurrence or not of an unplanned emergency department readmission during a 12-month follow-up period after their hospital discharge. A 6-item BGA was performed at emergency department admission before the discharge to acute care wards. Information on incident unplanned emergency department readmission was prospectively collected by phone call and by consulting the hospital registry. Several combinations of items of BGA identifying three levels of risk of unplanned emergency department readmission (i.e., low risk, intermediate risk and high risk) were examined. RESULTS The unplanned emergency department readmission was more frequently associated with a temporal disorientation (P=0.004). Area under receiver operating characteristic curves of unplanned emergency department readmission based on BGA items and their combinations ranged from 0.53 to 0.61. The best predictor of unplanned emergency department readmission was the temporal disorientation (hazard ratio>1.65, P<0.035), which defined the high-risk group. Inpatients classified in high-risk group of unplanned emergency department readmission were more frequently readmitted to emergency department than those in intermediate- and low-risk groups (P log Rank <0.004). Prognostic values for unplanned emergency department readmission of items and their combinations were poor with sensitivity below 67%, specificity ranging from 36.4 to 53.7, and positive likelihood ratio below 1.4. CONCLUSIONS The items of BGA and their combinations were significant risk factors for unplanned emergency department readmission, but their prognostic value was poor.
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Affiliation(s)
- C P Launay
- Olivier Beauchet, MD, PhD; Department of Neuroscience, Division of Geriatric Medicine, Angers University Hospital, 49933 Angers cedex 9, France; E-mail: ; Phone: ++33 2 41 35 45 27; Fax: ++33 2 41 35 48 94
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Creavin ST, Wisniewski S, Noel‐Storr AH, Trevelyan CM, Hampton T, Rayment D, Thom VM, Nash KJE, Elhamoui H, Milligan R, Patel AS, Tsivos DV, Wing T, Phillips E, Kellman SM, Shackleton HL, Singleton GF, Neale BE, Watton ME, Cullum S. Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database Syst Rev 2016; 2016:CD011145. [PMID: 26760674 PMCID: PMC8812342 DOI: 10.1002/14651858.cd011145.pub2] [Citation(s) in RCA: 308] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The Mini Mental State Examination (MMSE) is a cognitive test that is commonly used as part of the evaluation for possible dementia. OBJECTIVES To determine the diagnostic accuracy of the Mini-Mental State Examination (MMSE) at various cut points for dementia in people aged 65 years and over in community and primary care settings who had not undergone prior testing for dementia. SEARCH METHODS We searched the specialised register of the Cochrane Dementia and Cognitive Improvement Group, MEDLINE (OvidSP), EMBASE (OvidSP), PsycINFO (OvidSP), LILACS (BIREME), ALOIS, BIOSIS previews (Thomson Reuters Web of Science), and Web of Science Core Collection, including the Science Citation Index and the Conference Proceedings Citation Index (Thomson Reuters Web of Science). We also searched specialised sources of diagnostic test accuracy studies and reviews: MEDION (Universities of Maastricht and Leuven, www.mediondatabase.nl), DARE (Database of Abstracts of Reviews of Effects, via the Cochrane Library), HTA Database (Health Technology Assessment Database, via the Cochrane Library), and ARIF (University of Birmingham, UK, www.arif.bham.ac.uk). We attempted to locate possibly relevant but unpublished data by contacting researchers in this field. We first performed the searches in November 2012 and then fully updated them in May 2014. We did not apply any language or date restrictions to the electronic searches, and we did not use any methodological filters as a method to restrict the search overall. SELECTION CRITERIA We included studies that compared the 11-item (maximum score 30) MMSE test (at any cut point) in people who had not undergone prior testing versus a commonly accepted clinical reference standard for all-cause dementia and subtypes (Alzheimer disease dementia, Lewy body dementia, vascular dementia, frontotemporal dementia). Clinical diagnosis included all-cause (unspecified) dementia, as defined by any version of the Diagnostic and Statistical Manual of Mental Disorders (DSM); International Classification of Diseases (ICD) and the Clinical Dementia Rating. DATA COLLECTION AND ANALYSIS At least three authors screened all citations.Two authors handled data extraction and quality assessment. We performed meta-analysis using the hierarchical summary receiver-operator curves (HSROC) method and the bivariate method. MAIN RESULTS We retrieved 24,310 citations after removal of duplicates. We reviewed the full text of 317 full-text articles and finally included 70 records, referring to 48 studies, in our synthesis. We were able to perform meta-analysis on 28 studies in the community setting (44 articles) and on 6 studies in primary care (8 articles), but we could not extract usable 2 x 2 data for the remaining 14 community studies, which we did not include in the meta-analysis. All of the studies in the community were in asymptomatic people, whereas two of the six studies in primary care were conducted in people who had symptoms of possible dementia. We judged two studies to be at high risk of bias in the patient selection domain, three studies to be at high risk of bias in the index test domain and nine studies to be at high risk of bias regarding flow and timing. We assessed most studies as being applicable to the review question though we had concerns about selection of participants in six studies and target condition in one study.The accuracy of the MMSE for diagnosing dementia was reported at 18 cut points in the community (MMSE score 10, 14-30 inclusive) and 10 cut points in primary care (MMSE score 17-26 inclusive). The total number of participants in studies included in the meta-analyses ranged from 37 to 2727, median 314 (interquartile range (IQR) 160 to 647). In the community, the pooled accuracy at a cut point of 24 (15 studies) was sensitivity 0.85 (95% confidence interval (CI) 0.74 to 0.92), specificity 0.90 (95% CI 0.82 to 0.95); at a cut point of 25 (10 studies), sensitivity 0.87 (95% CI 0.78 to 0.93), specificity 0.82 (95% CI 0.65 to 0.92); and in seven studies that adjusted accuracy estimates for level of education, sensitivity 0.97 (95% CI 0.83 to 1.00), specificity 0.70 (95% CI 0.50 to 0.85). There was insufficient data to evaluate the accuracy of the MMSE for diagnosing dementia subtypes.We could not estimate summary diagnostic accuracy in primary care due to insufficient data. AUTHORS' CONCLUSIONS The MMSE contributes to a diagnosis of dementia in low prevalence settings, but should not be used in isolation to confirm or exclude disease. We recommend that future work evaluates the diagnostic accuracy of tests in the context of the diagnostic pathway experienced by the patient and that investigators report how undergoing the MMSE changes patient-relevant outcomes.
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Affiliation(s)
- Sam T Creavin
- University of BristolSchool of Social and Community MedicineCarynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Susanna Wisniewski
- Cochrane Dementia and Cognitive Improvement Group, Oxford UniversityOxfordUK
| | - Anna H Noel‐Storr
- University of OxfordRadcliffe Department of MedicineRoom 4401c (4th Floor)John Radcliffe Hospital, HeadingtonOxfordUKOX3 9DU
| | - Clare M Trevelyan
- Avon and Wiltshire Mental Health Partnership NHS TrustMedical EducationWoodland View, Brentry LaneBristolUKBS10 6NB
| | - Thomas Hampton
- Frimley Health NHS Foundation TrustENTFrimley Park HospitalPortsmouth RoadFrimley, CamberleySurreyUKGU16 7UJ
| | - Dane Rayment
- Avon and Wiltshire Partnership NHS TrustOlder Adult PsychiatryJenner House, Langley ParkChippenhamWiltshireUKSN15 1GG
| | - Victoria M Thom
- Avon & Wiltshire Mental Health Partnership NHS TrustForensic PsychiatryFromeside, Blackberry Hill HospitalBristolUKBS16 1EG
| | | | - Hosam Elhamoui
- Somerset Partnership NHS TrustPsychiatry91 Comeytrowe LaneTauntonSomersetUKTA1 5QG
| | - Rowena Milligan
- Mansion House SurgeryGeneral PracticeAbbey StreetStoneStaffordshireUKST15 0WA
| | - Anish S Patel
- Avon and Wiltshire Mental Health Partnership NHS TrustNBT Acute Mental Health Liaison TeamDonal Early HouseSouthmead HospitalBristolUKBS10 5NB
| | - Demitra V Tsivos
- North Bristol NHS TrustNeuropsychologySouthmead HospitalBristolUKBS10 5NB
| | - Tracey Wing
- Taunton and Somerset NHS trustCare of Elderly/ITU/A+EBristolUKBS1 3DH
| | - Emma Phillips
- 2gether NHS Foundation TrustCharlton Lane HospitalCheltenhamGloucestershireUKGL53 9DZ
| | - Sophie M Kellman
- Avon and Wiltshire Mental Health Partnership NHS TrustJenner House, Langley ParkChippenhamWiltshireUKSN15 1GG
| | - Hannah L Shackleton
- NHS ScotlandNHS Forth ValleyFalkirk Community Hospital, Majors LoanFalkirkUK
| | | | - Bethany E Neale
- RCGP Severn FacultyGeneral PracticeDeanery HouseBristolUKBA16 1GW
| | | | - Sarah Cullum
- University of BristolSchool of Social and Community MedicineCarynge Hall39 Whatley RoadBristolUKBS8 2PS
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Eisenmenger LB, Huo EJ, Hoffman JM, Minoshima S, Matesan MC, Lewis DH, Lopresti BJ, Mathis CA, Okonkwo DO, Mountz JM. Advances in PET Imaging of Degenerative, Cerebrovascular, and Traumatic Causes of Dementia. Semin Nucl Med 2016; 46:57-87. [DOI: 10.1053/j.semnuclmed.2015.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Lammers F, Mobascher A, Musso F, Shah NJ, Warbrick T, Zaborszky L, Winterer G. Effects of Ncl. Basalis Meynert volume on the Trail-Making-Test are restricted to the left hemisphere. Brain Behav 2016; 6:e00421. [PMID: 27110442 PMCID: PMC4834944 DOI: 10.1002/brb3.421] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/17/2015] [Accepted: 11/03/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cortical acetylcholine released from cells in the basal forebrain facilitates cue detection and improves attentional performance. Cholinergic fibres to the cortex originate from the CH4 cell group, sometimes referred to as the Nucleus basalis of Meynert and the Nucleus subputaminalis of Ayala. The aim of this work was to investigate the effects of volumes of cholinergic nuclei on attention and executive function. METHODS The volumes of CH4 and CH4p subregions were measured in a subgroup of 38 subjects (33.5 ± 11 years, 20 females) from a population-based cohort study of smokers and never-smokers who have undergone additional MR imaging. To define regions of interest, we applied a DARTEL-based procedure implemented in SPM8 and a validated probabilistic map of the basal forebrain. Attention and executive function were measured with Trail-Making Test (TMT A+B) and Stroop-Task. RESULTS We found a quadratic effect of the left CH4 subregion on performance of the TMT. Extremely small as well as extremely large volumes are associated with poor test performance. CONCLUSIONS Our results indicate that a small CH4 volume predisposes for a hypocholinergic state, whereas an extremely large volume predisposes for a hypercholinergic state. Both extremes have detrimental effects on attention. Comparable nonlinear effects have already been reported in pharmacological studies on the effects cholinergic agonists on attention.
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Affiliation(s)
- Florian Lammers
- Department of Anaesthesiology and Surgical Intensive Care Medicine Charité - University Medicine Berlin Berlin Germany
| | - Arian Mobascher
- Department of Psychiatry University Hospital Mainz Mainz Germany
| | - Francesco Musso
- Department of Psychiatry Heinrich-Heine University Düsseldorf Germany
| | - Nadim Jon Shah
- Institute of Neuroscience & Medicine Research Centre Jülich Jülich Germany; Department of Neurology Faculty of Medicine RWTH Aachen University Aachen Germany
| | - Tracy Warbrick
- Institute of Neuroscience & Medicine Research Centre Jülich Jülich Germany
| | - Laszlo Zaborszky
- Centre for Molecular and Behavioral Neuroscience Rutgers The State University of New Jersey Newark New Jersey 07102
| | - Georg Winterer
- Experimental and Clinical Research Centre (ECRC) Charité - University Medicine Berlin Berlin Germany; Pharmaimage Biomarker Solutions GmbH Biotech Park Berlin-Buch Robert-Rössle-Str. 10 13125 Berlin Germany
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Craftman ÅG, Johnell K, Fastbom J, Westerbotn M, von Strauss E. Time trends in 20 years of medication use in older adults: Findings from three elderly cohorts in Stockholm, Sweden. Arch Gerontol Geriatr 2015; 63:28-35. [PMID: 26791168 DOI: 10.1016/j.archger.2015.11.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 11/15/2015] [Accepted: 11/17/2015] [Indexed: 11/28/2022]
Abstract
UNLABELLED New drugs and expanded drug indications are constantly being introduced. Welfare states strive to provide equity in drug treatment for all of its citizens and todaýs healthcare systems spend financial resources on drugs for the elderly in a higher rate than for any other age group. Drug utilization in elderly persons has an impact in health and wellbeing in older people. THE PURPOSE OF THE RESEARCH It was to describe the changes in medication use including people aged 78 years and over regardless of residence and other characteristics over 20 years. MATERIALS AND METHODS The study population consisted of 4304 participants in three population-based cross-sectional surveys conducted in the Kungsholmen area of central Stockholm, Sweden. The participant's current drug utilization was reviewed by physicians following standardized protocols. Data were statistical analyzed. Logistic regression models was used to estimate odds ratios and 95% confidence intervals for use of analgesics and psychotropic drugs in the cohorts of 2001 and 2007, controlling for age, gender, education and cognition. THE PRINCIPAL RESULTS AND MAJOR CONCLUSIONS Results shows that the prevalence of medication use and polypharmacy in older adults has increased dramatically the late 1980s to the 2000s in central Stockholm, Sweden. In particular, the use of analgesics increased significantly, while some drug groups decreased, i.e., antipsychotics. Women used more medication than men in all three cohorts. Older adults living in service buildings used the largest amount of drugs in 1987, whereas those living in institutions were the most frequent users in 2001 and 2007.
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Affiliation(s)
- Åsa Gransjön Craftman
- Sophiahemmet University, Aging Research Center (ARC), Karolinska Institutet, Box 5605, SE-114 86 Stockholm, Sweden.
| | - Kristina Johnell
- Aging Research Center (ARC), Karolinska Institutet, Gävlegatan 16, SE-113 30 Stockholm, Sweden.
| | - Johan Fastbom
- Aging Research Center (ARC), Karolinska Institutet, Gävlegatan 16, SE-113 30 Stockholm, Sweden.
| | - Margareta Westerbotn
- Department of Research, Education, Development and Innovation, Education Center, SÖS.
| | - Eva von Strauss
- Aging Research Center (ARC), Karolinska Institutet, The Swedish Red Cross University College, Teknikringen 1, SE-114 28 Stockholm, Sweden.
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A change in sleep pattern may predict Alzheimer disease. Am J Geriatr Psychiatry 2014; 22:1262-71. [PMID: 23954041 DOI: 10.1016/j.jagp.2013.04.015] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 04/21/2013] [Accepted: 04/22/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Sleep problems may adversely affect neuronal health. We examined a subjective report of change (reduced duration and/or depth) in sleep pattern in relation to subsequent risk of incident all-cause dementia and Alzheimer disease (AD) over 9 years. METHODS This longitudinal study used data from a population-based sample of 214 Swedish adults aged 75 and over who were dementia-free both at baseline and at first follow-up (3 years later). The sample was 80% female and, on average, 83.4 years of age at baseline. All participants underwent a thorough clinical examination to ascertain all-cause dementia and AD. RESULTS Forty percent of participants reported a change in sleep duration at baseline. Between the 6th and 9th year after baseline, 28.5% were diagnosed with all-cause dementia, 22.0% of whom had AD. Reduced sleep was associated with a 75% increased all-cause dementia risk (hazard ratio: 1.75; 95% confidence interval: 1.04-2.93; Wald = 4.55, df = 1, p = 0.035) and double the risk of AD (hazard ratio: 2.01; 95% confidence interval: 1.12-3.61; Wald = 5.47, df = 1, p = 0.019) after adjusting for age, gender, and education. The results remained after adjusting for lifestyle and vascular factors but not after adjusting for depressive symptoms. No evidence supported a moderating effect of the use of sleeping pills, and the sleep-dementia relationship remained after controlling for the presence of the apolipoprotein E ε4 allele. CONCLUSION Self-reported sleep problems may increase the risk for dementia, and depressive symptoms may explain this relationship. Future research should determine whether treatment, in particular, behavioral or nonpharmacologic treatment, may represent one avenue toward reduction of dementia risk in late life.
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Cermakova P, Fereshtehnejad SM, Johnell K, Winblad B, Eriksdotter M, Religa D. Cardiovascular medication burden in dementia disorders: a nationwide study of 19,743 dementia patients in the Swedish Dementia Registry. ALZHEIMERS RESEARCH & THERAPY 2014; 6:34. [PMID: 25024749 PMCID: PMC4095690 DOI: 10.1186/alzrt264] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 06/03/2014] [Indexed: 12/29/2022]
Abstract
Introduction Administration of several cardiovascular drugs has an effect on dementia. We aimed to investigate whether there are differences in the use of cardiovascular medication between different dementia disorders. Methods We obtained information about dementia patients from the Swedish Dementia Registry. Patients were diagnosed with one of these dementia disorders: Alzheimer’s disease (n = 8,139), mixed dementia (n = 5,203), vascular dementia (n = 4,982), Lewy body dementia (n = 605), frontotemporal dementia (n = 409) and Parkinson’s disease dementia (n = 405). Multivariate logistic regression analysis was performed to investigate the association between use of cardiovascular medication and dementia disorders, after adjustment for age, gender, living alone, cognitive status and total number of drugs (a proxy for overall co-morbidity). Results Seventy percent of all the dementia patients used cardiovascular medication. Use of cardiovascular drugs is common in patients with vascular and mixed dementia. Male gender, higher age, slightly better cognitive status and living with another person was associated with use of cardiovascular medication. Conclusions Cardiovascular medication is used extensively across dementia disorders and particularly in vascular and mixed dementia. Future research should investigate the tolerability and effectiveness of these drugs in the different dementia disorders.
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Affiliation(s)
- Pavla Cermakova
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Karolinska Institutet, 141 57 Huddinge, Sweden ; International Clinical Research Center and St.Anne's University Hospital, Pekařská 53, 656 91 Brno, Czech Republic
| | - Seyed-Mohammad Fereshtehnejad
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, 141 57 Huddinge, Sweden
| | - Kristina Johnell
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Aging Research Center, Karolinska Institutet and Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden
| | - Bengt Winblad
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Karolinska Institutet, 141 57 Huddinge, Sweden ; Department of Geriatric Medicine, Karolinska University Hospital, 141 86 Huddinge, Sweden
| | - Maria Eriksdotter
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, 141 57 Huddinge, Sweden ; Department of Geriatric Medicine, Karolinska University Hospital, 141 86 Huddinge, Sweden
| | - Dorota Religa
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Karolinska Institutet, 141 57 Huddinge, Sweden ; Department of Geriatric Medicine, Karolinska University Hospital, 141 86 Huddinge, Sweden
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Chang KH, Chung CJ, Lin CL, Sung FC, Wu TN, Kao CH. Increased risk of dementia in patients with osteoporosis: a population-based retrospective cohort analysis. AGE (DORDRECHT, NETHERLANDS) 2014; 36:967-75. [PMID: 24347180 PMCID: PMC4039265 DOI: 10.1007/s11357-013-9608-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 12/03/2013] [Indexed: 06/03/2023]
Abstract
Osteoporosis is a common systemic skeletal disease that predominantly affects people older than 50 years and often co-occurs with dementia. The purpose of this study was to evaluate the risk of dementia in osteoporosis patients in Taiwan. Using data from Taiwan's National Health Insurance Research Database (NHIRD), we identified 23,941 patients with osteoporosis from 2000 to 2010 and 47,579 nonosteoporosis control patients, frequency-matched for age, sex, and index year, excluding patients with dementia at the baseline. We conducted univariate and multiple Cox proportional-hazards regression analyses to calculate the hazard ratios (HRs) and 95 % confidence intervals (CIs) of the association between osteoporosis and risk of dementia. After adjustment for potential risk factors, the osteoporosis patients exhibited 1.46-fold and 1.39-fold higher risk of dementia (95 % CI = 1.37-1.56) and Alzheimer's disease (95 % CI = 0.95-2.02), respectively, compared with the matched nonosteoporosis patients. We observed increased risk of dementia in both men and women with osteoporosis. The osteoporosis patients receiving bisphosphonate treatment or estrogen supplementation were associated with significantly lower risk of dementia compared with the osteoporosis patients who did not receive any treatment. Overall, our results suggest higher risks of dementia in osteoporosis patients than in nonosteoporosis patients. Osteoporosis could thus be considered an early risk factor for dementia. Future large-scale double-blind randomized clinical trials are required to clarify the role of medication in osteoporosis-related dementia.
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Affiliation(s)
- Kuang-Hsi Chang
- />Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- />Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chi-Jung Chung
- />Department of Medical Research, China Medical University and Hospital, Taichung, Taiwan
- />Department of Health Risk Management, College of Public Health, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- />Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- />Department of Public Health, China Medical University, Taichung, Taiwan
| | - Trong-Neng Wu
- />Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- />Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- />Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Number 2, Yuh-Der Road, Taichung, 40447 Taiwan
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Iyer GK, Alladi S, Bak TH, Shailaja M, Mamidipudi A, Rajan A, Gollahalli D, Chaudhuri JR, Kaul S. Dementia in developing countries: Does education play the same role in India as in the West? Dement Neuropsychol 2014; 8:132-140. [PMID: 29213894 PMCID: PMC5619120 DOI: 10.1590/s1980-57642014dn82000008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 05/20/2014] [Indexed: 11/21/2022] Open
Abstract
Evidence suggests that education protects from dementia by enhancing cognitive reserve. However, this may be influenced by several socio-demographic factors. Rising numbers of dementia in India, high levels of illiteracy and heterogeneity in socio-demographic factors provide an opportunity to explore this relationship. OBJECTIVE To study the association between education and age at dementia onset, in relation to socio-demographic factors. METHODS Association between age at dementia onset and literacy was studied in relationship to potential confounding factors such as gender, bilingualism, place of dwelling, occupation, vascular risk factors, stroke, family history of dementia and dementia subtypes. RESULTS Case records of 648 dementia patients diagnosed in a specialist clinic in a University hospital in Hyderabad, India were examined. All patients were prospectively enrolled as part of an ongoing longitudinal project that aims to evaluate dementia subjects with detailed clinical, etiological, imaging, and follow-up studies. Of the 648 patients, 98 (15.1%) were illiterate. More than half of illiterate skilled workers were engaged in crafts and skilled agriculture unlike literates who were in trade or clerical jobs. Mean age at onset in illiterates was 60.1 years and in literates 64.5 years (p=0.0002). Factors independently associated with age at dementia onset were bilingualism, rural dwelling and stroke, but not education. CONCLUSION Our study demonstrates that in India, rural dwelling, bilingualism, stroke and occupation modify the relationship between education and dementia.
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Affiliation(s)
- Gowri K. Iyer
- Department of Neurology, Nizam’s Institute of Medical
Sciences, Hyderabad, India
| | - Suvarna Alladi
- Department of Neurology, Nizam’s Institute of Medical
Sciences, Hyderabad, India
| | - Thomas H. Bak
- Department of Psychology, Centre for Cognitive Aging and
Cognitive Epidemiology (CCACE) and Centre for Clinical Brain Sciences (CCBS),
University of Edinburgh
| | - Mekala Shailaja
- Department of Neurology, Nizam’s Institute of Medical
Sciences, Hyderabad, India
| | - Annapurna Mamidipudi
- Department of Science, Technology and Society studies,
Maastricht University, Netherlands
| | - Amulya Rajan
- Department of Neurology, Nizam’s Institute of Medical
Sciences, Hyderabad, India
| | - Divyaraj Gollahalli
- Department of Neurology, Nizam’s Institute of Medical
Sciences, Hyderabad, India
| | | | - Subhash Kaul
- Department of Neurology, Nizam’s Institute of Medical
Sciences, Hyderabad, India
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50
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Prasher VP. PSYCHOTIC FEATURES AND EFFECT OF SEVERITY OF LEARNING DISABILITY ON DEMENTIA IN ADULTS WITH DOWN SYNDROME: REVIEW OF LITERATURE. ACTA ACUST UNITED AC 2014. [DOI: 10.1179/bjdd.1997.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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