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Steenland K, Tan Y, Wingo T, Shi L, Xiao S, Wharton W. The effect of race and co-morbidities on Alzheimer's disease based on Medicare data. Alzheimers Dement 2023; 19:1858-1864. [PMID: 36327171 PMCID: PMC10251261 DOI: 10.1002/alz.12838] [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: 06/13/2022] [Revised: 09/15/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Alzheimer's disease (AD) incidence is thought to be higher among Black than White individuals. METHODS We studied the US Medicare population from 2000 to 2018. Cox regression was used to determine the roles of race and co-morbidities for AD incidence. RESULTS We studied 11,880,906 Medicare beneficiaries, with 774,548 AD cases. Hazard ratios (HRs) by increasing numbers of co-morbidities (1-7) were 1.51, 2.00, 2.55, 3.16, 2.89, 4.77, and 5.65. Among those with no co-morbidities, Black individuals had a lower rate than those who are White (HR = 0.69), while among those with one more co-morbidities, Black individuals had a higher rate (HR = 1.19). The presence of hypertension increased AD rates by 14% for White individuals, but 69% for those who are Black. DISCUSSION More co-morbidities was strongly associated with higher AD rates. The higher rates for Black versus White individuals was apparent only for those with co-morbidities and appears driven both by more co-morbidities, and the greater effect of hypertension. HIGHLIGHTS Black individuals have been shown to have higher Alzheimer's disease (AD) rates than those who are White. Some co-morbidities are known to increase AD risk. Among those In Medicare data with no co-morbidities, Black individuals have less risk than those who are White. Among those with co-morbidities, Black individuals have higher rates than those who are White. Hypertension results in a much stronger increase in AD risk for Black versus White individuals.
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Affiliation(s)
- Kyle Steenland
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Youran Tan
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Thomas Wingo
- Department of Neurology and Department of Human Genetics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Liuhua Shi
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Siyao Xiao
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Whitney Wharton
- Department of Neurology, School of Medicine, Emory University, Atlanta, Georgia, USA
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2
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Zhang F, Petersen M, Johnson L, Hall J, O'Bryant SE. Comorbidities Incorporated to Improve Prediction for Prevalent Mild Cognitive Impairment and Alzheimer's Disease in the HABS-HD Study. J Alzheimers Dis 2023; 96:1529-1546. [PMID: 38007662 DOI: 10.3233/jad-230755] [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] [Indexed: 11/27/2023]
Abstract
BACKGROUND Blood biomarkers have the potential to transform Alzheimer's disease (AD) diagnosis and monitoring, yet their integration with common medical comorbidities remains insufficiently explored. OBJECTIVE This study aims to enhance blood biomarkers' sensitivity, specificity, and predictive performance by incorporating comorbidities. We assess this integration's efficacy in diagnostic classification using machine learning, hypothesizing that it can identify a confident set of predictive features. METHODS We analyzed data from 1,705 participants in the Health and Aging Brain Study-Health Disparities, including 116 AD patients, 261 with mild cognitive impairment, and 1,328 cognitively normal controls. Blood samples were assayed using electrochemiluminescence and single molecule array technology, alongside comorbidity data gathered through clinical interviews and medical records. We visually explored blood biomarker and comorbidity characteristics, developed a Feature Importance and SVM-based Leave-One-Out Recursive Feature Elimination (FI-SVM-RFE-LOO) method to optimize feature selection, and compared four models: Biomarker Only, Comorbidity Only, Biomarker and Comorbidity, and Feature-Selected Biomarker and Comorbidity. RESULTS The combination model incorporating 17 blood biomarkers and 12 comorbidity variables outperformed single-modal models, with NPV12 at 92.78%, AUC at 67.59%, and Sensitivity at 65.70%. Feature selection led to 22 chosen features, resulting in the highest performance, with NPV12 at 93.76%, AUC at 69.22%, and Sensitivity at 70.69%. Additionally, interpretative machine learning highlighted factors contributing to improved prediction performance. CONCLUSIONS In conclusion, combining feature-selected biomarkers and comorbidities enhances prediction performance, while feature selection optimizes their integration. These findings hold promise for understanding AD pathophysiology and advancing preventive treatments.
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Affiliation(s)
- Fan Zhang
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, TX, USA
- Department of Family Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Melissa Petersen
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, TX, USA
- Department of Family Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Leigh Johnson
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, TX, USA
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - James Hall
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, TX, USA
- Department of Family Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Sid E O'Bryant
- Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, TX, USA
- Department of Family Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
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3
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Pak VM, Paul S, Swieboda D, Balthazar MS, Wharton W. Sleep duration and biomarkers of inflammation in African American and white participants with a parental history of Alzheimer's disease. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12332. [PMID: 36177446 PMCID: PMC9473642 DOI: 10.1002/trc2.12332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/24/2022] [Accepted: 06/01/2022] [Indexed: 01/13/2023]
Abstract
Introduction African Americans (AA)s have worse inflammation, worse sleep, and a greater incidence of Alzheimer's disease (AD) compared to whites; however, no studies have examined associations between biomarkers, sleep, and cognition, and differences by race. Methods Seventy-six cognitively normal, middle aged (45-65 years) adults with a parental history of AD were included in this study. Associations between biomarkers (tumor necrosis factor-α [TNF-α], interleukin-10 [IL-10], intercellular adhesion molecule-1 [ICAM-1],, and C-reactive protein [CRP]) and self-reported sleep or cognition measures, were assessed. Results Average sleep duration was significantly lower for AA versus whites (average[SD]) in hours: 6.02(1.18) versus 7.23(0.91), P = .000004). We found a statistically significant association between plasma IL-10 and sleep duration (Spearman's ρ = 0.26, P = .04) and CSF ICAM-1 and sleep quality (Spearman's ρ = 0.30, P = .03). Discussion Longer sleep duration is positively associated with plasma IL-10 levels irrespective of race. Sleep quality was positively associated with CSF ICAM-1 only in African Americans.
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Affiliation(s)
| | | | | | - Monique S. Balthazar
- School of NursingEmory UniversityAtlantaGeorgiaUSA,Byrdine F. Lewis College of Nursing and Health ProfessionsGeorgia State UniversityAtlantaGeorgiaUSA
| | - Whitney Wharton
- School of NursingEmory UniversityAtlantaGeorgiaUSA,Cognitive Neurology DepartmentEmory UniversityAtlantaGeorgiaUSA
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4
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Heffernan KS, Stoner L, Meyer ML, Loprinzi PD. Association Between Estimated Pulse Wave Velocity and Cognitive Performance in Older Black and White Adults in NHANES. J Alzheimers Dis 2022; 88:985-993. [PMID: 35754267 DOI: 10.3233/jad-220042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Aging-associated cognitive decline is greater in non-Hispanic Black (NHB) adults than non-Hispanic White (NHW) adults. An important risk factor for cognitive decline with aging is arterial stiffening, though the importance to racial variation remains poorly understood. OBJECTIVE We examined the association of an estimate of arterial stiffness with cognitive function in a bi-racial sample of 60-85-year-old adults (N = 3,616, 26.5% NHB) enrolled in the National Health and Nutrition Examination Survey (NHANES) between 1999-2002 and 2011-2014. METHODS As a measure of vascular aging, pulse wave velocity was estimated (ePWV) using an equation incorporating age and mean arterial pressure and expressed as m/s. Using the digit symbol substitution test (DSST), cognitive function was expressed as the number of correctly matched symbols (out of 133) within 120 s. Linear regression models examined associations between ePWV and DSST. RESULTS In models that adjusted for sex, education, smoking, body mass index, history of cardiovascular disease, and hypertension, ePWV was inversely associated with DSST score in NHB adults (β= -3.47, 95% CI = -3.9 to -3.0; p < 0.001) and NHW adults (β= -3.51, 95% CI = -4.4 to -2.6; p < 0.001). CONCLUSION ePWV is inversely associated with a measure of cognitive function in older Black and White adults. ePWV may be a useful measure of vascular aging that can offer insight into cognitive aging.
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Affiliation(s)
- Kevin S Heffernan
- Department of Exercise Science, Syracuse University, Syracuse NY, USA
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michelle L Meyer
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul D Loprinzi
- Department of Health, Exercise Science and Recreation Management, University of Mississippi, Oxford MS, USA
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5
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Windon C, Iaccarino L, Mundada N, Allen I, Boxer AL, Byrd D, Rivera‐Mindt M, Rabinovici GD. Comparison of plasma and CSF biomarkers across ethnoracial groups in the ADNI. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12315. [PMID: 35510092 PMCID: PMC9057320 DOI: 10.1002/dad2.12315] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 02/06/2023]
Abstract
Introduction Ethnoracial differences in cerebrospinal fluid (CSF; amyloid beta 42 [Aβ42], total tau [t-tau], phosphorylated tau 181 [p-tau181], and plasma (p-tau181, neurofilament light [NfL]) biomarkers of Alzheimer's disease (AD) are incompletely understood. Methods We performed cross-sectional analyses with and without adjustment for covariates comparing baseline CSF (Aβ42, t-tau, p-tau181) and plasma (p-tau181, NfL) values in 47 African Americans (AAs) matched to 141 non-Hispanic Whites (NHWs) and 43 Latinos (LAs) matched to 129 NHWs from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Results Unadjusted comparisons revealed no significant differences in plasma or CSF biomarkers between AAs and NHWs. A trend toward a lower CSF t-tau and p-tau181 in LAs compared to NHWs was observed, without significant differences in plasma biomarkers. After adjusting for covariates, there were no significant differences in CSF or plasma biomarkers between AAs and NHWs or between LAs and NHWs. Discussion Plasma and CSF AD biomarkers may perform similarly across diverse populations but future studies in large, diverse cohorts are needed.
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Affiliation(s)
- Charles Windon
- Memory and Aging CenterDepartment of NeurologyWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Leonardo Iaccarino
- Memory and Aging CenterDepartment of NeurologyWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Nidhi Mundada
- Memory and Aging CenterDepartment of NeurologyWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Isabel Allen
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Adam L. Boxer
- Memory and Aging CenterDepartment of NeurologyWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Desiree Byrd
- Department of PsychologyQueens CollegeThe City University of New YorkQueensNew YorkUSA
| | - Monica Rivera‐Mindt
- Department of PsychologyFordham UniversityFordham University Dept. of PsychologyBronxNew YorkUSA
| | - Gil D. Rabinovici
- Memory and Aging CenterDepartment of NeurologyWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
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Gleason CE, Zuelsdorff M, Gooding DC, Kind AJH, Johnson AL, James TT, Lambrou NH, Wyman MF, Ketchum FB, Gee A, Johnson SC, Bendlin BB, Zetterberg H. Alzheimer's disease biomarkers in Black and non-Hispanic White cohorts: A contextualized review of the evidence. Alzheimers Dement 2021; 18:1545-1564. [PMID: 34870885 PMCID: PMC9543531 DOI: 10.1002/alz.12511] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 02/06/2023]
Abstract
Black Americans are disproportionately affected by dementia. To expand our understanding of mechanisms of this disparity, we look to Alzheimer's disease (AD) biomarkers. In this review, we summarize current data, comparing the few studies presenting these findings. Further, we contextualize the data using two influential frameworks: the National Institute on Aging-Alzheimer's Association (NIA-AA) Research Framework and NIA's Health Disparities Research Framework. The NIA-AA Research Framework provides a biological definition of AD that can be measured in vivo. However, current cut-points for determining pathological versus non-pathological status were developed using predominantly White cohorts-a serious limitation. The NIA's Health Disparities Research Framework is used to contextualize findings from studies identifying racial differences in biomarker levels, because studying biomakers in isolation cannot explain or reduce inequities. We offer recommendations to expand study beyond initial reports of racial differences. Specifically, life course experiences associated with racialization and commonly used study enrollment practices may better account for observations than exclusively biological explanations.
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Affiliation(s)
- Carey E Gleason
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,Wisconsin Alzheimer's Disease Research Center, Madison, Wisconsin, USA.,Geriatric Research, Education and Clinical Center (11G), William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Megan Zuelsdorff
- Wisconsin Alzheimer's Disease Research Center, Madison, Wisconsin, USA.,University of Wisconsin School of Nursing, Madison, Wisconsin, USA
| | - Diane C Gooding
- Department of Psychology, University of Wisconsin, Madison, Madison, Wisconsin, USA.,Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Amy J H Kind
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,Wisconsin Alzheimer's Disease Research Center, Madison, Wisconsin, USA.,Geriatric Research, Education and Clinical Center (11G), William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA.,Center for Health Disparities Research, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Adrienne L Johnson
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Taryn T James
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,Wisconsin Alzheimer's Disease Research Center, Madison, Wisconsin, USA
| | - Nickolas H Lambrou
- Geriatric Research, Education and Clinical Center (11G), William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Mary F Wyman
- Geriatric Research, Education and Clinical Center (11G), William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA.,Department of Psychology, University of Wisconsin, Madison, Madison, Wisconsin, USA
| | - Fred B Ketchum
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Alexander Gee
- Nehemiah Center for Urban Leadership Development, Madison, Wisconsin, USA
| | - Sterling C Johnson
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,Wisconsin Alzheimer's Disease Research Center, Madison, Wisconsin, USA.,Geriatric Research, Education and Clinical Center (11G), William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Barbara B Bendlin
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,Wisconsin Alzheimer's Disease Research Center, Madison, Wisconsin, USA
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK.,Hong Kong Center for Neurodegeneration, Hong Kong, China
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7
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Alzheimer disease in African American individuals: increased incidence or not enough data? Nat Rev Neurol 2021; 18:56-62. [PMID: 34873310 PMCID: PMC8647782 DOI: 10.1038/s41582-021-00589-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/13/2022]
Abstract
Research on racial differences in Alzheimer disease (AD) dementia has increased in recent years. Older African American individuals bear a disproportionate burden of AD and cognitive impairment compared with non-Latino white individuals. Tremendous progress has been made over the past two decades in our understanding of the neurobiological substrates of AD. However, owing to well-documented challenges of study participant recruitment and a persistent lack of biological data in the African American population, knowledge of the drivers of these racial disparities has lagged behind. Therapeutic targets and effective interventions for AD are increasingly sought, but without a better understanding of the disease in African American individuals, any identified treatments and/or cures will evade this rapidly growing at-risk population. In this Perspective, I introduce three key obstacles to progress in understanding racial differences in AD: uncertainty about diagnostic criteria, disparate cross-sectional and longitudinal findings; and a dearth of neuropathological data. I also highlight evidence-informed strategies to move the field forward. In this Perspective, Barnes introduces three key obstacles to progress in our understanding of racial differences in Alzheimer disease and highlights evidence-informed strategies that can move the field forward.
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8
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Lindauer A, Messecar D, McKenzie G, Gibson A, Wharton W, Bianchi A, Tarter R, Tadesse R, Boardman C, Golonka O, Gothard S, Dodge HH. The Tele-STELLA protocol: Telehealth-based support for families living with later-stage Alzheimer's disease. J Adv Nurs 2021; 77:4254-4267. [PMID: 34288013 DOI: 10.1111/jan.14980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/04/2021] [Accepted: 06/27/2021] [Indexed: 11/29/2022]
Abstract
AIMS We aim to establish the feasibility and acceptability of the Tele-STELLA (Support via Telehealth: Living and Learning with Advancing Alzheimer's Disease and Related Dementias) intervention. We will also assess the efficacy of the intervention in reducing the frequency of behavioural symptoms of dementia as well as family Care Partner reactivity to the symptoms. DESIGN This is a multi-component, quasi-experimental study that focuses on facilitating effective management of behavioural symptoms that occur in the later stages of dementia. METHODS Family Care Partners (n = 124) for persons with Alzheimer's disease will participate in two 8-week videoconferencing components that address behavioural symptoms-in both the persons with Alzheimer's disease and their Care Partners. In the first component ('Nova'), Care Partners work with one nurse for an hour/week for 4 weeks, then they join a small group for another 4 weeks. In the second component ('Constellation'), Care Partners work in a larger group to hone skills and knit supportive relationships. Behavioural symptom frequency and Care Partner reactivity to the behaviours will be measured prior to, during and after the intervention. The study is funded by the United States National Institute on Aging (R01AG067546); funding was initiated as on February, 2021. DISCUSSION Tele-STELLA fills a gap in current videoconference-based psychoeducational interventions in that it offers real-time interaction with nurses and peers. The intervention was designed with feedback by pilot participants. This study will assess Tele-STELLA in its current, novel format; thus, preparing it for a larger, future randomized controlled trial. IMPACT Tele-STELLA addresses symptoms that occur in the later stages of dementia, providing families with tools to facilitate effective behavioural management. Because Tele-STELLA is implemented via videoconferencing, it targets Care Partners who face barriers to support, such as cost and transportation. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov (#NCT04627662).
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Affiliation(s)
- Allison Lindauer
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA.,School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Deborah Messecar
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Glenise McKenzie
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Allison Gibson
- School of Social Work, University of Kentucky, Lexington, KY, USA
| | - Whitney Wharton
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Allison Bianchi
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Robin Tarter
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA.,School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Ruth Tadesse
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Charles Boardman
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Ona Golonka
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - Sarah Gothard
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - Hiroko H Dodge
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
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Hu WT, Ozturk T, Kollhoff A, Wharton W, Christina Howell J. Higher CSF sTNFR1-related proteins associate with better prognosis in very early Alzheimer's disease. Nat Commun 2021; 12:4001. [PMID: 34183654 PMCID: PMC8238986 DOI: 10.1038/s41467-021-24220-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 06/08/2021] [Indexed: 02/06/2023] Open
Abstract
Neuroinflammation is associated with Alzheimer's disease, but the application of cerebrospinal fluid measures of inflammatory proteins may be limited by overlapping pathways and relationships between them. In this work, we measure 15 cerebrospinal proteins related to microglial and T-cell functions, and show them to reproducibly form functionally-related groups within and across diagnostic categories in 382 participants from the Alzheimer's Disease Neuro-imaging Initiative as well participants from two independent cohorts. We further show higher levels of proteins related to soluble tumor necrosis factor receptor 1 are associated with reduced risk of conversion to dementia in the multi-centered (p = 0.027) and independent (p = 0.038) cohorts of people with mild cognitive impairment due to predicted Alzheimer's disease, while higher soluble TREM2 levels associated with slower decline in the dementia stage of Alzheimer's disease. These inflammatory proteins thus provide prognostic information independent of established Alzheimer's markers.
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Affiliation(s)
- William T Hu
- Department of Neurology and Center for Neurodegenerative Diseases, School of Medicine, Emory University, Atlanta, GA, USA.
- Rutgers Robert Wood Johnson Medical School and Rutgers Institute for Health, Health Care Policy and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA.
| | - Tugba Ozturk
- Department of Neurology and Center for Neurodegenerative Diseases, School of Medicine, Emory University, Atlanta, GA, USA
| | - Alexander Kollhoff
- Department of Neurology and Center for Neurodegenerative Diseases, School of Medicine, Emory University, Atlanta, GA, USA
| | - Whitney Wharton
- Nell Hodgson School of Nursing, Emory University, Atlanta, GA, USA
| | - J Christina Howell
- Department of Neurology and Center for Neurodegenerative Diseases, School of Medicine, Emory University, Atlanta, GA, USA
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Hendrickx JO, Martinet W, Van Dam D, De Meyer GRY. Inflammation, Nitro-Oxidative Stress, Impaired Autophagy, and Insulin Resistance as a Mechanistic Convergence Between Arterial Stiffness and Alzheimer's Disease. Front Mol Biosci 2021; 8:651215. [PMID: 33855048 PMCID: PMC8039307 DOI: 10.3389/fmolb.2021.651215] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/03/2021] [Indexed: 12/12/2022] Open
Abstract
The average age of the world's elderly population is steadily increasing. This unprecedented rise in the aged world population will increase the prevalence of age-related disorders such as cardiovascular disease (CVD) and neurodegeneration. In recent years, there has been an increased interest in the potential interplay between CVDs and neurodegenerative syndromes, as several vascular risk factors have been associated with Alzheimer's disease (AD). Along these lines, arterial stiffness is an independent risk factor for both CVD and AD. In this review, we discuss several inflammaging-related disease mechanisms including acute tissue-specific inflammation, nitro-oxidative stress, impaired autophagy, and insulin resistance which may contribute to the proposed synergism between arterial stiffness and AD.
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Affiliation(s)
- Jhana O. Hendrickx
- Laboratory of Physiopharmacology, Faculty of Pharmaceutical, Biomedical and Veterinary Sciences, University of Antwerp, Antwerp, Belgium
| | - Wim Martinet
- Laboratory of Physiopharmacology, Faculty of Pharmaceutical, Biomedical and Veterinary Sciences, University of Antwerp, Antwerp, Belgium
| | - Debby Van Dam
- Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
- Department of Neurology and Alzheimer Research Center, University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Guido R. Y. De Meyer
- Laboratory of Physiopharmacology, Faculty of Pharmaceutical, Biomedical and Veterinary Sciences, University of Antwerp, Antwerp, Belgium
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11
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Wharton W, Jeong L, Ni L, Bay AA, Shin RJ, McCullough LE, Silverstein H, Hart AR, Swieboda D, Hu W, Hackney ME. A Pilot randomized clinical trial of adapted tango to improve cognition and psychosocial function in African American women with family history of Alzheimer's disease (ACT trial). CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2021; 2:100018. [PMID: 36324714 PMCID: PMC9616328 DOI: 10.1016/j.cccb.2021.100018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/30/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022]
Abstract
the adapted tango intervention was very well received as demonstrated by minimal participant attrition, satisfaction questionnaires that indicated high satisfaction, and anecdotal reports. Adapted tango intervention may be helpful in controlling or reducing markers of inflammation in AA women with a parental history of AD. Participants in tango demonstrated improvements in whole-body spatial cognition and short-term and working memory, and reduced deterioration of executive function. Although our tango group did not show large positive effect in cumulative caregiver burden post intervention, the large positive effect in role Captivity, caregiver confidence, and deprivation of intimate exchange displays some of the positive effects of this dance intervention for the caregivers.
Alzheimer's disease (AD) is a devastating, progressive neurodegenerative disease resulting in memory loss and a severe reduction in the ability to perform activities of daily living. Ethnicity-related genetic factors promoting the development of dementias among African Americans (AA) and increased risk among women for developing AD indicates that AA women with a parental history of AD are at great risk for developing AD. This phase I study assessed the impact of a 12 week, 20-lesson adapted Argentine Tango intervention (n = 24) to a no-contact control group (n = 10) on measures of plasma inflammatory markers, cognition, and motor and psychosocial performance in middle-aged AA woman at increased risk for AD by virtue of parental history. Some woman (n = 16) were also caregivers; thus, the impact of the intervention on caregiving burden was examined in this subset. Preliminary analysis of efficacy was conducted with significance tests on biomarkers and key measures of cognition, including visuospatial and executive function, balance, and strength. After 12 weeks, Tango participants had significantly decreased inflammatory cytokine, including reductions in IL-7 (p = 0.003), IFN-γ (p = 0.011), TNFα (p = 0.011), and MCP-1 (p = 0.042) compared to controls. Large effects were noted for the Tango group on tests of executive functioning (d = 0.89), and inhibition (p = 0.031). Participants in Tango improved in dynamic and static balance (p = 0.018) and functional lower body strength (p = 0.023). Secondary assessment revealed trends favoring the intervention group were noted in spatial cognition and executive function. Moderate effects were noted in caregiving burden measures among the subset of caregivers. These data demonstrate substantial reductions in inflammatory biomarkers along with cognitive and motor improvements through a non-pharmacologic, affordable intervention among a small, well-characterized cohort of AA women with a parental history of AD.
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Affiliation(s)
| | - Leanne Jeong
- Emory University College of Arts and Sciences, 550 Asbury Circle, Atlanta, GA, 30322, USA
| | - Liang Ni
- Division of Geriatrics and Gerontology, Department of Medicine, Emory School of Medicine, 1841 Clifton Rd NE, Atlanta, GA, 30307, USA
| | - Allison A. Bay
- Division of Geriatrics and Gerontology, Department of Medicine, Emory School of Medicine, 1841 Clifton Rd NE, Atlanta, GA, 30307, USA
| | - Ryan J. Shin
- Emory University College of Arts and Sciences, 550 Asbury Circle, Atlanta, GA, 30322, USA
| | - Lauren E. McCullough
- Emory University Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA, 30329, USA
| | - Hayley Silverstein
- Division of Geriatrics and Gerontology, Department of Medicine, Emory School of Medicine, 1841 Clifton Rd NE, Atlanta, GA, 30307, USA
| | | | | | - William Hu
- Division of Cognitive Neurology, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08901, USA
| | - Madeleine E. Hackney
- Emory University School of Nursing, Atlanta, GA, 30307, USA
- Division of Geriatrics and Gerontology, Department of Medicine, Emory School of Medicine, 1841 Clifton Rd NE, Atlanta, GA, 30307, USA
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, 1670 Clairmont Rd., Decatur, GA, 30033, USA
- Department of Rehabilitation Medicine, Emory School of Medicine, 1648 Pierce Dr. NE, Atlanta, GA, 30307, USA
- Birmingham/Atlanta VA Geriatric Research Clinical and Education Center
- Corresponding author at: Emory University School of Medicine, Department of Medicine, Division of Geriatrics and Gerontology, Research Health Scientist, Atlanta VA Rehabilitation R&D Center for Visual and Neurocognitive Rehabilitation, 1841 Clifton Rd. NE, #553, Atlanta, GA 30329, USA.
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Comparing fluid biomarkers of Alzheimer's disease between African American or Black African and white groups: A systematic review and meta-analysis. J Neurol Sci 2020; 421:117270. [PMID: 33349466 DOI: 10.1016/j.jns.2020.117270] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/19/2020] [Accepted: 12/10/2020] [Indexed: 12/29/2022]
Abstract
RATIONALE Biomarker research for Alzheimer's disease (AD) has grown rapidly in recent years, ensuing the integration of the AD fluid biomarker profile: Aβ1-42, t-tau, and p-tau181, into clinical and research criteria. However, current insights of AD arise almost exclusively from studies on white individuals. Some studies have revealed that epidemiology, clinical features, and genetics of AD show variations between individuals from black and white backgrounds, conveying the importance of ethnoracial differences, and the possibility of such differences also influencing AD biomarker levels. This systematic review explored whether AD fluid biomarker levels differ between African American (AA) or Black African and white groups. AIM To compare AD fluid biomarkers (Aβ1-42, p-tau181, and t-tau) levels between AA or Black Africans and white individuals. METHOD PubMed, Scopus, and other sources were explored for studies that quantified AD biomarkers in biological fluid from whites and AA or Black African groups. Meta-analyses were performed to find the standardized mean difference for biomarkers that were quantified in ≥3 studies. RESULTS Five studies were included; studies on Black Africans were not found. The meta-analyses found CSF t-tau and p-tau181 were consistently lower in AA than white individuals, in samples with normal cognition or with mild cognitive impairment/dementia. CONCLUSIONS The meta-analyses found significant differences for CSF tau between AA and white individuals with normal cognition and within the dementia spectrum, expressing the importance of taking into account ethnoracial factors when interpreting CSF AD biomarkers levels. However, the generalisability of these differences is restricted by small samples' size, lack of unified methodologies and recruitment's biases within studies; further large multicentre studies with harmonized protocols and sufficient power are imperative to investigate the extent of ethnoracial differences across the spectrum of cognitive decline, with vaster efforts necessary to diversify recruitment.
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Gentile M, Iannuzzi A, Giallauria F, D’Andrea A, Venturini E, Pacileo M, Covetti G, Panico C, Mattiello A, Vitale G, Sarullo FM, Rubba P, Vigorito C, Panico S, Iannuzzo G. Association between Very Low-Density Lipoprotein Cholesterol (VLDL-C) and Carotid Intima-Media Thickness in Postmenopausal Women Without Overt Cardiovascular Disease and on LDL-C Target Levels. J Clin Med 2020; 9:jcm9051422. [PMID: 32403373 PMCID: PMC7290892 DOI: 10.3390/jcm9051422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/08/2020] [Accepted: 05/09/2020] [Indexed: 01/06/2023] Open
Abstract
Background: atherosclerotic process inexorably advances in patients reaching low-density lipoprotein cholesterol (LDL-C) targets. An attractive hypothesis is that lipoprotein particles (very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL)), could contribute to residual risk. The present study aims to investigate the relationship between carotid intima-media thickness (IMT) and different lipoprotein subfractions in a cohort of healthy postmenopausal women. Methods: 75 postmenopausal women, at LDL-C target levels without overt cardiovascular disease, underwent biochemical analyses (including subfraction assay of plasma lipoproteins) and carotid ultrasound examination. Results: a statistically significant correlation between VLDL and carotid IMT (p < 0.001) was found. No significant correlation was found between carotid IMT and LDL-C (p = 0.179), IDL-C (p = 0.815), high-density lipoprotein (HDL) (p = 0.855), and LDL score (p = 0.240). Moreover, IMT is significantly correlated to LDL particle diameter (p = 0.044). After adjusting for age, systolic blood pressure, body mass index, smoking habits, glucose plasma concentration, and Lipoprotein(a) (Lpa) levels, multivariate analysis showed that women in the third tertile of VLDL-C, compared with those in the first tertile, were significantly associated to the highest IMT (p = 0.04). Conclusions: in this cohort of postmenopausal women, VLDL-C was significantly associated to carotid IMT, independent of main cardiovascular risk factors. These findings pave the way for targeting circulating concentrations of VLDL-C to reduce cardiovascular events in patients with target LDL-C levels.
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Affiliation(s)
- Marco Gentile
- Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (C.P.); (A.M.); (P.R.); (S.P.); (G.I.)
- Correspondence:
| | - Arcangelo Iannuzzi
- Department of Medicine and Medical Specialties, “Antonio Cardarelli” Hospital, 80131 Naples, Italy; (A.I.); (G.C.)
| | - Francesco Giallauria
- “Federico II” University of Naples, Department of Translational Medical Sciences, 80131 Naples, Italy; (F.G.); (C.V.)
| | - Antonello D’Andrea
- Cardiology and Intensive Care Units, “Umberto I” Hospital, Viale San Francesco, 84014 Nocera Inferiore (Salerno), Italy; (A.D.); (M.P.)
| | - Elio Venturini
- Cardiac Rehabilitation Unit, Azienda USL Toscana Nord-Ovest, Cecina Civil Hospital, 57023 Cecina (LI), Italy;
| | - Mario Pacileo
- Cardiology and Intensive Care Units, “Umberto I” Hospital, Viale San Francesco, 84014 Nocera Inferiore (Salerno), Italy; (A.D.); (M.P.)
| | - Giuseppe Covetti
- Department of Medicine and Medical Specialties, “Antonio Cardarelli” Hospital, 80131 Naples, Italy; (A.I.); (G.C.)
| | - Camilla Panico
- Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (C.P.); (A.M.); (P.R.); (S.P.); (G.I.)
| | - Amalia Mattiello
- Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (C.P.); (A.M.); (P.R.); (S.P.); (G.I.)
| | - Giuseppe Vitale
- Cardiovascular Rehabilitation Unit, “Buccheri La Ferla Fatebenefratelli” Hospital, 90123 Palermo, Italy; (G.V.); (F.M.S.)
| | - Filippo Maria Sarullo
- Cardiovascular Rehabilitation Unit, “Buccheri La Ferla Fatebenefratelli” Hospital, 90123 Palermo, Italy; (G.V.); (F.M.S.)
| | - Paolo Rubba
- Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (C.P.); (A.M.); (P.R.); (S.P.); (G.I.)
| | - Carlo Vigorito
- “Federico II” University of Naples, Department of Translational Medical Sciences, 80131 Naples, Italy; (F.G.); (C.V.)
| | - Salvatore Panico
- Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (C.P.); (A.M.); (P.R.); (S.P.); (G.I.)
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (C.P.); (A.M.); (P.R.); (S.P.); (G.I.)
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