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Mozersky J, Hartz S, Linnenbringer E, Levin L, Streitz M, Stock K, Moulder K, Morris JC. Communicating 5-Year Risk of Alzheimer's Disease Dementia: Development and Evaluation of Materials that Incorporate Multiple Genetic and Biomarker Research Results. J Alzheimers Dis 2021; 79:559-572. [PMID: 33337371 DOI: 10.3233/jad-200993] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitively normal (CN) older adults participating in Alzheimer's disease (AD) research increasingly ask for their research results-including genetic and neuroimaging findings-to understand their risk of developing AD dementia. AD research results are typically not returned for multiple reasons, including possible psychosocial harms of knowing one is at risk of a highly feared and untreatable disease. OBJECTIVE We developed materials that convey information about 5-year absolute risk of developing AD dementia based on research results. METHODS 20 CN older adults who received a research brain MRI result were interviewed regarding their wishes for research results to inform material development (Pilot 1). Following material development, 17 CN older adults evaluated the materials for clarity and acceptability (Pilot 2). All participants were community-dwelling older adults participating in longitudinal studies of aging at a single site. RESULTS Participants want information on their risk of developing AD dementia to better understand their own health, satisfy curiosity, inform family, and future planning. Some articulated concerns, but the majority wanted to know their risk despite the limitations of information. Participants found the educational materials and results report clear and acceptable, and the majority would want to know their research results after reviewing them. CONCLUSION These materials will be used in a clinical study examining the psychosocial and cognitive effects of offering research results to a cohort of CN older adults. Future AD research may incorporate the return of complex risk information to CN older adults, and materials are needed to communicate this information.
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Affiliation(s)
- Jessica Mozersky
- Bioethics Research Center, Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Sarah Hartz
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Erin Linnenbringer
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Lillie Levin
- Bioethics Research Center, Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Marissa Streitz
- Department of Neurology, Washington University School of Medicine, St. Louis, MO; and Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Kristin Stock
- Washington University Danforth College of Arts and Sciences (post-baccalaureate program) and Music Speaks, LLC
| | - Krista Moulder
- Department of Neurology, Washington University School of Medicine, St. Louis, MO; and Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - John C Morris
- Department of Neurology, Washington University School of Medicine, St. Louis, MO; and Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
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Santos OA, Pedraza O, Lucas JA, Duara R, Greig-Custo MT, Hanna Al-Shaikh FS, Liesinger AM, Bieniek KF, Hinkle KM, Lesser ER, Crook JE, Carrasquillo MM, Ross OA, Ertekin-Taner N, Graff-Radford NR, Dickson DW, Murray ME. Ethnoracial differences in Alzheimer's disease from the FLorida Autopsied Multi-Ethnic (FLAME) cohort. Alzheimers Dement 2019; 15:635-643. [PMID: 30792090 PMCID: PMC6511501 DOI: 10.1016/j.jalz.2018.12.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/13/2018] [Accepted: 12/02/2018] [Indexed: 12/28/2022]
Abstract
Introduction: Our primary goal was to examine demographic and clinicopathologic differences across an ethnoracially diverse autopsy-confirmed cohort of Alzheimer’s disease cases. Methods: A retrospective study was conducted in the Florida Autopsied Multi-Ethnic cohort on 1625 Alzheimer’s disease cases, including decedents who self-reported as Hispanic/Latino (n = 67), black/African American (n = 19), and white/European American (n = 1539). Results: Hispanic decedents had a higher frequency of family history of cognitive impairment (58%), an earlier age at onset (median age of 70 years), longer disease duration (median of 12 years), and lower MMSE proximal to death (median of 4 points) compared with the other ethnoracial groups. Black decedents had a lower Braak tangle stage (stage V) and higher frequency of coexisting hippocampal sclerosis (21%); however, only hippocampal sclerosis differences survived adjustment for sex, age at onset, and disease duration. Neither Thal amyloid phase nor coexisting Lewy body disease differed across ethnoracial groups. Discussion: Despite a smaller sample size, Hispanics demonstrated longer disease duration with Alzheimer’s disease, but not greater lifespan. Neuropathologic differences across ethnoracial groups supported differences in tau pathology distribution and coexisting hippocampal sclerosis, which may impact biomarker studies.
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Affiliation(s)
- Octavio A Santos
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Otto Pedraza
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - John A Lucas
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Ranjan Duara
- Department of Neurology, Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA; University of Florida College of Medicine, Gainesville, FL, USA
| | - Maria T Greig-Custo
- Department of Neurology, Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
| | | | | | - Kevin F Bieniek
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Kelly M Hinkle
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | - Julia E Crook
- Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | | | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Nilüfer Ertekin-Taner
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA; Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
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Leeuwis AE, Smith LA, Melbourne A, Hughes AD, Richards M, Prins ND, Sokolska M, Atkinson D, Tillin T, Jäger HR, Chaturvedi N, van der Flier WM, Barkhof F. Cerebral Blood Flow and Cognitive Functioning in a Community-Based, Multi-Ethnic Cohort: The SABRE Study. Front Aging Neurosci 2018; 10:279. [PMID: 30279656 PMCID: PMC6154257 DOI: 10.3389/fnagi.2018.00279] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/28/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Lower cerebral blood flow (CBF) is associated with cardiovascular disease and vascular risk factors, and is increasingly acknowledged as an important contributor to cognitive decline and dementia. In this cross-sectional study, we examined the association between CBF and cognitive functioning in a community-based, multi-ethnic cohort. Methods: From the SABRE (Southall and Brent Revisited) study, we included 214 European, 151 South Asian and 87 African Caribbean participants (71 ± 5 years; 39%F). We used 3T pseudo-continuous arterial spin labeling to estimate whole-brain, hematocrit corrected CBF. We measured global cognition and three cognitive domains (memory, executive functioning/attention and language) with a neuropsychological test battery. Associations were investigated using linear regression analyses, adjusted for demographic variables, vascular risk factors and MRI measures. Results: Across groups, we found an association between higher CBF and better performance on executive functioning/attention (standardized ß [stß] = 0.11, p < 0.05). Stratification for ethnicity showed associations between higher CBF and better performance on memory and executive functioning/attention in the white European group (stß = 0.14; p < 0.05 and stß = 0.18; p < 0.01 respectively), associations were weaker in the South Asian and African Caribbean groups. Conclusions: In a multi-ethnic community-based cohort we showed modest associations between CBF and cognitive functioning. In particular, we found an association between higher CBF and better performance on executive functioning/attention and memory in the white European group. The observations are consistent with the proposed role of cerebral hemodynamics in cognitive decline.
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Affiliation(s)
- Anna E Leeuwis
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam Amsterdam UMC, Amsterdam, Netherlands
| | - Lorna A Smith
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science University College London, London, United Kingdom
| | - Andrew Melbourne
- Translational Imaging Group, Department of Medical Physics and Biomedical Engineering University College London, London, United Kingdom
| | - Alun D Hughes
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science University College London, London, United Kingdom.,MRC Unit for Lifelong Health and Ageing University College London, London, United Kingdom
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing University College London, London, United Kingdom
| | - Niels D Prins
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam Amsterdam UMC, Amsterdam, Netherlands
| | - Magdalena Sokolska
- Department of Medical Physics and Biomedical Engineering University College London, London, United Kingdom
| | - David Atkinson
- Centre for Medical Imaging University College London, London, United Kingdom
| | - Therese Tillin
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science University College London, London, United Kingdom
| | - Hans R Jäger
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation UCL Institute of Neurology, London, United Kingdom
| | - Nish Chaturvedi
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science University College London, London, United Kingdom.,MRC Unit for Lifelong Health and Ageing University College London, London, United Kingdom
| | - Wiesje M van der Flier
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam Amsterdam UMC, Amsterdam, Netherlands.,Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam Amsterdam UMC, Amsterdam, Netherlands
| | - Frederik Barkhof
- Institutes of Neurology and Healthcare Engineering University College London, London, United Kingdom.,Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam Amsterdam UMC, Amsterdam, Netherlands
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Kane JPM, Surendranathan A, Bentley A, Barker SAH, Taylor JP, Thomas AJ, Allan LM, McNally RJ, James PW, McKeith IG, Burn DJ, O'Brien JT. Clinical prevalence of Lewy body dementia. ALZHEIMERS RESEARCH & THERAPY 2018; 10:19. [PMID: 29448953 PMCID: PMC5815202 DOI: 10.1186/s13195-018-0350-6] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/29/2018] [Indexed: 11/24/2022]
Abstract
Background The prevalence of dementia with Lewy bodies (DLB) and dementia in Parkinson’s disease (PDD) in routine clinical practice is unclear. Prevalence rates observed in clinical and population-based cohorts and neuropathological studies vary greatly. Small sample sizes and methodological factors in these studies limit generalisability to clinical practice. Methods We investigated prevalence in a case series across nine secondary care services over an 18-month period, to determine how commonly DLB and PDD cases are diagnosed and reviewed within two regions of the UK. Results Patients with DLB comprised 4.6% (95% CI 4.0–5.2%) of all dementia cases. DLB was represented in a significantly higher proportion of dementia cases in services in the North East (5.6%) than those in East Anglia (3.3%; χ2 = 13.6, p < 0.01). DLB prevalence in individual services ranged from 2.4 to 5.9%. PDD comprised 9.7% (95% CI 8.3–11.1%) of Parkinson’s disease cases. No significant variation in PDD prevalence was observed between regions or between services. Conclusions We found that the frequency of clinical diagnosis of DLB varied between geographical regions in the UK, and that the prevalence of both DLB and PDD was much lower than would be expected in this case series, suggesting considerable under-diagnosis of both disorders. The significant variation in DLB diagnostic rates between these two regions may reflect true differences in disease prevalence, but more likely differences in diagnostic practice. The systematic introduction of more standardised diagnostic practice could improve the rates of diagnosis of both conditions.
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Affiliation(s)
- Joseph P M Kane
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Ajenthan Surendranathan
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK
| | - Allison Bentley
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK
| | - Sally A H Barker
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Alan J Thomas
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise M Allan
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Richard J McNally
- Institute of Health and Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Peter W James
- Institute of Health and Society, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Ian G McKeith
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - David J Burn
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - John T O'Brien
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK. .,Department of Psychiatry, University of Cambridge School of Clinical Medicine, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK.
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Willingness to Be a Brain Donor: A Survey of Research Volunteers From 4 Racial/Ethnic Groups. Alzheimer Dis Assoc Disord 2017; 31:135-140. [PMID: 27779492 DOI: 10.1097/wad.0000000000000174] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Racial and ethnic groups are under-represented among research subjects who assent to brain donation in Alzheimer disease research studies. There has been little research on this important topic. Although there are some studies that have investigated the barriers to brain donation among African American study volunteers, there is no known research on the factors that influence whether or not Asians or Latinos are willing to donate their brains for research. METHODS African American, Caucasian, Asian, and Latino research volunteers were surveyed at 15 Alzheimer Disease Centers to identify predictors of willingness to assent to brain donation. RESULTS Positive predictors included older age, Latino ethnicity, understanding of how the brain is used by researchers, and understanding of what participants need to do to ensure that their brain will be donated. Negative predictors included African/African American race, belief that the body should remain whole at burial, and concern that researchers might not be respectful of the body during autopsy. DISCUSSION The predictive factors identified in this study may be useful for researchers seeking to increase participation of diverse ethnic groups in brain donation.
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Park S, Kim T, Shin SA, Kim YK, Sohn BK, Park HJ, Youn JH, Lee JY. Behavioral and Neuroimaging Evidence for Facial Emotion Recognition in Elderly Korean Adults with Mild Cognitive Impairment, Alzheimer's Disease, and Frontotemporal Dementia. Front Aging Neurosci 2017; 9:389. [PMID: 29249960 PMCID: PMC5714934 DOI: 10.3389/fnagi.2017.00389] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/13/2017] [Indexed: 11/13/2022] Open
Abstract
Background: Facial emotion recognition (FER) is impaired in individuals with frontotemporal dementia (FTD) and Alzheimer’s disease (AD) when compared to healthy older adults. Since deficits in emotion recognition are closely related to caregiver burden or social interactions, researchers have fundamental interest in FER performance in patients with dementia. Purpose: The purpose of this study was to identify the performance profiles of six facial emotions (i.e., fear, anger, disgust, sadness, surprise, and happiness) and neutral faces measured among Korean healthy control (HCs), and those with mild cognitive impairment (MCI), AD, and FTD. Additionally, the neuroanatomical correlates of facial emotions were investigated. Methods: A total of 110 (33 HC, 32 MCI, 32 AD, 13 FTD) older adult participants were recruited from two different medical centers in metropolitan areas of South Korea. These individuals underwent an FER test that was used to assess the recognition of emotions or absence of emotion (neutral) in 35 facial stimuli. Repeated measures two-way analyses of variance were used to examine the distinct profiles of emotional recognition among the four groups. We also performed brain imaging and voxel-based morphometry (VBM) on the participants to examine the associations between FER scores and gray matter volume. Results: The mean score of negative emotion recognition (i.e., fear, anger, disgust, and sadness) clearly discriminated FTD participants from individuals with MCI and AD and HC [F(3,106) = 10.829, p < 0.001, η2 = 0.235], whereas the mean score of positive emotion recognition (i.e., surprise and happiness) did not. A VBM analysis showed negative emotions were correlated with gray matter volume of anterior temporal regions, whereas positive emotions were related to gray matter volume of fronto-parietal regions. Conclusion: Impairment of negative FER in patients with FTD is cross-cultural. The discrete neural correlates of FER indicate that emotional recognition processing is a multi-modal system in the brain. Focusing on the negative emotion recognition is a more effective way to discriminate healthy aging, MCI, and AD from FTD in older Korean adults.
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Affiliation(s)
- Soowon Park
- Department of Education, Sejong University, Seoul, South Korea
| | - Taehoon Kim
- Department of Psychiatry, Neuroscience Research Institute, Seoul National University and SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Seong A Shin
- Department of Biomedical Sciences, Seoul National University, Seoul, South Korea.,Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Bo Kyung Sohn
- Department of Psychiatry, Inje Univiersity Sanggye Paik Hospital, Seoul, South Korea
| | - Hyeon-Ju Park
- Department of Psychiatry, Neuroscience Research Institute, Seoul National University and SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Jung-Hae Youn
- Graduate School of Clinical Counseling Psychology, CHA University, Pocheon, South Korea
| | - Jun-Young Lee
- Department of Psychiatry, Neuroscience Research Institute, Seoul National University and SMG-SNU Boramae Medical Center, Seoul, South Korea
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8
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Tsuang D, Simpson KL, Li G, Barnhart RL, Edland SD, Bowen J, McCormick W, Teri L, Nochlin D, Larson EB, Thompson ML, Leverenz JB. Evaluation of selection bias in an incident-based dementia autopsy case series. Alzheimer Dis Assoc Disord 2006; 19:67-73. [PMID: 15942323 PMCID: PMC1524825 DOI: 10.1097/01.wad.0000165507.67993.47] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neuropathological (np) relative frequency estimates of dementia may be biased if the autopsied subjects are not representative of all dementia subjects within a target population. We identified characteristics that differed between autopsied and non-autopsied subjects from an incident-based dementia case series and compared autopsy-based estimates of the relative frequency of np diagnoses before and after adjusting for potential selection bias. Clinically demented subjects who were autopsied (n = 206), had died but were not autopsied (n = 271), were still alive (n = 71), or had dropped out of the study (n = 82) were included. Compared with non-autopsied subjects, autopsied subjects were more likely to be Caucasian, educated beyond high school, and married. They also tended to have a lower baseline Mini-Mental State Examination score and were more likely to have a clinical diagnosis of Alzheimer disease (AD) than non-autopsied subjects. Neuropathological AD with Lewy bodies (LB) had the largest crude relative frequency estimate at 38% of the autopsy sample, followed by 25% for AD with vascular lesions, 13% for pure AD, 13% for LB (with or without vascular lesions), and 8% for pure vascular pathologies. Adjustment for potential sources of selection bias had little effect on relative frequency estimates, suggesting that np diagnoses in the autopsied subjects provide reasonable dementia relative frequency estimates among all clinically demented cases in this series.
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Affiliation(s)
- Debby Tsuang
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.
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9
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Riekse RG, Leverenz JB, McCormick W, Bowen JD, Teri L, Nochlin D, Simpson K, Eugenio C, Larson EB, Tsuang D. Effect of vascular lesions on cognition in Alzheimer's disease: a community-based study. J Am Geriatr Soc 2004; 52:1442-8. [PMID: 15341544 PMCID: PMC1487184 DOI: 10.1111/j.1532-5415.2004.52405.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate whether clinical and neuropathological differences exist between Alzheimer's disease (AD) cases with and without vascular lesions neuropathologically diagnosed using Consortium to Establish a Registry for Alzheimer's Disease (CERAD) criteria. DESIGN Descriptive observational study. SETTING A community-based registry that identified incident dementia cases. PARTICIPANTS Of the 124 subjects with available clinical and neuropathological assessments, 30 had AD lesions alone, and 18 had AD with vascular lesions. Patients with other neuropathological findings were excluded. MEASUREMENTS Dependent measures included demographic, clinical, and neuropathological characteristics. Neuropathological diagnoses were made using the CERAD criteria and Braak and Braak staging. RESULTS Of the 124 autopsied cases, 85 cases were diagnosed with neuropathological AD. Of these, 30 had pathology consistent with "pure" AD, whereas 18 had AD pathology with significant vascular lesions (AD/V). There were no differences in age, sex, or education between groups. AD/V cases had higher baseline and final Mini-Mental State Examination (MMSE) scores than pure AD cases, but after adjusting for education, differences in MMSE scores were not statistically significant. The AD/V group had significantly lower Braak staging than the pure AD group, after adjusting for education and final MMSE scores. CONCLUSION In this comparison study of AD cases with and without vascular lesions, AD/V cases had less severe AD pathology than those with AD alone, indicating that cerebrovascular disease likely contributes to the severity of cognitive impairment in those with AD. Controlling for vascular risk factors in patients with AD may have a significant effect on severity of dementia.
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Affiliation(s)
- Robert G Riekse
- Department of Medicine, University of Washington, Seattle, Washington, USA.
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10
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Affiliation(s)
- Jennifer J Manly
- Cognitive Neuroscience Division, GH Sergievsky Center and Taub Institute for Research on Alzheimer's Disease & The Aging Brain, Columbia University Health Science Center, 630 West 168th Street, P&S Box 16, New York, NY 10032, USA
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Abstract
Although autopsy remains the only definitive way to confirm and sometimes diagnose disease, the autopsy rate has continued to decline during the past 3 decades. Despite numerous publications citing its value, the nursing literature lacks information addressing the benefits and implications of the autopsy to nurses who provide direct care to older adults. This article provides geriatric nurses with information about the benefits, purpose, process, and barriers of autopsy to better inform nurses as they ease family concerns and assist physicians in obtaining consent for autopsy.
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Affiliation(s)
- Elaine Souder
- Education Core, University of Arkansas, Arkansas, USA
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12
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McFarland C, Sweet RA, DeKosky ST, Houck PR, Mulsant BH, Pollock BG, Reynolds CF. The establishment of a brain bank for the study of late-life depression: a feasibility study of factors facilitating consent. CNS Spectr 2002; 7:816-21. [PMID: 12947244 DOI: 10.1017/s1092852900024330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Studies of postmortem brain tissue are advancing the understanding of the pathophysiology of major depressive disorder (MDD). The nature and quality of subject samples, however, limit their applicability to late-life MDD. OBJECTIVE To examine the feasibility of establishing a brain bank for late-life MDD, and identify clinical, demographic, and procedural factors that might facilitate subject enrollment. METHODS Elderly subjects participating in clinical trials associated with the Mental Health Intervention Research Center for Late-Life Mood Disorders (MHIRC/LLMD) at the University of Pittsburgh were approached by clinical research staff for consent to future brain-only autopsy. Subjects who consented to participation were compared with those who refused participation on demographic and clinical variables. MHIRC/LLMD clinical research staff were interviewed to determine factors that may have facilitated or hindered the consent process and reasons for subject consent or refusal. RESULTS Eighty out of 242 subjects (33%) subjects approached for participation in the brain bank provided consent. Consent to participate was associated with higher level of education and with lower Mini-Mental State Examination score. Several factors facilitating and hindering the consent process were identified. CONCLUSION We provide preliminary evidence for the feasibility of establishing a brain bank for the study of late-life MDD. Future efforts may be guided by the factors identified as facilitating the consent process, especially the inclusion of family in the consent process.
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Affiliation(s)
- C McFarland
- Department of Psychology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Barker WW, Luis CA, Kashuba A, Luis M, Harwood DG, Loewenstein D, Waters C, Jimison P, Shepherd E, Sevush S, Graff-Radford N, Newland D, Todd M, Miller B, Gold M, Heilman K, Doty L, Goodman I, Robinson B, Pearl G, Dickson D, Duara R. Relative frequencies of Alzheimer disease, Lewy body, vascular and frontotemporal dementia, and hippocampal sclerosis in the State of Florida Brain Bank. Alzheimer Dis Assoc Disord 2002; 16:203-12. [PMID: 12468894 DOI: 10.1097/00002093-200210000-00001] [Citation(s) in RCA: 471] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Alzheimer disease (AD) is the most common dementing illness in the elderly, but there is equivocal evidence regarding the frequency of other disorders such as Lewy body disease (LBD), vascular dementia (VaD), frontotemporal dementia (FTD), and hippocampal sclerosis (HS). This ambiguity may be related to factors such as the age and gender of subjects with dementia. Therefore, the objective of this study was to calculate the relative frequencies of AD, LBD, VaD, FTD, and HS among 382 subjects with dementia from the State of Florida Brain Bank and to study the effect of age and gender on these frequencies. AD was the most frequent pathologic finding (77%), followed by LBD (26%), VaD (18%), HS (13%), and FTD (5%). Mixed pathology was common: Concomitant AD was present in 66% of LBD patients, 77% of VaD patients, and 66% of HS patients. The relative frequency of VaD increased with age, whereas the relative frequencies of FTD and LBD declined with age. Males were overrepresented among those with LBD, whereas females were overrepresented among AD subjects with onset age over 70 years. These estimates of the a priori probabilities of dementing disorders have implications for clinicians and researchers.
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Affiliation(s)
- Warren W Barker
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
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14
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Affiliation(s)
- Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas 77030, USA.
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