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Royall DR, Palmer RF. Statin use moderates APOE's and CRP's associations with dementia and is associated with lesser dementia severity in ε4 carriers. Alzheimers Dement 2024; 20:1627-1636. [PMID: 38055626 PMCID: PMC10984456 DOI: 10.1002/alz.13543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/21/2023] [Accepted: 10/01/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION We tested the effect of statins on C-reactive protein (CRP) and apolipoprotein E (APOE)'s associations with dementia severity. METHODS A total of 1725 participants of the Alzheimer's Disease Neuroimaging Initiative (ADNI) were assigned from 12-month follow-up data into the following groups: (1) ε4 (-)/statin (-), (2) ε4 (-)/statin (+), (3) ε4 (+)/statin (-), and (4) ε4 (+)/statin (+). Dementia severity was assessed by a δ homolog: "dHABS." A mediation model was stratified on statin use and moderation effects tested by a chi-square difference. RESULTS Plasma CRP level decreased with ε4 allelic dose. Statins had no effect on the dHABS d-score in non-carriers but were associated with better scores in carriers. Treated carriers did not have more severe dementia than non-carriers. Statin use moderated the mutual adjusted effects of APOE and CRP. CRP was not a mediator of APOE's effect. DISCUSSION Statins may provide a protective effect on the dementia severity of ε4 carriers. HIGHLIGHTS δ is a dementia-specific phenotype related to general intelligence "g" and is assessed via a "d-score." Apolipoprotein E (APOE) and plasma C-reactive protein (CRP) are independently associated with δ. Plasma CRP decreases with ε4 allelic dose. Statins were associated with better (less demented) d-scores in ε4 carriers but had no effect in non-ε4 carriers. Treated ε4 carriers did not have more severe dementia than non-carriers. Statin use moderated the effects of APOE and CRP on δ. CRP was not a mediator of APOE's effect on δ.
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Affiliation(s)
- Donald R Royall
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, Texas, USA
- Department of Medicine, University of Texas Health Science Center, San Antonio, Texas, USA
- Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, Texas, USA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Disorders, San Antonio, USA
| | - Raymond F Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, Texas, USA
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Paradela RS, Justo AFO, Paes VR, Leite REP, Pasqualucci CA, Grinberg LT, Naslavsky MS, Zatz M, Nitrini R, Jacob-Filho W, Suemoto CK. Association between APOE-ε4 allele and cognitive function is mediated by Alzheimer's disease pathology: a population-based autopsy study in an admixed sample. Acta Neuropathol Commun 2023; 11:205. [PMID: 38115150 PMCID: PMC10731799 DOI: 10.1186/s40478-023-01681-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Apolipoprotein E ε4 allele (APOE-ε4) is the main genetic risk factor for late-onset Alzheimer's disease (AD) and may impact cognitive function also via other neuropathological lesions. However, there is limited evidence available from diverse populations, as APOE associations with dementia seem to differ by race. Therefore, we aimed to evaluate the pathways linking APOE-ε4 to cognitive abilities through AD and non-AD neuropathology in an autopsy study with an admixed sample. METHODS Neuropathological lesions were evaluated following international criteria using immunohistochemistry. Participants were classified into APOE-ε4 carriers (at least one ε4 allele) and non-carriers. Cognitive abilities were evaluated by the Clinical Dementia Rating Scale sum of boxes. Mediation analyses were conducted to assess the indirect association of APOE-ε4 with cognition through AD-pathology, lacunar infarcts, hyaline arteriosclerosis, cerebral amyloid angiopathy (CAA), Lewy body disease (LBD), and TAR DNA-binding protein 43 (TDP-43). RESULTS We included 648 participants (mean age 75 ± 12 years old, mean education 4.4 ± 3.7 years, 52% women, 69% White, and 28% APOE-ε4 carriers). The association between APOE-ε4 and cognitive abilities was mediated by neurofibrillary tangles (β = 0.88, 95% CI = 0.45; 1.38, p < 0.001) and neuritic plaques (β = 1.36, 95% CI = 0.86; 1.96, p < 0.001). Lacunar infarcts, hyaline arteriosclerosis, CAA, LBD, and TDP-43 were not mediators in the pathway from APOE-ε4 to cognition. CONCLUSION The association between APOE-ε4 and cognitive abilities was partially mediated by AD-pathology. On the other hand, cerebrovascular lesions and other neurodegenerative diseases did not mediate the association between APOE-ε4 and cognition.
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Affiliation(s)
- Regina Silva Paradela
- Division of Geriatrics, University of São Paulo Medical School, 455 Doutor Arnaldo Avenue, room 1355, São Paulo, SP, Brazil.
| | | | - Vítor Ribeiro Paes
- Department of Pathology, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Renata E P Leite
- Department of Pathology, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Carlos A Pasqualucci
- Department of Pathology, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Lea T Grinberg
- Memory and Aging Center, University of California, San Francisco, USA
| | - Michel Satya Naslavsky
- Human Genome and Stem Cell Center, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Mayana Zatz
- Human Genome and Stem Cell Center, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Wilson Jacob-Filho
- Division of Geriatrics, University of São Paulo Medical School, 455 Doutor Arnaldo Avenue, room 1355, São Paulo, SP, Brazil
| | - Claudia Kimie Suemoto
- Division of Geriatrics, University of São Paulo Medical School, 455 Doutor Arnaldo Avenue, room 1355, São Paulo, SP, Brazil
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Young CB, Johns E, Kennedy G, Belloy ME, Insel PS, Greicius MD, Sperling RA, Johnson KA, Poston KL, Mormino EC. APOE effects on regional tau in preclinical Alzheimer's disease. Mol Neurodegener 2023; 18:1. [PMID: 36597122 PMCID: PMC9811772 DOI: 10.1186/s13024-022-00590-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/14/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND APOE variants are strongly associated with abnormal amyloid aggregation and additional direct effects of APOE on tau aggregation are reported in animal and human cell models. The degree to which these effects are present in humans when individuals are clinically unimpaired (CU) but have abnormal amyloid (Aβ+) remains unclear. METHODS We analyzed data from CU individuals in the Anti-Amyloid Treatment in Asymptomatic AD (A4) and Longitudinal Evaluation of Amyloid Risk and Neurodegeneration (LEARN) studies. Amyloid PET data were available for 4486 participants (3163 Aβ-, 1323 Aβ+) and tau PET data were available for a subset of 447 participants (55 Aβ-, 392 Aβ+). Linear models examined APOE (number of e2 and e4 alleles) associations with global amyloid and regional tau burden in medial temporal lobe (entorhinal, amygdala) and early neocortical regions (inferior temporal, inferior parietal, precuneus). Consistency of APOE4 effects on regional tau were examined in 220 Aβ + CU and mild cognitive impairment (MCI) participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI). RESULTS APOE2 and APOE4 were associated with lower and higher amyloid positivity rates, respectively. Among Aβ+ CU, e2 and e4 were associated with reduced (-12 centiloids per allele) and greater (+15 centiloids per allele) continuous amyloid burden, respectively. APOE2 was associated with reduced regional tau in all regions (-0.05 to -0.09 SUVR per allele), whereas APOE4 was associated with greater regional tau (+0.02 to +0.07 SUVR per allele). APOE differences were confirmed by contrasting e3/e3 with e2/e3 and e3/e4. Mediation analyses among Aβ+ s showed that direct effects of e2 on regional tau were present in medial temporal lobe and early neocortical regions, beyond an indirect pathway mediated by continuous amyloid burden. For e4, direct effects on regional tau were only significant in medial temporal lobe. The magnitude of protective e2 effects on regional tau was consistent across brain regions, whereas detrimental e4 effects were greatest in medial temporal lobe. APOE4 patterns were confirmed in Aβ+ ADNI participants. CONCLUSIONS APOE influences early regional tau PET burden, above and beyond effects related to cross-sectional amyloid PET burden. Therapeutic strategies targeting underlying mechanisms related to APOE may modify tau accumulation among Aβ+ individuals.
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Affiliation(s)
- Christina B Young
- Stanford University School of Medicine, 453 Quarry Rd., Palo Alto, Stanford, CA, 94304, USA.
| | - Emily Johns
- Stanford University School of Medicine, 453 Quarry Rd., Palo Alto, Stanford, CA, 94304, USA
| | - Gabriel Kennedy
- Stanford University School of Medicine, 453 Quarry Rd., Palo Alto, Stanford, CA, 94304, USA
| | - Michael E Belloy
- Stanford University School of Medicine, 453 Quarry Rd., Palo Alto, Stanford, CA, 94304, USA
| | - Philip S Insel
- University of California San Francisco, San Francisco, CA, USA
| | - Michael D Greicius
- Stanford University School of Medicine, 453 Quarry Rd., Palo Alto, Stanford, CA, 94304, USA
| | - Reisa A Sperling
- Brigham and Women's Hospital, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Keith A Johnson
- Brigham and Women's Hospital, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Kathleen L Poston
- Stanford University School of Medicine, 453 Quarry Rd., Palo Alto, Stanford, CA, 94304, USA
| | - Elizabeth C Mormino
- Stanford University School of Medicine, 453 Quarry Rd., Palo Alto, Stanford, CA, 94304, USA
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Casten R, Leiby BE, Kelley M, Rovner BW. A randomized controlled trial to test the efficacy of a diabetes behavioral intervention to prevent memory decline in older blacks/African Americans with diabetes and mild cognitive impairment. Contemp Clin Trials 2022; 123:106977. [PMID: 36341847 PMCID: PMC9787831 DOI: 10.1016/j.cct.2022.106977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The prevalence of dementia in Blacks/African Americans (AAs) is almost twice that of Whites. Inequities in access to health care, socioeconomic conditions, and diabetes contribute to this disparity. Poorly controlled diabetes, which is more prevalent in Blacks/AAs, causes microvascular disease and neurodegeneration and increases dementia risk. Improving glycemic control, therefore, may prevent cognitive decline. To address this issue, we developed Diabetes Regulation for Eyesight and Memory (DREAM), a community health worker (CHW)-led behavioral intervention to improve diabetes self-management and thereby prevent cognitive decline. DREAM consists of home-based diabetes education, goal setting, and telehealth visits with a diabetes nurse educator. Exploratory aims will investigate whether APOE genotype moderates and retinal biomarkers mediate treatment effects. This report describes the trial's rationale, methodology, and study procedures. (clinicaltrials.gov identifier NCT04259047). METHODS This randomized controlled trial will test the efficacy of DREAM to prevent decline in memory (primary outcome) in Blacks/AAs aged 65+ with poorly controlled diabetes and Mild Cognitive Impairment (MCI). Two hundred participants will be randomized to DREAM or an attention control condition, and will receive 11 in-home treatment sessions over two years. Outcome data are collected at 6, 12, 18, and 24 months. The primary outcome is verbal learning as measured by Hopkins Verbal Learning Test (HVLT) Total Recall scores. Participants will have retinal imaging at baseline, 12, and 24 months. CONCLUSIONS This research aims to prevent cognitive decline in older Blacks/AAs with diabetes and MCI. If successful, this research will preserve health in an underserved population and reduce racial health disparities.
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Affiliation(s)
- Robin Casten
- Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College at Thomas, Jefferson University, 1015 Walnut Street, Suite 709, Philadelphia, PA 19107, USA.
| | - Benjamin E Leiby
- Division of Biostatistics, Department of Pharmacology, Physiology, and Cancer Biology, Sidney, Kimmel Medical College at Thomas Jefferson University, 130 S. 19(th) St, 17(th) Floor, Philadelphia, PA 19107, USA.
| | - Megan Kelley
- Department of Neurology, Sidney Kimmel Medical College at Thomas Jefferson University, 1015, Walnut Street, Suite 709, Philadelphia, PA 19107, USA.
| | - Barry W Rovner
- Departments of Neurology, Psychiatry, and Ophthalmology, Sidney Kimmel Medical College at Thomas Jefferson University, 900 Walnut Street, Philadelphia, PA 19107, USA.
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Zhao X, Li X. The prevalence of Alzheimer’s disease in the Chinese Han population: a meta-analysis. Neurol Res 2020; 42:291-298. [PMID: 32138626 DOI: 10.1080/01616412.2020.1716467] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Xingxing Zhao
- Neurology Department, Shanxi Medical University, Taiyuan, Shanxi, P.R. China
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, P.R. China
| | - Xinyi Li
- Neurology Department, Shanxi Dayi Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, P.R. China
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Royall DR, Bishnoi RJ, Palmer RF. Blood-based protein predictors of dementia severity as measured by δ: Replication across biofluids and cohorts. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2019; 11:763-774. [PMID: 31909176 PMCID: PMC6939046 DOI: 10.1016/j.dadm.2019.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Dementia severity can be empirically described by the latent dementia phenotype "δ" and its various composite "homologs". We have explored δ's blood-based protein biomarkers in the Texas Alzheimer's Research and Care Consortium (TARCC) study. However, it would be convenient to replicate those associations in the Alzheimer's Disease Neuroimaging Initiative (ADNI). To this end, we recently engineered a δ homolog from observed cognitive performance measures common to both projects (i.e., "dT2A"). METHODS We used nine rationally chosen peripheral blood-based protein biomarkers as indicators of a latent variable "INFLAMMATION". We then associated that construct with dT2A in structural equation models adjusted for age, gender, depressive symptoms, and apolipoprotein E (APOE) ε4 allelic burden. Significant factor loadings and INFLAMMATION's association with dT2A were confirmed in random splits of TARCC's relatively large sample, and across biofluids in the ADNI. RESULTS Nine proteins measured in serum (TARCC) or plasma (ADNI) explained ≅10% of dT2A's variance in both samples, independently of age, APOE, education, and gender. All loaded significantly on INFLAMMATION, and positively or negatively, depending on their known roles are PRO- or ANTI-inflammatory proteins, respectively. The parameters of interest were confirmed across random 50% splits of the TARCC's sample, and replicated across biofluids in the ADNI. DISCUSSION These results suggest that SEM can be used to replicate biomarker findings across samples and biofluids, and that a substantial fraction of dementia's variance is attributable to peripheral blood-based protein levels.
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Affiliation(s)
- Donald R. Royall
- Department of Psychiatry, The University of Texas Health Science Center, San Antonio, TX, USA
- Department of Medicine, the University of Texas Health Science Center, San Antonio, TX, USA
- Family and Community Medicine, the University of Texas Health Science Center, San Antonio, TX, USA
- The Biggs Institute for Alzheimer's and Neurodegenerative Disease, the University of Texas Health Science Center, San Antonio, TX, USA
| | - Ram J. Bishnoi
- The Department of Psychiatry, The Medical College of Georgia, Augusta, GA, USA
| | - Raymond F. Palmer
- Family and Community Medicine, the University of Texas Health Science Center, San Antonio, TX, USA
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Royall DR, Palmer RF. Blood-based protein mediators of senility with replications across biofluids and cohorts. Brain Commun 2019; 2:fcz036. [PMID: 32954311 PMCID: PMC7425523 DOI: 10.1093/braincomms/fcz036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/25/2019] [Accepted: 10/07/2019] [Indexed: 01/08/2023] Open
Abstract
Dementia severity can be quantitatively described by the latent dementia phenotype 'δ' and its various composite 'homologues'. We have explored δ's blood-based protein biomarkers in the Texas Alzheimer's Research and Care Consortium. However, it would be convenient to replicate them in the Alzheimer's Disease Neuroimaging Initiative. To that end, we have engineered a δ homologue from the observed cognitive performance measures common to both projects [i.e. 'd:Texas Alzheimer's Research and Care Consortium to Alzheimer's Disease Neuroimaging Initiative' (dT2A)]. In this analysis, we confirm 13/22 serum proteins as partial mediators of age's effect on dementia severity as measured by dT2A in the Texas Alzheimer's Research and Care Consortium and then replicate 4/13 in the Alzheimer's Disease Neuroimaging Initiative's plasma data. The replicated mediators of age-specific effects on dementia severity are adiponectin, follicle-stimulating hormone, pancreatic polypeptide and resistin. In their aggregate, the 13 confirmed age-specific mediators suggest that 'cognitive frailty' pays a role in dementia severity as measured by δ. We provide both discriminant and concordant support for that hypothesis. Weight, calculated low-density lipoprotein and body mass index are partial mediators of age's effect in the Texas Alzheimer's Research and Care Consortium. Biomarkers related to other disease processes (e.g. cerebrospinal fluid Alzheimer's disease-specific biomarkers in the Alzheimer's Disease Neuroimaging Initiative) are not. It now appears that dementia severity is the sum of multiple independent processes impacting δ. Each may have a unique set of mediating biomarkers. Age's unique effect appears to be at least partially mediated through proteins related to frailty. Age-specific mediation effects can be replicated across cohorts and biofluids. These proteins may offer targets for the remediation of age-specific cognitive decline (aka 'senility'), help distinguish it from other determinants of dementia severity and/or provide clues to the biology of Aging Proper.
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Affiliation(s)
- Donald R Royall
- Department of Psychiatry, The University of Texas Health Science Center, San Antonio, TX 78229-3900, USA
- Department of Medicine, The University of Texas Health Science Center, San Antonio, TX 78229-3900, USA
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX 78229-3900, USA
- The Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, The University of Texas Health Science Center, San Antonio, TX 78229-3900, USA
| | - Raymond F Palmer
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX 78229-3900, USA
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Rovner BW, Casten RJ, Hegel MT, Leiby B. Preventing Cognitive Decline in Black Individuals With Mild Cognitive Impairment: A Randomized Clinical Trial. JAMA Neurol 2019; 75:1487-1493. [PMID: 30208380 DOI: 10.1001/jamaneurol.2018.2513] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Mild cognitive impairment (MCI) is a transition state between normal cognitive aging and dementia that increases the risk for progressive cognitive decline. Preventing cognitive decline is a public health priority. Objective To determine whether behavioral activation prevents cognitive and functional decline over 2 years in black individuals with MCI. Design, Setting, and Participants Single-center, single-masked, attention-controlled randomized clinical trial. Participants were enrolled from June 21, 2011, to October 3, 2014, and follow-up ended December 13, 2016. Community-based recruitment and treatment of black individuals older than 65 years with amnestic MCI. Volunteer sample of 1390 persons with memory complaints were screened. Overall, 536 individuals had baseline assessment, and 315 (58.8%) were ineligible, most often owing to normal cognition (205 of 315 [65%]) or dementia (59 of 315 [18.7%]); 221 fully eligible participants were randomized. Analyses were intention to treat. Interventions Participants were randomized to behavioral activation, which aimed to increase cognitive, physical, and social activity (111 [50.2%]), or supportive therapy, an attention control treatment (110 [49.8%]). Main Outcomes and Measures The prespecified primary outcome was a decline of 6 or more recalled words on the total recall score of the Hopkins Verbal Learning Test-Revised assessed at 6, 12, 18, and 24 months. The secondary outcome was functional decline. Results Of 221 randomized participants (mean [SD] age, 75.8 [7.0] years, 175 women [79%]), 77 behavioral activation participants (69.4%) and 87 supportive therapy participants (79.1%) had 2-year outcome assessments. After baseline, behavioral activation participants engaged in significantly more cognitive activities than supportive therapy participants. The 2-year incidence of memory decline was 1.2% (95% CI, 0.2-6.4) for behavioral activation vs 9.3% (95% CI, 5.30-16.4) for supportive therapy (relative risk, 0.12; 95% CI, 0.02-0.74; P = .02). Behavioral activation was associated with stable everyday function, whereas supportive therapy was associated with decline (difference in slopes, 2.71; 95% CI, 0.12-5.30; P = .04). Rates of serious adverse events for behavioral activation and supportive therapy, respectively, were: falls (14 [13%] vs 28 [25%]), emergency department visits (24 [22%] vs 24 [22%]), hospitalizations (36 [32%] vs 31 [28%]), and deaths (7 [5%] vs 3 [4%]). Conclusions and Relevance Behavioral activation prevented cognitive and functional decline, but this finding requires further investigation. Black individuals have almost twice the rate of dementia as white individuals; behavioral activation may reduce this health disparity. Trial Registration ClinicalTrials.gov Identifier: NCT01299766.
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Affiliation(s)
- Barry W Rovner
- Department of Neurology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.,Department Psychiatry, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.,Department Ophthalmology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robin J Casten
- Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mark T Hegel
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Benjamin Leiby
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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Rovner BW, Casten RJ, Leiby B. Memory improvement in African Americans with amnestic mild cognitive impairment. Int J Geriatr Psychiatry 2019; 34:1447-1454. [PMID: 31087388 PMCID: PMC6742531 DOI: 10.1002/gps.5141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/04/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Amnestic mild cognitive impairment (aMCI) has an uncertain course. Valid methods to evaluate memory change will best identify predictors of course. This issue is especially relevant to older persons in minority groups, who may have encountered life course factors that adversely affect cognition. METHODS/DESIGN Growth curve mixture models were used to identify trajectories of memory test scores obtained every 6 months over 2 years in 221 African Americans with aMCI. RESULTS Participants sorted into two classes, with clinically and statistically significant differences in memory scores over time. Class 1 (n = 28 [14.7%]) had sustained improved scores. Class 2 (n = 162 [85.3%]) scores remained low, fluctuated, or declined. Class 1 had better baseline cognition and daily function than class 2. CONCLUSIONS The observed rate of improved memory is lower than reported reversion rates from aMCI to normal cognition. Evaluating trajectories of memory test scores rather than changes in categorical diagnoses of aMCI, which may depend on recalling (or not recalling) one or two words, may yield a more valid indicator of cognitive change. These approaches require further study in minority groups.
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Affiliation(s)
- Barry W. Rovner
- Jefferson Hospital for Neuroscience, 900 Walnut Street, Suite 200, Philadelphia, PA 19107
| | - Robin J. Casten
- Jefferson Hospital for Neuroscience, 900 Walnut Street, Suite 200, Philadelphia, PA 19107
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Royall DR, Palmer RF. Selection for depression-specific dementia cases with replication in two cohorts. PLoS One 2019; 14:e0216413. [PMID: 31150419 PMCID: PMC6544211 DOI: 10.1371/journal.pone.0216413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/21/2019] [Indexed: 01/01/2023] Open
Abstract
The latent variable "δ" (for "dementia") provides an etiologically "agnostic" omnibus dementia severity metric capable of recognizing the dementing potential of any condition. Depressive symptoms are independent predictors of δ and are thereby implicated as "dementing". Serum resistin levels partially mediate the association between depressive symptoms and δ. We use a novel "off-diagonal" CHI SQ algorithm to demonstrate our ability to select individuals demented solely by depression's effect in both the Texas Alzheimer's Research and Care Consortium (TARCC) (N ≌ 3,500), and the Alzheimer's Disease Neuroimaging Initiative (ADNI (N ≌ 1,750), and demonstrate the higher resistin levels of such cases in TARCC. This approach can be adapted to any δ-related dementia risk factor or biomarker and used identify individuals who might revert back to non-demented states after its successful treatment.
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Affiliation(s)
- Donald R. Royall
- Department of Psychiatry, the University of Texas Health Science Center, San Antonio, Texas, United States of America
- Department of Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
- Department of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
- South Texas Veterans’ Health System Audie L. Murphy Division Geriatric Research Education and Clinical Care Center, San Antonio, Texas, United States of America
| | - Raymond F. Palmer
- Department of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
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Del-Aguila JL, Benitez BA, Li Z, Dube U, Mihindukulasuriya KA, Budde JP, Farias FHG, Fernández MV, Ibanez L, Jiang S, Perrin RJ, Cairns NJ, Morris JC, Harari O, Cruchaga C. TREM2 brain transcript-specific studies in AD and TREM2 mutation carriers. Mol Neurodegener 2019; 14:18. [PMID: 31068200 PMCID: PMC6505298 DOI: 10.1186/s13024-019-0319-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/26/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Low frequency coding variants in TREM2 are associated with Alzheimer disease (AD) risk and cerebrospinal fluid (CSF) TREM2 protein levels are different between AD cases and controls. Similarly, TREM2 risk variant carriers also exhibit differential CSF TREM2 levels. TREM2 has three different alternative transcripts, but most of the functional studies only model the longest transcript. No studies have analyzed TREM2 expression levels or alternative splicing in brains from AD and cognitively normal individuals. We wanted to determine whether there was differential expression of TREM2 in sporadic-AD cases versus AD-TREM2 carriers vs sex- and aged-matched normal controls; and if this differential expression was due to a particular TREM2 transcript. METHODS We analyzed RNA-Seq data from parietal lobe brain tissue from AD cases with TREM2 variants (n = 33), AD cases (n = 195) and healthy controls (n = 118), from three independent datasets using Kallisto and the R package tximport to determine the read count for each transcript and quantified transcript abundance as transcripts per million. RESULTS The three TREM2 transcripts were expressed in brain cortex in the three datasets. We demonstrate for the first time that the transcript that lacks the transmembrane domain and encodes a soluble form of TREM2 (sTREM2) has an expression level around 60% of the canonical transcript, suggesting that around 25% of the sTREM2 protein levels could be explained by this transcript. We did not observe a difference in the overall TREM2 expression level between cases and controls. However, the isoform which lacks the 5' exon, but includes the transmembrane domain, was significantly lower in TREM2- p.R62H carriers than in AD cases (p = 0.007). CONCLUSION Using bulk RNA-Seq data from three different cohorts, we were able to quantify the expression level of the three TREM2 transcripts, demonstrating: (1) all three transcripts of them are highly expressed in the human cortex, (2) that up to 25% of the sTREM2 may be due to the expression of a specific isoform and not TREM2 cleavage; and (3) that TREM2 risk variants do not affect expression levels, suggesting that the effect of the TREM2 variants on CSF levels occurs at post-transcriptional level.
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Affiliation(s)
- Jorge L. Del-Aguila
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
- NeuroGenomics and Informatics, Washington University School of Medicine, St. Louis, MO USA
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO USA
| | - Bruno A. Benitez
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
- NeuroGenomics and Informatics, Washington University School of Medicine, St. Louis, MO USA
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO USA
| | - Zeran Li
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
- NeuroGenomics and Informatics, Washington University School of Medicine, St. Louis, MO USA
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO USA
| | - Umber Dube
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
- NeuroGenomics and Informatics, Washington University School of Medicine, St. Louis, MO USA
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO USA
| | - Kathie A. Mihindukulasuriya
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
- NeuroGenomics and Informatics, Washington University School of Medicine, St. Louis, MO USA
| | - John P. Budde
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
- NeuroGenomics and Informatics, Washington University School of Medicine, St. Louis, MO USA
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO USA
| | - Fabiana H. G. Farias
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
- NeuroGenomics and Informatics, Washington University School of Medicine, St. Louis, MO USA
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO USA
| | - Maria Victoria Fernández
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
- NeuroGenomics and Informatics, Washington University School of Medicine, St. Louis, MO USA
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO USA
| | - Laura Ibanez
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
- NeuroGenomics and Informatics, Washington University School of Medicine, St. Louis, MO USA
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO USA
| | - Shan Jiang
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO USA
| | - Richard J. Perrin
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO USA
- Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO USA
| | - Nigel J. Cairns
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO USA
- Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO USA
| | - John C. Morris
- Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO USA
| | - Oscar Harari
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
- NeuroGenomics and Informatics, Washington University School of Medicine, St. Louis, MO USA
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO USA
- Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO USA
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
- NeuroGenomics and Informatics, Washington University School of Medicine, St. Louis, MO USA
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO USA
- Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO USA
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Alzheimer’s Environmental and Genetic Risk Scores are Differentially Associated With General Cognitive Ability and Dementia Severity. Alzheimer Dis Assoc Disord 2019; 33:95-103. [DOI: 10.1097/wad.0000000000000292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lamar M, Yu L, Rubin LH, James BD, Barnes LL, Farfel JM, Gaiteri C, Buchman AS, Bennett DA, Schneider JA. APOE genotypes as a risk factor for age-dependent accumulation of cerebrovascular disease in older adults. Alzheimers Dement 2018; 15:258-266. [PMID: 30321502 PMCID: PMC6368888 DOI: 10.1016/j.jalz.2018.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/15/2018] [Accepted: 08/21/2018] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Apolipoprotein E (APOE) is a susceptibility gene for late-onset Alzheimer's disease neuropathology; less is known about the relationship between APOE and cerebrovascular disease (CVD) neuropathology. METHODS We investigated associations of APOE status with arteriolosclerosis, macroinfarcts and microinfarcts, and atherosclerosis in 1383 adults (65.9-108.2 years at death) with and without dementia. Excluding ε2/ε4 carriers, multivariable regressions for each CVD-related neuropathology compared ε4 and ε2 carriers to ε3/ε3 carriers adjusting for confounders including age and Alzheimer's neuropathology. RESULTS Three hundred forty-two individuals (24.7%; ∼87.7 years at death; 39.9% nondemented) were ε3/ε4 or ε4/ε4, and 180 (13.0%; ∼89.9 years at death; 66.6% nondemented) were ε2/ε3 or ε2/ε2. ε4 carriers had higher odds of macroinfarcts (odds ratio = 1.41, 95% confidence interval: 1.02-1.94, P = .03), whereas ε2 carriers had higher odds of moderate-to-severe arteriolosclerosis (odds ratio = 1.68, 95% confidence interval: 1.15-2.45, P = .006) compared to ε3/ε3 carriers. Age-stratified analyses suggested that these relationships were driven by ε4 carriers <90 years at death and ε2 carriers ≥90 years at death, respectively. DISCUSSION APOE differentially affects type and timing of CVD-related neuropathology.
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Affiliation(s)
- Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Leah H Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bryan D James
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Jose Marcelo Farfel
- Department of Geriatrics, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Chris Gaiteri
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA; Department of Pathology, Rush University Medical Center, Chicago, IL, USA
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Sennik S, Schweizer TA, Fischer CE, Munoz DG. Risk Factors and Pathological Substrates Associated with Agitation/Aggression in Alzheimer's Disease: A Preliminary Study using NACC Data. J Alzheimers Dis 2018; 55:1519-1528. [PMID: 27911311 DOI: 10.3233/jad-160780] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms are common manifestations of Alzheimer's disease (AD). A number of studies have targeted psychosis, i.e., hallucinations and delusions in AD, but few have assessed agitation/aggression in AD. OBJECTIVE To investigate the risk factors and pathological substrates associated with presence [A(+)] and absence [A(-)] of agitation/aggression (A) in autopsy-confirmed AD. METHODS Data was collected from the UDS data as of 2015 on the NACC database. Patients were stratified as intermediate (IAD) or high (HAD) pathological load of AD. Clinical diagnoses were not considered; additional pathological diagnoses were treated as variables. Analysis of data did not include a control group or corrections for multiple comparisons. RESULTS 1,716 patients met the eligibility criteria; 31.2% of the IAD and 47.8% of the HAD patients were A(+), indicating an association with severity of pathology (p = 0.001). Risk factors for A(+) included: age at initial visit, age at death, years of education, smoking (in females), recent cardiac events (in males), and clinical history of traumatic brain injury (TBI) (in males). A history of hypertension was not related to A(+). In terms of comorbidity, clinical diagnosis of Lewy body dementia syndrome was associated with A(+) but the association was not confirmed when pathological diagnosis based on demonstration of Lewy bodies was used as the criterion. The additional presence of phosphorylated TDP-43, but not tau pathologies, was associated with A(+)HAD. Vascular lesions, including lacunes, large arterial infarcts, and severity of atherosclerosis were negatively associated with A(+). Associated symptoms included delusions, hallucinations, and depression, but not irritability, aberrant motor behavior, sleep and night time behavioral changes, or changes in appetite and eating habits. CONCLUSIONS Smoking, TBI, and phosphorylated TDP-43 are associated with A(+)AD in specific groups, respectively. A(+) is directly associated with AD pathology load and inversely with vascular lesions.
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Affiliation(s)
- Simrin Sennik
- Keenan Biomedical Research Centre, the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Tom A Schweizer
- Keenan Biomedical Research Centre, the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,Department of Surgery, Division of Neurosurgery, Faculty of Medicine, University of Toronto, ON, Canada.,Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Corinne E Fischer
- Keenan Biomedical Research Centre, the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, ON, Canada
| | - David G Munoz
- Keenan Biomedical Research Centre, the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, ON, Canada.,Department of Laboratory Medicine, St. Michael's Hospital, Toronto, ON, Canada
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Salomon-Zimri S, Glat MJ, Barhum Y, Luz I, Boehm-Cagan A, Liraz O, Ben-Zur T, Offen D, Michaelson DM. Reversal of ApoE4-Driven Brain Pathology by Vascular Endothelial Growth Factor Treatment. J Alzheimers Dis 2018; 53:1443-58. [PMID: 27372644 DOI: 10.3233/jad-160182] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Apolipoprotein E4 (ApoE4), the most prevalent genetic risk factor for Alzheimer's disease (AD), is associated with increased neurodegeneration and vascular impairments. Vascular endothelial growth factor (VEGF), originally described as a key angiogenic factor, has recently been shown to play a crucial role in the nervous system. The objective of this research is to examine the role of VEGF in mediating the apoE4-driven pathologies. We show that hippocampal VEGF levels are lower in apoE4 targeted replacement mice compared to the corresponding apoE3 mice. This effect was accompanied by a specific decrease in both VEGF receptor-2 and HIF1-α. We next set to examine whether upregulation of VEGF can reverse apoE4-driven pathologies, namely the accumulation of hyperphosphorylated tau (AT8) and Aβ42, and reduced levels of the pre-synaptic marker, VGluT1, and of the ApoE receptor, ApoER2. This was first performed utilizing intra-hippocampal injection of VEGF-expressing-lentivirus (LV-VEGF). This revealed that LV-VEGF treatment reversed the apoE4-driven cognitive deficits and synaptic pathologies. The levels of Aβ42 and AT8, however, were increased in apoE3 mice, masking any potential effects of this treatment on the apoE4 mice. Follow-up experiments utilizing VEGF-expressing adeno-associated-virus (AAV-VEGF), which expresses VEGF specifically under the GFAP astrocytic promoter, prevented this effects on apoE3 mice, and reversed the apoE4-related increase in Aβ42 and AT8. Taken together, these results suggest that apoE4-driven pathologies are mediated by a VEGF-dependent pathway, resulting in cognitive impairments and brain pathology. These animal model findings suggest that the VEGF system is a promising target for the treatment of apoE4 carriers in AD.
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Affiliation(s)
- Shiran Salomon-Zimri
- Department of Neurobiology, The George S. Wise Faculty of Life Sciences, The Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Micaela Johanna Glat
- Sackler School of Medicine, Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Yael Barhum
- Sackler School of Medicine, Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Ishai Luz
- Department of Neurobiology, The George S. Wise Faculty of Life Sciences, The Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Anat Boehm-Cagan
- Department of Neurobiology, The George S. Wise Faculty of Life Sciences, The Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Ori Liraz
- Department of Neurobiology, The George S. Wise Faculty of Life Sciences, The Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Tali Ben-Zur
- Sackler School of Medicine, Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Offen
- Sackler School of Medicine, Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Daniel M Michaelson
- Department of Neurobiology, The George S. Wise Faculty of Life Sciences, The Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Ghayeghran AR, Akbarshahi M, Salehi Z, Davoudi-Kiakalayeh A. Analysis of apolipoprotein E genetic variation in patients with Alzheimer disease referred to Imam Reza Clinic, Rasht, Iran, in 2015. IRANIAN JOURNAL OF NEUROLOGY 2017; 16:173-177. [PMID: 29736222 PMCID: PMC5937002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Alzheimer disease (AD) is a progressive neurological degenerative disorder and the most common form of dementia. There are about 100 genes linked to AD including apolipoprotein E (ApoE). This gene exists in the form of three allele polymorphisms of ε2, ε3 and ε4 and six genotypes of ε2ε3, ε2ε2, ε3ε3, ε2ε4, ε3ε4, and ε4ε4. We aimed to study the association of ApoE polymorphism with AD in Guilan province, Iran. Methods: The study group consisted of 70 AD patients and 100 healthy individuals as a control group. All subjects were recruited from 21 March to 22 September 2015 at Imam Reza Clinic, Rasht, Iran. The genomic deoxyribonucleic acid (DNA) was extracted from peripheral blood leucocytes, and subsequently, subjects were genotyped for ApoE using tetra-primer amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). The association between the risk allele and AD was assessed using the MedCalc software. Results: The distributions of ε3ε3, ε3ε4, ε2ε2, ε2ε4, ε4ε4 and ε2ε3 Genotypes among patients were 55.7%, 30.0%, 1.4%, 2.9%, 8.6%, 1.4% and in the controls were 79.0%, 8.0%, 0%, 1.0%, 1.0%, 11.0%, respectively. The genotype frequencies were significantly different between cases and the controls (P < 0.001). The individuals with the ε4ε4 and ε3ε4 genotypes had a greater risk for AD as compared to others; odds ratio (OR) = 12.15, 95% confidence interval (CI): 1.41-104.50, P = 0.020; OR = 5.32, 95% CI: 2.16-13.08, P = 0.003. In addition, the ε4 allele is significantly associated with higher AD risk among the studied population (OR = 5.63, 95% CI: 2.74-11.58, P < 0.001). Conclusion: This case-control study suggests that the subjects with ε4ε4 and ε3ε4 genotypes had an increased risk for AD in Iranian population.
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Affiliation(s)
- Amir Reza Ghayeghran
- Department of Neurology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Akbarshahi
- Department of Neurology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Zivar Salehi
- Department of Biology, School of Sciences, University of Guilan, Rasht, Iran
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Yue JK, Robinson CK, Burke JF, Winkler EA, Deng H, Cnossen MC, Lingsma HF, Ferguson AR, McAllister TW, Rosand J, Burchard EG, Sorani MD, Sharma S, Nielson JL, Satris GG, Talbott JF, Tarapore PE, Korley FK, Wang KK, Yuh EL, Mukherjee P, Diaz‐Arrastia R, Valadka AB, Okonkwo DO, Manley GT. Apolipoprotein E epsilon 4 (APOE-ε 4) genotype is associated with decreased 6-month verbal memory performance after mild traumatic brain injury. Brain Behav 2017; 7:e00791. [PMID: 28948085 PMCID: PMC5607554 DOI: 10.1002/brb3.791] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 06/28/2017] [Accepted: 07/02/2017] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The apolipoprotein E (APOE) ε4 allele associates with memory impairment in neurodegenerative diseases. Its association with memory after mild traumatic brain injury (mTBI) is unclear. METHODS mTBI patients (Glasgow Coma Scale score 13-15, no neurosurgical intervention, extracranial Abbreviated Injury Scale score ≤1) aged ≥18 years with APOE genotyping results were extracted from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot) study. Cohorts determined by APOE-ε4(+/-) were assessed for associations with 6-month verbal memory, measured by California Verbal Learning Test, Second Edition (CVLT-II) subscales: Immediate Recall Trials 1-5 (IRT), Short-Delay Free Recall (SDFR), Short-Delay Cued Recall (SDCR), Long-Delay Free Recall (LDFR), and Long-Delay Cued Recall (LDCR). Multivariable regression controlled for demographic factors, seizure history, loss of consciousness, posttraumatic amnesia, and acute intracranial pathology on computed tomography (CT). RESULTS In 114 mTBI patients (APOE-ε4(-)=79; APOE-ε4(+)=35), ApoE-ε4(+) was associated with long-delay verbal memory deficits (LDFR: B = -1.17 points, 95% CI [-2.33, -0.01], p = .049; LDCR: B = -1.58 [-2.63, -0.52], p = .004), and a marginal decrease on SDCR (B = -1.02 [-2.05, 0.00], p = .050). CT pathology was the strongest predictor of decreased verbal memory (IRT: B = -8.49, SDFR: B = -2.50, SDCR: B = -1.85, LDFR: B = -2.61, LDCR: B = -2.60; p < .001). Seizure history was associated with decreased short-term memory (SDFR: B = -1.32, p = .037; SDCR: B = -1.44, p = .038). CONCLUSION The APOE-ε4 allele may confer an increased risk of impairment of 6-month verbal memory for patients suffering mTBI, with implications for heightened surveillance and targeted therapies. Acute intracranial pathology remains the driver of decreased verbal memory performance at 6 months after mTBI.
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Affiliation(s)
- John K. Yue
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Caitlin K. Robinson
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - John F. Burke
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Ethan A. Winkler
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Hansen Deng
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Maryse C. Cnossen
- Department of Public HealthErasmus Medical CenterRotterdamThe Netherlands
| | - Hester F. Lingsma
- Department of Public HealthErasmus Medical CenterRotterdamThe Netherlands
| | - Adam R. Ferguson
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | | | - Jonathan Rosand
- Program in Medical and Population GeneticsThe Broad Institute at MIT and HarvardCambridgeMAUSA
- Department of NeurologyHarvard Medical SchoolBostonMAUSA
| | - Esteban G. Burchard
- Department of Bioengineering and Therapeutic SciencesUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Marco D. Sorani
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Sourabh Sharma
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Stritch School of Medicine at Loyola UniversityMaywoodILUSA
| | - Jessica L. Nielson
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Gabriela G. Satris
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Jason F. Talbott
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
- Department of RadiologyUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Phiroz E. Tarapore
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Frederick K. Korley
- Department of Emergency MedicineUniversity of Michigan at Ann ArborAnn ArborMIUSA
| | - Kevin K.W. Wang
- Departments of Psychiatry and NeuroscienceUniversity of FloridaGainesvilleFLUSA
| | - Esther L. Yuh
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Department of RadiologyUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Pratik Mukherjee
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Department of RadiologyUniversity of California, San FranciscoSan FranciscoCAUSA
| | | | - Alex B. Valadka
- Department of Neurological SurgeryVirginia Commonwealth UniversityRichmondVAUSA
| | - David O. Okonkwo
- Department of Neurological SurgeryUniversity of Pittsburgh Medical CenterPittsburghPAUSA
| | - Geoffrey T. Manley
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
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Royall DR, Al-Rubaye S, Bishnoi R, Palmer RF. Few serum proteins mediate APOE's association with dementia. PLoS One 2017; 12:e0172268. [PMID: 28291794 PMCID: PMC5349443 DOI: 10.1371/journal.pone.0172268] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 02/02/2017] [Indexed: 02/08/2023] Open
Abstract
The latent variable "δ" (for "dementia") appears to be uniquely responsible for the dementing aspects of cognitive impairment. Age, depression, gender and the apolipoprotein E (APOE) e4 allele are independently associated with δ. In this analysis, we explore serum proteins as potential mediators of APOE's specific association with δ in a large, ethnically diverse longitudinal cohort, the Texas Alzheimer's Research and Care Consortium (TARCC). APOE was associated only with C-Reactive Protein (CRP), Adiponectin (APN) and Amphiregulin (AREG), although the latter two's associations did not survive Bonferroni correction for multiple comparisons. All three proteins were associated with δ and had weak potential mediation effects on APOE's association with that construct. Our findings suggest that APOE's association with cognitive performance is specific to δ and partially mediated by serum inflammatory proteins. The majority of APOE's significant unadjusted effect on δ is unexplained. It may instead arise from direct central nervous system effects, possibly on native intelligence. If so, then APOE may exert a life-long influence over δ and therefore all-cause dementia risk.
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Affiliation(s)
- Donald R. Royall
- Department of Psychiatry, the University of Texas Health Science Center, San Antonio, Texas, United States of America
- Department of Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
- Department of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
- South Texas Veterans’ Health System Audie L. Murphy Division Geriatric Research Education and Clinical Care Center, San Antonio, Texas, United States of America
| | - Safa Al-Rubaye
- Department of Psychiatry, the University of Texas Health Science Center, San Antonio, Texas, United States of America
| | - Ram Bishnoi
- Department of Psychiatry, the Medical College of Georgia, Augusta, Georgia, United States of America
| | - Raymond F. Palmer
- Department of Family and Community Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
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Royall DR, Palmer RF. δ scores predict mild cognitive impairment and Alzheimer's disease conversions from nondemented states. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2017; 6:214-221. [PMID: 28378011 PMCID: PMC5369695 DOI: 10.1016/j.dadm.2017.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION We tested the latent variable "δ" (for "dementia")'s ability to predict conversion to "mild cognitive impairment" (MCI) and Alzheimer's disease (AD). METHODS An ethnicity equivalent d homolog ("dEQ") was constructed in n = 1113 Mexican- American (MA) and n = 1958 non-Hispanic white (NHW) participants in the Texas Alzheimer's Research and Care Consortium. "Normal Controls" (NC) (n = 1276) and MCI cases (n = 611) were followed annually for up to 6 years [m = 4.7(0.6)]. RESULTS 22.0% (n = 281) of NC converted to "MCI" or "AD". 17.3%( n = 106) of MCI converted to "AD." Independently of covariates, each quintile increase in the dEQ scores of NC increased the odds of conversion by 52%. Each quintile increase in the dEQ scores of MCI cases increased the odds of conversion to AD almost three-fold. DISCUSSION Baseline δ scores predict MCI and AD conversions from nondemented states in MA and NHW.
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Affiliation(s)
- Donald R. Royall
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
- Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
- Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, TX, USA
- South Texas Veterans' Health System Audie L. Murphy Division GRECC, San Antonio, TX, USA
| | - Raymond F. Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, TX, USA
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Royall DR, Al-Rubaye S, Bishnoi R, Palmer RF. Serum protein mediators of dementia and aging proper. Aging (Albany NY) 2016; 8:3241-3254. [PMID: 27922822 PMCID: PMC5270666 DOI: 10.18632/aging.101091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/17/2016] [Indexed: 12/27/2022]
Abstract
The latent variable "δ" (for "dementia") appears to be uniquely responsible for the dementing aspects of cognitive impairment. Age, depressive symptoms, gender and the apolipoprotein E (APOE) ε4 allele are independently associated with δ. In this analysis, we explore serum proteins as potential mediators of age's specific association with δ in a large, ethnically diverse longitudinal cohort, the Texas Alzheimer's Research and Care Consortium (TARCC). 22 serum proteins were recognized as partial mediators of age's association with δ. These include Insulin-like Growth Factor-Binding Protein 2 (IGF-BP2), which we had previously associated with age-specific cognitive change, and both Pancreatic Polypeptide (PP) and von Willebrand Factor (vWF), previously associated with δ. Nine other δ-related proteins were not confirmed by this ethnicity adjusted analysis. Our findings suggest that age's association with the disabling fraction of cognitive performance is partially mediated by serum proteins, somatomedins and hormones. Those proteins may offer targets for the specific treatment of age-related effects on dementia severity and conversion risk.
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Affiliation(s)
- Donald R. Royall
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
- South Texas Veterans’ Health System Audie L. Murphy Division GRECC, San Antonio, TX 78229, USA
| | - Safa Al-Rubaye
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Ram Bishnoi
- Department of Psychiatry, The Medical College of Georgia, Augusta, GA 30912, USA
| | - Raymond F. Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
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Royall DR. Welcome Back to Your Future: The Assessment of Dementia by the Latent Variable "δ". J Alzheimers Dis 2016; 49:515-9. [PMID: 26444759 DOI: 10.3233/jad-150249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The latent variable "δ" (for "dementia") has been proposed as a phenotype for all cause dementia. δ is extracted from cognitive batteries by a specific confirmatory factor analysis in a structural equation modeling framework. δ appears to be uniquely responsible for cognition's association with functional status. Because it is extracted from Spearman's general intelligence factor "g", this has broad implications for dementia's assessment and pathophysiology. This issue of the Journal of Alzheimer's Disease brings together several demonstrations of δ's psychometric properties by investigative groups from three continents. In their aggregate, they suggest that δ homologs may have far ranging applications in dementia's clinical assessment and biomarker selection.
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Affiliation(s)
- Donald R Royall
- Departments of Psychiatry, Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX, USA.,South Texas Veterans' Health System, Audie L. Murphy Division GRECC, San Antonio, TX, USA
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Royall DR, Palmer RF. Aging is a weak but relentless determinant of dementia severity. Oncotarget 2016; 7:13307-18. [PMID: 26930722 PMCID: PMC4924643 DOI: 10.18632/oncotarget.7759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/08/2016] [Indexed: 02/06/2023] Open
Abstract
Structural Equation Models (SEM) can explicitly distinguish "dementia-relevant" variance in cognitive task performance (i.e., "δ" for dementia). In prior work, δ appears to uniquely account for dementia severity regardless of the cognitive measures used to construct it. In this study, we test δ as a mediator of age's prospective association with future cognitive performance and dementia severity in a large, ethnically diverse longitudinal cohort, the Texas Alzheimer's Research and Care Consortium (TARCC). Age had adverse effects on future cognition, and these were largely mediated through δ, independently of education, ethnicity, gender, depression ratings, serum homo-cysteine levels, hemoglobin A1c, and apolipoprotein e4 status. Age explained 4% of variance in δ, and through it, 11-18% of variance in future cognitive performance. Our findings suggest that normative aging is a dementing condition (i.e., a "senility"). While the majority of variance in dementia severity must be independent of age, age's specific effect is likely to accumulate over the lifespan. Our findings also constrain age's dementing effects on cognition to the age-related fraction of "general intelligence" (Spearman's "g"). That has broad biological and pathophysiological implications.
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Affiliation(s)
- Donald R. Royall
- Department of Psychiatry, The University of Texas Health Science Center, San Antonio, TX, USA
- Department of Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
- The South Texas Veterans' Health System, Audie L. Murphy Division GRECC, San Antonio, TX, USA
| | - Raymond F. Palmer
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
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Royall DR, Palmer RF. Thrombopoietin is associated with δ's intercept, and only in Non-Hispanic Whites. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2016; 3:35-42. [PMID: 27239547 PMCID: PMC4879650 DOI: 10.1016/j.dadm.2016.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction Serum thrombopoietin (THPO) is a biomarker of Alzheimer's disease (AD) and the latent dementia phenotype, “δ”. Both associations may be specific to non-Hispanic whites (NHW), not Mexican-Americans (MA). In this analysis, we examine ethnicity's effect on THPO's association with change in δ scores, in the Texas Alzheimer's Research and Care Consortium (TARCC). Methods We constructed an ethnicity equivalent δ homolog (“dEQ”) among n = 1113 MA and n = 1958 NHW. dEQ was output as a composite “dEQ-score” for each of five annual TARCC waves. Those composites were used as indicators of a latent growth curve (LGC). The mean dEQ intercept (idEQ) and slope (ΔdEQ) were estimated in a random subset of N = 1528 participants and replicated in the remainder (n = 1544). THPO was regressed onto idEQ and ΔdEQ. Those associations were tested separately in MA and NHW. Results dEQ correlated strongly with CDR-SB (r = 0.99, P < .001) and achieved high AUCs for AD diagnosis at each wave (range = 0.95–0.99). THPO was significantly associated with idEQ but not ΔdEQ. That effect was observed in NHW only. In MA, THPO had no associations with either idEQ or ΔdEQ. Discussion We confirm THPO's ethnicity-specific association with δ in NHW. It is further clarified that this association is specific to δ's intercept and not its slope. This analysis provides a model for how dementia's specific serum biomarkers can be characterized.
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Affiliation(s)
- Donald R Royall
- Department of Psychiatry, The University of Texas Health Science Center, San Antonio, TX, USA; Department of Medicine, The University of Texas Health Science Center, San Antonio, TX, USA; Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX, USA; South Texas Veterans' Health System, Audie L. Murphy Division GRECC, San Antonio, TX, USA
| | - Raymond F Palmer
- Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX, USA
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