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Wiegersma AM, Boots A, Langendam MW, Limpens J, Shenkin SD, Korosi A, Roseboom TJ, de Rooij SR. Do prenatal factors shape the risk for dementia?: A systematic review of the epidemiological evidence for the prenatal origins of dementia. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02471-7. [PMID: 37029828 DOI: 10.1007/s00127-023-02471-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 03/30/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE Prenatal factors such as maternal stress, infection and nutrition affect fetal brain development and may also influence later risk for dementia. The purpose of this systematic review was to provide an overview of all studies which investigated the association between prenatal factors and later risk for dementia. METHODS We systematically searched MEDLINE and Embase for original human studies reporting on associations between prenatal factors and dementia from inception to 23 November 2022. Prenatal factors could be any factor assessed during pregnancy, at birth or postnatally, provided they were indicative of a prenatal exposure. Risk of bias was assessed using the Newcastle Ottawa Scale. We followed PRISMA guidelines for reporting. RESULTS A total of 68 studies met eligibility criteria (including millions of individuals), assessing maternal age (N = 30), paternal age (N = 22), birth order (N = 15), season of birth (N = 16), place of birth (N = 13), prenatal influenza pandemic (N = 1) or Chinese famine exposure (N = 1), birth characteristics (N = 3) and prenatal hormone exposure (N = 4). We observed consistent results for birth in a generally less optimal environment (e.g. high infant mortality area) being associated with higher dementia risk. Lower and higher birth weight and prenatal famine exposure were associated with higher dementia risk. The studies on season of birth, digit ratio, prenatal influenza pandemic exposure, parental age and birth order showed inconsistent results and were hampered by relatively high risk of bias. CONCLUSION Our findings suggest that some prenatal factors, especially those related to a suboptimal prenatal environment, are associated with an increased dementia risk. As these associations may be confounded by factors such as parental socioeconomic status, more research is needed to examine the potential causal role of the prenatal environment in dementia.
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Affiliation(s)
- Aline Marileen Wiegersma
- Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Aging & Later Life, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
| | - Amber Boots
- Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging & Later Life, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Miranda W Langendam
- Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Methodology, Amsterdam, The Netherlands
| | - Jacqueline Limpens
- Medical Library, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Susan D Shenkin
- Geriatric Medicine, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Aniko Korosi
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Tessa J Roseboom
- Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging & Later Life, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Susanne R de Rooij
- Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging & Later Life, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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2
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Paik H, Lee J, Jeong CS, Park JS, Lee JH, Rappoport N, Kim Y, Sohn HY, Jo C, Kim J, Cho SB. Identification of a pleiotropic effect of ADIPOQ on cardiac dysfunction and Alzheimer's disease based on genetic evidence and health care records. Transl Psychiatry 2022; 12:389. [PMID: 36114174 PMCID: PMC9481623 DOI: 10.1038/s41398-022-02144-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 08/21/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
Observations of comorbidity in heart diseases, including cardiac dysfunction (CD) are increasing, including and cognitive impairment, such as Alzheimer's disease and dementia (AD/D). This comorbidity might be due to a pleiotropic effect of genetic variants shared between CD and AD/D. Here, we validated comorbidity of CD and AD/D based on diagnostic records from millions of patients in Korea and the University of California, San Francisco Medical Center (odds ratio 11.5 [8.5-15.5, 95% Confidence Interval (CI)]). By integrating a comprehensive human disease-SNP association database (VARIMED, VARiants Informing MEDicine) and whole-exome sequencing of 50 brains from individuals with and without Alzheimer's disease (AD), we identified missense variants in coding regions including APOB, a known risk factor for CD and AD/D, which potentially have a pleiotropic role in both diseases. Of the identified variants, site-directed mutation of ADIPOQ (268 G > A; Gly90Ser) in neurons produced abnormal aggregation of tau proteins (p = 0.02), suggesting a functional impact for AD/D. The association of CD and ADIPOQ variants was confirmed based on domain deletion in cardiac cells. Using the UK Biobank including data from over 500000 individuals, we examined a pleiotropic effect of the ADIPOQ variant by comparing CD- and AD/D-associated phenotypic evidence, including cardiac hypertrophy and cognitive degeneration. These results indicate that convergence of health care records and genetic evidences may help to dissect the molecular underpinnings of heart disease and associated cognitive impairment, and could potentially serve a prognostic function. Validation of disease-disease associations through health care records and genomic evidence can determine whether health conditions share risk factors based on pleiotropy.
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Affiliation(s)
- Hyojung Paik
- Division of Supercomputing, Korea Institute of Science and Technology Information, Daejeon, 34141, Republic of Korea
- Bakar Computational Health Sciences Institute, University of California San Francisco, 550 16th Street, San Francisco, CA, 94143, USA
- Department of Pediatrics, School of Medicine, University of California San Francisco, 550 16th Street, San Francisco, CA, 94143, USA
- Department of Data and HPC Science, University of Science and Technology, Daejeon, 34113, Republic of Korea
| | - Junehawk Lee
- Division of Supercomputing, Korea Institute of Science and Technology Information, Daejeon, 34141, Republic of Korea
| | - Chan-Seok Jeong
- Division of Supercomputing, Korea Institute of Science and Technology Information, Daejeon, 34141, Republic of Korea
| | - Jun Sung Park
- Biomedical Science and Engineering Interdisciplinary Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Jeong Ho Lee
- Biomedical Science and Engineering Interdisciplinary Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Nadav Rappoport
- Bakar Computational Health Sciences Institute, University of California San Francisco, 550 16th Street, San Francisco, CA, 94143, USA
- Departement of Software and Information Systems Engineering, Ben-Gurion University of the Negev, Beersheba, 8410501, Israel
| | - Younghoon Kim
- Division of Supercomputing, Korea Institute of Science and Technology Information, Daejeon, 34141, Republic of Korea
| | - Hee-Young Sohn
- Division of Brain Disease Research, Department for Chronic Disease Convergence Research, Korea National Institute of Health, Chungcheongbuk-do, 28159, Republic of Korea
| | - Chulman Jo
- Division of Brain Disease Research, Department for Chronic Disease Convergence Research, Korea National Institute of Health, Chungcheongbuk-do, 28159, Republic of Korea
| | - Jimin Kim
- Division of Supercomputing, Korea Institute of Science and Technology Information, Daejeon, 34141, Republic of Korea
| | - Seong Beom Cho
- Department of Bio-Medical Informatics, Gachon University, College of Medicine, Incheon, 21565, Republic of Korea.
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3
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Gallagher R, Woolaston A, Tofler G, Bauman A, Zhao E, Jeon YH, Neubeck L, Mitchell JA, Naismith SL. Cognitive impairment and psychological state in acute coronary syndrome patients: A prospective descriptive study at cardiac rehabilitation entry, completion and follow-up. Eur J Cardiovasc Nurs 2021; 20:56-63. [PMID: 33570597 DOI: 10.1177/1474515120933105] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/20/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cognitive impairment may limit the uptake of secondary prevention in acute coronary syndrome patients, but is poorly understood, including in cardiac rehabilitation participants. AIM The aim of this study was to explore cognitive impairment in relation to psychological state in acute coronary syndrome patients over the course of cardiac rehabilitation and follow-up. METHODS Acute coronary syndrome patients without diagnosed dementia were assessed on verbal learning, processing speed, executive function and visual attention, at cardiac rehabilitation entry, completion and follow-up and scores adjusted using normative data. The hospital anxiety and depression scale measured psychological state. RESULTS Participants (n = 40) had an average age of 66.2 (±8.22) years and were 70% men. Mild cognitive impairment occurred at cardiac rehabilitation entry in single 62.5% and multiple 22.5% domains but was significantly less prevalent by cardiac rehabilitation completion (52.5% and 15.0%) and follow-up (32.5% and 7.0%). Domains most often impaired were verbal learning (52.5%) and processing speed (25.6%), again decreasing significantly with time (verbal learning cardiac rehabilitation completion 42.5%, follow-up 22.5%; processing speed cardiac rehabilitation completion 15.0%, follow-up 15.0%). A small group of patients had persistent multiple domain cognitive impairment. At cardiac rehabilitation entry patients with cognitive impairment in processing speed, a single domain or multiple domains had more depression, and patients with cognitive impairment in executive function had more depression and anxiety. CONCLUSIONS At cardiac rehabilitation entry, mild cognitive impairment is very common in post-acute coronary syndrome patients and worse in patients who have depression or anxiety symptoms. Cognitive impairment decreases significantly by cardiac rehabilitation follow-up. A small proportion of patients has persistent, multiple domain cognitive impairment flagging potential long-term changes and the need for further investigations and cognitive rehabilitation.
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Affiliation(s)
- Robyn Gallagher
- Sydney Nursing School and Charles Perkins Centre, University of Sydney, Australia
| | - Anna Woolaston
- Sydney Nursing School and Charles Perkins Centre, University of Sydney, Australia
| | - Geoffrey Tofler
- Department of Cardiology, Royal North Shore Hospital, Australia
| | - Adrian Bauman
- School of Public Health and Charles Perkins Centre, University of Sydney, Australia
| | - Emma Zhao
- Sydney Nursing School and Charles Perkins Centre, University of Sydney, Australia
| | - Yun-Hee Jeon
- Sydney Nursing School and Charles Perkins Centre, University of Sydney, Australia
| | - Lis Neubeck
- Sydney Nursing School and Charles Perkins Centre, University of Sydney, Australia.,School of Health and Social Care, Edinburgh Napier University, UK
| | | | - Sharon L Naismith
- School of Psychology and Charles Perkins Centre, University of Sydney, Australia
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4
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Chu HT, Liang CS, Yeh TC, Hu LY, Yang AC, Tsai SJ, Shen CC. Tinnitus and risk of Alzheimer's and Parkinson's disease: a retrospective nationwide population-based cohort study. Sci Rep 2020; 10:12134. [PMID: 32699252 PMCID: PMC7376045 DOI: 10.1038/s41598-020-69243-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 07/07/2020] [Indexed: 01/09/2023] Open
Abstract
Tinnitus has been implied as a “soft” sign of neurodegenerative disease, which is characterized by progressive loss of neuronal function, such as Alzheimer’s disease (AD) and Parkinson’s disease (PD). This study aimed to determine whether the risk of developing AD/PD increases after having tinnitus. We conducted a retrospective matched cohort study with 12,657 tinnitus patients and 25,314 controls from the National Health Insurance Research Database (NHIRD) in Taiwan with almost 10 years follow-up. Tinnitus-related risk on developing AD/PD followingly was determined by the Cox regression to identify potential confounding factors. Through the 10-year follow-up period, 398 individuals with tinnitus (3.1%) and 501 control individuals (2.0%) developed AD (P < 0.001), and 211 tinnitus patients (1.7%) and 249 control patients (1.0%) developed PD (P < 0.001). Compared with controls, patients with tinnitus were 1.54 times more likely to develop AD (95% confidence interval (CI) 1.34–1.78, P < 0.001) and 1.56 times more likely to develop PD (95% CI 1.29–1.89, P < 0.001), after adjusting confounding factors. Our results indicate an association between tinnitus and higher risk of developing AD and PD. Additional physical comorbidities may also increase the risk of developing AD and PD.
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Affiliation(s)
- Hsuan-Te Chu
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Li-Yu Hu
- Department of Psychiatry, Taipei Veterans General Hospital, No 201, Sec 2. Shi-Pai Rd., Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Albert C Yang
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Shih-Jen Tsai
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan. .,Department of Psychiatry, Taipei Veterans General Hospital, No 201, Sec 2. Shi-Pai Rd., Taipei, 11217, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Cheng-Che Shen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan.
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5
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Ptok U, Papassotiropoulos A, Maier W, Heun R. Seasonal distribution of births in patients with Alzheimer’s disease and elderly depressive patients. Eur Psychiatry 2020; 16:157-61. [PMID: 11353593 DOI: 10.1016/s0924-9338(01)00557-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
SummaryWinter births have been associated with a higher risk of Alzheimer’s disease (AD) and other psychiatric disorders. In the present investigation, this putative association was examined in a sample of gerontopsychiatric patients. An analysis of the quarterly birth rates of 83 patients with AD, 78 elderly depressive patients with an early onset and 74 patients with a late onset of the depressive disorder, 48 patients with both AD and depression (co-morbid patients) and 107 healthy control subjects, revealed no particular seasonal distribution for any of the diagnostic groups. In AD and co-morbid patients, controlling for the ApoE genotype did not change this finding. Logistic regression analysis revealed the expected findings that increasing age and the presence of the ApoE4 allele were associated with a higher risk of dementia. Younger age and female gender were identified as risk factors for a depressive disorder. A winter birth (birth in the first three months of the year) was not associated with any of the diagnostic subgroups.We concluded that in our sample a seasonal distribution of births was not found to increase the risk for AD or geriatric depression.
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Affiliation(s)
- U Ptok
- Department of Psychiatry, University of Bonn, Sigmund-Freud-St. 25 53105, Bonn, Germany.
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6
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Novotny M, Klimova B, Valis M. Nitrendipine and Dementia: Forgotten Positive Facts? Front Aging Neurosci 2018; 10:418. [PMID: 30618724 PMCID: PMC6305303 DOI: 10.3389/fnagi.2018.00418] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/03/2018] [Indexed: 12/17/2022] Open
Abstract
Nowadays, there are about 50 million people suffering from dementia worldwide. In 2030, it is expected that there will be 82 million people living with dementia and in 2050, their number should reach 152 million. This increase in the number of people with dementia results in significant social and economic problems. Therefore, researchers attempt to reduce risk factors causing the development of dementia such as high blood pressure. Epidemiological studies have shown that hypertension increases the risk of dementia at an older age. It can, therefore, be assumed that hypertension therapy will reduce the risk of dementia. However, previous clinical studies have shown that the efficacy of different antihypertensive drugs differs in this respect. The drug group that appears to be the most effective in these analyses is calcium channel blockers (CCBs). The most significant preventive efficacy in terms of protection against dementia has been demonstrated with nitrendipine. Its use is, therefore, particularly advantageous in elderly patients with systolic hypertension who are at high risk of dementia. The purpose of this study is to restore the discussion on the prevention of vascular dementia and Alzheimer’s dementia with nitrendipine in indicated hypertonic patients. The authors performed a literature search of available sources describing the issue of dementia, hypertension and its treatment with nitrendipine. In addition, they made a comparison and evaluation of relevant findings. The results of the detected research studies indicate that nitrendipine is able to reduce the incidence of dementia [Alzheimer’s disease (AD), vascular and mixed] by 55%. The treatment of 1,000 patients with nitrendipine for 5 years may prevent 20 cases of dementia. However, what has not yet been explained is the temporal link between hypertension and dementia due to the long-time intervals between hypertension and the development of dementia.
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Affiliation(s)
- Michal Novotny
- Biomedical Research Centrum, University Hospital Hradec Králové, Hradec Králové, Czechia
| | - Blanka Klimova
- Department of Neurology, University Hospital Hradec Králové, Hradec Králové, Czechia.,Faculty of Informatics and Management, University of Hradec Králové, Hradec Králové, Czechia
| | - Martin Valis
- Department of Neurology, University Hospital Hradec Králové, Hradec Králové, Czechia
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Abdin E, Chong SA, Peh CX, Vaingankar JA, Chua BY, Verma S, Jeyagurunathan A, Shafie S, Subramaniam M. The mediational role of physical activity, social contact and stroke on the association between age, education, employment and dementia in an Asian older adult population. BMC Psychiatry 2017; 17:98. [PMID: 28320363 PMCID: PMC5359944 DOI: 10.1186/s12888-017-1272-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 03/15/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Our study aimed to investigate the pathways by which socio-demographic factors, modifiable health and lifestyle risk factors influence each other, and subsequently, lead to dementia. METHODS We used data from the Well-being of the Singapore Elderly study, a nationally representative survey of the older adult population aged 60 years and above in Singapore. Dementia diagnosis was established using 10/66 dementia criteria. Structural equation modelling (SEM) without latent variable was applied to confirm the hypothesized model. RESULTS The results of SEM supported the hypothesized model (χ 2 = 14.999, df = 10, p = 0.132). The final model showed that those aged 75-84 years and 85 years and over (vs. 60-74 years), having no formal education, who had completed primary or secondary education (vs. completed tertiary), who were homemakers and retired (vs. paid work), and with a history of stroke were directly associated with higher odds of having dementia, while those who had more frequent contact with friends and neighbors as well as being physically active were directly associated with lower odds of having dementia diagnosis. The study also found that physical activity, more frequent contact with friends and stroke played a significant role as mediators in these relationships. The overall pathways model explained 57.7% of the variance in dementia. CONCLUSION Our results suggest that physical activity, social contact and stroke were potential mediators in the relationship between age, education, employment and dementia. Intervention programmes focusing on physical activity such as exercise and social contact may be useful in reducing the risk of dementia among older adults.
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Affiliation(s)
- Edimansyah Abdin
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Chao Xu Peh
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Janhavi Ajit Vaingankar
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Boon Yiang Chua
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Swapna Verma
- Early Psychosis Intervention Programme, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Anitha Jeyagurunathan
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Saleha Shafie
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
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8
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Tolppanen AM, Ahonen R, Koponen M, Lavikainen P, Purhonen M, Taipale H, Tanskanen A, Tiihonen J, Tiihonen M, Hartikainen S. Month and Season of Birth as a Risk Factor for Alzheimer's Disease: A Nationwide Nested Case-control Study. J Prev Med Public Health 2016; 49:134-8. [PMID: 27055550 PMCID: PMC4829371 DOI: 10.3961/jpmph.16.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/19/2016] [Indexed: 01/21/2023] Open
Abstract
Objectives: Season of birth, an exogenous indicator of early life environment, has been related to higher risk of adverse psychiatric outcomes but the findings for Alzheimer’s disease (AD) have been inconsistent. We investigated whether the month or season of birth are associated with AD. Methods: A nationwide nested case-control study including all community-dwellers with clinically verified AD diagnosed in 2005 to 2012 (n=70 719) and up to four age- sex- and region of residence-matched controls (n=282 862) residing in Finland. Associations between month and season of birth and AD were studied with conditional logistic regression. Results: Month of birth was not associated with AD (p=0.09). No strong associations were observed with season (p=0.13), although in comparison to winter births (December-February) summer births (June-August) were associated with higher odds of AD (odds ratio, 1.03; 95% confidence interval, 1.00 to 1.05). However, the absolute difference in prevalence in winter births was only 0.5% (prevalence of those born in winter were 31.7% and 32.2% for cases and controls, respectively). Conclusions: Although our findings do not support the hypothesis that season of birth is related to AD/dementia risk, they do not invalidate the developmental origins of health and disease hypothesis in late-life cognition. It is possible that season does not adequately capture the early life circumstances, or that other (postnatal) risk factors such as lifestyle or socioeconomic factors overrule the impact of prenatal and perinatal factors.
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Affiliation(s)
- Anna-Maija Tolppanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Research Center for Comparative Effectiveness and Patient Safety, University of Eastern Finland, Kuopio, Finland
| | - Riitta Ahonen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Marjaana Koponen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Kuopio Research Center of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Piia Lavikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Kuopio Research Center of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Maija Purhonen
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Heidi Taipale
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Kuopio Research Center of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,National Institute for Health and Welfare, Helsinki, Finland
| | - Jari Tiihonen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Miia Tiihonen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Kuopio Research Center of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Sirpa Hartikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Kuopio Research Center of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
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9
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Cai Z, Xiao M, Chang L, Yan LJ. Role of insulin resistance in Alzheimer's disease. Metab Brain Dis 2015; 30:839-51. [PMID: 25399337 DOI: 10.1007/s11011-014-9631-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 11/07/2014] [Indexed: 01/01/2023]
Abstract
A critical role of insulin resistance (IR) in Alzheimer's disease (AD) includes beta-amyloid (Aβ) production and accumulation, the formation of neurofibrillary tangles (NFTs), failure of synaptic transmission and neuronal degeneration. Aβ is sequentially cleavaged from APP by two proteolytic enzymes: β-secretase and γ-secretase. IR could regulate Aβ production via enhancing β- and γ-secretase activity. Meanwhile, IR induces oxidative stress and inflammation in the brain which contributes to Aβ and tau pathology. Aβ accumulation can enhance IR through Aβ-mediated inflammation and oxidative stress. IR is a possible linking between amyloid plaques and NFTs pathology via oxidative stress and neuroinflammation. Additionally, IR could disrupt acetylcholine activity, and accelerate axon degeneration and failures in axonal transport, and lead to cognitive impairment in AD. Preclinical and clinical studies have supported that insulin could be useful in the treatment of AD. Thus, an effective measure to inhibit IR may be a novel drug target in AD.
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Affiliation(s)
- Zhiyou Cai
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan Renmin Hospital, No. 39 Chaoyang Middle Road, Shiyan, 442000, Hubei Province, People's Republic of China,
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10
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Abstract
It has recently been proposed that heart failure is a risk factor for Alzheimer's disease. Decreased cerebral blood flow and neurohormonal activation due to heart failure may contribute to the dysfunction of the neurovascular unit and cause an energy crisis in neurons. This leads to the impaired clearance of amyloid beta and hyperphosphorylation of tau protein, resulting in the formation of amyloid beta plaques and neurofibrillary tangles. In this article, we will summarize the current understanding of the relationship between heart failure and Alzheimer's disease based on epidemiological studies, brain imaging research, pathological findings and the use of animal models. The importance of atherosclerosis, myocardial infarction, atrial fibrillation, blood pressure and valve disease as well as the effect of relevant medications will be discussed.
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Affiliation(s)
- P Cermakova
- Division for Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska InstitutetHuddinge, Sweden
- International Clinical Research Center and St. Anne's University HospitalBrno, Czech Republic
| | - M Eriksdotter
- Department of Geriatric Medicine, Karolinska University HospitalStockholm, Sweden
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska InstitutetStockholm, Sweden
| | - L H Lund
- Department of Cardiology, Karolinska University HospitalStockholm, Sweden
- Unit of Cardiology, Department of Medicine, Karolinska InstitutetStockholm, Sweden
| | - B Winblad
- Division for Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska InstitutetHuddinge, Sweden
- Department of Geriatric Medicine, Karolinska University HospitalStockholm, Sweden
| | - P Religa
- Department of Medicine, Center for Molecular Medicine, Karolinska InstitutetStockholm, Sweden
| | - D Religa
- Division for Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska InstitutetHuddinge, Sweden
- Department of Geriatric Medicine, Karolinska University HospitalStockholm, Sweden
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Statins in neurological disorders: An overview and update. Pharmacol Res 2014; 88:74-83. [DOI: 10.1016/j.phrs.2014.06.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/11/2014] [Accepted: 06/11/2014] [Indexed: 01/16/2023]
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12
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Acetylcholinesterase inhibitors as Alzheimer therapy: From nerve toxins to neuroprotection. Eur J Med Chem 2013; 70:165-88. [DOI: 10.1016/j.ejmech.2013.09.050] [Citation(s) in RCA: 223] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 09/24/2013] [Accepted: 09/28/2013] [Indexed: 11/22/2022]
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Chao LL, Decarli C, Kriger S, Truran D, Zhang Y, Laxamana J, Villeneuve S, Jagust WJ, Sanossian N, Mack WJ, Chui HC, Weiner MW. Associations between white matter hyperintensities and β amyloid on integrity of projection, association, and limbic fiber tracts measured with diffusion tensor MRI. PLoS One 2013; 8:e65175. [PMID: 23762308 PMCID: PMC3675157 DOI: 10.1371/journal.pone.0065175] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 04/23/2013] [Indexed: 01/08/2023] Open
Abstract
The goal of this study was to assess the relationship between Aβ deposition and white matter pathology (i.e., white matter hyperintensities, WMH) on microstructural integrity of the white matter. Fifty-seven participants (mean age: 78±7 years) from an ongoing multi-site research program who spanned the spectrum of normal to mild cognitive impairment (Clinical dementia rating 0–0.5) and low to high risk factors for arteriosclerosis and WMH pathology (defined as WMH volume >0.5% total intracranial volume) were assessed with positron emission tomography (PET) with Pittsburg compound B (PiB) and magnetic resonance and diffusion tensor imaging (DTI). Multivariate analysis of covariance were used to investigate the relationship between Aβ deposition and WMH pathology on fractional anisotropy (FA) from 9 tracts of interest (i.e., corona radiata, internal capsule, cingulum, parahippocampal white matter, corpus callosum, superior longitudinal, superior and inferior front-occipital fasciculi, and fornix). WMH pathology was associated with reduced FA in projection (i.e., internal capsule and corona radiate) and association (i.e., superior longitudinal, superior and inferior fronto-occipital fasciculi) fiber tracts. Aβ deposition (i.e., PiB positivity) was associated with reduced FA in the fornix and splenium of the corpus callosum. There were interactions between PiB and WMH pathology in the internal capsule and parahippocampal white matter, where Aβ deposition reduced FA more among subjects with WMH pathology than those without. However, accounting for apoE ε4 genotype rendered these interactions insignificant. Although this finding suggests that apoE4 may increase amyloid deposition, both in the parenchyma (resulting in PiB positivity) and in blood vessels (resulting in amyloid angiopathy and WMH pathology), and that these two factors together may be associated with compromised white matter microstructural integrity in multiple brain regions, additional studies with a longitudinal design will be necessary to resolve this issue.
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Affiliation(s)
- Linda L Chao
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America. linda.chao @ucsf.edu
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Xu P, Li D, Tang X, Bao X, Huang J, Tang Y, Yang Y, Xu H, Fan X. LXR Agonists: New Potential Therapeutic Drug for Neurodegenerative Diseases. Mol Neurobiol 2013; 48:715-28. [DOI: 10.1007/s12035-013-8461-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 04/09/2013] [Indexed: 01/04/2023]
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Bruno D, Reiss PT, Petkova E, Sidtis JJ, Pomara N. Decreased recall of primacy words predicts cognitive decline. Arch Clin Neuropsychol 2013; 28:95-103. [PMID: 23299182 DOI: 10.1093/arclin/acs116] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
One of the cognitive changes associated with Alzheimer's disease is a diminution of the primacy effect, i.e., the tendency toward better recall of items studied early on a list compared with the rest. We examined whether learning and recall of primacy words predicted subsequent cognitive decline in 204 elderly subjects who were non-demented and cognitively intact when first examined. Our results show that poorer primacy performance in the Rey Auditory Verbal Learning Test delayed recall trials, but not in immediate recall trials, is an effective predictor of subsequent decline in general cognitive function. This pattern of performance can be interpreted as evidence that failure to consolidate primacy items is a marker of cognitive decline.
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Affiliation(s)
- Davide Bruno
- Department of Psychology, Liverpool Hope University, Hope Park, Liverpool, L16 9JD, UK
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Tang CY, Narula J, Friedman JI. Novel imaging strategies for assessment of cerebrovascular involvement. ACTA ACUST UNITED AC 2012; 79:674-82. [PMID: 23239206 DOI: 10.1002/msj.21354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is an important correlation between vascular risk factors and nonspecific imaging findings in the brain such as white-matter hyperintensities. These vascular risk factors are also associated with dementia and lesser forms of cognitive impairment. One hypothesis is that these vascular risk factors lead to disruption of connective networks in the central nervous system that are supported by myelinated white-matter fibers, which in turn lead to deficits in functional signaling between various brain regions. Another possibility is an alteration of the neurovascular coupling due to vascular risk factors. This reduced functional signaling contributes to the cognitive deficits in persons harboring these vascular risk factors. Lifestyle changes may restore some of these functional deficits through brain plasticity. It is imperative that preclinical diagnostic techniques are developed to identify these early brain changes in persons harboring vascular risk factors, as such efforts may improve primary and secondary prevention efforts. Recently developed imaging techniques may provide objective imaging biomarkers to measure the structural and functional brain changes in persons with vascular risk factors and resulting subclinical atherosclerotic disease. This article reviews a few of these novel imaging techniques.
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Dias EDM, Giollo LT, Martinelli DD, Mazeti C, Júnior HM, Vilela-Martin JF, Yugar-Toledo JC. Carotid intima-media thickness is associated with cognitive deficiency in hypertensive patients with elevated central systolic blood pressure. Cardiovasc Ultrasound 2012; 10:41. [PMID: 23078629 PMCID: PMC3495224 DOI: 10.1186/1476-7120-10-41] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 09/18/2012] [Indexed: 11/18/2022] Open
Abstract
Background The role of hypertension in the loss of cognitive function is controversial. Relationships between hypertension and increases in cerebral vascular resistance, diffused lesions and multiple lacunar infarcts of the white matter are well known. Thus, the objectives of this study were: to evaluate the relationship between hypertension and cognitive dysfunction (CD), identify risk factors and determine the association between early markers of vascular disease and CD in hypertensive individuals. Methods Two hundred individuals aged between 40 and 80 years old were evaluated in this cross-sectional prospective study. Fifty participants were controls (CT). The remaining 150 hypertensive patients were subdivided into two groups, those with CD (HCD) and those without CD (HNCD). All participants underwent clinical evaluations and biochemical blood tests were performed. CD was investigated using the Mini Mental State Examination (MMSE) following the guidelines for its use in Brazil. The impact of hypertension on the arterial bed was assessed by identifying and measuring changes in the intima-media thickness (IMT) by vascular ultrasonography of the carotid arteries and analyses of the central blood pressure and Augmentation Index by applanation tonometry of the radial artery. Results There were no significant differences in the total cholesterol, high-density lipoprotein cholesterol and triglycerides plasma concentrations between the three groups. The serum creatinine and estimated glomerular filtration rate were within normal ranges for all three groups. A significantly lower MMSE score was recorded for the HCD Group compared to the HNCD and CT Groups (p-value < 0.05). The IMT was significantly different between the HNCD and HCD Groups (p-value = 0.0124). A significant difference in the IMT was also observed between hypertensive patients and the CT Group (p-value < 0.0001). Age, low-density cholesterol, high-density cholesterol, triglycerides and IMT increased the Odds Ratio for cognitive dysfunction. The central systolic pressure was significantly higher in the HCD and HNCD Groups compared to CT Group (p-value < 0.0001). Conclusions Hypertensive patients with CD have changes in the vascular morphology characterized by an increased carotid IMT, enhanced atherosclerotic lipid profile and impaired hemodynamic functional manifested by elevated central systolic blood pressure.
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Affiliation(s)
- Eros da Mota Dias
- Hypertension Clinic, Department of Internal Medicine, State Medical School of São José do Rio Preto, Brazil
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Mehta M, Adem A, Kahlon MS, Sabbagh MN. The nicotinic acetylcholine receptor: smoking and Alzheimer's disease revisited. Front Biosci (Elite Ed) 2012; 4:169-80. [PMID: 22201862 PMCID: PMC5502782 DOI: 10.2741/367] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Epidemiological studies regarding Alzheimer's disease (AD) in smokers currently suggest inconsistent results. The clinicopathological findings also vary as to how AD pathology is affected by smoking behavior. Even though clinicopathological, functional, and epidemiological studies in humans do not present a consistent picture, much of the in vitro data implies that nicotine has neuroprotective effects when used in neurodegenerative disorder models. Current studies of the effects of nicotine and nicotinic agonists on cognitive function in both the non-demented and those with AD are not convincing. More data is needed to determine whether repetitive activation of nAChR with intermittent or acute exposure to nicotine, acute activation of nAChR, or long-lasting inactivation of nAChR secondary to chronic nicotine exposure will have a therapeutic effect and/or explain the beneficial effects of those types of drugs. Other studies show multifaceted connections between nicotine, nicotinic agonists, smoking, and nAChRs implicated in AD etiology. Although many controversies still exist, ongoing studies are revealing how nicotinic receptor changes and functions may be significant to the neurochemical, pathological, and clinical changes that appear in AD.
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Affiliation(s)
- Mona Mehta
- Banner Sun Health Research Institute, Sun City, AZ
| | - Abdu Adem
- Department of Pharmacology, Faculty of Medicine and Health Sciences, Al Ain, United Arab Emirates 3. Arizona Neurological Institute, Sun City, AZ
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Cataldo JK, Prochaska JJ, Glantz SA. Cigarette smoking is a risk factor for Alzheimer's Disease: an analysis controlling for tobacco industry affiliation. J Alzheimers Dis 2010; 19:465-80. [PMID: 20110594 DOI: 10.3233/jad-2010-1240] [Citation(s) in RCA: 202] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To examine the relationship between smoking and Alzheimer's disease (AD) after controlling for study design, quality, secular trend, and tobacco industry affiliation of the authors, electronic databases were searched; 43 individual studies met the inclusion criteria. For evidence of tobacco industry affiliation, http://legacy.library.ucsf.edu was searched. One fourth (11/43) of individual studies had tobacco-affiliated authors. Using random effects meta-analysis, 18 case control studies without tobacco industry affiliation yielded a non-significant pooled odds ratio of 0.91 (95% CI, 0.75-1.10), while 8 case control studies with tobacco industry affiliation yielded a significant pooled odds ratio of 0.86 (95% CI, 0.75-0.98) suggesting that smoking protects against AD. In contrast, 14 cohort studies without tobacco-industry affiliation yielded a significantly increased relative risk of AD of 1.45 (95% CI, 1.16-1.80) associated with smoking and the three cohort studies with tobacco industry affiliation yielded a non-significant pooled relative risk of 0.60 (95% CI 0.27-1.32). A multiple regression analysis showed that case-control studies tended to yield lower average risk estimates than cohort studies (by -0.27 +/- 0.15, P=0.075), lower risk estimates for studies done by authors affiliated with the tobacco industry (by -0.37 +/- 0.13, P=0.008), no effect of the quality of the journal in which the study was published (measured by impact factor, P=0.828), and increasing secular trend in risk estimates (0.031/year +/- 0.013, P=0.02). The average risk of AD for cohort studies without tobacco industry affiliation of average quality published in 2007 was estimated to be 1.72 +/- 0.19 (P< 0.0005). The available data indicate that smoking is a significant risk factor for AD.
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Affiliation(s)
- Janine K Cataldo
- Department of Physiological Nursing, Gerontology, University of California, San Francisco, San Francisco, CA 94143-0610, USA.
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Altérations cognitives liées au tabac. Presse Med 2009; 38:1241-52. [DOI: 10.1016/j.lpm.2009.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 01/14/2009] [Accepted: 01/30/2009] [Indexed: 01/19/2023] Open
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Meinert CL, McCaffrey LD, Breitner JCS. Alzheimer's Disease Anti-inflammatory Prevention Trial: design, methods, and baseline results. Alzheimers Dement 2009; 5:93-104. [PMID: 19328435 DOI: 10.1016/j.jalz.2008.09.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 09/18/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Alzheimer's Disease Anti-inflammatory Prevention Trial (ADAPT) was designed to address whether non-steroidal anti-inflammatory drugs (NSAIDs) can prevent or delay the onset of Alzheimer's disease (AD). METHODS ADAPT was a randomized, double-placebo-controlled, multicenter chemoprevention trial conducted at six U.S. dementia research clinics. At entry, participants were required to test "normal" on a battery of cognitive tests and to be age 70+ with a family history of Alzheimer-like dementia. Persons were randomly assigned to 200 mg b.i.d. celecoxib (Celebrex, Pfizer), 220 mg b.i.d. naproxen sodium (Aleve, Bayer), or placebo. The primary outcome measure was AD. Secondary outcome measures were cognitive decline and measures related to safety of the treatments when used long term. ADAPT was designed to detect a 30% reduction in AD incidence with 80% power. The estimated sample size requirement was 2,625. RESULTS Enrollment began in March 2001 and ended in December 2004 when treatments were suspended because of concerns regarding cardiovascular safety of the treatments. Followup ranged from 1 to 46 months. The achieved enrollment was 2,528. Recruitment was achieved primarily via mailings to people aged 70+ living in the catchment areas of the six field sites.
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Lee LK, Shahar S, Rajab N. Serum folate concentration, cognitive impairment, and DNA damage among elderly individuals in Malaysia. Nutr Res 2009; 29:327-34. [DOI: 10.1016/j.nutres.2009.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 04/30/2009] [Accepted: 05/13/2009] [Indexed: 11/26/2022]
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Small GW, Siddarth P, Burggren AC, Kepe V, Ercoli LM, Miller KJ, Lavretsky H, Thompson PM, Cole GM, Huang SC, Phelps ME, Bookheimer SY, Barrio JR. Influence of cognitive status, age, and APOE-4 genetic risk on brain FDDNP positron-emission tomography imaging in persons without dementia. ACTA ACUST UNITED AC 2009; 66:81-7. [PMID: 19124691 DOI: 10.1001/archgenpsychiatry.2008.516] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Amyloid senile plaques and tau neurofibrillary tangles are neuropathological hallmarks of Alzheimer disease that accumulate in the brains of people without dementia years before they develop dementia. Positron emission tomography (PET) scans after intravenous injections of 2-(1-{6-[(2-[F-18]fluoroethyl)(methyl)amino]-2-naphthyl}ethylidene)malononitrile (FDDNP), which binds to plaques and tangles in vitro, demonstrate increased cerebral binding in patients with Alzheimer disease compared with cognitively intact controls. Here we investigated whether known risk factors for Alzheimer disease and dementia are associated with FDDNP-PET binding. OBJECTIVE To determine if impaired cognitive status, older age, apolipoprotein E-4 (APOE-4) genetic risk for Alzheimer disease, family history of dementia, and less education are associated with increased regional cerebral FDDNP-PET binding. DESIGN Cross-sectional clinical study. SETTING A university research institute. PARTICIPANTS Volunteer sample of 76 middle-aged and older persons without dementia (mean age, 67 years) including 36 with mild cognitive impairment. Of the 72 subjects with genetic data, 34 were APOE-4 carriers. MAIN OUTCOME MEASURES The FDDNP-PET signal in brain regions of interest, including medial and lateral temporal, posterior cingulate, parietal, and frontal. RESULTS For all regions studied, cognitive status was associated with increased FDDNP binding (P < .02 to .005). Older age was associated with increased lateral temporal FDDNP binding. Carriers of APOE-4 demonstrated higher frontal FDDNP binding than noncarriers. In the mild cognitive impairment group, age was associated with increased medial and lateral temporal FDDNP binding, and APOE-4 carriers had higher medial temporal binding than noncarriers. CONCLUSIONS Impaired cognitive status, older age, and APOE-4 carrier status are associated with increased brain FDDNP-PET binding in persons without dementia, consistent with previous clinical and postmortem studies associating these risk factors with amyloid plaque and tau tangle accumulation. Stratifying subject groups according to APOE-4 carrier status, age, and cognitive status may therefore be an informative strategy in future clinical trials using FDDNP-PET.
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Affiliation(s)
- Gary W Small
- Semel Institute, 760 Westwood Plaza, Ste 88-201, Los Angeles, CA 90024, USA.
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White matter lesions in the elderly: Pathophysiological hypothesis on the effect on brain plasticity and reserve. J Neurol Sci 2008; 273:3-9. [DOI: 10.1016/j.jns.2008.06.023] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 05/22/2008] [Accepted: 06/18/2008] [Indexed: 01/31/2023]
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Lifecourse Social Conditions and Racial and Ethnic Patterns of Cognitive Aging. Neuropsychol Rev 2008; 18:223-54. [DOI: 10.1007/s11065-008-9064-z] [Citation(s) in RCA: 240] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 07/30/2008] [Indexed: 11/26/2022]
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Moretti R, Torre P, Antonello RM, Manganaro D, Vilotti C, Pizzolato G. Risk factors for vascular dementia: hypotension as a key point. Vasc Health Risk Manag 2008; 4:395-402. [PMID: 18561514 PMCID: PMC2496988 DOI: 10.2147/vhrm.s2434] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Physiologically, the cerebral autoregulation system allows maintenance of constant cerebral blood flow over a wide range of blood pressure. In old people, there is a progressive reshape of cerebral autoregulation from a sigmoid curve to a straight line. This implies that any abrupt change in blood pressure will result in a rapid and significant change in cerebral blood flow. Hypertension has often been observed to be a risk factor for vascular dementia (VaD) and sometimes for Alzheimer disease although not always. Indeed, high blood pressure may accelerate cerebral white matter lesions, but white matter lesions have been found to be facilitated by excessive fall in blood pressure, including orthostatic dysregulation and postprandial hypotension. Many recent studies observed among other data, that there was a correlation between systolic pressure reduction and cognitive decline in women, which was not accounted for by other factors. Baseline blood pressure level was not significantly related to cognitive decline with initial good cognition. Some researchers speculate that blood pressure reduction might be an early change of the dementing process. The most confounding factor is that low pressure by itself might be a predictor of death; nevertheless, the effect of low blood pressure on cognition is underestimated because of a survival bias. Another explanation is that clinically unrecognized vascular lesions in the brain or atherosclerosis are responsible for both cognitive decline and blood pressure reduction. We discuss the entire process, and try to define a possible mechanism that is able to explain the dynamic by which hypotension might be related to dementia.
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Affiliation(s)
- Rita Moretti
- Department of Internal Medicine and Clinical Neurology, University of Trieste, Italy.
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Neural Correlates of Visuospatial Working Memory in Healthy Young Adults at Risk for Hypertension. Brain Imaging Behav 2008. [DOI: 10.1007/s11682-008-9025-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bifulco M, Malfitano AM, Marasco G. Potential therapeutic role of statins in neurological disorders. Expert Rev Neurother 2008; 8:827-37. [PMID: 18457539 DOI: 10.1586/14737175.8.5.827] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Statins, the inhibitors of HMG-CoA reductase, are currently among the most commonly prescribed agents for the prevention of cardiovascular disease. It is well established that statins reduce cholesterol levels and prevent coronary heart disease. Moreover, evidence suggests that statins have additional properties such as endothelial protection via actions on the nitric oxide synthetase system as well as antioxidant, anti-inflammatory and antiplatelet effects. There is evidence that all these actions might have potential therapeutic implications not only in stroke, but also in various neurological disorders, such as Alzheimer's disease, Parkinson's disease, multiple sclerosis and primary brain tumors. In this review, we summarize the protective effects of statins on various neurological diseases. Currently available data suggest that statins are safe and effective in the treatment of these neurological disorders, although further experiments and new data are required.
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Affiliation(s)
- Maurizio Bifulco
- Dipartimento di Scienze Farmaceutiche, University di Salerno, Via Ponte Don Melillo 84084 Fisciano, Salerno, Italy.
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Abstract
The Alzheimer's disease (AD) is multifactorial. How to explain this group of very heterogeneous factors? Many of them can be considered as biopsychosocial risk factors. In other words, the risk factors, in link with the physiological functioning and a physiopathology, are difficultly dissociable of contingencies of psychological and/or social nature. The vital lead could be the stress bound to these variables, be it biological or psychosocial. It remains to ask the question of the preventive efficiency of treatments to relieve the impact of the traumatizing events of life that entail a depressive state or a state of posttraumatic stress. The hippocamp has to be the object of a quite particular attention. AD is a disease of the adaptation. This integrative model combines three vulnerabilities: a genetic vulnerability which would be there to dictate the type of lesions, their localization and the age of occurence; a psychobiographic vulnerability corresponding to a personality with inadequate mechanisms of defence, precarious adaptability in front of the adversity, weak impact strength and biography built on events of life during childhood, then during the grown-up life of traumatic nature, with a psychosocial environment insufficiently auxiliary; a neuroendocrinologic vulnerability which would base on a deregulation of the corticotrope axis, acquired during its infantile maturation, hampered by too premature stress. It would lead to a bad biological adaptability in stress later, at the origin of the observable lesions in the insanities.
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Affiliation(s)
- Jean-Pierre Clément
- Pôle de psychiatrie du sujet âgé, centre hospitalier Esquirol, SHU, 15, rue du Dr-Marcland, 87025 Limoges cedex, France.
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Moretti R, Torre P, Antonello RM, Vilotti C, Pizzolato G. New treatment options for vascular dementia. ACTA ACUST UNITED AC 2007. [DOI: 10.2217/1745509x.3.2.209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Clinical trials performed in patients defined as affected by vascular dementia have so far achieved unsatisfactory results. Recently, preliminary results have been published demonstrating a generally stable performance in cognitive tasks, with a slightly better performance in executive functions and a better behavioral response, in a group of subcortical vascular dementia patients treated with rivastigmine. A recent proposal is that vascular dementia is not an univocal and unique pathology: the etiopathogenesis of multi-infarct dementia is quite different to that of subcortical vascular dementia. Future studies need to consider those entities separately to obtain good results for a group of patients for whom, until now, there have been few therapeutic options. The aim of this review is to summarize the consolidated notions, perspectives and new therapeutic options to better define the possible future treatment of vascular dementia.
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Affiliation(s)
- Rita Moretti
- University of Trieste, Department of Internal Medicine and Clinical Neurology, Ospedale di Cattinara, Strada di Fiume, 447 34149 Trieste, Italy
| | - Paola Torre
- University of Trieste, Department of Internal Medicine and Clinical Neurology, Ospedale di Cattinara, Strada di Fiume, 447 34149 Trieste, Italy
| | - Rodolfo M Antonello
- University of Trieste, Department of Internal Medicine and Clinical Neurology, Ospedale di Cattinara, Strada di Fiume, 447 34149 Trieste, Italy
| | - Cristina Vilotti
- University of Trieste, Department of Internal Medicine and Clinical Neurology, Ospedale di Cattinara, Strada di Fiume, 447 34149 Trieste, Italy
| | - Gilberto Pizzolato
- University of Trieste, Department of Internal Medicine and Clinical Neurology, Ospedale di Cattinara, Strada di Fiume, 447 34149 Trieste, Italy
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Sparks DL, Sabbagh M, Connor D, Soares H, Lopez J, Stankovic G, Johnson-Traver S, Ziolkowski C, Browne P. Statin therapy in Alzheimer's disease. Acta Neurol Scand 2006; 185:78-86. [PMID: 16866915 DOI: 10.1111/j.1600-0404.2006.00689.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Previous studies have suggested that statin therapy may be of benefit in treating Alzheimer's disease (AD). We initiated a double-blind, placebo-controlled, randomized (1:1) trial with a 1-year exposure to once-daily atorvastatin calcium (80 mg; two 40 mg tablets) or placebo among individuals with mild-to-moderate AD [Mini-Mental State Examination (MMSE) score of 12-28]. Stable dose use of cholinesterase inhibitors, estrogen and vitamin E was allowed, as was the use of most other medications in the treatment of co-morbidities. We demonstrated that atorvastatin treatment produced significantly (P = 0.003) improved performance on cognition and memory after 6 months of treatment (ADAS-cog) among patients with mild-to-moderate AD. This superior effect persisted at 1 year (P = 0.055). This positive effect on the ADAS-cog performance after 6 months of treatment was more prominent among individuals entering the trial with higher MMSE scores (P = 0.054). Benefit on other clinical measures was identified in the atorvastatin-treated population compared with placebo. Accordingly, atorvastatin therapy may be of benefit in the treatment of mild-to-moderately affected AD patients, but the level of benefit produced may be predicated on earlier treatment. Evidence also suggests that atorvastatin may slow the progression of mild-to-moderate AD, thereby prolonging the quality of an afflicted individual's life.
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Affiliation(s)
- D L Sparks
- Robert Laboratory for Neurodegenerative Disease Research, Sun Health Research Institute, Sun City, AZ 85351, USA.
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Whalley LJ, Dick FD, McNeill G. A life-course approach to the aetiology of late-onset dementias. Lancet Neurol 2006; 5:87-96. [PMID: 16361026 DOI: 10.1016/s1474-4422(05)70286-6] [Citation(s) in RCA: 206] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Substantial progress has been made in the understanding of the neurobiology of dementias, but comprehensive causal models are not available. Genetic and environmental factors probably interact to determine vulnerability to the dementias. The life-course approach to age-related diseases, when systematically applied to the dementias, provides opportunities to identify the nature and timing of environmental contributions. We discuss the relevance of the fetal origins of adult disease hypothesis to the dementias. Associations between the dementias (most often described as Alzheimer's disease) and ischaemic heart disease, obesity, hypertension, hyperlipidaemia, and non-insulin-dependent diabetes mellitus are set against associations between dementias and childhood intelligence, low educational attainments, low socioeconomic status, occupation, and lifetime dietary history. Biological mechanisms that explain how fetal development might influence the risk of adult disease may be relevant to many age-related diseases including the dementias and, possibly, to the biology of ageing.
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Affiliation(s)
- Lawrence J Whalley
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
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Stewart MCW, Deary IJ, Fowkes FGR, Price JF. Relationship between Lifetime Smoking, Smoking Status at Older Age and Human Cognitive Function. Neuroepidemiology 2006; 26:83-92. [PMID: 16352911 DOI: 10.1159/000090253] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Cigarette smoking is a major risk factor for clinical cardiovascular disease and may also be associated with poorer cognitive functioning in older age. We measured lifetime cigarette smoking, smoking status and cognitive function in over 2,000 men and women from the general population aged over 50 years with subclinical atherosclerosis (ankle brachial pressure index<or=0.95 but no history of clinical cardiovascular disease). In this population, an association was found between greater lifetime smoking and poorer cognitive function in men and between smoking cessation and better cognitive function in women. The former relationship appeared to reflect an association between smoking habit and prior cognitive function (in early life), whereas the latter remained significant after adjustment for tests of crystallised cognitive function, suggesting a relationship between continuing to smoke (as opposed to quitting) and age-related cognitive decline. Both relationships were independent of the degree of atherosclerosis (as measured using the ankle brachial pressure index), suggesting alternative underlying mechanisms for the association between smoking and human adult cognitive function.
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Affiliation(s)
- Marlene C W Stewart
- Wolfson Unit for the Prevention of Peripheral Vascular Diseases, Public Health Sciences, University of Edinburgh, Edinburgh, UK
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Corder EH, Ervin JF, Lockhart E, Szymanski MH, Schmechel DE, Hulette CM. Cardiovascular damage in Alzheimer disease: autopsy findings from the Bryan ADRC. J Biomed Biotechnol 2006; 2005:189-97. [PMID: 16046825 PMCID: PMC1184050 DOI: 10.1155/jbb.2005.189] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Autopsy information on cardiovascular damage was investigated for
pathologically confirmed Alzheimer disease (AD) patients (n = 84)
and non-AD control patients (n = 60). The 51 relevant items were
entered into a grade-of-membership model to describe vascular
damage in AD. Five latent groups were identified “I: early-onset
AD,” “II: controls, cancer,” “III: controls, extensive
atherosclerosis,” “IV: late-onset AD, male,” and “V:
late-onset AD, female.” Expectedly, Groups IV and V had elevated
APOE ϵ4 frequency. Unexpectedly, there was
limited atherosclerosis and frequent myocardial valve and
ventricular damage. The findings do not indicate a strong
relationship between atherosclerosis and AD, although both are
associated with the APOE ϵ4. Instead, autopsy
findings of extensive atherosclerosis were associated with
possible, not probable or definite AD, and premature death. They
are consistent with the hypothesis that brain hypoperfusion
contributes to dementia, possibly to AD pathogenesis, and raise
the possibility that the APOE allele ϵ4
contributes directly to heart valve and myocardial damage.
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Affiliation(s)
- Elizabeth H. Corder
- Center for Demographic Studies,
Duke University, 2117 Campus Drive, Box 90408, Durham, NC
27708-0408, USA
| | - John F. Ervin
- Division of
Neurology, Duke University Medical Center, Durham, NC
27710, USA
| | - Evelyn Lockhart
- Department of Pathology, Duke
University Medical Center, Durham, NC 27710, USA
| | - Mari H. Szymanski
- Division of
Neurology, Duke University Medical Center, Durham, NC
27710, USA
| | - Donald E. Schmechel
- Department of Pathology, Duke
University Medical Center, Durham, NC 27710, USA
| | - Christine M. Hulette
- Division of
Neurology, Duke University Medical Center, Durham, NC
27710, USA
- *Christine M. Hulette:
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Hohnadel EJ, Hernandez CM, Gearhart DA, Terry AV. Effect of repeated nicotine exposure on high-affinity nicotinic acetylcholine receptor density in spontaneously hypertensive rats. Neurosci Lett 2005; 382:158-63. [PMID: 15911141 DOI: 10.1016/j.neulet.2005.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2005] [Revised: 02/22/2005] [Accepted: 03/04/2005] [Indexed: 11/26/2022]
Abstract
Spontaneously hypertensive rats (SHRs) are often used as a model of attention deficit hyperactivity disorder (ADHD) and to investigate the effects of hypertension on cognitive function. Further, they appear to have reduced numbers of central nicotinic acetylcholine receptors (nAChRs) and, therefore, may be useful to model certain aspects of Alzheimer's disease (AD) and other forms of dementia given that a decrease in nAChRs is thought to contribute to cognitive decline in these disorders. In the present study, based on reports that chronic nicotine exposure increases nAChRs in several mammalian models, we tested the hypothesis that repeated exposures to a relatively low dose of the alkaloid would ameliorate the receptor deficits in SHR. Thus, young-adult SHRs and age-matched Wistar-Kyoto (WKY) control rats were treated with either saline or nicotine twice a day for 14 days (total daily dose = 0.7 mg/kg nicotine base) and then sacrificed. Quantitative receptor autoradiography with [125I]-IPH, an epibatidine analog, revealed: (1) that high-affinity nAChRs were higher in saline-treated WKY (control) rats compared to saline-treated SHRs in 18 of the 19 brain region measured, although statistically different only in the mediodorsal thalamic nuclei, (2) that nicotine significantly increased nAChR binding in WKY rats in six brain areas including cortical regions and the anterior thalamic nucleus, (3) that there were no cases where nicotine significantly increased nAChR binding in SHRs. These results indicate that subjects deficient in nAChRs may be less sensitive to nAChR upregulation with nicotine than normal subjects and require higher doses or longer periods of exposure.
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Affiliation(s)
- Elizabeth J Hohnadel
- Program in Clinical and Experimental Therapeutics, University of Georgia College of Pharmacy (Augusta Campus), Medical College of Georgia, Augusta, GA 30912, USA
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Bi X, Baudry M, Liu J, Yao Y, Fu L, Brucher F, Lynch G. Inhibition of Geranylgeranylation Mediates the Effects of 3-Hydroxy-3-methylglutaryl (HMG)-CoA Reductase Inhibitors on Microglia. J Biol Chem 2004; 279:48238-45. [PMID: 15364922 DOI: 10.1074/jbc.m405442200] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Inflammatory responses involving microglia, the resident macrophages of the brain, are thought to contribute importantly to the progression of Alzheimer's disease (AD) and possibly other neurodegenerative disorders. The present study tested whether the mevalonate-isoprenoid biosynthesis pathway, which affects inflammation in many types of tissues, tonically regulates microglial activation. This question takes on added significance given the potential use of statins, drugs that block the rate-limiting step (3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG-CoA reductase)) in mevalonate and cholesterol synthesis, in AD treatment. Both mevastatin and simvastatin caused a concentration- and time-dependent activation of microglia in cultured rat hippocampal slices. This response consisted of a transformation of the cells from a typical resting configuration to an amoeboid, macrophage-like morphology, increased expression of a macrophage antigen, and up-regulation of the cytokine tumor necrosis factor-alpha. Evidence for proliferation was also obtained. Statin-induced microglial changes were blocked by mevalonate but not by cholesterol, indicating that they were probably due to suppression of isoprenoid synthesis. In accord with this, the statin effects were absent in slices co-incubated with geranylgeranyl pyrophosphate, a mevalonate product that provides for the prenylation of Rho GTPases. Finally, PD98089, a compound that blocks activation of extracellularly regulated kinases1/2, suppressed statin-induced up-regulation of tumor necrosis factor-alpha but had little effect on microglial transformation. These results suggest that 1) the mevalonate-isoprenoid pathway is involved in regulating microglial morphology and in controlling expression of certain cytokines and 2) statins have the potential for enhancing a component of AD with uncertain relationships to other features of the disease.
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Affiliation(s)
- Xiaoning Bi
- Department of Psychiatry & Human Behavior, University of California Irvine, Irvine, CA 92617-1695, USA.
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Cervilla J, Prince M, Joels S, Lovestone S, Mann A. Premorbid cognitive testing predicts the onset of dementia and Alzheimer's disease better than and independently of APOE genotype. J Neurol Neurosurg Psychiatry 2004; 75:1100-6. [PMID: 15258208 PMCID: PMC1739178 DOI: 10.1136/jnnp.2003.028076] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether a cognitive test package can predict the onset of dementia up to 11 years later, and the extent to which this prediction is independent of that provided by APOE genotype. METHODS Prospective cohort study based on 54 general practices in the UK; 657 survivors of the 1088 participants in the MRC treatment trial of hypertension in older adults were followed for up to 11 years; 370 participants (57% of survivors) were traced, screened for dementia, and genotyped for APOE in 1994. Baseline assessments included trail making test A, paired associated learning test, Raven's progressive matrices, and national adult reading test. At follow up, both mini-mental state examination and CAMCOG were used. Outcome measures were DSM-IIIR dementia and NINCDS-ADRDA possible and probable Alzheimer's disease. RESULTS All the cognitive tests completed in 1983 predicted onset of dementia and Alzheimer's disease up to 11 years later, as did APOE genotype. Cognitive test performance was not associated with APOE genotype. Addition of cognitive tests increased the area under the ROC curve for the prediction of Alzheimer's disease provided by age, family history, and APOE genotype (0.81 v 0.69, p = 0.048); addition of APOE genotype did not increase the area under the ROC curve for the prediction provided by age, family history, and cognitive tests (0.81 v 0.77, p = 0.28). CONCLUSIONS Simple tests of cognitive ability provide useful predictive information up to a decade before the onset of dementia. The predictive information provided is independent of, but not enhanced by, the addition of APOE genotype.
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Affiliation(s)
- J Cervilla
- Institute of Psychiatry, King's College London, UK
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Casserly I, Topol E. Convergence of atherosclerosis and Alzheimer's disease: inflammation, cholesterol, and misfolded proteins. Lancet 2004; 363:1139-46. [PMID: 15064035 DOI: 10.1016/s0140-6736(04)15900-x] [Citation(s) in RCA: 353] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Late-onset sporadic Alzheimer's disease is a heterogeneous disorder. In elderly patients, increasing evidence suggests a link between this neurodegenerative disease, and vascular risk factors and atherosclerosis. The nature of this link remains speculative. Some investigators have suggested that the disease arises as a secondary event related to atherosclerosis of extracranial or intracranial vessels. A toxic effect of vascular factors on the microvasculature of susceptible brain regions has also been argued. An alternative explanation is that atherosclerosis and Alzheimer's disease are independent but convergent disease processes. This hypothesis is lent support by observations of shared epidemiology, pathophysiological elements, and response to treatment in both disorders. It provides a potential framework for an improved understanding of the pathogenesis of Alzheimer's disease, especially in elderly patients with vascular risk factors, and offers some promise toward the search for preventive and therapeutic treatments.
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Affiliation(s)
- Ivan Casserly
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Letenneur L, Larrieu S, Barberger-Gateau P. Alcohol and tobacco consumption as risk factors of dementia: a review of epidemiological studies. Biomed Pharmacother 2004; 58:95-9. [PMID: 14992790 DOI: 10.1016/j.biopha.2003.12.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2003] [Indexed: 11/21/2022] Open
Abstract
The association between dementia and smoking or alcohol use has been examined in several epidemiological studies. In many case-control studies, a decreased risk of dementia or Alzheimer's disease (AD) was observed among smokers. However, when this association was analysed in prospective studies, an increased risk of AD was observed. In addition, in the PAQUID study, we showed that the decreased risk disappeared after adjustment for educational level and occupation. These factors are strong confounders in the association between dementia and tobacco use. We also showed that moderate consumption of wine was associated with a lower risk of developing AD. This result remains unchanged after adjustment for many potential confounders. The association between moderate alcohol consumption and risk of developing a dementia or AD was recently confirmed by prospective studies. In some studies, wine consumption was more specifically associated with a decreased risk, whereas beer or spirit consumption was not associated. These results suggest that tobacco consumption is not associated with a lower risk of dementia and that moderate alcohol intake does not increase the risk of developing dementia.
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Affiliation(s)
- Luc Letenneur
- Inserm U 593, case 11, Université Victor Segalen Bordeaux 2, 146, rue Léo Saignat, 33076 Bordeaux cedex, France.
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Abstract
Hypertension is one of the principal risk factors for cerebrovascular diseases. Several epidemiologic studies have also indicated a positive correlation between cognitive decline or dementia and blood pressure level. Indeed, the results of most longitudinal studies show that cognitive functioning is often inversely proportional to blood pressure values measured 15 or 20 years previously. Cerebral infarcts, lacunae, and white matter changes are implicated in the pathogenesis of vascular dementia, but may also favor the development of Alzheimer's disease. Microcirculation disorders and endothelial dysfunctions are also advanced to explain the deterioration in cognitive functions in hypertensive subjects. Data from recent therapeutic trials open the way to the prevention of dementia (vascular or Alzheimer's type) by antihypertensive treatments and must be confirmed by other studies.
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Affiliation(s)
- Olivier Hanon
- Hôpital Broca, CHU Cochin Port-Royal, Université René Descartes, Paris V, 54/56 Rue Pascal, 75013 Paris, France.
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42
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Tyas SL. Are tobacco and alcohol use related to Alzheimer's disease? A critical assessment of the evidence and its implications. Addict Biol 2003; 1:237-54. [PMID: 12893463 DOI: 10.1080/1355621961000124856] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Elucidation of the association of tobacco and alcohol use with Alzheimer's disease (AD) may advance etiological hypotheses and provide a theoretical basis for treatment. There is currently no cure or effective treatment for AD, and no cause has been established. Pharmacological evidence supports a plausible biological mechanism for the involvement of tobacco use: nicotine compensates for some of the cholinergic deficits observed in AD. Epidemiological evidence, however, is inconsistent, although recent meta-analyses also support a protective effect. Although smoking per se is certainly not advocated, further investigation of a potential protective effect of nicotine on AD is warranted. Pharmacological studies implicate alcohol use as a possible risk factor for AD; the epidemiological studies are again inconclusive. Alcohol consumption is associated with daily smoking and smokers are, in turn, more likely to consume alcohol. Since tobacco use may decrease the risk of developing AD and alcohol use may increase it, it is important to consider these two substances together: the effect of one may negate the other. This literature review critically evaluates the evidence for an association of tobacco and alcohol use with AD and identifies key issues for further research.
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Affiliation(s)
- S L Tyas
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Canada.
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Harmanci H, Emre M, Gurvit H, Bilgic B, Hanagasi H, Gurol E, Sahin H, Tinaz S. Risk Factors for Alzheimer Disease: A Population-Based Case-Control Study in Istanbul, Turkey. Alzheimer Dis Assoc Disord 2003; 17:139-45. [PMID: 14512826 DOI: 10.1097/00002093-200307000-00003] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective is to study risk factors for Alzheimer disease (AD) in Istanbul, Turkey. This is a population-based case-control study. We screened people over age 70 in the community for cognitive impairment. The screen positives and a proportion of screen negatives underwent neurologic examination in the second phase. Cases were 57 "probable" AD patients and controls were 127 cognitively normal individuals identified by neurologic examination. Odds ratios (OR) were calculated using multivariate logistic regression analysis. Having a university/college degree had a protective effect on AD risk (OR = 0.10, 95% confidence interval [CI] = 0.02-0.50). Exposure to occupational electromagnetic field had an OR of 4.02 (95% CI = 1.02-15.78). Use of electricity for residential heating also showed elevated risk (OR = 2.77, 95% CI = 1.12-6.85). Our results suggest that having a higher education is protective from AD and that electromagnetic field exposure at work or at home is a significant risk factor.
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Affiliation(s)
- Hande Harmanci
- Department of Public Health, Marmara University Medical Faculty, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
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Abstract
As the contribution of carotid stenosis to cognitive impairment still remains unclear, neuropsychological function and soft neurological signs were examined in patients aged 65 and over. Twenty-five patients with symptomatic carotid stenosis (CS) of 75% or more were compared with 25 patients with first anterior circulation stroke, 25 with peripheral vascular disease and 25 healthy controls. All patients were assessed using CAMCOG (Cambridge Cognitive Examination), tests examining frontal lobe function (Behavioural Dyscontrol Scale [BDYS], Trail-Making Tests A and B, Controlled Word Association Test) and a scale for primitive reflexes (Frontal Release Signs Scale). Patients with symptomatic CS showed greater global impairment on CAMCOG and more severe impairment in frontal lobe function than controls. Those patients scoring less than 15 on the BDYS were more likely to have experienced transient ischemic attacks (TIA) for 5 or more years. Frontal lobe dysfunction, suicidal thinking and age were all independent predictors of global cognitive impairment. Mean number of frontal release signs was higher in patients with CS than in controls, with a higher proportion of patients showing all release signs except glabellar, paratonia and snout reflexes. The study is limited by small numbers and the absence of brain imaging, but provides some evidence for an association between severe carotid stenosis and neuropsychological impairment. The presence of clinically 'silent' cerebrovascular disease affecting frontal lobe function may be missed in routine clinical practice.
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Affiliation(s)
- R Rao
- Department of Old Age Psychiatry, GKT Medical School and Institute of Psychiatry, SE58AF London, UK.
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Abstract
Cholesterol has been implicated in the pathogenesis of amyloid plaques in Alzheimer's disease (AD) and in the formation of neurofibrillary pathology in Niemann-Pick disease. Several epidemiology studies have implicated high cholesterol as a risk factor for AD and have shown that the use of cholesterol-reducing agents (statins) can be protective against the disease. We and others have shown that cholesterol levels modulate the processing of the amyloid precursor protein (APP) both in vivo and in vitro, affecting the accumulation of A-beta (Abeta) peptides that may directly impact the risk of AD. Mutations in the Niemann-Pick C gene (NPC) result in deficient cholesterol transport/storage. Clinically, Niemann-Pick disease causes a severe childhood lipidosis, with neurodegeneration characterized by the presence of AD-type neurofibrillary tangles (NFTs) composed of hyperphosphorylated tau. Studies of mouse models of NPC show that defects in cellular cholesterol trafficking are associated with enhanced generation of Abeta and the hyperphosphorylation of tau, further implicating the cholesterol homeostasis pathway as a risk factor for amyloidosis.
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Affiliation(s)
- Mark Burns
- Center for Dementia Research, Nathan S. Kline Institute, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA
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Fukunaga A, Kawase T, Kashima H, Hashimoto J, Uchida K. Effects of habitual cigarette smoking on higher cortical function in patients with unruptured cerebral aneurysms. Neurol Med Chir (Tokyo) 2002; 42:419-25; discussion 425-6. [PMID: 12416564 DOI: 10.2176/nmc.42.419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Postoperative changes in higher cortical function and cerebral blood flow (CBF) were investigated in patients with unruptured cerebral aneurysms to assess the effect of habitual smoking on the known transient changes after aneurysm surgery. Fifty-six adults with unruptured cerebral aneurysms, including 11 heavy smokers (smoking index > or = 600) and 45 non-smokers, were evaluated using three neuropsychological examinations, the Mini-Mental State Examination, the Maze test, and the Kana-hiroi test, and single photon emission computed tomography to measure CBF before and after surgery. Neuropsychological changes were assessed by reliable change indices to take into account the practice effects. The scores of at least one examination decreased in 15 of 56 patients 1 month after surgery. On the Maze test, five of 11 heavy smokers and five of 45 non-smokers deteriorated after surgery, showing a significant difference (p = 0.018). The CBF in heavy smokers often decreased after surgery, but there was no statistically significant difference in logistic regression. Three months after surgery, the neuropsychological scores of 13 of the 15 deteriorated patients recovered to the preoperative level. Higher cortical function in heavy smokers with unruptured cerebral aneurysms often decreases transiently after operation, compared to non-smokers. Therefore, surgery planning for heavy smokers with unruptured cerebral aneurysms should consider this outcome.
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Affiliation(s)
- Atsushi Fukunaga
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
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47
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Sparks DL, Connor DJ, Browne P, Sabbagh MN. Should the guidelines for monitoring serum cholesterol levels in the elderly be re-evaluated? J Mol Neurosci 2002; 19:209-12. [PMID: 12212783 DOI: 10.1007/s12031-002-0035-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Elevated circulating cholesterol can have profound effects on the health of an individual. Such excess cholesterol can promote coronary artery disease, production and accumulation of beta-amyloid in the brain, and possibly Alzheimer's disease (AD). In a clinical trial evaluating the benefit of a cholesterol-lowering drug in the treatment of AD, mean cholesterol levels at baseline among individuals participating in the trial were found to be relatively high. Based on this observation we suggest that cholesterol levels should be actively monitored in the elderly, as many individuals with AD are over 65 years of age and therefore excluded by currently accepted guidelines.
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Affiliation(s)
- D Larry Sparks
- Laboratory of Neurodegenerative Disease Research, Sun Health Research Institute, Sun City, AZ 85351, USA.
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Siennicki-Lantz A, Lilja B, Elmståhl S. Cerebral perfusion deficits in age-associated memory impairment. The role of tobacco smoking. Aging Clin Exp Res 2002; 14:108-16. [PMID: 12092784 DOI: 10.1007/bf03324424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Several studies report a high prevalence of memory complaints in the elderly, non-demented population. Since the pathogenesis and diversity of memory impairment in healthy people is still an unresolved issue, we designed our study to ascertain the occurrence of brain abnormalities in Age-Associated Memory Impairment (AAMI) by measuring regional cerebral blood flow (rCBF). METHODS Fifty-three subjects were invited to the case-control study: 26 subjects who fulfilled the AAMI criteria, and 27 controls (age, mean+/-SD 65.8+/-7.3 vs 65.5+/-6.7). rCBF was determined using 99mTC-ECD SPECT by relative measurements made in the cortical and white matter regions and in the thalamus. RESULTS The AAMI group vs controls had restricted rCBF in the temporal lobe of the left hemisphere (median; 85.8 vs 87.8, p=0.04), in the thalamus (median; 87.3 vs 89.8, p=0.036) and the frontal white matter (median; right hemisphere 80.0 vs 84.1, p=0.01; left hemisphere 77.7 vs 81.6, p=0.04). AAMI subjects who previously smoked had lower rCBF values in the temporal, parietal, occipital and frontal lobes bilaterally, and poorer memory test results than ex-smoker controls. By contrast, rCBF did not differ between non-smoking AAMI subjects and controls. CONCLUSIONS Compared to controls, AAMI subjects had restricted rCBF, A history of previous smoking could partly contribute to the rCBF differences between these groups. Further studies on failing memory and rCBF in representative cohorts of smoking and non-smoking populations are now needed.
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49
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Almeida OP, Hulse GK, Lawrence D, Flicker L. Smoking as a risk factor for Alzheimer's disease: contrasting evidence from a systematic review of case-control and cohort studies. Addiction 2002; 97:15-28. [PMID: 11895267 DOI: 10.1046/j.1360-0443.2002.00016.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To investigate the risk of Alzheimer's disease (AD) associated with smoking. DESIGN Meta-analyses of case-control and cohort studies. DATA SOURCE Index Medicus-Medline (1966-April 2000) and PsycINFO (1984-April 2000) databases were systematically consulted for the retrieval of references. This search was supplemented by manual search of relevant references quoted by other studies and reviews. STUDY SELECTION Irrelevant abstracts and articles were identified by one of the authors. These papers were retrieved and examined by at least two of the authors, who initially assessed them for the relevance of the exposure (smoking), outcome (AD) and study-design (case-control or cohort study). DATA EXTRACTION Two reviewers rated independently the quality of selected papers. Whenever possible, raw data were extracted and the crude odds ratio (OR) calculated using the Cornfield method. The pooled risk ratios were estimated using a fixed-effects model. FINDINGS Twenty-one case-control studies reported data on 5323 subjects. The estimated pooled odds ratio (OR) was 0.74 [95% confidence interval (CI) = 0.66-0.84]. In another analysis incorporating ORs adjusted for confounding variables (such as age, sex, schooling and alcohol use), the pooled odds ratio was 0.82 (95% CI = 0.70-0.97). Finally, in a analysis that included only the four case-control studies that used matched design the pooled odds ratio was 0.82 (95% CI = 0.53-1.27). Eight cohort studies reported data on 43 885 people at risk-the overall relative risk (RR) of AD among ever smokers was 1.10 (95% CI = 0.94-1.29). Restricting the analysis to the two cohort studies that described the number of subjects who were smokers at baseline and later developed AD produced a RR of 1.99 (95% CI = 1.33-2.98). CONCLUSIONS Case-control and cohort studies produce conflicting results as to the direction of the association between smoking and AD. Survival bias and other methodological problems associated with case-control studies may partly explain this difference. Access to information collected by ongoing follow-up studies may contribute to clarify the role of smoking in AD. If new results confirm that smoking is associated with increased risk of AD, then smoking prevention and cessation should become public health priorities in the fight against dementia.
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Affiliation(s)
- Osvaldo P Almeida
- Department of Psychiatry and Behavioural Science, University of Western Australia, Perth, Australia.
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50
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Abstract
It is well established that 3-hydroxy-3-methyglutaryl coenzyme A (HMG-CoA) reductase inhibitors ("statins") reduce cholesterol levels and prevent coronary heart disease (CHD). Although a causal relation between elevated cholesterol levels and stroke has not been well defined, a number of large secondary prevention studies and meta-analyses have shown that statin therapy reduces stroke in patients with CHD and hypercholesterolemia. In addition to the vascular effects of statins (stabilization of atherosclerotic plaques, decreased carotid intimal-medial thickness), there are increasing data to suggest that these agents have additional properties that are potentially neuroprotective. These include endothelial protection via actions on the nitric oxide synthase system, as well as antioxidant, anti-inflammatory and anti-platelet effects. These actions of statins might have potential uses in other neurological disorders such as Alzheimer's disease and certain types of brain tumors.
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Affiliation(s)
- B Cucchiara
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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