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He X, Xiao H, Guo H, Weng Y, Zhang L, Fang Q, Tang X. Atrial fibrillation-related ischemic stroke and cognitive impairment: Research progress on the characteristics and pathogenesis. Brain Res Bull 2025; 227:111392. [PMID: 40403935 DOI: 10.1016/j.brainresbull.2025.111392] [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: 03/29/2025] [Revised: 05/15/2025] [Accepted: 05/17/2025] [Indexed: 05/24/2025]
Abstract
Post-stroke cognitive impairment (PSCI) is a significant neurological complication, affecting up to one-third of stroke survivors. Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia, significantly increasing the risk of ischemic stroke. Increasing evidence suggests that AF plays a pivotal role in exacerbating cognitive decline in stroke patients. This review integrates current clinical, imaging, and mechanistic findings to elucidate how AF-related strokes exacerbate cognitive decline through multiple overlapping pathways, including thromboembolism, neuroinflammation, atherosclerosis, cerebral hypoperfusion, cerebral small vessel disease, and silent infarctions. These processes collectively impair cerebrovascular integrity, induce neuronal damage, and accelerate brain aging. The review further evaluates the role of clinical and neuroimaging biomarkers as predictive tools and their utility in guiding therapeutic strategies. By integrating insights of the latest researches, we aim to provide a comprehensive framework for alleviating cognitive decline in patients with AF-related stroke and highlight future research directions.
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Affiliation(s)
- Xinyi He
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu 215006, China.
| | - Haixing Xiao
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu 215006, China.
| | - Hui Guo
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu 215006, China.
| | - Yizhen Weng
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu 215006, China.
| | - Lulu Zhang
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu 215006, China.
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu 215006, China.
| | - Xiang Tang
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu 215006, China.
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Wei CY, Tzeng RC, Tai HC, Su CH, Chiu PY. Walking reduces the risk of dementia in patients with Parkinson's disease: a longitudinal follow-up study. Ther Adv Neurol Disord 2025; 18:17562864251330251. [PMID: 40291756 PMCID: PMC12033631 DOI: 10.1177/17562864251330251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2024] [Accepted: 03/10/2025] [Indexed: 04/30/2025] Open
Abstract
Background Physical activity, particularly regular aerobic exercise, is effective in preventing dementia. However, such activities are less feasible for patients with Parkinson's disease (PD) or other motor dysfunctions. Objectives In this study, we investigated whether the minimal amount of exercise (MAE) through walking, which is practical for individuals with motor dysfunction, can reduce the risk of dementia in patients with PD. Design For this retrospective longitudinal study, we enrolled 470 patients with PD without dementia from 3 centers in Taiwan. Methods In total, 187 (39.8%) subsequently developed dementia, whereas 283 (60.2%) did not; the mean follow-up periods for these cohorts were 3.1 (range 0.3-6.1) and 2.4 (range 0.3-6.0) years, respectively. MAE was defined as walking approximately 1500-3000 steps or for 15-30 min. The patients were further stratified by the weekly frequency of MAE into MAE-no (frequency: 0), MAE-weekly (frequency: 1 or 2), and MAE-daily (frequency: ⩾3) groups, respectively. The incidence rates of dementia were compared among the three groups. Cox proportional-hazards analyses were performed to measure the effect of MAE on the incidence of dementia. The statistical model was adjusted for age, sex, education level, cognition level, activities of daily living, neuropsychiatric symptoms, vascular risk factors, and relevant medications. Results The MAE-weekly and MAE-daily groups were 0.69 (95% confidence interval (CI): 0.41-1.17) and 0.59 (95% CI: 0.41-0.84) times, respectively, less likely to develop dementia than the MAE-no group. When the MAE-weekly and MAE-daily groups were combined, the hazard ratio for dementia was 0.62 (95% CI: 0.45-0.85). Cox regression revealed that older age, female sex, atrial fibrillation, antidiabetic drug use, and poor daily function were associated with an increased incidence of dementia. Conclusion MAE may help prevent dementia in patients with PD. This finding highlights the benefits of walking for patients with PD and, potentially, older adults with motor dysfunction due to various disorders.
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Affiliation(s)
- Cheng-Yu Wei
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei, Taiwan
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Ray-Chang Tzeng
- Department of Neurology, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan
| | - Hsu-Chih Tai
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei, Taiwan
| | - Chun-Hsien Su
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei, Taiwan
| | - Pai-Yi Chiu
- Department of Neurology, Show Chwan Memorial Hospital, No. 542, Sec. 1, Chung-Shan Road, Changhua 500, Taiwan
- Department of Applied Mathematics, Tunghai University, Taichung, Taiwan
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Adewuyi EO, Laws SM. Genomic Characterisation of the Relationship and Causal Links Between Vascular Calcification, Alzheimer's Disease, and Cognitive Traits. Biomedicines 2025; 13:618. [PMID: 40149595 PMCID: PMC11940612 DOI: 10.3390/biomedicines13030618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Revised: 02/23/2025] [Accepted: 02/25/2025] [Indexed: 03/29/2025] Open
Abstract
Background/Objectives: Observational studies suggest a link between vascular calcification and dementia or cognitive decline, but the evidence is conflicting, and the underlying mechanisms are unclear. Here, we investigate the shared genetic and causal relationships of vascular calcification-coronary artery calcification (CAC) and abdominal aortic calcification (AAC)-with Alzheimer's disease (AD), and five cognitive traits. Methods: We analyse large-scale genome-wide association studies (GWAS) summary statistics, using well-regarded methods, including linkage disequilibrium score regression (LDSC), Mendelian randomisation (MR), pairwise GWAS (GWAS-PW), and gene-based association analysis. Results: Our findings reveal a nominally significant positive genome-wide genetic correlation between CAC and AD, which becomes non-significant after excluding the APOE region. CAC and AAC demonstrate significant negative correlations with cognitive performance and educational attainment. MR found no causal association between CAC or AAC and AD or cognitive traits, except for a bidirectional borderline-significant association between AAC and fluid intelligence scores. Pairwise-GWAS analysis identifies no shared causal SNPs (posterior probability of association [PPA]3 < 0.5). However, we find pleiotropic loci (PPA4 > 0.9), particularly on chromosome 19, with gene association analyses revealing significant genes in shared regions, including APOE, TOMM40, NECTIN2, and APOC1. Moreover, we identify suggestively significant loci (PPA4 > 0.5) on chromosomes 1, 6, 7, 9 and 19, implicating pleiotropic genes, including NAV1, IPO9, PHACTR1, UFL1, FHL5, and FOCAD. Conclusions: Current findings reveal limited genetic correlation and no significant causal associations of CAC and AAC with AD or cognitive traits. However, significant pleiotropic loci, particularly at the APOE region, highlight the complex interplay between vascular calcification and neurodegenerative processes. Given APOE's roles in lipid metabolism, neuroinflammation, and vascular integrity, its involvement may link vascular and neurodegenerative disorders, pointing to potential targets for further investigation.
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Affiliation(s)
- Emmanuel O. Adewuyi
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
- Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia;
| | - Simon M. Laws
- Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia;
- Collaborative Genomics and Translation Group, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
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Ma Y, Yang Y, Wang X, Huang Y, Nan J, Feng J, Yan F, Han L. Prevalence and Risk Factors of Poststroke Cognitive Impairment: A Systematic Review and Meta-Analysis. Public Health Nurs 2025; 42:1047-1059. [PMID: 39702976 DOI: 10.1111/phn.13503] [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: 07/31/2024] [Accepted: 11/18/2024] [Indexed: 12/21/2024]
Abstract
BACKGROUND Stroke is a common disease that poses a significant threat to human health. Approximately one-third of stroke patients experience poststroke cognitive impairment (PSCI), which severely impacts their quality of life and survival time. Although the prevalence and risk factors for PSCI have been widely reported, these results have not been synthesized. OBJECTIVES This systematic review was conducted to explore the prevalence and risk factors of PSCI. METHODS PubMed, EMBASE, Web of Science, and Cochrane Library were comprehensively searched for studies exploring the prevalence and risk factors of PSCI from inception to July 5, 2022. RESULTS A total of 49 articles were included for meta-analysis. It was found that the combined prevalence of PSCI was 39%-47%. Risk factors for PSCI include female gender, age, education level less than 7 years, atrial fibrillation, diabetes, smoking, drinking, hypertension, coronary artery disease, carotid artery plaque, admission NIHSS score ≥ 5, unemployment, and homocysteine. CONCLUSIONS This systematic review has revealed a combined prevalence of PSCI is ranging from 39% to 47% and identified several risk factors for PSCI. These findings indicate a high incidence of the condition and underscore the need for increased public awareness. Future investigations should prioritize the identification of PSCI risk factors, providing a theoretical basis for nursing professionals to effectively manage and treat PSCI patients.
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Affiliation(s)
- Yuxia Ma
- School of Nursing, Evidence-Based Nursing Center, Lanzhou University, Lanzhou, China
- First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Yifang Yang
- School of Nursing, Evidence-Based Nursing Center, Lanzhou University, Lanzhou, China
| | - Xinyu Wang
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanan Huang
- Nursing Department, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jinhan Nan
- School of Nursing, Evidence-Based Nursing Center, Lanzhou University, Lanzhou, China
| | - Juanjuan Feng
- School of Nursing, Evidence-Based Nursing Center, Lanzhou University, Lanzhou, China
| | - Fanghong Yan
- School of Nursing, Evidence-Based Nursing Center, Lanzhou University, Lanzhou, China
| | - Lin Han
- School of Nursing, Evidence-Based Nursing Center, Lanzhou University, Lanzhou, China
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, China
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Zhang J, Yue D, Zhang H. Cardiovascular disease attenuates the protective effect of folate on global cognitive function in an elderly population: a cross-sectional study. Sci Rep 2025; 15:3327. [PMID: 39865092 PMCID: PMC11770194 DOI: 10.1038/s41598-025-87129-x] [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: 05/17/2024] [Accepted: 01/16/2025] [Indexed: 01/28/2025] Open
Abstract
Research suggests that folic acid contributes to improving cognitive function. However, there is a lack of systematic research on the association of dietary intake of folate and serum, and red blood cell (RBC) folate levels with global cognitive impairment (CoI) in the elderly population. Importantly, excessive supplementation with folate among American adults at high risk of cardiovascular disease (CVD) may have harmful effects. CVD often leads to worse cognitive function; therefore, it is necessary to explore the characteristics of the association of folate with CoI in both CVD and non-CVD populations. Participants aged ≥ 60 years from the national health and nutrition examination survey (NHANES) 2011-2014 were included. Dietary intake of folate and serum and RBC folate levels were determined through questionnaires or laboratory measurements. Global cognitive function was assessed via the results of three cognitive assessments. Multivariable logistic regression and restricted cubic splines (RCS) were employed to assess the odds ratios (ORs), 95% confidence intervals (CIs), and potential non-linearities of folate with cognition. Additionally, the interaction term of CVD with RBC folate was included in the model, and effect modification was detected through likelihood ratio tests. Finally, several sensitivity analyses were conducted to validate our findings. This study included 2104 participants with complete data and a median age of 68 years, with females comprising 51% of the participants. Of the participants, 444 individuals were defined as having CoI. In the NHANES, Pearson correlation analysis revealed moderate to weak correlations between dietary, serum, and RBC folate levels and CoI (all < 0.6). In addition, when different sources of folate were included separately in the models, fully adjusted logistic regression with continuous variables included in the model revealed that only RBC folate was significantly associated with CoI [odds ratio (OR) 0.86, 95% confidence interval (95% CI) 0.75-0.97, P = 0.02]. According to tertile groups, compared with participants in the lowest tertile, individuals in the highest tertile of total dietary folate levels (OR 0.67, 95% CI 0.48-0.94, P = 0.02), folic acid levels (OR 0.57, 95% CI 0.38-0.86, P = 0.01), and RBC folate levels (OR 0.62, 95% CI 0.44-0.85, P = 0.004) had significantly lower odds of having CoI. The RCS showed a linear negative correlation between RBC folate levels and CoI. Furthermore, interaction analysis suggested that CVD attenuated the protective effect of RBC folate. Several sensitivity analyses also suggested a modifying effect of CVD on the association between RBC folate and CoI. A significant negative correlation exists between RBC folate levels and CoI in the elderly population of the United States, and this association is stronger than that of other folate measures. However, the protective effect of RBC folate on CoI is negated in patients with CVD, and further investigation is needed to explore the underlying mechanisms involved.
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Affiliation(s)
- Jianqiang Zhang
- Department of Neurology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
- Department of Medical Intensive Care Unit, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Di Yue
- School of Mathematics, Shanghai University of Finance & Economics, Shanghai, China
| | - Huifeng Zhang
- Department of Cardiovascular, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, No. 24, Jinghua Road, Jianxi District, Luoyang, Henan Province, China.
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Militaru M, Lighezan DF, Tudoran C, Zara F, Bucur A, Militaru AG. Relationship Between Depression and Decreased Activity Level and Cognitive Impairment in Patients with Diabetes Mellitus Type 2 and/or Atrial Fibrillation. J Clin Med 2025; 14:563. [PMID: 39860569 PMCID: PMC11766045 DOI: 10.3390/jcm14020563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Revised: 12/26/2024] [Accepted: 01/13/2025] [Indexed: 01/27/2025] Open
Abstract
Background: The interdependence between type 2 diabetes mellitus (DM-2), atrial fibrillation (AF), and cognitive decline (CD)/dementia is a debated topic. In this study, we highlighted the influence of DM-2 and FA individually and in association on the severity of CD/dementia. Methods: This study comprises 248 patients with very high cardiovascular risk (VHCVR) according to Systematic Coronary Risk Evaluation (SCORE2), of whom 184 had DM-2 and/or AF, and 64 were age-matched controls (without DM-2/AF), admitted to the Municipal Hospital Timisoara. Results: Mini-Mental-State-Examination (MMSE), Montreal Cognitive Assessment (MoCA), Activities of Daily Living Score (ADL), and Instrumental Activities of Daily Living Score (IADL) were significantly decreased, and Geriatric Depression Scale (GDS-15) increased in patients with DM-2 and AF in comparison to controls (p < 0.05), with the subjects with DM-2 and AF having more severe CD compared to those with only one of these two pathologies. The logistic regression model showed that the risk of CD (MMSE < 27) or dementia (MMSE < 24) increased significantly in patients with DM-2 and/or AF depending on the SCORE2 values, ADL, and GDS-15. In DM-2 and/or AF patients, an increase of 1% in SCORE2 was associated with an elevation of 2.40% in the odds of CD and of 4.30% of dementia. In these patients, depression (GDS score) increased the risk of CD by 36.3%, and if ADL improved, the risk of CD decreased by 44.0%. Conclusions: Our findings suggest a direct association between CD, DM-2, and AF with SCORE2, cognitive parameters, ADL, and depression. In patients with DM-2 and/or AF, it is important to identify subclinical CD to prevent the evolution to dementia.
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Affiliation(s)
- Marius Militaru
- Department of Neuroscience, Discipline of Neurology II, University of Medicine and Pharmacy “Victor Babes”, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
- Emergency City Hospital Timisoara, Gheorghe Dima Street, Nr. 5, 300254 Timisoara, Romania; (D.F.L.); (A.G.M.)
- Centre of Advanced Research in Cardiology and Hemostasology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Daniel Florin Lighezan
- Emergency City Hospital Timisoara, Gheorghe Dima Street, Nr. 5, 300254 Timisoara, Romania; (D.F.L.); (A.G.M.)
- Centre of Advanced Research in Cardiology and Hemostasology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Department of Internal Medicine I, Discipline of Medical Semiology I, University of Medicine and Pharmacy “Victor Babes”, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Cristina Tudoran
- Department VII, Internal Medicine II, Discipline of Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Centre of Molecular Research in Nephrology and Vascular Disease, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- County Emergency Hospital “Pius Brinzeu”, L. Rebreanu, Nr. 156, 300723 Timisoara, Romania
| | - Flavia Zara
- Department of Microscopic Morphology, University of Medicine and Pharmacy “Victor Babes”, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
- Department of Pathology, Emergency City Hospital, Gheorghe Dima Street, Nr. 5, 300254 Timisoara, Romania
| | - Adina Bucur
- Department of Functional Sciences, Discipline of Public Health, Centre for Translational Research and Systems Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
| | - Anda Gabriela Militaru
- Emergency City Hospital Timisoara, Gheorghe Dima Street, Nr. 5, 300254 Timisoara, Romania; (D.F.L.); (A.G.M.)
- Centre of Advanced Research in Cardiology and Hemostasology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Department of Internal Medicine I, Discipline of Medical Semiology I, University of Medicine and Pharmacy “Victor Babes”, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
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Varrias D, Saralidze T, Borkowski P, Pargaonkar S, Spanos M, Bazoukis G, Kokkinidis D. Atrial Fibrillation and Dementia: Pathophysiological Mechanisms and Clinical Implications. Biomolecules 2024; 14:455. [PMID: 38672471 PMCID: PMC11048426 DOI: 10.3390/biom14040455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/17/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Numerous longitudinal studies suggest a strong association between cardiovascular risk factors and cognitive impairment. Individuals with atrial fibrillation are at higher risk of dementia and cognitive dysfunction, as atrial fibrillation increases the risk of cerebral hypoperfusion, inflammation, and stroke. The lack of comprehensive understanding of the observed association and the complex relationship between these two diseases makes it very hard to provide robust guidelines on therapeutic indications. With this review, we attempt to shed some light on how atrial fibrillation is related to dementia, what we know regarding preventive interventions, and how we could move forward in managing those very frequently overlapping conditions.
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Affiliation(s)
- Dimitrios Varrias
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA (P.B.); (S.P.)
| | - Tinatin Saralidze
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA (P.B.); (S.P.)
| | - Pawel Borkowski
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA (P.B.); (S.P.)
| | - Sumant Pargaonkar
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA (P.B.); (S.P.)
| | - Michail Spanos
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;
| | - George Bazoukis
- School of Medicine, European University Cyprus, 2417 Nicosia, Cyprus
| | - Damianos Kokkinidis
- Section of Cardiovascular Medicine, Yale University, New Haven, CT 06520, USA
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Chen A, Li Q, Huang Y, Li Y, Chuang YN, Hu X, Guo S, Wu Y, Guo Y, Bian J. Feasibility of Identifying Factors Related to Alzheimer's Disease and Related Dementia in Real-World Data. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.10.24302621. [PMID: 38405723 PMCID: PMC10889002 DOI: 10.1101/2024.02.10.24302621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
A comprehensive view of factors associated with AD/ADRD will significantly aid in studies to develop new treatments for AD/ADRD and identify high-risk populations and patients for prevention efforts. In our study, we summarized the risk factors for AD/ADRD by reviewing existing meta-analyses and review articles on risk and preventive factors for AD/ADRD. In total, we extracted 477 risk factors in 10 categories from 537 studies. We constructed an interactive knowledge map to disseminate our study results. Most of the risk factors are accessible from structured Electronic Health Records (EHRs), and clinical narratives show promise as information sources. However, evaluating genomic risk factors using RWD remains a challenge, as genetic testing for AD/ADRD is still not a common practice and is poorly documented in both structured and unstructured EHRs. Considering the constantly evolving research on AD/ADRD risk factors, literature mining via NLP methods offers a solution to automatically update our knowledge map.
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Affiliation(s)
- Aokun Chen
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Rd, Suite 7000, Gainesville, FL 32610
| | - Qian Li
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Rd, Suite 7000, Gainesville, FL 32610
| | - Yu Huang
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Rd, Suite 7000, Gainesville, FL 32610
| | - Yongqiu Li
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Rd, Suite 7000, Gainesville, FL 32610
| | - Yu-neng Chuang
- Department of Computer Science, George R. Brown School of Engineering, Rice University, 6100 Main St., Houston, TX 77005
| | - Xia Hu
- Department of Computer Science, George R. Brown School of Engineering, Rice University, 6100 Main St., Houston, TX 77005
| | - Serena Guo
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL 32610
| | - Yonghui Wu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Rd, Suite 7000, Gainesville, FL 32610
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Rd, Suite 7000, Gainesville, FL 32610
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Rd, Suite 7000, Gainesville, FL 32610
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Althukair WT, Nuhmani S. Effect of different coronary artery revascularization procedures on cognition: A systematic review. Heliyon 2023; 9:e19735. [PMID: 37810024 PMCID: PMC10558982 DOI: 10.1016/j.heliyon.2023.e19735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
Coronary revascularization interventions have been associated with post-intervention cognitive decline. Hence, this systematic review aims to compare the long-term effects of different coronary revascularization interventions on cognition. The Cochrane Library and MEDLINE databases were searched for articles published between January 2009 and January 2023. Articles on clinical trials and cohort studies that compared at least two different interventions with a minimum three months follow up were included to evaluate the consequences of different intervention techniques on cognition. Each selected study was evaluated using a revised tool to assess the risk of bias in randomized trials (RoB 2), and Risk of Bias In Non-Randomized Studies - of Interventions(ROBINS-1) was used for evaluating non-randomized studies. Five eligible studies, with four different comparisons, were included. Out of these studies, three RCTs and two cohort studies were included A participants gone through different procedures; on-pump and off-pump coronary artery bypass grafting (CABG), Percutaneous coronary intervention (PCI conventional cardiopulmonary bypass (CCPB), the miniaturized cardiopulmonary bypass (MCPB) and endoscopic coronary artery bypass grafting (Endo-CABG). These comparisons showed that different interventions have different effects on cognition; however, there is no solid evidence of correlations between them. Thus, the results of this review suggest that there should be greater focus on comparing interventions and that a reasonable follow-up duration should be set to avoid the influence of confounders. There is also a need to determine the effect of long-term cognitive decline while reducing interference by other variables.
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Affiliation(s)
- Wadha Tareq Althukair
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
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Liu H, Zhang X, Liu H, Chong ST. Using Machine Learning to Predict Cognitive Impairment Among Middle-Aged and Older Chinese: A Longitudinal Study. Int J Public Health 2023; 68:1605322. [PMID: 36798738 PMCID: PMC9926933 DOI: 10.3389/ijph.2023.1605322] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023] Open
Abstract
Objective: To explore the predictive value of machine learning in cognitive impairment, and identify important factors for cognitive impairment. Methods: A total of 2,326 middle-aged and elderly people completed questionnaire, and physical examination evaluation at baseline, Year 2, and Year 4 follow-ups. A random forest machine learning (ML) model was used to predict the cognitive impairment at Year 2 and Year 4 longitudinally. Based on Year 4 cross-sectional data, the same method was applied to establish a prediction model and verify its longitudinal prediction accuracy for cognitive impairment. Meanwhile, the ability of random forest and traditional logistic regression model to longitudinally predict 2-year and 4-year cognitive impairment was compared. Results: Random forest models showed high accuracy for all outcomes at Year 2, Year 4, and cross-sectional Year 4 [AUC = 0.81, 0.79, 0.80] compared with logistic regression [AUC = 0.61, 0.62, 0.70]. Baseline physical examination (e.g., BMI, Blood pressure), biomarkers (e.g., cholesterol), functioning (e.g., functional limitations), demography (e.g., age), and emotional status (e.g., depression) characteristics were identified as the top ten important predictors of cognitive impairment. Conclusion: ML algorithms could enhance the prediction of cognitive impairment among the middle-aged and older Chinese for 4 years and identify essential risk markers.
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Affiliation(s)
- Haihong Liu
- Centre for Research in Psychology and Human Well-being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi, Malaysia,Department of Psychology, Chengde Medical University, Chengde, China
| | - Xiaolei Zhang
- Department of Biomedical Engineering, Chengde Medical University, Chengde, China,Faculty of Engineering, Universiti Putra Malaysia, Serdang, Malaysia
| | - Haining Liu
- Department of Psychology, Chengde Medical University, Chengde, China,Hebei Key Laboratory of Nerve Injury and Repair, Chengde Medical University, Chengde, China,Hebei International Research Center of Medical Engineering, Chengde Medical University, Chengde, China,*Correspondence: Haining Liu, ; Sheau Tsuey Chong,
| | - Sheau Tsuey Chong
- Centre for Research in Psychology and Human Well-being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi, Malaysia,Counselling Psychology Programme, Secretariat of Postgraduate Studies, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi, Malaysia,*Correspondence: Haining Liu, ; Sheau Tsuey Chong,
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11
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Ukawa S, Zhao W, Okabayashi S, Kimura T, Ando M, Wakai K, Tsushita K, Kawamura T, Tamakoshi A. Association between daily sleep duration and the risk of incident dementia according to the presence or absence of diseases among older Japanese individuals in the New Integrated Suburban Seniority Investigation (NISSIN) project. Sleep Med 2022; 100:190-195. [PMID: 36113230 DOI: 10.1016/j.sleep.2022.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/01/2022] [Accepted: 08/25/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study aimed to investigate the association between daily sleep duration and incident dementia among physically and socially independent older people with/without diseases (hypertension, diabetes mellitus, cardiovascular diseases) in a Japanese age-specific cohort. METHODS We carried out a prospective cohort study including 1954 (1006 men and 948 women) Japanese individuals aged 64/65 years. Information on daily sleep duration, medical status, demographics, and lifestyle characteristics was collected by a baseline questionnaire survey and health checkup (2000-2005). Dates of incident dementia were confirmed using the nationally standardized dementia scale proposed by the Ministry of Health, Labor, and Welfare. A competing risk model was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident dementia. We treated censored cases due to death as competing events. RESULTS During a median of 15.6 years of follow-up, 260 participants reported incident dementia. Compared with participants without diseases and who slept 6-7.9 h/day, those with a shorter daily sleep duration of <6 h/day, presence of disease and shorter, moderate, or longer daily sleep duration ≥8 h/day had an increased risk of incident dementia (HR 1.73; 95% CI 1.04-2.88, HR 1.98; 95% CI 1.14-3.44, HR 1.44; 95% CI 1.03-2.00, and HR 2.09; 95% CI 1.41-3.09, respectively) with a significant interaction between the presence of diseases and sleep duration (p < 0.001). CONCLUSIONS The present findings suggest that habitual sleep duration predicts future risk of dementia.
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Affiliation(s)
- Shigekazu Ukawa
- Department of Social Welfare Science and Clinical Psychology, Osaka Metropolitan University Graduate School of Human Life and Ecology, Osaka, Japan.
| | - Wenjing Zhao
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Satoe Okabayashi
- Agency for Health, Safety and Environment, Kyoto University, Kyoto, Japan
| | - Takashi Kimura
- Department of Public Health, Faculty of Medicine, Hokkaido University, Hokkaido, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Aichi, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Aichi, Japan
| | | | - Takashi Kawamura
- Agency for Health, Safety and Environment, Kyoto University, Kyoto, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Faculty of Medicine, Hokkaido University, Hokkaido, Japan
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12
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Porter T, Sim M, Prince RL, Schousboe JT, Bondonno C, Lim WH, Zhu K, Kiel DP, Hodgson JM, Laws SM, Lewis JR. Abdominal aortic calcification on lateral spine images captured during bone density testing and late-life dementia risk in older women: A prospective cohort study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 26:100502. [PMID: 36213133 PMCID: PMC9535408 DOI: 10.1016/j.lanwpc.2022.100502] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Dementia after the age of 80 years (late-life) is increasingly common due to vascular and non-vascular risk factors. Identifying individuals at higher risk of late-life dementia remains a global priority. METHODS In prospective study of 958 ambulant community-dwelling older women (≥70 years), lateral spine images (LSI) captured in 1998 (baseline) from a bone density machine were used to assess abdominal aortic calcification (AAC). AAC was classified into established categories (low, moderate and extensive). Cardiovascular risk factors and apolipoprotein E (APOE) genotyping were evaluated. Incident 14.5-year late-life dementia was identified from linked hospital and mortality records. FINDINGS At baseline women were 75.0 ± 2.6 years, 44.7% had low AAC, 36.4% had moderate AAC and 18.9% had extensive AAC. Over 14.5- years, 150 (15.7%) women had a late-life dementia hospitalisation (n = 132) and/or death (n = 58). Compared to those with low AAC, women with moderate and extensive AAC were more likely to suffer late-life dementia hospitalisations (9.3%, 15.5%, 18.3%, respectively) and deaths (2.8%, 8.3%, 9.4%, respectively). After adjustment for cardiovascular risk factors and APOE, women with moderate and extensive AAC had twice the relative hazards of late-life dementia (moderate, aHR 2.03 95%CI 1.38-2.97; extensive, aHR 2.10 95%CI 1.33-3.32), compared to women with low AAC. INTERPRETATION In community-dwelling older women, those with more advanced AAC had higher risk of late-life dementia, independent of cardiovascular risk factors and APOE genotype. Given the widespread use of bone density testing, simultaneously capturing AAC information may be a novel, non-invasive, scalable approach to identify older women at risk of late-life dementia. FUNDING Kidney Health Australia, Healthway Health Promotion Foundation of Western Australia, Sir Charles Gairdner Hospital Research Advisory Committee Grant, National Health and Medical Research Council of Australia.
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Key Words
- AAC, abdominal aortic calcification
- AAC24, abdominal aortic calcification 24 scale scores
- AD, Alzheimer's disease
- APOE, apolipoprotein E
- ASVD, atherosclerotic vascular disease
- AUC, area under the curve
- Aging
- CAC, coronary artery calcification
- CVD, cardiovascular disease
- DXA, dual-energy X-ray absorptiometry
- Dementia
- Epidemiology
- FRS, Framingham General Cardiovascular Risk Scores
- IDI, integrated discrimination improvement
- Imaging
- LSI, lateral spine imaging
- NRI, net reclassification improvement
- ROC, receiver operator characteristics
- Vascular disease
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Affiliation(s)
- Tenielle Porter
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia
- Collaborative Genomics and Translation Group, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
| | - Marc Sim
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Medical School, University of Western Australia, Crawley, WA, Australia
| | - Richard L. Prince
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Medical School, University of Western Australia, Crawley, WA, Australia
| | - John T. Schousboe
- Park Nicollet Clinic and HealthPartners Institute, HealthPartners, Minneapolis, MN, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Catherine Bondonno
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Medical School, University of Western Australia, Crawley, WA, Australia
| | - Wai H. Lim
- Medical School, University of Western Australia, Crawley, WA, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Kun Zhu
- Medical School, University of Western Australia, Crawley, WA, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Douglas P. Kiel
- Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine Beth, Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Jonathan M. Hodgson
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Medical School, University of Western Australia, Crawley, WA, Australia
| | - Simon M. Laws
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia
- Collaborative Genomics and Translation Group, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
| | - Joshua R. Lewis
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Medical School, University of Western Australia, Crawley, WA, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, the University of Sydney, Sydney, NSW, Australia
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13
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Leukocyte Telomere Length as a Molecular Biomarker of Coronary Heart Disease. Genes (Basel) 2022; 13:genes13071234. [PMID: 35886017 PMCID: PMC9318544 DOI: 10.3390/genes13071234] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/04/2022] [Accepted: 07/09/2022] [Indexed: 02/01/2023] Open
Abstract
Background. This work is a review of preclinical and clinical studies of the role of telomeres and telomerase in the development and progression of coronary heart disease (CHD). Materials and methods. A search for full-text publications (articles, reviews, meta-analyses, Cochrane reviews, and clinical cases) in English and Russian was carried out in the databases PubMed, Oxford University Press, Scopus, Web of Science, Springer, and E-library electronic library using keywords and their combinations. The search depth is 11 years (2010–2021). Results. The review suggests that the relative leukocyte telomere length (LTL) is associated with the development of socially significant and widespread cardiovascular diseases such as CHD and essential hypertension. At the same time, the interests of researchers are mainly focused on the study of the relative LTL in CHD. Conclusions. Despite the scientific and clinical significance of the analyzed studies of the relative length of human LTL as a biological marker of cardiovascular diseases, their implementation in real clinical practice is difficult due to differences in the design and methodology of the analyzed studies, as well as differences in the samples by gender, age, race, and ethnicity. The authors believe that clinical studies of the role of the relative length of leukocyte telomeres in adult patients with coronary heart disease are the most promising and require large multicenter studies with a unified design and methodology.
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Zuo W, Wu J. The interaction and pathogenesis between cognitive impairment and common cardiovascular diseases in the elderly. Ther Adv Chronic Dis 2022; 13:20406223211063020. [PMID: 35126964 PMCID: PMC8814974 DOI: 10.1177/20406223211063020] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 11/04/2021] [Indexed: 02/05/2023] Open
Abstract
Both cognitive impairment and cardiovascular diseases have a high incidence in the elderly population, increasing the burden of care and reducing the quality of life. Studies have suggested that cognitive impairment interacts with cardiovascular diseases such as coronary heart disease, abnormal blood pressure, heart failure, and arrhythmia. On one hand, cognitive impairment in the elderly influences the progression and self-management of cardiovascular diseases and increases the risk of cardiovascular-related adverse events. On the other hand, coronary heart disease, heart failure, higher blood pressure variability, orthostatic hypotension, and atrial fibrillation may aggravate cognitive impairment. The role of blood pressure levels on cognition remains controversial. Several shared biological pathways have been proposed as the underlying mechanism for the association. Cardiovascular diseases may lead to cognitive decline even dementia through cerebral perfusion damage, brain structural changes, inflammation, β-amyloid deposition, and neuroendocrine disorders. It is of great significance to study the interaction and put forward effective interventions in an overall perspective to reduce care burden and improve the quality of life of the elderly patients.
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Affiliation(s)
- Wenhang Zuo
- National Clinical Research Center for Geriatrics, Department of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Jinhui Wu
- National Clinical Research Center for Geriatrics, Department of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, People’s Republic of China
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15
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Rivard L, Friberg L, Conen D, Healey JS, Berge T, Boriani G, Brandes A, Calkins H, Camm AJ, Yee Chen L, Lluis Clua Espuny J, Collins R, Connolly S, Dagres N, Elkind MSV, Engdahl J, Field TS, Gersh BJ, Glotzer TV, Hankey GJ, Harbison JA, Haeusler KG, Hills MT, Johnson LSB, Joung B, Khairy P, Kirchhof P, Krieger D, Lip GYH, Løchen ML, Madhavan M, Mairesse GH, Montaner J, Ntaios G, Quinn TJ, Rienstra M, Rosenqvist M, Sandhu RK, Smyth B, Schnabel RB, Stavrakis S, Themistoclakis S, Van Gelder IC, Wang JG, Freedman B. Atrial Fibrillation and Dementia: A Report From the AF-SCREEN International Collaboration. Circulation 2022; 145:392-409. [PMID: 35100023 DOI: 10.1161/circulationaha.121.055018] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Growing evidence suggests a consistent association between atrial fibrillation (AF) and cognitive impairment and dementia that is independent of clinical stroke. This report from the AF-SCREEN International Collaboration summarizes the evidence linking AF to cognitive impairment and dementia. It provides guidance on the investigation and management of dementia in patients with AF on the basis of best available evidence. The document also addresses suspected pathophysiologic mechanisms and identifies knowledge gaps for future research. Whereas AF and dementia share numerous risk factors, the association appears to be independent of these variables. Nevertheless, the evidence remains inconclusive regarding a direct causal effect. Several pathophysiologic mechanisms have been proposed, some of which are potentially amenable to early intervention, including cerebral microinfarction, AF-related cerebral hypoperfusion, inflammation, microhemorrhage, brain atrophy, and systemic atherosclerotic vascular disease. The mitigating role of oral anticoagulation in specific subgroups (eg, low stroke risk, short duration or silent AF, after successful AF ablation, or atrial cardiopathy) and the effect of rhythm versus rate control strategies remain unknown. Likewise, screening for AF (in cognitively normal or cognitively impaired patients) and screening for cognitive impairment in patients with AF are debated. The pathophysiology of dementia and therapeutic strategies to reduce cognitive impairment warrant further investigation in individuals with AF. Cognition should be evaluated in future AF studies and integrated with patient-specific outcome priorities and patient preferences. Further large-scale prospective studies and randomized trials are needed to establish whether AF is a risk factor for cognitive impairment, to investigate strategies to prevent dementia, and to determine whether screening for unknown AF followed by targeted therapy might prevent or reduce cognitive impairment and dementia.
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Affiliation(s)
- Léna Rivard
- Montreal Heart Institute, Université de Montréal, Canada (L.R., P. Khairy)
| | - Leif Friberg
- Karolinska Institute, Stockholm, Sweden (L.F., M.R.)
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.C., J.S.H., S.C.)
| | - Jeffrey S Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.C., J.S.H., S.C.)
| | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Italy (G.B.)
| | | | | | - A John Camm
- Cardiovascular Clinical Academic Group, St Georges Hospital, London, UK (A.J.C.)
| | | | | | | | - Stuart Connolly
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.C., J.S.H., S.C.)
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Germany (N.D.)
| | | | - Johan Engdahl
- Karolinska Institutet, Department of Clinical Sciences, Danderyds Hospital, Stockholm, Sweden (J.E.)
| | - Thalia S Field
- University of British Columbia, Vancouver Stroke Program, Canada (T.S.F.)
| | | | | | - Graeme J Hankey
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia (G.J.H.)
| | | | - Karl G Haeusler
- Department of Neurology, Universitätsklinikum Würzburg, Germany (K.G.H.)
| | | | | | - Boyoung Joung
- Yonsei University College of Medicine, Seoul, South Korea (B.J.)
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Canada (L.R., P. Khairy)
| | - Paulus Kirchhof
- University Heart and Vascular Center UKE Hamburg, Germany (P. Kirchhof)
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (P. Kirchhof)
- Institute of Cardiovascular Sciences, University of Birmingham, UK, and AFNET, Münster, Germany (P. Kirchhof)
| | - Derk Krieger
- University Hospital of Zurich, Switzerland (D.K.)
| | | | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø (M.L.L.)
| | - Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.M.)
| | | | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain (J.M.)
- Stroke Research Program, Institute of Biomedicine of Seville, Spain (J.M.)
- IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Spain (J.M.)
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain (J.M.)
| | | | | | - Michiel Rienstra
- Karolinska Institute, Stockholm, Sweden (L.F., M.R.)
- University of Groningen, University Medical Center Groningen, the Netherlands (M.R., I.C.V.G.)
| | | | | | - Breda Smyth
- Department of Public Health, Health Service Executive West, Galway, Ireland (B.S.)
| | | | | | | | - Isabelle C Van Gelder
- University of Groningen, University Medical Center Groningen, the Netherlands (M.R., I.C.V.G.)
| | - Ji-Guang Wang
- Jiaotong University School of Medicine, China (J.G.W.)
| | - Ben Freedman
- Charles Perkins Centre and Concord Hospital Cardiology, University of Sydney, Australia (B.F.)
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Yang J, Sui H, Jiao R, Zhang M, Zhao X, Wang L, Deng W, Liu X. Random-Forest-Algorithm-Based Applications of the Basic Characteristics and Serum and Imaging Biomarkers to Diagnose Mild Cognitive Impairment. Curr Alzheimer Res 2022; 19:76-83. [PMID: 35088670 PMCID: PMC9189735 DOI: 10.2174/1567205019666220128120927] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 12/04/2021] [Accepted: 01/13/2022] [Indexed: 11/24/2022]
Abstract
Background
Mild cognitive impairment (MCI) is considered the early stage of Alzheimer's Disease (AD). The purpose of our study was to analyze the basic characteristics and serum and imaging biomarkers for the diagnosis of MCI patients as a more objective and accurate approach. Methods
The Montreal Cognitive Test was used to test 119 patients aged ≥65. Such serum biomarkers were detected as preprandial blood glucose, triglyceride, total cholesterol, Aβ1-40, Aβ1-42, and P-tau. All the subjects were scanned with 1.5T MRI (GE Healthcare, WI, USA) to obtain DWI, DTI, and ASL images. DTI was used to calculate the anisotropy fraction (FA), DWI was used to calculate the apparent diffusion coefficient (ADC), and ASL was used to calculate the cerebral blood flow (CBF). All the images were then registered to the SPACE of the Montreal Neurological Institute (MNI). In 116 brain regions, the medians of FA, ADC, and CBF were extracted by automatic anatomical labeling. The basic characteristics included gender, education level, and previous disease history of hypertension, diabetes, and coronary heart disease. The data were randomly divided into training sets and test ones. The recursive random forest algorithm was applied to the diagnosis of MCI patients, and the recursive feature elimination (RFE) method was used to screen the significant basic features and serum and imaging biomarkers. The overall accuracy, sensitivity, and specificity were calculated, respectively, and so were the ROC curve and the area under the curve (AUC) of the test set. Results
When the variable of the MCI diagnostic model was an imaging biomarker, the training accuracy of the random forest was 100%, the correct rate of the test was 86.23%, the sensitivity was 78.26%, and the specificity was 100%. When combining the basic characteristics, the serum and imaging biomarkers as variables of the MCI diagnostic model, the training accuracy of the random forest was found to be 100%; the test accuracy was 97.23%, the sensitivity was 94.44%, and the specificity was 100%. RFE analysis showed that age, Aβ1-40, and cerebellum_4_6 were the most important basic feature, serum biomarker, imaging biomarker, respectively. Conclusion
Imaging biomarkers can effectively diagnose MCI. The diagnostic capacity of the basic trait biomarkers or serum biomarkers for MCI is limited, but their combination with imaging biomarkers can improve the diagnostic capacity, as indicated by the sensitivity of 94.44% and the specificity of 100% in our model. As a machine learning method, a random forest can help diagnose MCI effectively while screening important influencing factors.
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Affiliation(s)
- Juan Yang
- Department of Neurology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
- Department of Neurology, Shanghai Pudong New Area People's Hospital,Shanghai, 201299, China
| | - Haijing Sui
- Department of Radiology, Shanghai Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Ronghong Jiao
- Department of Clinical Laboratory, Shanghai Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Min Zhang
- hcit.ai Co., Shanghai, People's Republic of China
| | - Xiaohui Zhao
- Department of Neurology, Shanghai Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Lingling Wang
- Department of Neurology, Shanghai Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Wenping Deng
- Huawei Technology Co., Ltd Co, Shanghai, People's Republic of China
| | - Xueyuan Liu
- Department of Neurology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
- Department of Neurology, Shanghai Pudong New Area People's Hospital,Shanghai, 201299, China
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17
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Johansen MC, Blaha MJ. Coronary Artery Calcium: A Risk Factor for Brain Aging? Circ Cardiovasc Imaging 2021; 14:e013062. [PMID: 34256575 DOI: 10.1161/circimaging.121.013062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michelle C Johansen
- Cerebrovascular Division, Department of Neurology, Johns Hopkins University, Baltimore, MD (M.C.J.).,Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (M.C.J., M.J.B.)
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (M.C.J., M.J.B.)
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18
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Xia C, Vonder M, Sidorenkov G, Ma R, Oudkerk M, van der Harst P, De Deyn PP, Vliegenthart R. Coronary Artery Calcium and Cognitive Function in Dutch Adults: Cross-Sectional Results of the Population-Based ImaLife Study. J Am Heart Assoc 2021; 10:e018172. [PMID: 33525927 PMCID: PMC7955332 DOI: 10.1161/jaha.120.018172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/16/2020] [Indexed: 01/03/2023]
Abstract
Background The aim of this study was to investigate whether increased severity of coronary artery calcium (CAC), an imaging biomarker of subclinical coronary atherosclerosis, is associated with worse cognitive function independent of cardiovascular risk factors in a large population-based Dutch cohort with broad age range. Methods and Results A cross-sectional analysis was performed in 4988 ImaLife participants (aged 45-91 years, 58.3% women) without history of cardiovascular disease. CAC scores were obtained using nonenhanced cardiac computed tomography scanning. The CogState Brief Battery was used to assess 4 cognitive domains: processing speed, attention, working memory, and visual learning based on detection task, identification task, 1-back task, and 1-card-learning task, respectively. Differences in mean scores of each cognitive domain were compared among 4 CAC categories (0, 1-99, 100-399, ≥400) using analysis of covariates to adjust for classical cardiovascular risk factors. Age-stratified analysis (45-54, 55-64, and ≥65 years) was performed to assess whether the association of CAC severity with cognitive function differed by age. Overall, higher CAC was associated with worse performance on 1-back task after adjusting for classical cardiovascular risk factors, but CAC was not associated with the other cognitive tasks. Age-stratified analyses revealed that the association of CAC severity with working memory persisted in participants aged 45 to 54 years, while in the elderly this association lost significance. Conclusions In this Dutch population of ≥45 years, increased CAC severity was associated with worse performance of working memory, independent of classical cardiovascular risk factors. The inverse relationship of CAC score categories with working memory was strongest in participants aged 45 to 54 years.
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Affiliation(s)
- Congying Xia
- Department of RadiologyUniversity of GroningenGroningenThe Netherlands
| | - Marleen Vonder
- Department of EpidemiologyUniversity of GroningenGroningenThe Netherlands
| | - Grigory Sidorenkov
- Department of EpidemiologyUniversity of GroningenGroningenThe Netherlands
| | - Runlei Ma
- Department of RadiologyUniversity of GroningenGroningenThe Netherlands
| | - Matthijs Oudkerk
- Faculty of Medical SciencesUniversity of GroningenGroningenThe Netherlands
| | - Pim van der Harst
- Department of CardiologyUniversity of GroningenGroningenThe Netherlands
- Department of CardiologyUniversity Medical Center UtrechtGroningenThe Netherlands
| | - Peter Paul De Deyn
- Department of NeurologyAlzheimer Center GroningenUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
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Lakshmanan S, Kinninger A, Golub I, Dahal S, Birudaraju D, Ahmad K, Ghanem AK, Rezvanizadeh V, Roy SK, Budoff MJ. 20-Year trend of high prevalence of zero coronary artery calcium in beach cities of Southern California: A blue zone? Am J Prev Cardiol 2020; 4:100098. [PMID: 34327474 PMCID: PMC8315595 DOI: 10.1016/j.ajpc.2020.100098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/06/2020] [Accepted: 10/10/2020] [Indexed: 12/14/2022] Open
Abstract
Background Blue zones are longevity hotspots around the world characterized by highest concentrations of healthy centenarians. Certified blue zone communities are designed by implementation of environmental and policy changes that promote healthy behaviors. Objective To examine the trends of prevalence of zero CAC, a marker of ideal cardiovascular and overall health status and burden of cardiovascular risk factors in Beach Cities/certified blue zones of Southern California and rest of California. Methods This is a population-based cohort study of persons aged 50 years or older in California, who underwent CAC screening between 2000 and 2019. A total of 3864 participants from Beach Cities of Southern California were identified by Zip Codes and compared with 35,537 participants from rest of California. We compared trends of prevalence of zero CAC and cardiovascular risk factors between the two groups, in 5-year intervals. Results Among 39,401 participants (mean age, 58.1 years; 36% women), 13,374 (34%) had zero CAC. The prevalence of CAC = 0 was significantly higher in Beach Cities compared to the rest of California (p < 0.001). Across the study period, the prevalence of cardiac risk factors including obesity, smoking, diabetes and hypertension remain significantly lower in Beach Cities. (p < 0.001) Conclusions This study, shows for the first time, that higher prevalence of zero CAC in Beach Cities of California, adds validity to excellent prognosis and longevity in these areas. The impact of policy implementation and environmental changes on lifestyle patterns, cardiovascular health and healthy ageing needs to be evaluated.
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Affiliation(s)
- Suvasini Lakshmanan
- Lundquist Institute of Biomedical Innovation and Research at Harbor UCLA Medical Center, Torrance, CA, USA
| | - April Kinninger
- Lundquist Institute of Biomedical Innovation and Research at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Ilana Golub
- Lundquist Institute of Biomedical Innovation and Research at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Suraj Dahal
- Lundquist Institute of Biomedical Innovation and Research at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Divya Birudaraju
- Lundquist Institute of Biomedical Innovation and Research at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Khadije Ahmad
- Lundquist Institute of Biomedical Innovation and Research at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Ahmad K Ghanem
- Lundquist Institute of Biomedical Innovation and Research at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Vahid Rezvanizadeh
- Lundquist Institute of Biomedical Innovation and Research at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Sion K Roy
- Lundquist Institute of Biomedical Innovation and Research at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Matthew J Budoff
- Lundquist Institute of Biomedical Innovation and Research at Harbor UCLA Medical Center, Torrance, CA, USA
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Non-invasive markers of vascular disease: An opportunity for early diagnosis of cognitive impairment. Atherosclerosis 2020; 312:101-103. [PMID: 33051024 DOI: 10.1016/j.atherosclerosis.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 01/04/2023]
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