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Georgiopoulos C, Papadimitriou S, Nyholm D, Kilander L, Löwenmark M, Fällmar D, Virhammar J. Quantitative brain stem assessment in discriminating neurodegenerative disorders from normal pressure hydrocephalus. J Neuroimaging 2024. [PMID: 38676300 DOI: 10.1111/jon.13204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND AND PURPOSE Differentiating idiopathic normal pressure hydrocephalus (iNPH) from neurodegenerative disorders such as progressive supranuclear palsy (PSP), Multiple System Atrophy-parkinsonian type (MSA-P), and vascular dementia (VaD) is challenging due to overlapping clinical and neuroimaging findings. This study assesses if quantitative brain stem and cerebellum metrics can aid in this differentiation. METHODS We retrospectively compared the sagittal midbrain area, midbrain to pons ratio, MR parkinsonism index (MRPI), and cerebellar atrophy in 30 PSP patients, 31 iNPH patients, 27 MSA-P patients, 32 VaD patients, and 25 healthy controls. Statistical analyses determined group differences, sensitivity, specificity, and the area under the receiver operating characteristic curves. RESULTS There was an overlap in midbrain morphology between PSP and iNPH, as assessed with MRPI, midbrain to pons ratio, and midbrain area. A cutoff value of MRPI > 13 exhibited 84% specificity in distinguishing PSP from iNPH and 100% in discriminating PSP from all other conditions. A cutoff value of midbrain to pons ratio at <0.15 yielded 95% specificity for differentiating PSP from iNPH and 100% from all other conditions. A cutoff value of midbrain area at <87 mm2 exhibited 97% specificity for differentiating PSP from iNPH and 100% from all other conditions. All measures showed low sensitivity. Cerebellar atrophy did not differ significantly among groups. CONCLUSION Our study questions MRPI's diagnostic performance in distinguishing PSP from iNPH. Simpler indices such as midbrain to pons ratio and midbrain area showed similar or better accuracy. However, all these indices displayed low sensitivity despite significant differences among PSP, MSA-P, and VaD.
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Affiliation(s)
| | | | - Dag Nyholm
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - Malin Löwenmark
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - David Fällmar
- Department of Surgical Sciences, Neuroradiology, Uppsala University, Uppsala, Sweden
| | - Johan Virhammar
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
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2
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Clancy U, Kancheva AK, Valdés Hernández MDC, Jochems ACC, Muñoz Maniega S, Quinn TJ, Wardlaw JM. Imaging Biomarkers of VCI: A Focused Update. Stroke 2024; 55:791-800. [PMID: 38445496 DOI: 10.1161/strokeaha.123.044171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Vascular cognitive impairment is common after stroke, in memory clinics, medicine for the elderly services, and undiagnosed in the community. Vascular disease is said to be the second most common cause of dementia after Alzheimer disease, yet vascular dysfunction is now known to predate cognitive decline in Alzheimer disease, and most dementias at older ages are mixed. Neuroimaging has a major role in identifying the proportion of vascular versus other likely pathologies in patients with cognitive impairment. Here, we aim to provide a pragmatic but evidence-based summary of the current state of potential imaging biomarkers, focusing on magnetic resonance imaging and computed tomography, which are relevant to diagnosing, estimating prognosis, monitoring vascular cognitive impairment, and incorporating our own experiences. We focus on markers that are well-established, with a known profile of association with cognitive measures, but also consider more recently described, including quantitative tissue markers of vascular injury. We highlight the gaps in accessibility and translation to more routine clinical practice.
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Affiliation(s)
- Una Clancy
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.)
| | - Angelina K Kancheva
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom (A.K.K., T.J.Q.)
| | - Maria Del C Valdés Hernández
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.)
| | - Angela C C Jochems
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.)
| | - Susana Muñoz Maniega
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.)
| | - Terence J Quinn
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom (A.K.K., T.J.Q.)
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.)
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Tseng PH, Huang WT, Wang JH, Huang BR, Huang HY, Tsai ST. Cerebrospinal fluid shunt surgery reduces the risk of developing dementia and Alzheimer's disease in patients with idiopathic normal pressure hydrocephalus: a nationwide population-based propensity-weighted cohort study. Fluids Barriers CNS 2024; 21:16. [PMID: 38355601 PMCID: PMC10868070 DOI: 10.1186/s12987-024-00517-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/26/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Patients with idiopathic normal-pressure hydrocephalus (iNPH) are predisposed to developing dementing disorders. Cerebrospinal fluid (CSF) shunt implantation is a treatment used to improve the motor and cognitive disabilities of these patients; however, its effect on the risk of developing dementing disorders remains unclear. We conducted a population-based propensity-weighted cohort study to investigate whether CSF shunt surgery may reduce the risk of subsequently developing dementia, Alzheimer's disease (AD), and vascular dementia in iNPH patients. METHODS Patients aged ≥ 60 years who were diagnosed with iNPH (n = 2053) between January 2001 and June 2018 were identified from the Taiwan National Health Insurance Research Database. Various demographic characteristics (age, sex, and monthly income) and clinical data (incidence year, comorbidities, and Charlson comorbidity index) were collected and divided into the shunt surgery group (SSG) and the non-shunt surgery group (NSSG). Stabilized inverse probability of treatment weighting by using the propensity score was performed to achieve a balanced distribution of confounders across the two study groups. The cumulative incidence rate and risk of dementing disorders were estimated during a 16-year follow-up period. RESULTS After weighting, the data of 375.0 patients in SSG and 1677.4 patients in NSSG were analyzed. Kaplan-Meier curve analysis indicated that the cumulative incidence rate of AD (p = 0.009), but not dementia (p = 0.241) and vascular dementia (p = 0.761), in SSG was significantly lower than that in NSSG over the 16-year follow-up period. Cox proportional hazards regression analysis revealed that SSG had a reduced hazard ratio (HR) for developing AD [HR (95% CI) 0.17 (0.04-0.69)], but not for dementia [HR (95% CI) 0.83 (0.61-1.12)] and vascular dementia [HR (95% CI) 1.18 (0.44-3.16)], compared with NSSG. Further Fine-Gray hazard regression analysis with death as a competing event demonstrated that SSG had a reduced subdistribution HR (sHR) for developing dementia [sHR (95% CI) 0.74 (0.55-0.99)] and AD [sHR (95% CI) 0.15 (0.04-0.61)], but not for vascular dementia [sHR (95% CI) 1.07 (0.40-2.86)]. CONCLUSION CSF shunt surgery is associated with reduced risks of the subsequent development of dementia and AD in iNPH patients. Our findings may provide valuable information for assessing the benefit-to-risk profile of CSF shunt surgery.
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Affiliation(s)
- Pao-Hui Tseng
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970, Taiwan
- Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, 970, Taiwan
| | - Wan-Ting Huang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Sec 3, Zhongyang Road, Hualien, 970, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Sec 3, Zhongyang Road, Hualien, 970, Taiwan
| | - Bor-Ren Huang
- Department of Neurosurgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, 427, Taiwan
- School of Medicine, Tzu Chi University, Hualien, 970, Taiwan
| | - Hsin-Yi Huang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Sec 3, Zhongyang Road, Hualien, 970, Taiwan.
| | - Sheng-Tzung Tsai
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970, Taiwan.
- Institute of Medical Sciences, Tzu Chi University, Hualien, 970, Taiwan.
- School of Medicine, Tzu Chi University, Hualien, 970, Taiwan.
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Sultana M, Camicioli R, Dixon RA, Whitehead S, Pieruccini-Faria F, Petrotchenko E, Speechley M, Borchers CH, Montero-Odasso M. A Metabolomics Analysis of a Novel Phenotype of Older Adults at Higher Risk of Dementia. J Alzheimers Dis 2024; 99:S317-S325. [PMID: 37781807 DOI: 10.3233/jad-230683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Background Older adults presenting with dual-decline in cognition and walking speed face a 6-fold higher risk for dementia compared with those showing no decline. We hypothesized that the metabolomics profile of dual-decliners would be unique even before they show signs of decline in cognition and gait speed. Objective The objective of this study was to determine if plasma metabolomics signatures can discriminate dual-decliners from no decliners, purely cognitive decliners, and purely motor decliners prior to decline. Methods A retrospective cross-sectional study using baseline plasma for untargeted metabolomics analyses to investigate early signals of later dual-decline status in study participants (n = 76) with convenient sampling. Dual-decline was operationalized as decline in gait speed (>10 cm/s) and cognition (>2 points decline in Montreal Cognitive Assessment score) on at least two consecutive 6-monthly assessments. The participants' decliner status was evaluated 3 years after the blood sample was collected. Pair-wise comparison of detected compounds was completed using principal components and hierarchical clustering analyses. Results Analyses did not detect any cluster separation in untargeted metabolomes across baseline groups. However, follow-up analyses of specific molecules detected 4 compounds (17-Hydroxy-12-(hydroxymethyl)-10-oxo-8 oxapentacyclomethyl hexopyranoside, Fleroxacin, Oleic acid, and 5xi-11,12-Dihydroxyabieta-8(14),9(11),12-trien-20-oic acid) were at significantly higher concentration among the dual-decliners compared to non-decliners. The pure cognitive decliner group had significantly lower concentration of six compounds (1,3-nonanediol acetate, 4-(2-carboxyethyl)-2-methoxyphenyl beta-D-glucopyranosiduronic acid, oleic acid, 2E-3-[4-(sulfo-oxy)phenyl] acrylic acid, palmitelaidic acid, and myristoleic acid) compared to the non-decliner group. Conclusions The unique metabolomics profile of dual-decliners warrants follow-up metabolomics analysis. Results may point to modifiable pathways.
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Affiliation(s)
| | | | - Roger A Dixon
- Psychology Science, University of Alberta, Edmonton, AB, Canada
| | - Shawn Whitehead
- Department of Anatomy and Cell Biology, Western University, London, ON, Canada
| | | | | | - Mark Speechley
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | | | - Manuel Montero-Odasso
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Department of Medicine, Western University, London, ON, Canada
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Xiang LS, Zhang Y, Xie F, Fei X, Wang Y, Shi Y. Reliability and validity of the Cognitive Assessment for Stroke Patients (Chinese version) for patients with nonaphasic stroke. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-7. [PMID: 38104350 DOI: 10.1080/23279095.2023.2292236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
This study aimed to preliminarily explore the reliability and validity of the Chinese version of the Cognitive Assessment for Stroke Patients (CASP) in patients with nonaphasic stroke and provide a reliable basis for its clinical application in China. The original French version of the CASP was translated into Mandarin Chinese. The study enrolled 58 patients in the neurological center. Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and CASP were used to evaluate cognitive function. Content validity, structural validity, and concurrent validity, internal consistency, interrater consistency, and retesting reliability were used to evaluate the results. The Spearman correlation coefficient of each item and the total CASP score was between 0.320 and 0.905 (p < .05), showing good content validity. Two initial factors were extracted using principal component analysis and the orthogonal rotation method, with a cumulative contribution rate of 70.100%. Except for the subitem reproducing a copy of a cube, the factor loading of all subitems was >0.5, indicating good construct validity. The total CASP score significantly correlated with the total MMSE (r = 0.796, p < .001) and total MoCA (r = 0.816, p < .001) scores, indicating good concurrent validity. Cronbach's α of the CASP was 0.812, showing good internal consistency. The interrater consistency (ICC > 0.85) and retesting reliability (ICC = 0.7-0.951) were good. The Chinese version of the CASP has good reliability and validity and can play a good auxiliary role in evaluating cognitive dysfunction in patients with stroke.
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Affiliation(s)
- Li-Sha Xiang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
- Department of Rehabilitation Medicine, School of Clinical Medicine, Soochow University, Soochow, China
| | - Yi Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Fan Xie
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xiao Fei
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ya Wang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yue Shi
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
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Hosoki S, Hansra GK, Jayasena T, Poljak A, Mather KA, Catts VS, Rust R, Sagare A, Kovacic JC, Brodtmann A, Wallin A, Zlokovic BV, Ihara M, Sachdev PS. Molecular biomarkers for vascular cognitive impairment and dementia. Nat Rev Neurol 2023; 19:737-753. [PMID: 37957261 DOI: 10.1038/s41582-023-00884-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/15/2023]
Abstract
As disease-specific interventions for dementia are being developed, the ability to identify the underlying pathology and dementia subtypes is increasingly important. Vascular cognitive impairment and dementia (VCID) is the second most common cause of dementia after Alzheimer disease, but progress in identifying molecular biomarkers for accurate diagnosis of VCID has been relatively limited. In this Review, we examine the roles of large and small vessel disease in VCID, considering the underlying pathophysiological processes that lead to vascular brain injury, including atherosclerosis, arteriolosclerosis, ischaemic injury, haemorrhage, hypoperfusion, endothelial dysfunction, blood-brain barrier breakdown, inflammation, oxidative stress, hypoxia, and neuronal and glial degeneration. We consider the key molecules in these processes, including proteins and peptides, metabolites, lipids and circulating RNA, and consider their potential as molecular biomarkers alone and in combination. We also discuss the challenges in translating the promise of these biomarkers into clinical application.
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Affiliation(s)
- Satoshi Hosoki
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Gurpreet K Hansra
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Tharusha Jayasena
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Anne Poljak
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Bioanalytical Mass Spectrometry Facility, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, NSW, Australia
| | - Karen A Mather
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Vibeke S Catts
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Ruslan Rust
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Abhay Sagare
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jason C Kovacic
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, NY, USA
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Amy Brodtmann
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Anders Wallin
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Berislav V Zlokovic
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
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Yoo MJ, Kang M, Tsoukra P, Chen Z, Farrand S, Kelso W, Evans A, Eratne D, Walterfang M, Velakoulis D, Loi SM. Comparing survival and mortality in patients with late-onset and young-onset vascular dementia. Int Psychogeriatr 2023; 35:519-527. [PMID: 37052303 DOI: 10.1017/s1041610223000248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVES Vascular dementia (VD) is one of the more common types of dementia. Much is known about VD in older adults in terms of survival and associated risk factors, but comparatively less is known about VD in a younger population. This study aimed to investigate survival in people with young-onset VD (YO-VD) compared to those with late-onset VD (LO-VD) and to investigate predictors of mortality. DESIGN Retrospective file review from 1992 to 2014. SETTING The inpatient unit of a tertiary neuropsychiatry service in Victoria, Australia. PARTICIPANTS Inpatients with a diagnosis of VD. MEASUREMENTS AND METHODS Mortality information was obtained from the Australian Institute of Health and Welfare. Clinical variables included age of onset, sex, vascular risk factors, structural neuroimaging, and Hachinksi scores. Statistical analyses used were Kaplan-Meier curves for median survival and Cox regression for predictors of mortality. RESULTS Eighty-four participants were included with few clinical differences between the LO-VD and YO-VD groups. Sixty-eight (81%) had died. Median survival was 9.9 years (95% confidence interval 7.9, 11.7), with those with LO-VD having significantly shorter survival compared to those with YO-VD (6.1 years and 12.8 years, respectively) and proportionally more with LO-VD had died (94.6%) compared to those with YO-VD (67.5%), χ2(1) = 9.16, p = 0.002. The only significant predictor of mortality was increasing age (p = 0.001). CONCLUSION While there were few clinical differences, and older age was the only factor associated with survival, further research into the effects of managing cardiovascular risk factors and their impact on survival are recommended.
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Affiliation(s)
- M J Yoo
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Matthew Kang
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne and Melbourne Health, Parkville, VIC, Australia
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, VIC, Australia
| | | | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Sarah Farrand
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Wendy Kelso
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Andrew Evans
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Dhamidhu Eratne
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne and Melbourne Health, Parkville, VIC, Australia
| | - Mark Walterfang
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne and Melbourne Health, Parkville, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne and Melbourne Health, Parkville, VIC, Australia
| | - Samantha M Loi
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne and Melbourne Health, Parkville, VIC, Australia
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Yang X, Chen C, Wang A, Li C, Cheng G. Imaging, Genetic, and Pathological Features of Vascular Dementia. Eur Neurol 2023; 86:277-284. [PMID: 37271126 DOI: 10.1159/000531088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/14/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Over the past decades, marked progress has been made in detecting vascular dementia (VD) both through maturation of diagnostic concepts and advances in brain imaging, especially MRI. We summarized the imaging, genetic, and pathological features of VD in this review. SUMMARY It is a challenge for the diagnosis and treatment of VD, particularly in patients where there is no evident temporal relation between cerebrovascular events and cognitive dysfunction. In patients with cognitive dysfunction with poststroke onset, the etiological classification is still complicated. KEY MESSAGES In this review, we summarized the clinical, imaging, and genetic as well as pathological features of VD. We hope to offer a framework to translate diagnostic criteria to daily practice, address treatment, and highlight some future perspectives.
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Affiliation(s)
- Xiaoni Yang
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Chao Chen
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Aishuai Wang
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Changsheng Li
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Guangqing Cheng
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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Prajjwal P, Marsool MDM, Inban P, Sharma B, Asharaf S, Aleti S, Gadam S, Al Sakini AS, Hadi DD. Vascular dementia subtypes, pathophysiology, genetics, neuroimaging, biomarkers, and treatment updates along with its association with Alzheimer's dementia and diabetes mellitus. Dis Mon 2023; 69:101557. [PMID: 37031059 DOI: 10.1016/j.disamonth.2023.101557] [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: 04/10/2023]
Abstract
Dementia is a chronic progressive cognitive decline illness that results in functional impairment. Vascular dementia (VaD), second only to Alzheimer's disease (AD), is one of the most prevalent forms of dementia in the elderly (aged over 65 years), with a varied presentation and unpredictable disease development caused by cerebrovascular or cardiovascular illness. To get a better understanding of the changes occurring in the brain and to drive therapy efforts, new biomarkers for early and precise diagnosis of AD and VaD are required. In this review, Firstly, we describe the subtypes of vascular dementia, their clinical features, pathogenesis, genetics implemented, and their associated neuroimaging and biomarkers, while describing extensively the recent biomarkers discovered in the literature. Secondly, we describe some of the well-documented and other less-defined risk factors and their association and pathophysiology in relation to vascular dementia. Finally, we follow recent updates in the management of vascular dementia along with its association and differentiation from Alzheimer's disease. The aim of this review is to gather the scattered updates and the most recent changes in blood, CSF, and neuroimaging biomarkers related to the multiple subtypes of vascular dementia along with its association with Alzheimer's dementia and diabetes mellitus.
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Affiliation(s)
| | | | - Pugazhendi Inban
- Internal Medicine, Government Medical College, Omandurar, Chennai, India
| | | | - Shahnaz Asharaf
- Internal Medicine, Travancore Medical College, Kollam, Kerala, India
| | - Soumya Aleti
- PGY-2, Internal Medicine, Berkshire Medical Center, Pittsfield, MA, USA
| | - Srikanth Gadam
- Internal Medicine, Postdoctoral Research Fellow, Mayo Clinic, USA
| | | | - Dalia Dhia Hadi
- University of Baghdad, Al-Kindy College of Medicine, Baghdad, Iraq
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10
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Lindvall E, Franzon K, Lundström E, Kilander L. The impact of stroke on the ability to live an independent life at old age: a community-based cohort study of Swedish men. BMC Geriatr 2023; 23:126. [PMID: 36879184 PMCID: PMC9990268 DOI: 10.1186/s12877-023-03817-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 02/10/2023] [Indexed: 03/08/2023] Open
Abstract
INTRODUCTION Few studies with controls from the same cohort have investigated the impact of stroke on the ability to live an independent life at old age. We aimed to analyze how great an impact being a stroke survivor would have on cognition and disability. We also analyzed the predictive value of baseline cardiovascular risk factors. METHODS We included 1147 men, free from stroke, dementia, and disability, from the Uppsala Longitudinal Study of Adult Men, between 69-74 years of age. Follow-up data were collected between the ages of 85-89 years and were available for 481 of all 509 survivors. Data on stroke diagnosis were obtained through national registries. Dementia was diagnosed through a systematic review of medical charts and in accordance with the current diagnostic criteria. The primary outcome, preserved functions, was a composite outcome comprising four criteria: no dementia, independent in personal activities of daily living, ability to walk outside unassisted, and not living in an institution. RESULTS Among 481 survivors with outcome data, 64 (13%) suffered a stroke during the follow-up. Only 31% of stroke cases, compared to 72% of non-stroke cases (adjusted OR 0.20 [95% CI 0.11-0.37]), had preserved functions. The chance of being free of dementia was 60% lower in the stroke group, OR 0.40 [95% CI 0.22-0.72]. No cardiovascular risk factors were independently able to predict preserved functions among stroke cases. CONCLUSION Stroke has long lasting consequences for many aspects of disability at very high age.
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Affiliation(s)
- Elias Lindvall
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala Academic Hospital, Neurological Reception, Sjukhusvägen, 75185, Uppsala, Sweden.
| | - Kristin Franzon
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - Erik Lundström
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala Academic Hospital, Neurological Reception, Sjukhusvägen, 75185, Uppsala, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
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11
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Biesbroek JM, Biessels GJ. Diagnosing vascular cognitive impairment: Current challenges and future perspectives. Int J Stroke 2023; 18:36-43. [PMID: 35098817 PMCID: PMC9806474 DOI: 10.1177/17474930211073387] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Cerebrovascular disease is a major cause of cognitive decline and dementia. This is referred to as vascular cognitive impairment (VCI). Diagnosing VCI is important, among others to optimize treatment to prevent further vascular injury. This narrative review addresses challenges in current diagnostic approaches to VCI and potential future developments. First we summarize how diagnostic criteria for VCI evolved over time. We then highlight challenges in diagnosing VCI in clinical practice: assessment of severity of vascular brain injury on brain imaging is often imprecise and the relation between vascular lesion burden and cognitive functioning shows high intersubject variability. This can make it difficult to establish causality in individual patients. Moreover, because VCI is essentially an umbrella term, it lacks specificity on disease mechanisms, prognosis, and treatment. We see the need for a fundamentally different approach to diagnosing VCI, which should be more dimensional, including multimodal quantitative assessment of injury, with more accurate estimation of cognitive impact, and include biological definitions of disease that can support further development of targeted treatment. Recent developments in the field that can form the basis of such an approach are discussed.
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Affiliation(s)
- J Matthijs Biesbroek
- Department of Neurology, UMC Utrecht
Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands,Department of Neurology,
Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht
Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands,Geert Jan Biessels, Department of
Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, G03.232,
PO Box 85500, 3508 GA Utrecht, The Netherlands.
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12
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Lee LH, Wu SC, Ho CF, Liang WL, Liu YC, Chou CJ. White matter hyperintensities in cholinergic pathways may predict poorer responsiveness to acetylcholinesterase inhibitor treatment for Alzheimer's disease. PLoS One 2023; 18:e0283790. [PMID: 37000849 PMCID: PMC10065432 DOI: 10.1371/journal.pone.0283790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/19/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Acetylcholinesterase inhibitor (AChEI) drug regimens are the mainstay treatment options for patients with Alzheimer's disease (AD). Herein, We examined the association between clinical response to AChEI and white matter hyperintensities on magnetic resonance imaging (MRI) scan at baseline. METHODS Between 2020 and 2021, we recruited 101 individuals with a clinical diagnosis of probable AD. Each participant underwent complete neuropsychological testing and 3T (Telsa) brain magnetic resonance imaging. Responsiveness to AChEI, as assessed after 12 months, was designated as less than two points of regression in Mini-Mental State Examination scores (MMSE) and stable clinical dementia rating scale. We also evaluated MRI images by examining scores on the Cholinergic Pathways Hyperintensities Scale (CHIPS), Fazekas scale, and medial temporal atrophy (MTA) scale. RESULTS In our cohort, 52 patients (51.4%) were classified as responders. We observed significantly higher CHIPS scores in the nonresponder group (21.1 ± 12.9 vs. 14.9 ± 9.2, P = 0.007). Age at baseline, education level, sex, Clinical Dementia Rating sum of boxes scores, and three neuroimaging parameters were tested in regression models. Only CHIPS scores predicted clinical response to AChEI treatment. CONCLUSION WMHs in the cholinergic pathways, not diffuse white matter lesions or hippocampal atrophy, correlated with poorer responsiveness to AChEI treatment. Therefore, further investigation into the role of the cholinergic pathway in AD is warranted.
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Affiliation(s)
- Li-Hua Lee
- Department of Neurology, Cardinal Tien Hospital, New Taipei City, Taipei, Taiwan
| | - Shu-Ching Wu
- Department of Neurology, Cardinal Tien Hospital, New Taipei City, Taipei, Taiwan
| | - Cheng-Feng Ho
- Department of Radiology, Cardinal Tien Hospital, New Taipei City, Taipei, Taiwan
| | - Wan-Lin Liang
- Department of Medical Research, Far Eastern Hospital, New Taipei City, Taipei, Taiwan
| | - Yi-Chien Liu
- Department of Neurology, Cardinal Tien Hospital, New Taipei City, Taipei, Taiwan
- Department of Education and Research, Medical school of Fu-Jen University, New Taipei City, Taipei, Taiwan
- Geriatric Behavioral Neurology Project, Tohoku University New Industry Hatchery Center (NICHe), Sendai, Japan
- * E-mail:
| | - Chia-Ju Chou
- Department of Neurology, Cardinal Tien Hospital, New Taipei City, Taipei, Taiwan
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13
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Stephan BCM, Gaughan DM, Edland S, Gudnason V, Launer LJ, White LR. Mid- and later-life risk factors for predicting neuropathological brain changes associated with Alzheimer's and vascular dementia: The Honolulu Asia Aging Study and the Age, Gene/Environment Susceptibility-Reykjavik Study. Alzheimers Dement 2022; 19:1705-1713. [PMID: 36193864 DOI: 10.1002/alz.12762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/31/2022] [Accepted: 06/14/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Dementia prediction models are necessary to inform the development of dementia risk reduction strategies. Here, we examine the utility of neuropathological-based risk scores to predict clinical dementia. METHODS Models were developed for predicting Alzheimer's disease (AD) and non-AD neuropathologies using the Honolulu Asia Aging neuropathological sub-study (HAAS; n = 852). Model accuracy for predicting clinical dementia, over 30 years, was tested in the non-autopsied HAAS sample (n = 2960) and the Age, Gene/Environment Susceptibility-Reykjavik Study (n = 4614). RESULTS Different models were identified for predicting neurodegenerative and vascular neuropathology (c-statistic range: 0.62 to 0.72). These typically included age, APOE, and a blood pressure-related measure. The neurofibrillary tangle and micro-vascular lesion models showed good accuracy for predicting clinical vascular dementia. DISCUSSION There may be shared risk factors across dementia-related lesions, suggesting common pathways. Strategies targeting these models may reduce risk or postpone clinical symptoms of dementia as well as reduce neuropathological burden associated with AD and vascular lesions.
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Affiliation(s)
- Blossom C M Stephan
- Institute of Mental Health, Academic Unit 1: Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Denise M Gaughan
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, Maryland, USA
| | - Steven Edland
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA.,Division of Biostatistics, School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Villi Gudnason
- Icelandic Heart Association, Kopavogur, Iceland.,University of Iceland, Reykjavik, Iceland
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, Maryland, USA
| | - Lon R White
- Pacific Health Research and Education Institute, Honolulu, Hawaii, USA
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14
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Shan ZY, Mohamed AZ, Andersen T, Rendall S, Kwiatek RA, Fante PD, Calhoun VD, Bhuta S, Lagopoulos J. Multimodal MRI of myalgic encephalomyelitis/chronic fatigue syndrome: A cross-sectional neuroimaging study toward its neuropathophysiology and diagnosis. Front Neurol 2022; 13:954142. [PMID: 36188362 PMCID: PMC9523103 DOI: 10.3389/fneur.2022.954142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/30/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), is a debilitating illness affecting up to 24 million people worldwide but concerningly there is no known mechanism for ME/CFS and no objective test for diagnosis. A series of our neuroimaging findings in ME/CFS, including functional MRI (fMRI) signal characteristics and structural changes in brain regions particularly sensitive to hypoxia, has informed the hypothesis that abnormal neurovascular coupling (NVC) may be the neurobiological origin of ME/CFS. NVC is a critical process for normal brain function, in which glutamate from an active neuron stimulates Ca2+ influx in adjacent neurons and astrocytes. In turn, increased Ca2+ concentrations in both astrocytes and neurons trigger the synthesis of vascular dilator factors to increase local blood flow assuring activated neurons are supplied with their energy needs. This study investigates NVC using multimodal MRIs: (1) hemodynamic response function (HRF) that represents regional brain blood flow changes in response to neural activities and will be modeled from a cognitive task fMRI; (2) respiration response function (RRF) represents autoregulation of regional blood flow due to carbon dioxide and will be modeled from breath-holding fMRI; (3) neural activity associated glutamate changes will be modeled from a cognitive task functional magnetic resonance spectroscopy. We also aim to develop a neuromarker for ME/CFS diagnosis by integrating the multimodal MRIs with a deep machine learning framework. Methods and analysis This cross-sectional study will recruit 288 participants (91 ME/CFS, 61 individuals with chronic fatigue, 91 healthy controls with sedentary lifestyles, 45 fibromyalgia). The ME/CFS will be diagnosed by consensus diagnosis made by two clinicians using the Canadian Consensus Criteria 2003. Symptoms, vital signs, and activity measures will be collected alongside multimodal MRI. The HRF, RRF, and glutamate changes will be compared among four groups using one-way analysis of covariance (ANCOVA). Equivalent non-parametric methods will be used for measures that do not exhibit a normal distribution. The activity measure, body mass index, sex, age, depression, and anxiety will be included as covariates for all statistical analyses with the false discovery rate used to correct for multiple comparisons. The data will be randomly divided into a training (N = 188) and a validation (N = 100) group. Each MRI measure will be entered as input for a least absolute shrinkage and selection operator—regularized principal components regression to generate a brain pattern of distributed clusters that predict disease severity. The identified brain pattern will be integrated using multimodal deep Boltzmann machines as a neuromarker for predicting ME/CFS fatigue conditions. The receiver operating characteristic curve of the identified neuromarker will be determined using data from the validation group. Ethics and study registry This study was reviewed and approved by University of the Sunshine Coast University Ethics committee (A191288) and has been registered with The Australian New Zealand Clinical Trials Registry (ACTRN12622001095752). Dissemination of results The results will be disseminated through peer reviewed scientific manuscripts and conferences and to patients through social media and active engagement with ME/CFS associations.
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Affiliation(s)
- Zack Y. Shan
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
- *Correspondence: Zack Y. Shan
| | - Abdalla Z. Mohamed
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
| | - Thu Andersen
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
| | - Shae Rendall
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
| | - Richard A. Kwiatek
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
| | - Peter Del Fante
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
| | - Vince D. Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, United States
| | - Sandeep Bhuta
- Medical Imaging Department, Gold Coast University Hospital, Parklands, QLD, Australia
| | - Jim Lagopoulos
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
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15
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Moretti R, Giuffré M, Crocè LS, Gazzin S, Tiribelli C. Nonalcoholic Fatty Liver Disease and Altered Neuropsychological Functions in Patients with Subcortical Vascular Dementia. J Pers Med 2022; 12:jpm12071106. [PMID: 35887603 PMCID: PMC9323787 DOI: 10.3390/jpm12071106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/20/2022] [Accepted: 07/01/2022] [Indexed: 02/06/2023] Open
Abstract
NAFLD is the most common cause of abnormality in liver function tests. NAFLD is considered a potential cardiovascular risk factor and is linked to cardiovascular risk factors such as obesity, hypertension, type 2 diabetes, and dyslipidemia. Few previous studies have investigated whether NAFLD could be independently associated with cognitive impairment. The current study aims to find a possible role of NAFLD in the development of subcortical vascular dementia (sVaD). We considered NAFLD as a possible independent vascular risk factor or, considering its metabolic role, associated with other commonly accepted sVaD risk factors, i.e., lack of folate, vitamin B12, and vitamin D-OH25, and increased levels of homocysteine. We studied 319 patients diagnosed with sVaD. All patients underwent an abdominal ultrasound examination to classify steatosis into four levels (1-none up to 4-severe). sVaD patients were divided into two groups according to the presence or absence of NAFLD. Our results demonstrated a strong correlation between NAFLD and sVaD. Patients with the two comorbidities had worse neuropsychological outcomes and a worse metabolic profile. We also found a robust relationship between NAFLD and severe vitamin B12, folate, vitamin D hypovitaminosis, and higher hyperhomocysteinemia levels. This way, it is evident that NAFLD contributes to a more severe metabolic pathway. However, the strong relationship with the three parameters (B12, folate and vitamin D, and homocysteinemia) suggests that NAFLD can contribute to a proinflammatory condition.
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Affiliation(s)
- Rita Moretti
- Department of Medical, Surgical, and Health Sciences, University of Trieste, 34149 Trieste, Italy; (R.M.); (L.S.C.)
| | - Mauro Giuffré
- Department of Medical, Surgical, and Health Sciences, University of Trieste, 34149 Trieste, Italy; (R.M.); (L.S.C.)
- Italian Liver Foundation, Centro Studi Fegato, 34149 Trieste, Italy; (S.G.); (C.T.)
- Correspondence: ; Tel.: +39-0403-994-044
| | - Lory Saveria Crocè
- Department of Medical, Surgical, and Health Sciences, University of Trieste, 34149 Trieste, Italy; (R.M.); (L.S.C.)
- Italian Liver Foundation, Centro Studi Fegato, 34149 Trieste, Italy; (S.G.); (C.T.)
| | - Silvia Gazzin
- Italian Liver Foundation, Centro Studi Fegato, 34149 Trieste, Italy; (S.G.); (C.T.)
| | - Claudio Tiribelli
- Italian Liver Foundation, Centro Studi Fegato, 34149 Trieste, Italy; (S.G.); (C.T.)
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Cognitive Decline in Older People with Multiple Sclerosis—A Narrative Review of the Literature. Geriatrics (Basel) 2022; 7:geriatrics7030061. [PMID: 35735766 PMCID: PMC9223056 DOI: 10.3390/geriatrics7030061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/02/2022] [Accepted: 06/02/2022] [Indexed: 12/04/2022] Open
Abstract
Several important questions regarding cognitive aging and dementia in older people with multiple sclerosis (PwMS) are the focus of this narrative review: Do older PwMS have worse cognitive decline compared to older people without MS? Can older PwMS develop dementia or other neurodegenerative diseases such as Alzheimer’s disease (AD) that may be accelerated due to MS? Are there any potential biomarkers that can help to determine the etiology of cognitive decline in older PwMS? What are the neural and cellular bases of cognitive aging and neurodegeneration in MS? Current evidence suggests that cognitive impairment in MS is distinguishable from that due to other neurodegenerative diseases, although older PwMS may present with accelerated cognitive decline. While dementia is prevalent in PwMS, there is currently no consensus on defining it. Cerebrospinal fluid and imaging biomarkers have the potential to identify disease processes linked to MS and other comorbidities—such as AD and vascular disease—in older PwMS, although more research is required. In conclusion, one should be aware that multiple underlying pathologies can coexist in older PwMS and cause cognitive decline. Future basic and clinical research will need to consider these complex factors to better understand the underlying pathophysiology, and to improve diagnostic accuracy.
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17
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Delgado J, Masoli J, Hase Y, Akinyemi R, Ballard C, Kalaria RN, Allan LM. Trajectories of cognitive change following stroke: stepwise decline towards dementia in the elderly. Brain Commun 2022; 4:fcac129. [PMID: 35669941 PMCID: PMC9161377 DOI: 10.1093/braincomms/fcac129] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/17/2022] [Accepted: 05/20/2022] [Indexed: 11/14/2022] Open
Abstract
Stroke events increase the risk of developing dementia, 10% for a first-ever stroke and 30% for recurrent strokes. However, the effects of stroke on global cognition, leading up to dementia, remain poorly understood. We investigated: (i) post-stroke trajectories of cognitive change, (ii) trajectories of cognitive decline in those who develop dementia over periods of follow-up length and (iii) risk factors precipitating the onset of dementia. Prospective cohort of hospital-based stroke survivors in North-East England was followed for up to 12 years. In this study, we included 355 stroke survivors of ≥75 years of age, not demented 3 months post-stroke, who had had annual assessments during follow-up. Global cognition was measured annually and characterized using standardized tests: Cambridge Cognition Examination-Revised and Mini-Mental State Examination. Demographic data and risk factors were recorded at baseline. Mixed-effects models were used to study trajectories in global cognition, and logistic models to test associations between the onset of dementia and key risk factors, adjusted for age and sex. Of the 355 participants, 91 (25.6%) developed dementia during follow-up. The dementia group had a sharper decline in Cambridge Cognition Examination-Revised (coeff. = -1.91, 95% confidence interval = -2.23 to -1.59, P < 0.01) and Mini-Mental State Examination (coeff. = -0.46, 95% confidence interval = -0.58 to -0.34, P < 0.01) scores during follow-up. Stroke survivors who developed dementia within 3 years after stroke showed a steep decline in global cognition. However, a period of cognitive stability after stroke lasting 3 years was identified for individuals diagnosed with dementia in 4-6 years (coeff. = 0.28, 95% confidence interval = -3.28 to 3.8, P = 0.88) of 4 years when diagnosed at 7-9 years (coeff. = -3.00, 95% confidence interval = -6.45 to 0.45, P = 0.09); and of 6 years when diagnosed at 10-12 years (coeff. = -6.50, 95% confidence interval = -13.27 to 0.27, P = 0.06). These groups then showed a steep decline in Cambridge Cognition Examination-Revised in the 3 years prior to diagnosis of dementia. Risk factors for dementia within 3 years include recurrent stroke (odds ratio = 3.99, 95% confidence interval = 1.30-12.25, P = 0.016) and previous disabling stroke, total number of risk factors for dementia (odds ratio = 2.02, 95% confidence interval = 1.26-3.25, P = 0.004) and a Cambridge Cognition Examination-Revised score below 80 at baseline (odds ratio = 3.50, 95% confidence interval = 1.29-9.49, P = 0.014). Our unique longitudinal study showed cognitive decline following stroke occurs in two stages, a period of cognitive stability followed by rapid decline before a diagnosis of dementia. This pattern suggests stroke may predispose survivors for dementia by diminishing cognitive reserve but with a smaller impact on cognitive function, where cognitive decline may be precipitated by subsequent events, e.g. another cerebrovascular event. This supports the assertion that the development of vascular dementia can be stepwise even when patients have small stroke lesions.
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Affiliation(s)
- João Delgado
- Epidemiology and Public Health, College of Medicine and Health, University of Exeter, College House, St Lukes, Campus, Exeter EX1 2LT, UK
| | - Jane Masoli
- Epidemiology and Public Health, College of Medicine and Health, University of Exeter, College House, St Lukes, Campus, Exeter EX1 2LT, UK
- Healthcare for Older People Department, Royal Devon and Exeter NHS Foundation Trust, RD&E, Barrack Road, Exeter EX2 5D, UK
| | - Yoshiki Hase
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| | - Rufus Akinyemi
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, University College Hospital Campus, Ibadan, Nigeria
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, Medical School Building F.04, St Luke's Campus, Exeter EX1 2LU, UK
| | - Raj N. Kalaria
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, University College Hospital Campus, Ibadan, Nigeria
| | - Louise M. Allan
- Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, South Cloisters 1.40, University of Exeter, St Luke's Campus, Exeter EX1 2LU, UK
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Hwang PH, Longstreth WT, Thielke SM, Francis CE, Carone M, Kuller LH, Fitzpatrick AL. Longitudinal Changes in Hearing and Visual Impairments and Risk of Dementia in Older Adults in the United States. JAMA Netw Open 2022; 5:e2210734. [PMID: 35511175 PMCID: PMC9073563 DOI: 10.1001/jamanetworkopen.2022.10734] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Hearing and vision problems are individually associated with increased dementia risk, but the impact of having concurrent hearing and vision deficits, ie, dual sensory impairment (DSI), on risk of dementia, including its major subtypes Alzheimer disease (AD) and vascular dementia (VaD), is not well known. OBJECTIVE To evaluate whether DSI is associated with incident dementia in older adults. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study from the Cardiovascular Health Study (CHS) was conducted between 1992 and 1999, with as many as 8 years of follow-up. The multicenter, population-based sample was recruited from Medicare eligibility files in 4 US communities with academic medical centers. Of 5888 participants aged 65 years and older in CHS, 3602 underwent cranial magnetic resonance imaging and completed the modified Mini-Mental State Examination in 1992 to 1994 as part of the CHS Cognition Study. A total of 227 participants were excluded due to prevalent dementia, leaving a total of 3375 participants without dementia at study baseline. The study hypothesis was that DSI would be associated with increased risk of dementia compared with no sensory impairment. The association between the duration of DSI with risk of dementia was also evaluated. Data analysis was conducted from November 2019 to February 2020. EXPOSURES Hearing and vision impairments were collected via self-report at baseline and as many as 5 follow-up visits. MAIN OUTCOMES AND MEASURES All-cause dementia, AD, and VaD, classified by a multidisciplinary committee using standardized criteria. RESULTS A total of 2927 participants with information on hearing and vision at all available study visits were included in the analysis (mean [SD] age, 74.6 [4.8] years; 1704 [58.2%] women; 455 [15.5%] African American or Black; 2472 [85.5%] White). Compared with no sensory impairment, DSI was associated with increased risk of all-cause dementia (hazard ratio [HR], 2.60; 95% CI, 1.66-2.06; P < .001), AD (HR, 3.67; 95% CI, 2.04-6.60; P < .001) but not VaD (HR, 2.03; 95% CI, 1.00-4.09; P = .05). CONCLUSIONS AND RELEVANCE In this cohort study, DSI was associated with increased risk of dementia, particularly AD. Evaluation of hearing and vision in older adults may help to identify those at high risk of developing dementia.
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Affiliation(s)
- Phillip H Hwang
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - W T Longstreth
- Department of Epidemiology, University of Washington, Seattle
- Department of Neurology, University of Washington, Seattle
| | - Stephen M Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
- Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, Washington
| | | | - Marco Carone
- Department of Biostatistics, University of Washington, Seattle
| | - Lewis H Kuller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Annette L Fitzpatrick
- Department of Epidemiology, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
- Department of Family Medicine, University of Washington, Seattle
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Guo L, Li K, Zhou J, Luo L. Panax Notoginseng Saponin Rg1 Can Effectively Improve the Cognitive Function of 5 × FAD Mice. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:5152761. [PMID: 35449867 PMCID: PMC9017436 DOI: 10.1155/2022/5152761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 11/18/2022]
Abstract
In order to investigate the effect of notoginsenoside Rg1 on cognitive function in 5∗FAD mice and the mechanism of Cx43 in improving cognitive function in mice, the methods 5∗FAD mice are selected as experimental animals and normal mice as healthy control. They were divided into three groups: healthy control group (n = 10), disease group (n = 10), and treatment group (n = 10, Panax notoginsenoside Rg 1150 mg/kg/d) for 2 months. Two months later, three groups of mice were subjected to classical water maze and Y-maze to test the cognitive ability of mice, and the correct response times and total response time were recorded. At the end of the cognitive function test, the mice were executed, and the brain tissues were taken. The expression of Cx43 protein and the changes of glial cells and neurons in the brain of the mice were analyzed at the cellular level. After treatment with Panax notoginseng saponin Rg 1150 mg/kg/d, it was found that the escape latency of mice in the treatment group was significantly lower than that in the disease group from the third day of training (P < 0.05); the time spent on the platform quadrant and the number of times crossing the platform in the treated mice were significantly increased, and the difference was statistically significant (P < 0.05); the expression of Cx43 protein in the brain of mice after treatment was significantly higher than that of mice in the disease group (P < 0.05). Conclusion. Panax notoginseng saponin Rg1 can effectively improve the cognitive function of 5∗FAD mice by increasing the secretion of Cx43 protein, thus increasing the reactivity of glial cells and neurons.
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Affiliation(s)
- Lili Guo
- Department of Neurology, Hangzhou Xixi Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou 310024, China
| | - Kun Li
- Department of Neurology, Hangzhou Xixi Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou 310024, China
| | - Jiajun Zhou
- Department of Neurology, Hangzhou Xixi Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou 310024, China
| | - Lian Luo
- Department of Neurology, Hangzhou Xixi Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou 310024, China
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20
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Small Vessel Disease: Ancient Description, Novel Biomarkers. Int J Mol Sci 2022; 23:ijms23073508. [PMID: 35408867 PMCID: PMC8998274 DOI: 10.3390/ijms23073508] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 12/22/2022] Open
Abstract
Small vessel disease (SVD) is one of the most frequent pathological conditions which lead to dementia. Biochemical and neuroimaging might help correctly identify the clinical diagnosis of this relevant brain disease. The microvascular alterations which underlie SVD have common origins, similar cognitive outcomes, and common vascular risk factors. Nevertheless, the arteriolosclerosis process, which underlines SVD development, is based on different mechanisms, not all completely understood, which start from a chronic hypoperfusion state and pass through a chronic brain inflammatory condition, inducing a significant endothelium activation and a consequent tissue remodeling action. In a recent review, we focused on the pathophysiology of SVD, which is complex, involving genetic conditions and different co-morbidities (i.e., diabetes, chronic hypoxia condition, and obesity). Currently, many points still remain unclear and discordant. In this paper, we wanted to focus on new biomarkers, which can be the expression of the endothelial dysfunction, or of the oxidative damage, which could be employed as markers of disease progression or for future targets of therapies. Therefore, we described the altered response to the endothelium-derived nitric oxide-vasodilators (ENOV), prostacyclin, C-reactive proteins, and endothelium-derived hyperpolarizing factors (EDHF). At the same time, due to the concomitant endothelial activation and chronic neuroinflammatory status, we described hypoxia-endothelial-related markers, such as HIF 1 alpha, VEGFR2, and neuroglobin, and MMPs. We also described blood–brain barrier disruption biomarkers and imaging techniques, which can also describe perivascular spaces enlargement and dysfunction. More studies should be necessary, in order to implement these results and give them a clinical benefit.
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Pagnon de la Vega M, Näslund C, Brundin R, Lannfelt L, Löwenmark M, Kilander L, Ingelsson M, Giedraitis V. Mutation analysis of disease causing genes in patients with early onset or familial forms of Alzheimer's disease and frontotemporal dementia. BMC Genomics 2022; 23:99. [PMID: 35120450 PMCID: PMC8817590 DOI: 10.1186/s12864-022-08343-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 01/28/2022] [Indexed: 12/05/2022] Open
Abstract
Background Most dementia disorders have a clear genetic background and a number of disease genes have been identified. Mutations in the tau gene (MAPT) lead to frontotemporal dementia (FTD), whereas mutations in the genes for the amyloid-β precursor protein (APP) and the presenilins (PSEN1, PSEN2) cause early-onset, dominantly inherited forms of Alzheimer’s disease (AD). Even if mutations causing Mendelian forms of these diseases are uncommon, elucidation of the pathogenic effects of such mutations have proven important for understanding the pathogenic processes. Here, we performed a screen to identify novel pathogenic mutations in known disease genes among patients undergoing dementia investigation. Results Using targeted exome sequencing we have screened all coding exons in eleven known dementia genes (PSEN1, PSEN2, APP, MAPT, APOE, GRN, TARDBP, CHMP2B, TREM2, VCP and FUS) in 102 patients with AD, FTD, other dementia diagnoses or mild cognitive impairment. We found three AD patients with two previously identified pathogenic mutations in PSEN1 (Pro264Leu and Met146Val). In this screen, we also identified the recently reported APP mutation in two siblings with AD. This mutation, named the Uppsala mutation, consists of a six amino acid intra-amyloid β deletion. In addition, we found several potentially pathogenic mutations in PSEN2, FUS, MAPT, GRN and APOE. Finally, APOE ε4 was prevalent in this patient group with an allele frequency of 54%. Conclusions Among the 102 screened patients, we found two disease causing mutations in PSEN1 and one in APP, as well as several potentially pathogenic mutations in other genes related to neurodegenerative disorders. Apart from giving important information to the clinical investigation, the identification of disease mutations can contribute to an increased understanding of disease mechanisms.
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Affiliation(s)
- María Pagnon de la Vega
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Carl Näslund
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
| | - RoseMarie Brundin
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Lars Lannfelt
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Malin Löwenmark
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Martin Ingelsson
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden.,Krembil Brain Institute, University Health Network, Toronto, Canada.,Department of Medicine and Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - Vilmantas Giedraitis
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden.
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22
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Di Salvo A. The role of association between the cholinergic precursor choline alphoscerate and sulodexide in vascular dementia. GERIATRIC CARE 2022. [DOI: 10.4081/gc.2021.9891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Dementia is a syndrome of acquired intellectual deficit resulting in significant impairment of social or occupational functioning. Vascular dementia (VaD) is the second most common causes of dementia after Alzheimer’s disease, causing around 15% of cases. However, unlike Alzheimer’s disease an involvement of the cerebral cholinergic system in the pathophysiology of VaD has been hypothesized and there is no standard treatment. In the Vascular Dementia Italian Sulodexide Study (VA.D.I.S.S.) the positive results obtained with the sulodexide are worthy of note. In this study 40 elderly subjects with recent onset (less than 9 month) slight to moderate mental deterioration due to vascular origin were observed for nine months during oral treatment with sulodexide and choline alphoscerate with the aim of analyzing whether therapeutic effects can be enhanced. These preliminary results suggest that the additional therapy of choline alphoscerate with sulodexide represents a way to increase the beneficial effects of cholinergic therapies in the VaD and improve all the different examinate score: mini mental state evaluation (MMSE), basic activities of daily living (ADL), instrumental activities of daily living (IADL).
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Clancy U, Ramirez J, Chappell FM, Doubal FN, Wardlaw JM, Black SE. Neuropsychiatric symptoms as a sign of small vessel disease progression in cognitive impairment. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2022; 3:100041. [PMID: 36324402 PMCID: PMC9616231 DOI: 10.1016/j.cccb.2022.100041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/12/2022] [Accepted: 01/16/2022] [Indexed: 11/27/2022]
Abstract
Background Neuropsychiatric symptoms associate cross-sectionally with cerebral small vessel disease but it is not clear whether these symptoms could act as early clinical markers of small vessel disease progression. We investigated whether longitudinal change in Neuropsychiatric Inventory (NPI) scores associated with white matter hyperintensity (WMH) progression in a memory clinic population. Material and methods We included participants from the prospective Sunnybrook Dementia Study with Alzheimer's disease and vascular subtypes of mild cognitive impairment and dementia with two MRI and ≥ 1 NPI. We conducted linear mixed-effects analyses, adjusting for age, atrophy, vascular risk factors, cognition, function, and interscan interval. Results At baseline (n=124), greater atrophy, age, vascular risk factors and total NPI score were associated with higher baseline WMH volume, while longitudinally, all but vascular risk factors were associated. Change in total NPI score was associated with change in WMH volume, χ2 = 7.18, p = 0.007, whereby a one-point change in NPI score from baseline to follow-up was associated with a 0.0017 change in normalized WMH volume [expressed as cube root of (WMH volume cm³ as % intracranial volume)], after adjusting for age, atrophy, vascular risk factors and interscan interval. Conclusions In memory clinic patients, WMH progression over 1-2 years associated with worsening neuropsychiatric symptoms, while WMH volume remained unchanged in those with stable NPI scores in this population with low background WMH burden.
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Affiliation(s)
- Una Clancy
- Brain Research Imaging Centre, Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | - Joel Ramirez
- Dr. Sandra Black Centre for Brain Resilience & Recovery, LC Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, 2075 Bayview Avenue, Room A4 21, Toronto, ON M4N 3M5, Canada,Corresponding author.
| | - Francesca M. Chappell
- Brain Research Imaging Centre, Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | - Fergus N. Doubal
- Brain Research Imaging Centre, Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | - Joanna M. Wardlaw
- Brain Research Imaging Centre, Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | - Sandra E. Black
- Dr. Sandra Black Centre for Brain Resilience & Recovery, LC Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, 2075 Bayview Avenue, Room A4 21, Toronto, ON M4N 3M5, Canada,Department of Medicine (Neurology), Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
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Wang C, Song P, Niu Y. The management of dementia worldwide: A review on policy practices, clinical guidelines, end-of-life care, and challenge along with aging population. Biosci Trends 2022; 16:119-129. [DOI: 10.5582/bst.2022.01042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Changying Wang
- Department of Scientific Research Management Affairs, Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, China
| | - Peipei Song
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuhong Niu
- Department of Scientific Research Management Affairs, Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, China
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25
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Seshadri S, Caunca MR, Rundek T. Vascular Dementia and Cognitive Impairment. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Rundek T, Tolea M, Ariko T, Fagerli EA, Camargo CJ. Vascular Cognitive Impairment (VCI). Neurotherapeutics 2022; 19:68-88. [PMID: 34939171 PMCID: PMC9130444 DOI: 10.1007/s13311-021-01170-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 01/03/2023] Open
Abstract
Vascular cognitive impairment (VCI) is predominately caused by vascular risk factors and cerebrovascular disease. VCI includes a broad spectrum of cognitive disorders, from mild cognitive impairment to vascular dementia caused by ischemic or hemorrhagic stroke, and vascular factors alone or in a combination with neurodegeneration including Alzheimer's disease (AD) and AD-related dementia. VCI accounts for at least 20-40% of all dementia diagnosis. Growing evidence indicates that cerebrovascular pathology is the most important contributor to dementia, with additive or synergistic interactions with neurodegenerative pathology. The most common underlying mechanism of VCI is chronic age-related dysregulation of CBF, although other factors such as inflammation and cardiovascular dysfunction play a role. Vascular risk factors are prevalent in VCI and if measured in midlife they predict cognitive impairment and dementia in later life. Particularly, hypertension, high cholesterol, diabetes, and smoking at midlife are each associated with a 20 to 40% increased risk of dementia. Control of these risk factors including multimodality strategies with an inclusion of lifestyle modification is the most promising strategy for treatment and prevention of VCI. In this review, we present recent developments in age-related VCI, its mechanisms, diagnostic criteria, neuroimaging correlates, vascular risk determinants, and current intervention strategies for prevention and treatment of VCI. We have also summarized the most recent and relevant literature in the field of VCI.
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Affiliation(s)
- Tatjana Rundek
- Department of Neurology and Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Magdalena Tolea
- Department of Neurology and Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Taylor Ariko
- Department of Neurology and Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eric A Fagerli
- Department of Neurology and Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christian J Camargo
- Department of Neurology and Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Staszewski J, Dȩbiec A, Skrobowska E, Stȩpień A. Cerebral Vasoreactivity Changes Over Time in Patients With Different Clinical Manifestations of Cerebral Small Vessel Disease. Front Aging Neurosci 2021; 13:727832. [PMID: 34744687 PMCID: PMC8563577 DOI: 10.3389/fnagi.2021.727832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/13/2021] [Indexed: 01/15/2023] Open
Abstract
Objectives: Endothelial dysfunction (ED) has been linked to the pathogenesis of cerebral small vessel disease (SVD). We aimed to assess ED and cerebrovascular reactivity (CVR) in the patients with a diverse manifestation of SVD, with similar and extensive white matter lesions (WMLs, modified Fazekas scale grade ≥2), compared with a control group (CG) without the MRI markers of SVD, matched for age, gender, hypertension, diabetes, and to evaluate the change of CVR following 24 months. Methods: We repeatedly measured the vasomotor reactivity reserve (VMRr) and breath-holding index (BHI) of the middle cerebral artery (MCA) by the transcranial Doppler ultrasound (TCD) techniques in 60 subjects above 60 years with a history of lacunar stroke (LS), vascular dementia (VaD), or parkinsonism (VaP) (20 in each group), and in 20 individuals from a CG. Results: The mean age, frequency of the main vascular risk factors, and sex distribution were similar in the patients with the SVD groups and a CG. The VMRr and the BHI were more severely impaired at baseline (respectively, 56.7 ± 18% and 0.82 ± 0.39) and at follow-up (respectively, 52.3 ± 16.7% and 0.71 ± 0.38) in the patients with SVD regardless of the clinical manifestations (ANOVA, p > 0.1) than in the CG (respectively, baseline VMRr 77.2 ± 15.6%, BHI 1.15 ± 0.47, p < 0.001; follow-up VMRr 74.3 ± 17.6%, BHI 1.11 ± 0.4, p < 0.001). All the assessed CVR measures (VMRr and BHI) significantly decreased over time in the subjects with SVD (Wilcoxon's signed-rank test p = 0.01), but this was not observed in the CG (p > 0.1) and the decrease of CVR measures was not related to the SVD radiological progression (p > 0.1). Conclusions: This study provided evidence that the change in CVR measures is detectable over a 24-month period in patients with different clinical manifestations of SVD. Compared with the patients in CG with similar atherothrombotic risk factors, all the CVR measures (BMRr and BHI) significantly declined over time in the subjects with SVD. The reduction in CVR was not related to the SVD radiological progression.
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Affiliation(s)
- Jacek Staszewski
- Military Institute of Medicine, Clinic of Neurology, Warsaw, Poland
| | | | - Ewa Skrobowska
- Department of Radiology, Military Institute of Medicine, Warsaw, Poland
| | - Adam Stȩpień
- Military Institute of Medicine, Clinic of Neurology, Warsaw, Poland
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28
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Diaz MM, Custodio N, Montesinos R, Lira D, Herrera-Perez E, Pintado-Caipa M, Cuenca-Alfaro J, Gamboa C, Lanata S. Thyroid Dysfunction, Vitamin B12, and Folic Acid Deficiencies Are Not Associated With Cognitive Impairment in Older Adults in Lima, Peru. Front Public Health 2021; 9:676518. [PMID: 34552900 PMCID: PMC8450418 DOI: 10.3389/fpubh.2021.676518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 08/12/2021] [Indexed: 01/27/2023] Open
Abstract
Background: Reversible etiologies of cognitive impairment are common and treatable, yet the majority of mild cognitive impairment (MCI) and dementia research in Latin America has focused on irreversible, neurodegenerative etiologies. Objective: We sought to determine if thyroid dysfunction and vitamin B12 and folate deficiencies are associated with cognitive disorders among older adults with memory complaints in Lima, Peru. Methods: This was a retrospective review of patients who presented for cognitive evaluations to a multidisciplinary neurology clinic in Lima, Peru from January 2014 to February 2020. We included individuals aged ≥60 years, native Spanish-speakers, with at least a primary school educational level and a complete clinical assessment. Patients had either subjective cognitive decline (SCD), MCI, or dementia. One-way ANOVA and multiple logistic regression analyses were performed. Results: We included 720 patients (330 SCD, 154 MCI, and 236 dementia); the dementia group was significantly older [mean age SCD 69.7 ± 4.1, dementia 72.4 ± 3.7 (p = 0.000)] and had lower folate levels than SCD patients. The MCI group had higher free T3 levels compared with SCD patients. Those with lower TSH had greater dementia risk (OR = 2.91, 95%CI: 1.15-6.86) but not MCI risk in unadjusted models. B12 deficiency or borderline B12 deficiency was present in 34% of the dementia group, yet no clear correlation was seen between neuropsychological test results and B12 levels in our study. There was no association between MCI or dementia and thyroid hormone, B12 nor folate levels in adjusted models. Conclusion: Our findings do not support an association between metabolic and endocrine disorders and cognitive impairment in older Peruvians from Lima despite a high prevalence of B12 deficiency. Future work may determine if cognitive decline is associated with metabolic or endocrine changes in Latin America.
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Affiliation(s)
- Monica M. Diaz
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Rehabilitación, Instituto Peruano de Neurociencias, Lima, Peru
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Grupo de investigación Molident, Universidad San Ignacio de Loyola, Lima, Peru
| | - Maritza Pintado-Caipa
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Atlantic Fellow, Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Jose Cuenca-Alfaro
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
- Carrera de Psicología, Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Peru
| | - Carlos Gamboa
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
| | - Serggio Lanata
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
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Koch M, Furtado JD, Cronjé HT, DeKosky ST, Fitzpatrick AL, Lopez OL, Kuller LH, Mukamal KJ, Jensen MK. Plasma antioxidants and risk of dementia in older adults. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12208. [PMID: 34504943 PMCID: PMC8418668 DOI: 10.1002/trc2.12208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/08/2021] [Accepted: 07/28/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Plant-based diets rich in fruits and vegetables have been associated with lower risk of dementia, but the specific role of antioxidants, a key class of bioactive phytochemicals, has not been well ascertained. METHODS We measured antioxidants in a case-cohort study nested within the Ginkgo Evaluation of Memory Study. We included 996 randomly selected participants and 521 participants who developed dementia, of which 351 were diagnosed with Alzheimer's disease (AD) during a median of 5.9 years of follow-up. We measured baseline plasma levels of retinol, α-, and γ-tocopherol; zeaxanthin and lutein (combined); beta-cryptoxanthin; cis-lycopene; trans-lycopene; α-carotene; and trans-β-carotene by organic phase extraction followed by chromatographic analysis and related these to neurologist-adjudicated risks of all-cause dementia and AD. RESULTS Plasma retinol, α-, and γ-tocopherol, and carotenoids were not significantly related to risk of dementia or AD. Associations were not significant upon Bonferroni correction for multiple testing and were consistent within strata of sex, age, apolipoprotein E ε4 genotype, mild cognitive impairment at baseline, and intake of multivitamin, vitamin A or β-carotene, or vitamin E supplements. Higher trans-β-carotene tended to be related to a higher risk of dementia (adjusted hazard ratio [HR] per 1 standard deviation [SD] higher trans-β-carotene: 1.10; 95% confidence interval [CI]: 1.00, 1.20) and α-carotene tended to be associated with higher risk of AD only (adjusted HR per 1 SD higher α-carotene: 1.15; 95% CI: 1.02, 1.29). DISCUSSION Plasma antioxidants were not significantly associated with risk of dementia or AD among older adults. Similar studies in younger populations are required to better understand the association between plasma antioxidants and dementia risk.
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Affiliation(s)
- Manja Koch
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Jeremy D. Furtado
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Héléne Toinét Cronjé
- Department of Public HealthSection of EpidemiologyUniversity of CopenhagenCopenhagenDenmark
| | | | - Annette L. Fitzpatrick
- Departments of Family MedicineEpidemiology and Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Oscar L. Lopez
- Department of NeurologySchool of MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Lewis H. Kuller
- Department of EpidemiologyGraduate School of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Kenneth J. Mukamal
- Department of MedicineBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Majken K. Jensen
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of Public HealthSection of EpidemiologyUniversity of CopenhagenCopenhagenDenmark
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Hwang PH, Longstreth W, Thielke SM, Francis CE, Carone M, Kuller LH, Fitzpatrick AL. Ophthalmic conditions associated with dementia risk: The Cardiovascular Health Study. Alzheimers Dement 2021; 17:1442-1451. [PMID: 33788406 PMCID: PMC8527838 DOI: 10.1002/alz.12313] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/16/2021] [Accepted: 01/21/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Ophthalmic conditions and dementia appear to overlap and may share common pathways, but research has not differentiated dementia subtypes. METHODS Diagnoses of cataracts, age-related macular degeneration (AMD), diabetic retinopathy (DR), and glaucoma were based on medical histories and International Classification of Diseases, Ninth Revision (ICD-9) codes for 3375 participants from the Cardiovascular Health Study. Dementia, including Alzheimer's disease (AD) and vascular dementia (VaD), was classified using standardized research criteria. RESULTS Cataracts were associated with AD (hazard ratio [HR] = 1.34; 95% confidence interval [CI] = 1.01-1.80) and VaD/mixed dementia (HR = 1.41; 95% CI = 1.02-1.95). AMD was associated with AD only (HR = 1.87; 95% CI = 1.13-3.09), whereas DR was associated with VaD/mixed dementia only (HR = 2.63; 95% CI = 1.10-6.27). DISCUSSION Differential associations between specific ophthalmic conditions and dementia subtypes may elucidate pathophysiologic pathways. Lack of association between glaucoma and dementia was most surprising from these analyses.
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Affiliation(s)
- Phillip H. Hwang
- Department of Epidemiology, University of Washington, Seattle, WA, USA;,Corresponding author contact information: University of Washington, Department of Epidemiology, 3980 15 Avenue Northeast, Box 351619, Seattle, WA 98195, , Phone: (206) 331-8633
| | - W.T. Longstreth
- Department of Epidemiology, University of Washington, Seattle, WA, USA;,Department of Neurology, University of Washington, Seattle, WA, USA
| | - Stephen M. Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA;,Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, WA, USA
| | | | - Marco Carone
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Lewis H. Kuller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Annette L. Fitzpatrick
- Department of Epidemiology, University of Washington, Seattle, WA, USA;,Department of Global Health, University of Washington, Seattle, WA, USA;,Department of Family Medicine, University of Washington, Seattle, WA, USA
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Fällmar D, Andersson O, Kilander L, Löwenmark M, Nyholm D, Virhammar J. Imaging features associated with idiopathic normal pressure hydrocephalus have high specificity even when comparing with vascular dementia and atypical parkinsonism. Fluids Barriers CNS 2021; 18:35. [PMID: 34325703 PMCID: PMC8323278 DOI: 10.1186/s12987-021-00270-3] [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: 04/27/2021] [Accepted: 07/23/2021] [Indexed: 11/27/2022] Open
Abstract
Background Vascular dementia (VaD) and atypical parkinsonism often present with symptoms that can resemble idiopathic normal pressure hydrocephalus (iNPH) and enlarged cerebral ventricles, and can be challenging differential diagnoses. The aim was to investigate frequencies of imaging features usually associated with iNPH and their radiological diagnostic accuracy in a sample containing the relevant differential diagnoses VaD, progressive supranuclear palsy (PSP), multiple system atrophy parkinsonian type (MSA-P), and healthy controls. Methods Nine morphological imaging features usually associated with iNPH were retrospectively investigated in MR images of 55 patients with shunt-responsive iNPH, 32 patients with VaD, 30 patients with PSP, 27 patients with MSA-P, and 39 age-matched healthy controls. Logistic regression and receiver operating characteristic curves were used to assess diagnostic accuracy, sensitivity, and specificity for each imaging finding. Results In a logistic regression model using iNPH diagnosis as a dependent variable, the following imaging features contributed significantly to the model: callosal angle (OR = 0.95 (0.92–0.99), p = 0.012), Evans’ index * 100 (OR = 1.51 (1.23–1.86), p < 0.001), enlarged Sylvian fissures (OR = 6.01 (1.42–25.40), p = 0.015), and focally enlarged sulci (OR = 10.18 (1.89–55.02), p = 0.007). Imaging features with 95% specificity for iNPH were: callosal angle ≤ 71°, temporal horns ≥ 7 mm, Evans’ index ≥ 0.37, iNPH Radscale ≥ 9, and presence of DESH, bilateral ventricular roof bulgings or focally enlarged sulci. A simplified version of the iNPH Radscale with only four features resulted in equally high diagnostic accuracy as the original iNPH Radscale. Conclusions There is a notable overlap between some of the commonly used imaging markers regarding iNPH, VaD and atypical parkinsonism, such as PSP. However, this study shows that the specificity of imaging markers usually associated with iNPH was high even when comparing with these challenging differential diagnoses. The callosal angle was the single imaging feature with highest diagnostic accuracy to discriminate iNPH from its mimics. A simplified rating scale using only a few selected features could be used with retained specificity. Supplementary Information The online version contains supplementary material available at 10.1186/s12987-021-00270-3.
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Affiliation(s)
- David Fällmar
- Department of Surgical Sciences, Radiology, Uppsala University, Bonadsv 27, 75757, Uppsala, Sweden.
| | - Oliver Andersson
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - Malin Löwenmark
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - Dag Nyholm
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Johan Virhammar
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
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COVID-19 Lockdown Effect on Not Institutionalized Patients with Dementia and Caregivers. Healthcare (Basel) 2021; 9:healthcare9070893. [PMID: 34356269 PMCID: PMC8303803 DOI: 10.3390/healthcare9070893] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/01/2021] [Accepted: 07/13/2021] [Indexed: 01/19/2023] Open
Abstract
SARS-COV-2 is a severe medical condition. Old patients are very vulnerable, but they have been studied only as institutionalized patients. During the lock-down, little attention is dedicated to old, demented patients who lived at home. This study wants to examine their behavioral reactions by video-phone follow-up. We conducted a longitudinal study in subcortical vascular dementia (sVAD) patients. We enrolled 221 sVAD, not institutionalized patients. We divided sVAD patients into low-medium grade sVAD (A) and severe sVAD (B), based on neuroimaging severity degree and executive alterations. At baseline, at the end of lock-down, and two months later, global behavioral symptoms were recorded for each patient. We found significantly higher scores of general behavioral deterioration, anxiety, delusions, hallucinations and apathy after controlling for sVAD severity. The direct consequence was a drastic increment of psychotropic drugs prescribed and employed during the lock-down. Moreover, caregivers’ stress has been evaluated, together with their anxiety and depression levels. During the lock-down, their scores increased and reflected a severe worsening of their behavior. Our data demonstrate that social isolation induces a severe perception of loneliness and abandonment; these fears can exacerbate behavior disturbances in old-aged frail persons. Thus, these can be considered as indirect victims of SARS-COV-2.
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Babiloni C, Arakaki X, Bonanni L, Bujan A, Carrillo MC, Del Percio C, Edelmayer RM, Egan G, Elahh FM, Evans A, Ferri R, Frisoni GB, Güntekin B, Hainsworth A, Hampel H, Jelic V, Jeong J, Kim DK, Kramberger M, Kumar S, Lizio R, Nobili F, Noce G, Puce A, Ritter P, Smit DJA, Soricelli A, Teipel S, Tucci F, Sachdev P, Valdes-Sosa M, Valdes-Sosa P, Vergallo A, Yener G. EEG measures for clinical research in major vascular cognitive impairment: recommendations by an expert panel. Neurobiol Aging 2021; 103:78-97. [PMID: 33845399 DOI: 10.1016/j.neurobiolaging.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 02/17/2021] [Accepted: 03/05/2021] [Indexed: 11/22/2022]
Abstract
Vascular contribution to cognitive impairment (VCI) and dementia is related to etiologies that may affect the neurophysiological mechanisms regulating brain arousal and generating electroencephalographic (EEG) activity. A multidisciplinary expert panel reviewed the clinical literature and reached consensus about the EEG measures consistently found as abnormal in VCI patients with dementia. As compared to cognitively unimpaired individuals, those VCI patients showed (1) smaller amplitude of resting state alpha (8-12 Hz) rhythms dominant in posterior regions; (2) widespread increases in amplitude of delta (< 4 Hz) and theta (4-8 Hz) rhythms; and (3) delayed N200/P300 peak latencies in averaged event-related potentials, especially during the detection of auditory rare target stimuli requiring participants' responses in "oddball" paradigms. The expert panel formulated the following recommendations: (1) the above EEG measures are not specific for VCI and should not be used for its diagnosis; (2) they may be considered as "neural synchronization" biomarkers to enlighten the relationships between features of the VCI-related cerebrovascular lesions and abnormalities in neurophysiological brain mechanisms; and (3) they may be tested in future clinical trials as prognostic biomarkers and endpoints of interventions aimed at normalizing background brain excitability and vigilance in wakefulness.
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Affiliation(s)
- Claudio Babiloni
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Rome, Italy; San Raffaele Cassino, Cassino, FR, Italy.
| | | | - Laura Bonanni
- Department of Neuroscience Imaging and Clinical Sciences and CESI, University G D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Ana Bujan
- Psychological Neuroscience Lab, School of Psychology, University of Minho, Portugal
| | | | - Claudio Del Percio
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Rome, Italy
| | | | - Gary Egan
- Foundation Director of the Monash Biomedical Imaging (MBI) research facilities, Monash University, Clayton, Australia
| | - Fanny M Elahh
- Memory and Aging Center, University of California, San Francisco
| | - Alan Evans
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | | | - Giovanni B Frisoni
- Memory Clinic and LANVIE - Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Geneva, Switzerland; Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Bahar Güntekin
- Department of Biophysics, School of Medicine, Istanbul Medipol University, Istanbul, Turkey; REMER, Clinical Electrophysiology, Neuroimaging and Neuromodulation Lab, Istanbul Medipol University, Istanbul, Turkey
| | - Atticus Hainsworth
- University of London St George's Molecular and Clinical Sciences Research Institute, London, UK
| | - Harald Hampel
- Sorbonne University, GRC No. 21, Alzheimer Precision Medicine, Pitié-Salpêtrière Hospital, Paris, France
| | - Vesna Jelic
- Division of Clinical Geriatrics, NVS Department, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jaeseung Jeong
- Department of Bio and Brain Engineering/Program of Brain and Cognitive Engineering Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - Doh Kwan Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, South Korea
| | - Milica Kramberger
- Center for cognitive and movement disorders, Department of neurology, University Medical Center Ljubljana, Slovenia
| | - Sanjeev Kumar
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Flavio Nobili
- Clinica neurologica, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Dipartimento di Neuroscienze, Oftalmologia, Genetica, Riabilitazione e Scienze Materno-infantili (DiNOGMI)
| | | | - Aina Puce
- Department of Psychological and Brain Sciences at Indiana University in Bloomington, Indiana, USA
| | - Petra Ritter
- Brain Simulation Section, Department of Neurology, Charité Universitätsmedizin and Berlin Institute of Health, Berlin, Germany; Bernstein Center for Computational Neuroscience, Berlin, Germany
| | - Dirk J A Smit
- Department of Psychiatry Academisch Medisch Centrum Universiteit van Amsterdam, Amsterdam, the Netherlands
| | - Andrea Soricelli
- IRCCS SDN, Naples, Italy; Department of Motor Sciences and Healthiness, University of Naples Parthenope, Naples, Italy
| | - Stefan Teipel
- Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany; German Center for Neurodegenerative Diseases (DZNE) - Rostock/Greifswald, Rostock, Germany
| | - Federico Tucci
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Rome, Italy
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales; Neuropsychiatric Institute, The Prince of Wales Hospital, Sydney, Australia
| | | | - Pedro Valdes-Sosa
- Cuban Neuroscience Center, Havana, Cuba; Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Andrea Vergallo
- Sorbonne University, GRC No. 21, Alzheimer Precision Medicine, Pitié-Salpêtrière Hospital, Paris, France
| | - Görsev Yener
- Izmir Biomedicine and Genome Center. Dokuz Eylul University Health Campus, Izmir, Turkey
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Koch M, Furtado JD, DeKosky ST, Fitzpatrick AL, Lopez OL, Kuller LH, Mukamal KJ, Jensen MK. Case-cohort study of plasma phospholipid fatty acid profiles, cognitive function, and risk of dementia: a secondary analysis in the Ginkgo Evaluation of Memory Study. Am J Clin Nutr 2021; 114:154-162. [PMID: 33880495 PMCID: PMC8277434 DOI: 10.1093/ajcn/nqab087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/02/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Phospholipids are biomarkers of dietary fat intake and metabolism, linked to several cardiometabolic disorders. Few prospective studies have assessed plasma phospholipids in relation to dementia risk and cognitive function. OBJECTIVES We aimed to evaluate the association between a decrease in linoleic acid accompanied with an increase in other fatty acids and cognitive function and dementia risk. METHODS We conducted a case-cohort study nested within the Ginkgo Evaluation of Memory Study. We included 1252 participants, 498 of whom who developed dementia during a mean of 5 y of follow-up. We measured 45 individual plasma phospholipids (as a percentage of total plasma phospholipid fatty acids) by GC and related these to Modified Mini-Mental State Examination (3MSE) scores at baseline and neurologist-adjudicated incidence of all-cause dementia and Alzheimer disease (AD), adjusting for sociodemographic and clinical characteristics. RESULTS Substitution of 1% of SFAs for 1% of linoleic acid, the predominant polyunsaturated n-6 (ɷ-6) fatty acid, was associated with higher risk of dementia (HR per 1% of SFAs instead of linoleic acid = 1.03; 95% CI: 1.00, 1.07) and a 0.08 point lower 3MSE score at baseline (95% CI: -0.12, -0.03), signifying worse cognitive function. When compared with linoleic acid, we found no associations of total monounsaturated, n-3 polyunsaturated, or trans fatty acids with risk of dementia or AD. However, the substitution of 1% of the marine n-3 PUFA DHA for linoleic acid was associated with lower risk of dementia (HR = 0.86 per 1% of DHA instead of linoleic acid; 95% CI: 0.76, 0.96). These associations were not modified by apolipoprotein E genotype, mild cognitive impairment at baseline, age, or sex. CONCLUSIONS Specific elements of diet may be associated with late-life dementia, a hypothesis that requires formal testing in randomized controlled trials and that represents a possible preventive intervention.
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Affiliation(s)
- Manja Koch
- Department of Nutrition, Harvard TH Chan School of Public
Health, Boston, MA, USA
| | - Jeremy D Furtado
- Department of Nutrition, Harvard TH Chan School of Public
Health, Boston, MA, USA
| | - Steven T DeKosky
- Department of Neurology, University of Florida,
Gainesville, FL, USA
| | - Annette L Fitzpatrick
- Departments of Family Medicine, Epidemiology, and Global
Health, University of Washington, Seattle, WA, USA
| | - Oscar L Lopez
- Department of Neurology, School of Medicine, University of
Pittsburgh, Pittsburgh, PA, USA
| | - Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health,
University of Pittsburgh, Pittsburgh, PA, USA
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical
Center, Boston, MA, USA
| | - Majken K Jensen
- Department of Nutrition, Harvard TH Chan School of Public
Health, Boston, MA, USA
- Department of Public Health, Section of Epidemiology,
University of Copenhagen, Copenhagen, Denmark
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35
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Bir SC, Khan MW, Javalkar V, Toledo EG, Kelley RE. Emerging Concepts in Vascular Dementia: A Review. J Stroke Cerebrovasc Dis 2021; 30:105864. [PMID: 34062312 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105864] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/29/2021] [Accepted: 04/28/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Vascular dementia (VaD) is the second most common cause of dementia and a major health concern worldwide. A comprehensive review on VaD is warranted for better understanding and guidance for the practitioner. We provide an updated overview of the epidemiology, pathophysiological mechanisms, neuroimaging patterns as well as current diagnostic and therapeutic approaches. MATERIALS AND METHODS A narrative review of current literature in VaD was performed based on publications from the database of PubMed, Scopus and Google Scholar up to January, 2021. RESULTS VaD can be the result of ischemic or hemorrhagic tissue injury in a particular region of the brain which translates into clinically significant cognitive impairment. For example, a cerebral infarct in the speech area of the dominant hemisphere would translate into clinically significant impairment as would involvement of projection pathways such as the arcuate fasciculus. Specific involvement of the angular gyrus of the dominant hemisphere, with resultant Gerstman's syndrome, could have a pronounced effect on functional ability despite being termed a "minor stroke". Small vessel cerebrovascular disease can have a cumulate effect on cognitive function over time. It is unfortunately well recognized that "good" functional recovery in acute ischemic or haemorrhagic stroke, including subarachnoid haemorrhage, does not necessarily translate into good cognitive recovery. The victim may often be left unable to have gainful employment, drive a car safely or handle their affairs independently. CONCLUSIONS This review should serve as a compendium of updated information on VaD and provide guidance in terms of newer diagnostic and potential therapeutic approaches.
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Affiliation(s)
- Shyamal C Bir
- Department of Neurology Ocshner/LSU Health Sciences Center-Sheveport, Shreveport, LA, USA
| | - Muhammad W Khan
- Department of Neurology Ocshner/LSU Health Sciences Center-Sheveport, Shreveport, LA, USA
| | - Vijayakumar Javalkar
- Department of Neurology Ocshner/LSU Health Sciences Center-Sheveport, Shreveport, LA, USA
| | | | - Roger E Kelley
- Department of Neurology Ocshner/LSU Health Sciences Center-Sheveport, Shreveport, LA, USA.
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36
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Dunphy L, Akin-Komolafe T, Etheridge Z. Mixed dementia and hyperactive delirium: a diagnostic challenge. BMJ Case Rep 2021; 14:14/5/e238542. [PMID: 33962917 PMCID: PMC8108661 DOI: 10.1136/bcr-2020-238542] [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: 11/03/2022] Open
Abstract
It is well recognised that acute confusion or delirium complicates up to 10% of acute medical admissions. Disorientation in time and place with an impaired short-term memory and conscious level are the hallmarks of an acute confusion. In delirium, disorders of perception may produce restlessness and agitation. A similar state during the final days of life is termed 'terminal delirium'. Less than 10% of affected individuals will have a primary neurological disorder, for example, dementia, a neurodegenerative disease with varying aetiologies. Currently there are at least 50 million people globally suffering from dementia rendering it a global healthcare problem. Mixed dementia (MD) can be defined as a cognitive decline sufficient to impair independent functioning in daily life resulting from the coexistence of Alzheimer's disease (AD) and cerebrovascular pathology. MD occurs in patients with a neurodegenerative disorder, such as AD, Lewy body or Pick's disease and additionally cerebrovascular disease. The mechanistic synergisms between the coexisting pathologies affecting dementia risk, progression and the ultimate clinical manifestations remain elusive. Although AD can be diagnosed with a considerable degree of accuracy, the distinction between isolated AD, vascular dementia and MD, when both pathologies coexist in the same patient remains one of the most difficult diagnostic challenges because their clinical presentation can overlap. Neuropathological studies indicate that mixed vascular Alzheimer's dementia (MD) has a prevalence of 22% in the elderly. The authors present the case of a 78-year-old man with a diagnosis of MD presenting to the emergency department with delirium, a common but serious acute neuropsychiatric syndrome with the core features of inattention and global cognitive dysfunction. This case demonstrates the challenges in establishing a diagnosis in patients presenting with MD and shows that a cognitive assessment at presentation in a delirious state offers very little diagnostic information. It is therefore suggested to conduct a routine cognitive function examination on patients with dementia to anticipate new neurological signs and/or symptoms thus allowing earlier diagnosis and treatment. However, a baseline cognitive assessment when the patient was well, duration and nature of deterioration as well as collateral history will help differentiate delirium from an underlying dementia.
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Affiliation(s)
- Louise Dunphy
- Surgery, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Tosin Akin-Komolafe
- Department of Acute Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Zac Etheridge
- Department of Acute Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK
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37
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Tan X, Sundström J, Lind L, Franzon K, Kilander L, Benedict C. Reverse Dipping of Systolic Blood Pressure Is Associated With Increased Dementia Risk in Older Men. Hypertension 2021; 77:1383-1390. [DOI: 10.1161/hypertensionaha.120.16711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A lower day-to-night systolic blood pressure (BP) dip has previously been associated with poor brain health and cognitive functions. Here, we sought to examine whether reduced (nighttime/daytime ratio of systolic BP >0.9 and ≤1) and reverse (nighttime/daytime ratio of systolic BP >1) dipping of systolic BP is associated with the prospective risk of being diagnosed with any dementia in Swedish older men. Twenty-four-hour ambulatory BP monitoring was used to estimate the nocturnal systolic BP dipping status of men at mean age 71 (n=997; 35% on antihypertensive medication) and 77.6 (n=611; 41% on antihypertensive medication). Dementia incidence during the observational period up to 24 years (n=286 cases) was determined by reviewing participants’ medical history and independently confirmed by at least 2 experienced geriatricians. Using time-updated Cox regression (ie, time-updated information on covariates and exposure), we found that reverse systolic BP dipping was associated with a higher risk of being diagnosed with any dementia (adjusted HR, 1.64 [95% CI, 1.14–2.34],
P
=0.007) and Alzheimer’s disease (1.67 [1.01–2.76],
P
=0.047) but not vascular dementia (1.29 [0.55–3.06],
P
=0.559). In contrast, reduced dipping of nocturnal systolic BP was not associated with a higher risk of being diagnosed with dementia. Our findings suggest that reverse systolic BP dipping may represent an independent risk factor for dementia and Alzheimer’s disease in older men. Future studies should decipher whether therapies lowering nocturnal systolic BP below daytime levels, such as bedtime dosing of antihypertensive medication, can meaningfully curb the development of dementia.
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Affiliation(s)
- Xiao Tan
- Department of Neuroscience (X.T., C.B.), Uppsala University, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden (X.T.)
| | - Johan Sundström
- Department of Medical Sciences, Clinical Epidemiology (J.S.), Uppsala University, Sweden
| | - Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology (L.L.), Uppsala University, Sweden
| | - Kristin Franzon
- Department of Public Health and Caring Sciences, Geriatrics (K.F., L.K.), Uppsala University, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Geriatrics (K.F., L.K.), Uppsala University, Sweden
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Kokkinou M, Beishon LC, Smailagic N, Noel-Storr AH, Hyde C, Ukoumunne O, Worrall RE, Hayen A, Desai M, Ashok AH, Paul EJ, Georgopoulou A, Casoli T, Quinn TJ, Ritchie CW. Plasma and cerebrospinal fluid ABeta42 for the differential diagnosis of Alzheimer's disease dementia in participants diagnosed with any dementia subtype in a specialist care setting. Cochrane Database Syst Rev 2021; 2:CD010945. [PMID: 33566374 PMCID: PMC8078224 DOI: 10.1002/14651858.cd010945.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Dementia is a syndrome that comprises many differing pathologies, including Alzheimer's disease dementia (ADD), vascular dementia (VaD) and frontotemporal dementia (FTD). People may benefit from knowing the type of dementia they live with, as this could inform prognosis and may allow for tailored treatment. Beta-amyloid (1-42) (ABeta42) is a protein which decreases in both the plasma and cerebrospinal fluid (CSF) of people living with ADD, when compared to people with no dementia. However, it is not clear if changes in ABeta42 are specific to ADD or if they are also seen in other types of dementia. It is possible that ABeta42 could help differentiate ADD from other dementia subtypes. OBJECTIVES To determine the accuracy of plasma and CSF ABeta42 for distinguishing ADD from other dementia subtypes in people who meet the criteria for a dementia syndrome. SEARCH METHODS We searched MEDLINE, and nine other databases up to 18 February 2020. We checked reference lists of any relevant systematic reviews to identify additional studies. SELECTION CRITERIA We considered cross-sectional studies that differentiated people with ADD from other dementia subtypes. Eligible studies required measurement of participant plasma or CSF ABeta42 levels and clinical assessment for dementia subtype. DATA COLLECTION AND ANALYSIS Seven review authors working independently screened the titles and abstracts generated by the searches. We collected data on study characteristics and test accuracy. We used the second version of the 'Quality Assessment of Diagnostic Accuracy Studies' (QUADAS-2) tool to assess internal and external validity of results. We extracted data into 2 x 2 tables, cross-tabulating index test results (ABeta42) with the reference standard (diagnostic criteria for each dementia subtype). We performed meta-analyses using bivariate, random-effects models. We calculated pooled estimates of sensitivity, specificity, positive predictive values, positive and negative likelihood ratios, and corresponding 95% confidence intervals (CIs). In the primary analysis, we assessed accuracy of plasma or CSF ABeta42 for distinguishing ADD from other mixed dementia types (non-ADD). We then assessed accuracy of ABeta42 for differentiating ADD from specific dementia types: VaD, FTD, dementia with Lewy bodies (DLB), alcohol-related cognitive disorder (ARCD), Creutzfeldt-Jakob disease (CJD) and normal pressure hydrocephalus (NPH). To determine test-positive cases, we used the ABeta42 thresholds employed in the respective primary studies. We then performed sensitivity analyses restricted to those studies that used common thresholds for ABeta42. MAIN RESULTS We identified 39 studies (5000 participants) that used CSF ABeta42 levels to differentiate ADD from other subtypes of dementia. No studies of plasma ABeta42 met the inclusion criteria. No studies were rated as low risk of bias across all QUADAS-2 domains. High risk of bias was found predominantly in the domains of patient selection (28 studies) and index test (25 studies). The pooled estimates for differentiating ADD from other dementia subtypes were as follows: ADD from non-ADD: sensitivity 79% (95% CI 0.73 to 0.85), specificity 60% (95% CI 0.52 to 0.67), 13 studies, 1704 participants, 880 participants with ADD; ADD from VaD: sensitivity 79% (95% CI 0.75 to 0.83), specificity 69% (95% CI 0.55 to 0.81), 11 studies, 1151 participants, 941 participants with ADD; ADD from FTD: sensitivity 85% (95% CI 0.79 to 0.89), specificity 72% (95% CI 0.55 to 0.84), 17 studies, 1948 participants, 1371 participants with ADD; ADD from DLB: sensitivity 76% (95% CI 0.69 to 0.82), specificity 67% (95% CI 0.52 to 0.79), nine studies, 1929 participants, 1521 participants with ADD. Across all dementia subtypes, sensitivity was greater than specificity, and the balance of sensitivity and specificity was dependent on the threshold used to define test positivity. AUTHORS' CONCLUSIONS Our review indicates that measuring ABeta42 levels in CSF may help differentiate ADD from other dementia subtypes, but the test is imperfect and tends to misdiagnose those with non-ADD as having ADD. We would caution against the use of CSF ABeta42 alone for dementia classification. However, ABeta42 may have value as an adjunct to a full clinical assessment, to aid dementia diagnosis.
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Affiliation(s)
- Michelle Kokkinou
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Lucy C Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Nadja Smailagic
- Institute of Public Health, University of Cambridge , Cambridge, UK
| | | | - Chris Hyde
- Exeter Test Group, College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter , UK
| | - Obioha Ukoumunne
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | | | - Anja Hayen
- Department of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Meera Desai
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Abhishekh Hulegar Ashok
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College , London, UK
| | - Eleanor J Paul
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, UK
| | | | - Tiziana Casoli
- Center for Neurobiology of Aging, IRCCS INRCA, Ancona, Italy
| | - Terry J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Craig W Ritchie
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Kuang H, Zhou ZF, Zhu YG, Wan ZK, Yang MW, Hong FF, Yang SL. Pharmacological Treatment of Vascular Dementia: A Molecular Mechanism Perspective. Aging Dis 2021; 12:308-326. [PMID: 33532143 PMCID: PMC7801279 DOI: 10.14336/ad.2020.0427] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/27/2020] [Indexed: 11/01/2022] Open
Abstract
Vascular dementia (VaD) is a neurodegenerative disease, with cognitive dysfunction attributable to cerebrovascular factors. At present, it is the second most frequently occurring type of dementia in older adults (after Alzheimer's disease). The underlying etiology of VaD has not been completely elucidated, which limits its management. Currently, there are no approved standard treatments for VaD. The drugs used in VaD are only suitable for symptomatic treatment and cannot prevent or reduce the occurrence and progression of VaD. This review summarizes the current status of pharmacological treatment for VaD, from the perspective of the molecular mechanisms specified in various pathogenic hypotheses, including oxidative stress, the central cholinergic system, neuroinflammation, neuronal apoptosis, and synaptic plasticity. As VaD is a chronic cerebrovascular disease with multifactorial etiology, combined therapy, targeting multiple pathophysiological factors, may be the future trend in VaD.
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Affiliation(s)
- Huang Kuang
- 1Department of Physiology, College of Medicine, Nanchang University, Nanchang, China
| | - Zhi-Feng Zhou
- 1Department of Physiology, College of Medicine, Nanchang University, Nanchang, China
| | - Yu-Ge Zhu
- 1Department of Physiology, College of Medicine, Nanchang University, Nanchang, China
| | - Zhi-Kai Wan
- 1Department of Physiology, College of Medicine, Nanchang University, Nanchang, China
| | - Mei-Wen Yang
- 2Department of Nurse, Nanchang University Hospital, Nanchang 330006, Jiangxi, China
| | - Fen-Fang Hong
- 3Department of Experimental Teaching Center, Nanchang University, Nanchang, China
| | - Shu-Long Yang
- 1Department of Physiology, College of Medicine, Nanchang University, Nanchang, China.,3Department of Experimental Teaching Center, Nanchang University, Nanchang, China
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Tian X, Qin Y, Tian Y, Ge X, Cui J, Han H, Liu L, Yu H. Identification of vascular dementia and Alzheimer's disease hub genes expressed in the frontal lobe and temporal cortex by weighted co-expression network analysis and construction of a protein-protein interaction. Int J Neurosci 2021; 132:1049-1060. [PMID: 33401985 DOI: 10.1080/00207454.2020.1860966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: It is difficult to distinguish cognitive decline due to AD from that sustained by cerebrovascular disease in view of the great overlap. It is uncertain in the molecular biological pathway behind AD and VaD.Objective: Our study aimed to explore the hub molecules and their associations with each other to identify potential biomarkers and therapeutic targets for the AD and VaD.Methods: We screened the differentially expressed genes of AD and VaD, used weighted gene co-expression network analysis and then constructed a VaD-AD-specific protein-protein interaction network with functional annotation to their related metabolic pathways. Finally, we performed a ROC curve analysis of hub proteins to get an idea about their diagnostic value.Results: In the frontal lobe and temporal cortex, hub genes were identified. With regard to VaD, there were only three hub genes which encoded the neuropeptides, SST, NMU and TAC1. The AUC of these genes were 0.804, 0.768 and 0.779, respectively. One signature was established for these three hub genes with AUC of 0.990. For the identification of AD and VaD, all hub genes were receptors. These genes included SH3GL2, PROK2, TAC3, HTR2A, MET, TF, PTH2R CNR1, CHRM4, PTPN3 and CRH. The AUC of these genes were 0.853, 0.859, 0.796, 0.775, 0.706, 0.677, 0.696, 0.668 and 0.652, respectively. The other signature was built for eleven hub genes with AUC of 0.990.Conclusion: In the frontal lobe and temporal cortex regions, hub genes are used as diagnostic markers, which may provide insight into personalized potential biomarkers and therapeutic targets for patients with VaD and AD.
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Affiliation(s)
- Xiaodou Tian
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, P.R. China
| | - Yao Qin
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, P.R. China
| | - Yuling Tian
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, P.R. China
| | - Xiaoyan Ge
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, P.R. China
| | - Jing Cui
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, P.R. China
| | - Hongjuan Han
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, P.R. China
| | - Long Liu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, P.R. China
| | - Hongmei Yu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, P.R. China.,Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Shanxi Medical University, Taiyuan, P.R. China
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D'Souza CE, Greenway MRF, Graff-Radford J, Meschia JF. Cognitive Impairment in Patients with Stroke. Semin Neurol 2021; 41:75-84. [PMID: 33418591 DOI: 10.1055/s-0040-1722217] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Despite substantial advances in stroke care, vascular cognitive impairment remains a prominent source of disability. Unlike sensorimotor impairments, cognition often continues to decline after stroke. An aging population will increase the prevalence of vascular cognitive impairment, with stroke playing an important role. Ten percent of patients presenting with stroke have pre-stroke dementia; an additional 10% will develop incident dementia with a first stroke, and 30% with a recurrent stroke. While stroke increases the risk of cognitive impairment, the presence of cognitive impairment also impacts acute stroke treatment and increases risk of poor outcome by nearly twofold. There is substantial overlap in the clinical and pathological aspects of vascular and degenerative dementias in many patients. How they relate to one another is controversial. The treatment of vascular cognitive impairment remains supportive, focusing on treating vascular risk factors. Cognitive rehabilitation after stroke is an area of active research, and existing pharmacologic treatments have limited benefit. Heightened awareness of cognitive impairment in the setting of stroke is imperative for prognostication and management, impetus for research and, ultimately, the discovery of efficacious treatments.
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Affiliation(s)
- Caitlin E D'Souza
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida.,Department of Neurology, Baptist Health, Jacksonville, Florida
| | | | | | - James F Meschia
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida
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Alexopoulos P, Soldatos R, Kontogianni E, Frouda M, loanna Aligianni S, Skondra M, Passa M, Konstantopoulou G, Stamouli E, Katirtzoglou E, Politis A, Economou P, Alexaki M, Siarkos K, Politis A. COVID-19 Crisis Effects on Caregiver Distress in Neurocognitive Disorder. J Alzheimers Dis 2021; 79:459-466. [DOI: 10.3233/jad-200991] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: The outbreak of the COVID-19 pandemic seems to have mental health implications for both people with neurocognitive disorder and their caregivers. Objective: The study aimed to shed light on relations between caregiver mental reaction to the pandemic and caregiver distress related to neuropsychiatric symptoms, memory impairment progression, and functional impairment of people with neurocognitive disorder during the period of confinement in Greece. Methods: The study included caregivers of patients with mild (N = 13) and major (N = 54) neurocognitive disorder. The caregiver-based telephone interview was based on items of the neuropsychiatric inventory questionnaire, the AD8 Dementia Screening Instrument, and the Bristol Activities of Daily Living Scale. Regarding the mental impact of the COVID-19 crisis on caregivers, four single questions referring to their worries in the last seven days were posed, in addition to the scales Generalized Anxiety Disorder 7-Item (GAD-7) and the 22-item Impact of Event Scale-revised (IES-R). A stepwise linear regression model was employed for studying the relationship between caregiver distress and demographic and clinical data and caregiver mental reaction to COVID-19 pandemic outbreak. Results: Caregiver distress severity during the confinement period was influenced not only by memory deficits (p = 0.009) and neuropsychiatric symptoms (p < 0.001) of patients, but also by caregiver hyperarousal (p = 0.003) and avoidance symptoms (p = 0.033) and worries directly linked to the COVID-19 crisis (p = 0.022). Conclusion: These observations provide further evidence for the urgent need for support of caregivers of patients with neurocognitive disorder during the COVID-19 pandemic.
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Affiliation(s)
- Panagiotis Alexopoulos
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Faculty of Medicine, Technische Universität München, Munich, Germany
- Psychogeriatric unit for neurocognitive assessment and caregiver counselling, Patras Office of The Hellenic Red Cross, Patras, Greece
- Patras Dementia Day Care Center, Corporation for Succor and Care of Elderly and Disabled –FRODIZO, Patras, Greece
| | - Rigas Soldatos
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Kontogianni
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Frouda
- Patras Dementia Day Care Center, Corporation for Succor and Care of Elderly and Disabled –FRODIZO, Patras, Greece
| | - Souzana loanna Aligianni
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Maria Skondra
- Department of Psychiatry, Patras University Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
- Psychogeriatric unit for neurocognitive assessment and caregiver counselling, Patras Office of The Hellenic Red Cross, Patras, Greece
- Department of Nursing, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Maria Passa
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Konstantopoulou
- Special Office for Health Consulting Services and Faculty of Education and Social Work, School of Humanities and Social Sciences, University of Patras, University of Patras, Patras, Greece
| | - Evangelia Stamouli
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evgenia Katirtzoglou
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Politis
- Charing Cross Hospital, Department of Neurosurgery, Imperial College London
| | - Polychronis Economou
- Department of Civil Engineering (Statistics), University of Patras, Patras, Greece
| | - Maria Alexaki
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostas Siarkos
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Politis
- First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins Medical School, Baltimore, MD, USA
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Smith EE, Barber P, Field TS, Ganesh A, Hachinski V, Hogan DB, Lanctôt KL, Lindsay MP, Sharma M, Swartz RH, Ismail Z, Gauthier S, Black SE. Canadian Consensus Conference on Diagnosis and Treatment of Dementia (CCCDTD)5: Guidelines for management of vascular cognitive impairment. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12056. [PMID: 33209971 PMCID: PMC7657196 DOI: 10.1002/trc2.12056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/09/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Vascular disease is a common cause of dementia, and often coexists with other brain pathologies such as Alzheimer's disease to cause mixed dementia. Many of the risk factors for vascular disease are treatable. Our objective was to review evidence for diagnosis and treatment of vascular cognitive impairment (VCI) to issue recommendations to clinicians. METHODS A subcommittee of the Canadian Consensus Conference on Diagnosis and Treatment of Dementia (CCCDTD) reviewed areas of emerging evidence. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assign the quality of the evidence and strength of the recommendations. RESULTS Using standardized diagnostic criteria, managing hypertension to conventional blood pressure targets, and reducing risk for stroke are strongly recommended. Intensive blood pressure lowering in middle-aged adults with vascular risk factors, using acetylsalicylic acid in persons with VCI and covert brain infarctions but not if only white matter lesions are present, and using cholinesterase inhibitors are weakly recommended. CONCLUSIONS The CCCDTD has provided evidence-based recommendations for diagnosis and management of VCI for use nationally in Canada, that may also be of use worldwide.
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Affiliation(s)
- Eric E. Smith
- Department of Clinical Neurosciences and Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - Philip Barber
- Department of Clinical Neurosciences and Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - Thalia S. Field
- Vancouver Stroke ProgramDjavad Mowafaghian Centre for Brain Health, Division of NeurologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Aravind Ganesh
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Vladimir Hachinski
- Department of Clinical Neurological SciencesWestern UniversityLondonOntarioCanada
| | - David B. Hogan
- Department of Medicine and Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - Krista L. Lanctôt
- Department of Psychiatry and Hurvitz Brain Sciences Research ProgramSunnybrook Research Institute and Departments of Psychiatry and PharmacologyUniversity of TorontoTorontoOntarioCanada
| | | | - Mukul Sharma
- Department of Medicine (Neurology)Population Health Research InstituteMcMaster UniversityCanada
| | - Richard H. Swartz
- Department of Medicine (Neurology)Hurvitz Brain Sciences ProgramSunnybrook HSCUniversity of TorontoTorontoCanada
| | - Zahinoor Ismail
- Departments of PsychiatryClinical Neurosciences and Community Health SciencesHotchkiss Brain Institute and O'Brien Institute for Public HealthUniversity of CalgaryCalgaryCanada
| | - Serge Gauthier
- McGill Center for Studies in AgingMcGill UniversityMontrealCanada
| | - Sandra E. Black
- Department of Medicine (Neurology)Hurvitz Brain Sciences Research ProgramLC Campbell Cognitive Neurology UnitCanadian Partnership for Stroke RecoveryUniversity of TorontoTorontoCanada
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B Åhman H, Berglund L, Cedervall Y, Kilander L, Giedraitis V, McKee KJ, Ingelsson M, Rosendahl E, Åberg AC. Dual-Task Tests Predict Conversion to Dementia-A Prospective Memory-Clinic-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218129. [PMID: 33153203 PMCID: PMC7662628 DOI: 10.3390/ijerph17218129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/20/2020] [Accepted: 10/31/2020] [Indexed: 12/29/2022]
Abstract
The aim of this study was to investigate whether Timed Up-and-Go (TUG) dual-task (TUGdt) tests predict dementia incidence among patients with subjective or mild cognitive impairment (SCI; MCI). Other study objectives were to determine whether TUGdt improves dementia prediction compared to a) demographic characteristics and standard cognitive tests alone; and b) TUG and Verbal Fluency performed separately. Patients (n = 172, age range 39–91 years, 78 women) with SCI or MCI performed TUGdt tests, including 1) naming animals and 2) reciting months backwards, and clinical cognitive tests at baseline. Diagnoses were identified at follow-up after 2.5 years. Logistic regression was used to predict dementia incidence, receiver operating characteristic (ROC) curves and c-statistics for predictive capacity. Analyses were stratified by age and gender. At follow-up, 51 patients had developed dementia. The TUGdt result “animals/10 s” was associated with dementia incidence (standardized odds ratio (OR) = 4.06, 95% confidence interval (CI) 2.28–7.23, p < 0.001), more so among patients under the median age of 72 years (standardized OR = 19.4, 95% CI 3.53–106.17, p < 0.001). TUGdt “animals/10 s” improved dementia prediction compared to demographic characteristics and standard tests alone (c-statistics 0.88 to 0.94) and single-task tests (c-statistics 0.86 to 0.89), but only in the younger patient group. TUGdt has the potential to become a useful tool for dementia prediction.
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Affiliation(s)
- Hanna B Åhman
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, SE-751 22 Uppsala, Sweden; (L.B.); (Y.C.); (L.K.); (V.G.); (M.I.); (A.C.Å.)
- Correspondence:
| | - Lars Berglund
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, SE-751 22 Uppsala, Sweden; (L.B.); (Y.C.); (L.K.); (V.G.); (M.I.); (A.C.Å.)
- School of Education, Health and Social Studies, Dalarna University, SE-791 88 Falun, Sweden;
| | - Ylva Cedervall
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, SE-751 22 Uppsala, Sweden; (L.B.); (Y.C.); (L.K.); (V.G.); (M.I.); (A.C.Å.)
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, SE-751 22 Uppsala, Sweden; (L.B.); (Y.C.); (L.K.); (V.G.); (M.I.); (A.C.Å.)
| | - Vilmantas Giedraitis
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, SE-751 22 Uppsala, Sweden; (L.B.); (Y.C.); (L.K.); (V.G.); (M.I.); (A.C.Å.)
| | - Kevin J. McKee
- School of Education, Health and Social Studies, Dalarna University, SE-791 88 Falun, Sweden;
| | - Martin Ingelsson
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, SE-751 22 Uppsala, Sweden; (L.B.); (Y.C.); (L.K.); (V.G.); (M.I.); (A.C.Å.)
| | - Erik Rosendahl
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-901 87 Umeå, Sweden;
| | - Anna Cristina Åberg
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, SE-751 22 Uppsala, Sweden; (L.B.); (Y.C.); (L.K.); (V.G.); (M.I.); (A.C.Å.)
- School of Education, Health and Social Studies, Dalarna University, SE-791 88 Falun, Sweden;
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Montero-Odasso M, Speechley M, Muir-Hunter SW, Pieruccini-Faria F, Sarquis-Adamson Y, Hachinski V, Bherer L, Borrie M, Wells J, Garg AX, Tian Q, Ferrucci L, Bray NW, Cullen S, Mahon J, Titus J, Camicioli R. Dual decline in gait speed and cognition is associated with future dementia: evidence for a phenotype. Age Ageing 2020; 49:995-1002. [PMID: 32559288 PMCID: PMC7583522 DOI: 10.1093/ageing/afaa106] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND concurrent declines in gait speed and cognition have been associated with future dementia. However, the clinical profile of 'dual decliners', those with concomitant decline in both gait speed and cognition, has not been yet described. We aimed to describe the phenotype and the risk for incident dementia of those who present with dual decline in comparison with non-dual decliners. METHODS prospective cohort of community-dwelling older adults free of dementia at baseline. We evaluated participants' gait speed, cognition, medical status, functionality, incidence of adverse events and dementia, biannually over 7 years. Gait speed was assessed with a 6-m electronic walkway and global cognition using the MoCA test. We compared characteristics between dual decliners and non-dual decliners using t-test, chi-square and hierarchical regression models. We estimated incident dementia using Cox models. RESULTS among 144 participants (mean age 74.23 ± 6.72 years, 54% women), 17% progressed to dementia. Dual decliners had a 3-fold risk (HR: 3.12, 95%CI: 1.23-7.93, P = 0.017) of progression to dementia compared with non-dual decliners. Dual decliners were significantly older with a higher prevalence of hypertension and dyslipidemia (P = 0.002). Hierarchical regression models show that age and sex alone explained 3% of the variation in the dual decliners group. Adding hypertension and dyslipidemia increased the explained variation by 8 and 10%, respectively. The risk of becoming a dual decliner was 4-fold higher if hypertension was present. CONCLUSION older adults with a concurrent decline in gait speed and cognition represent a group at the highest risk of progression to dementia. Older adults with dual decline have a distinct phenotype with a higher prevalence of hypertension, a treatable condition.
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Affiliation(s)
- Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Department of Medicine and Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada
| | - Mark Speechley
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada
| | - Susan W Muir-Hunter
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Department of Medicine and Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Frederico Pieruccini-Faria
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Department of Medicine and Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Yanina Sarquis-Adamson
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
| | - Vladimir Hachinski
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada
- Department of Clinical Neurological Sciences, The University of Western Ontario, London, ON, Canada
| | - Louis Bherer
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
- Montreal Heart Institute, and Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
| | - Michael Borrie
- Department of Medicine and Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Jennie Wells
- Department of Medicine and Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Amit X Garg
- Department of Medicine and Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada
| | - Qu Tian
- Translational Gerontology Branch Longitudinal Studies Section, National Institute on Aging, Baltimore, MD, USA
| | - Luigi Ferrucci
- Translational Gerontology Branch Longitudinal Studies Section, National Institute on Aging, Baltimore, MD, USA
| | - Nick W Bray
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- School of Kinesiology, The University of Western Ontario, London, ON, Canada
| | - Stephanie Cullen
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- School of Kinesiology, The University of Western Ontario, London, ON, Canada
| | - Joel Mahon
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- School of Kinesiology, The University of Western Ontario, London, ON, Canada
| | - Josh Titus
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- School of Kinesiology, The University of Western Ontario, London, ON, Canada
| | - Richard Camicioli
- Division of Neurology and Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Khedr EM, Gomaa AMS, Ahmed OG, Sayed HMM, Gamea A. Cognitive Impairment, P300, and Transforming Growth Factor β1 in Different Forms of Dementia. J Alzheimers Dis 2020; 78:837-845. [PMID: 33044184 DOI: 10.3233/jad-200885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND There are currently few biomarkers to assist in early diagnosis of dementias. OBJECTIVE To distinguish between different dementias: Alzheimer's disease (AD), vascular dementia (VaD), and Parkinson's disease dementia (PDD) using simple neurophysiologic (P300) and laboratory markers (transforming growth factor β1 "TGF-β1"). METHODS The study included 15 patients for each type of dementia and 25 age- and sex-matched control subjects. Dementia patients were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition-revised (DSM-IV-R). Modified Mini-Mental State Examination (3MS), Memory Assessment Scale (MAS), P300, and TGF-β1 were examined for each participant. RESULTS There were no significant differences between groups as regard to age, sex, and education, social, and economic levels. Significant differences between groups were observed in registration and naming variables of the 3MS. Compared with the control group, P300 latency was prolonged in all groups, although to a greater extent in AD and PDD than in VaD. A serum level of TGF-β1 was significantly elevated in all groups but was significantly higher in AD and VaD than in PDD. 3MS tended to correlate with P300 more than TGF-β1, and to be stronger in AD than the other groups. CONCLUSION Measurements of P300 latency and serum levels of TGF-β1 can help distinguish AD, PDD, and VaD. P300 was more prolonged in AD and PDD than VaD whereas TGF-β1 was significantly higher in AD and VaD than PDD. Thus P300 and TGF-β1 may be useful biomarkers for detection and evaluation of the extent of cognitive dysfunction.
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Affiliation(s)
- Eman M Khedr
- Department of Neuropsychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Asmaa M S Gomaa
- Department of Medical Physiology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Omyma G Ahmed
- Department of Medical Physiology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hanaa M M Sayed
- Department of Medical Physiology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ayman Gamea
- Department of Neuropsychiatry, Faculty of Medicine, South Valley University, Qena, Egypt
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Bosnić Z, Bratić B, Ivanović M, Semnic M, Oder I, Kurbalija V, Vujanić Stankov T, Bugarski Ignjatović V. Improving Alzheimer’s disease classification by performing data fusion with vascular dementia and stroke data. J EXP THEOR ARTIF IN 2020. [DOI: 10.1080/0952813x.2020.1818290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Zoran Bosnić
- University of Ljubljana, Faculty of Computer and Information Science, Ljubljana, Slovenia
| | - Brankica Bratić
- University of Novi Sad, Faculty of Sciences, Novi Sad, Serbia
| | | | - Marija Semnic
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
- Clinic of Neurology, Clinical Centre of Vojvodina, Novi Sad, Serbia
| | - Iztok Oder
- University of Ljubljana, Faculty of Computer and Information Science, Ljubljana, Slovenia
| | | | - Tijana Vujanić Stankov
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
- Clinic of Neurology, Clinical Centre of Vojvodina, Novi Sad, Serbia
| | - Vojislava Bugarski Ignjatović
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
- Clinic of Neurology, Clinical Centre of Vojvodina, Novi Sad, Serbia
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Åhman HB, Cedervall Y, Kilander L, Giedraitis V, Berglund L, McKee KJ, Rosendahl E, Ingelsson M, Åberg AC. Dual-task tests discriminate between dementia, mild cognitive impairment, subjective cognitive impairment, and healthy controls - a cross-sectional cohort study. BMC Geriatr 2020; 20:258. [PMID: 32727472 PMCID: PMC7392684 DOI: 10.1186/s12877-020-01645-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 07/13/2020] [Indexed: 12/13/2022] Open
Abstract
Background Discrimination between early-stage dementia and other cognitive impairment diagnoses is central to enable appropriate interventions. Previous studies indicate that dual-task testing may be useful in such differentiation. The objective of this study was to investigate whether dual-task test outcomes discriminate between groups of individuals with dementia disorder, mild cognitive impairment, subjective cognitive impairment, and healthy controls. Methods A total of 464 individuals (mean age 71 years, 47% women) were included in the study, of which 298 were patients undergoing memory assessment and 166 were cognitively healthy controls. Patients were grouped according to the diagnosis received: dementia disorder, mild cognitive impairment, or subjective cognitive impairment. Data collection included participants’ demographic characteristics. The patients’ cognitive test results and diagnoses were collected from their medical records. Healthy controls underwent the same cognitive tests as the patients. The mobility test Timed Up-and-Go (TUG single-task) and two dual-task tests including TUG (TUGdt) were carried out: TUGdt naming animals and TUGdt months backwards. The outcomes registered were: time scores for TUG single-task and both TUGdt tests, TUGdt costs (relative time difference between TUG single-task and TUGdt), number of different animals named, number of months recited in correct order, number of animals per 10 s, and number of months per 10 s. Logistic regression models examined associations between TUG outcomes pairwise between groups. Results The TUGdt outcomes “animals/10 s” and “months/10 s” discriminated significantly (p < 0.001) between individuals with an early-stage dementia diagnosis, mild cognitive impairment, subjective cognitive impairment, and healthy controls. The TUGdt outcome “animals/10 s” showed an odds ratio of 3.3 (95% confidence interval 2.0–5.4) for the groups dementia disorders vs. mild cognitive impairment. TUGdt cost outcomes, however, did not discriminate between any of the groups. Conclusions The novel TUGdt outcomes “words per time unit”, i.e. “animals/10 s” and “months/10 s”, demonstrate high levels of discrimination between all investigated groups. Thus, the TUGdt tests in the current study could be useful as complementary tools in diagnostic assessments. Future studies will be focused on the predictive value of TUGdt outcomes concerning dementia risk for individuals with mild cognitive impairment or subjective cognitive impairment.
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Affiliation(s)
- Hanna B Åhman
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Box 564, SE-751 22, Uppsala, Sweden.
| | - Ylva Cedervall
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Box 564, SE-751 22, Uppsala, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Box 564, SE-751 22, Uppsala, Sweden
| | - Vilmantas Giedraitis
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Box 564, SE-751 22, Uppsala, Sweden
| | - Lars Berglund
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Box 564, SE-751 22, Uppsala, Sweden
| | - Kevin J McKee
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Erik Rosendahl
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Martin Ingelsson
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Box 564, SE-751 22, Uppsala, Sweden
| | - Anna Cristina Åberg
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Box 564, SE-751 22, Uppsala, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Hwang PH, Longstreth W, Brenowitz WD, Thielke SM, Lopez OL, Francis CE, DeKosky ST, Fitzpatrick AL. Dual sensory impairment in older adults and risk of dementia from the GEM Study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12054. [PMID: 32671180 PMCID: PMC7340796 DOI: 10.1002/dad2.12054] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hearing and vision loss are independently associated with dementia, but the impact of dual sensory impairment (DSI) on dementia risk is not well understood. METHODS Self-reported measures of hearing and vision were taken from 2051 participants at baseline from the Gingko Evaluation of Memory Study. Dementia status was ascertained using standardized criteria. Cox models were used to estimate risk of dementia associated with number of sensory impairments (none, one, or two). RESULTS DSI was significantly associated with higher risk of all-cause dementia (hazard ratio [HR] = 1.86; 95% confidence interval [CI] = 1.25-2.76) and Alzheimer's disease (HR = 2.12; 95% CI = 1.34-3.36). Individually only visual impairment was independently associated with an increased risk of all-cause dementia (HR = 1.32; 95% CI = 1.02-1.71). DISCUSSION Older adults with DSI are at a significantly increased risk for dementia. Further studies are needed to evaluate whether treatments can modify this risk.
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Affiliation(s)
- Phillip H. Hwang
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - W.T. Longstreth
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Department of NeurologyUniversity of WashingtonSeattleWashingtonUSA
| | - Willa D. Brenowitz
- Department of PsychiatryUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Stephen M. Thielke
- Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleWashingtonUSA
- Geriatric ResearchEducationand Clinical CenterPuget Sound VA Medical CenterSeattleWashingtonUSA
| | - Oscar L. Lopez
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | | | | | - Annette L. Fitzpatrick
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Department of Family MedicineUniversity of WashingtonSeattleWashingtonUSA
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
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Koch M, DeKosky ST, Goodman M, Sun J, Furtado JD, Fitzpatrick AL, Mackey RH, Cai T, Lopez OL, Kuller LH, Mukamal KJ, Jensen MK. Association of Apolipoprotein E in Lipoprotein Subspecies With Risk of Dementia. JAMA Netw Open 2020; 3:e209250. [PMID: 32648923 PMCID: PMC7352155 DOI: 10.1001/jamanetworkopen.2020.9250] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 04/22/2020] [Indexed: 12/13/2022] Open
Abstract
Importance The ε4 allele of the apolipoprotein E (APOE) gene and lower apolipoprotein E (apoE) protein levels in plasma are risk factors for Alzheimer disease, but the underlying biological mechanisms are not fully understood. Half of plasma apoE circulates on high-density lipoproteins (HDLs). Higher apoE levels in plasma HDL were previously found to be associated with lower coronary heart disease risk, but the coexistence of another apolipoprotein, apoC3, modified this lower risk. Objective To investigate associations between the presence of apoE in different lipoproteins with cognitive function, particularly the risk of dementia. Design, Setting, and Participants This prospective case-cohort study embedded in the Ginkgo Evaluation of Memory Study (2000-2008) analyzed data from 1351 community-dwelling participants 74 years and older. Of this group, 995 participants were free of dementia at baseline (recruited from September 2000 to June 2002) and 521 participants were diagnosed with incident dementia during follow-up until 2008. Data analysis was performed from January 2018 to December 2019. Exposures Enzyme-linked immunosorbent assay-measured concentration of apoE in whole plasma, HDL-depleted plasma (non-HDL), HDL, and HDL subspecies that contain or lack apoC3 or apoJ. Main Outcomes and Measures Adjusted hazard ratios for risk of dementia and Alzheimer disease during follow-up and adjusted differences (β coefficients) in Alzheimer Disease Assessment-Cognitive Subscale (ADAS-cog) and Modified Mini-Mental State Examination scores at baseline. Results Among 1351 participants, the median (interquartile range) age was 78 (76-81) years; 639 (47.3%) were women. The median (interquartile range) follow-up time was 5.9 (3.7-6.5) years. Higher whole plasma apoE levels and higher apoE levels in HDL were associated with better cognitive function assessed by ADAS-cog (whole plasma, β coefficient, -0.15; 95% CI, -0.24 to -0.06; HDL, β coefficient, -0.20; 95% CI, -0.30 to -0.10) but were unassociated with dementia or Alzheimer disease risk. When separated by apoC3, a higher apoE level in HDL that lacks apoC3 was associated with better cognitive function (ADAS-cog per SD: β coefficient, 0.17; 95% CI, -0.27 to -0.07; Modified Mini-Mental State Examination score per SD: β coefficient, 0.25; 95% CI, 0.07 to 0.42) and lower risk of dementia (hazard ratio per SD, 0.86; 95% CI, 0.76 to 0.99). In contrast, apoE levels in HDL that contains apoC3 were unassociated with any of these outcomes. Conclusions and Relevance In a prospective cohort of older adults with rigorous follow-up of dementia, the apoE level in HDL that lacked apoC3 was associated with better cognitive function and lower dementia risk. This finding suggests that the cardioprotective associations of this novel lipoprotein extend to dementia.
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Affiliation(s)
- Manja Koch
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Matthew Goodman
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jiehuan Sun
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jeremy D. Furtado
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Rachel H. Mackey
- Department of Family Medicine, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
| | - Tianxi Cai
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Oscar L. Lopez
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lewis H. Kuller
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Kenneth J. Mukamal
- Beth Israel Deaconess Medical Center, Department of Medicine, Boston, Massachusetts
| | - Majken K. Jensen
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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