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Nwosu A, Qian M, Phillips J, Hellegers CA, Rushia S, Sneed J, Petrella JR, Goldberg TE, Devanand DP, Doraiswamy PM. Computerized Cognitive Training in Mild Cognitive Impairment: Findings in African Americans and Caucasians. J Prev Alzheimers Dis 2024; 11:149-154. [PMID: 38230727 DOI: 10.14283/jpad.2023.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND African Americans with MCI may be at increased risk for dementia compared to Caucasians. The effect of race on the efficacy of cognitive training in MCI is unclear. METHODS We used data from a two-site, 78-week randomized trial of MCI comparing intensive, home-based, computerized training with Web-based cognitive games or Web-based crossword puzzles to examine the effect of race on outcomes. The study outcomes were changes from baseline in cognitive and functional scales as well as MRI-measured changes in hippocampal volume and cortical thickness. Analyses used linear models adjusted for baseline scores. This was an exploratory study. RESULTS A total of 105 subjects were included comprising 81 whites (77.1%) and 24 African Americans (22.8%). The effect of race on the change from baseline in ADAS-Cog-11 was not significant. The effect of race on change from baseline to week 78 in the Functional Activities Questionnaire (FAQ) was significant with African American participants' FAQ scores showing greater improvements at weeks 52 and 78 (P = 0.009, P = 0.0002, respectively) than white subjects. Within the CCT cohort, FAQ scores for African American participants showed greater improvement between baseline and week 78, compared to white participants randomized to CCT (P = 0.006). There was no effect of race on the UPSA. There was no effect of race on hippocampal or cortical thickness outcomes. CONCLUSIONS Our preliminary findings suggest that web-based cognitive training programs may benefit African Americans with MCI at least as much as Caucasians, and highlight the need to further study underrepresented minorities in AD prevention trials. (Supported by the National Institutes of Health, National Institute on Aging; ClinicalTrials.gov number, NCT03205709.).
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Affiliation(s)
- A Nwosu
- Adaora Nwosu, Neurocognitive Disorders Program, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA,
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Motter JN, Rushia SN, Qian M, Ndouli C, Nwosu A, Petrella JR, Doraiswamy PM, Goldberg TE, Devanand DP. Expectancy Does Not Predict 18-month Treatment Outcomes with Cognitive Training in Mild Cognitive Impairment. J Prev Alzheimers Dis 2024; 11:71-78. [PMID: 38230719 DOI: 10.14283/jpad.2023.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Computerized cognitive training (CCT) has emerged as a potential treatment option for mild cognitive impairment (MCI). It remains unclear whether CCT's effect is driven in part by expectancy of improvement. OBJECTIVES This study aimed to determine factors associated with therapeutic expectancy and the influence of therapeutic expectancy on treatment effects in a randomized clinical trial of CCT versus crossword puzzle training (CPT) for older adults with MCI. DESIGN Randomized clinical trial of CCT vs CPT with 78-week follow-up. SETTING Two-site study - New York State Psychiatric Institute and Duke University Medical Center. PARTICIPANTS 107 patients with MCI. INTERVENTION 12 weeks of intensive training with CCT or CPT with follow-up booster training over 78 weeks. MEASUREMENTS Patients rated their expectancies for CCT and CPT prior to randomization. RESULTS Patients reported greater expectancy for CCT than CPT. Lower patient expectancy was associated with lower global cognition at baseline and older age. Expectancy did not differ by sex or race. There was no association between expectancy and measures of everyday functioning, hippocampus volume, or apolipoprotein E genotype. Expectancy was not associated with change in measures of global cognition, everyday functioning, and hippocampus volume from baseline to week 78, nor did expectancy interact with treatment condition. CONCLUSIONS While greater cognitive impairment and increased age was associated with low expectancy of improvement, expectancy was not associated with the likelihood of response to treatment with CPT or CCT.
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Affiliation(s)
- J N Motter
- Jeffrey N. Motter, Department of Psychiatry, Division of Geriatric Psychiatry, 1051 Riverside Drive, New York, NY 10032, United States.
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Doraiswamy PM, Miller MG, Hellegers CA, Nwosu A, Choe J, Murdoch DM. Erratum to: Blueberry Supplementation Effects on Neuronal and Pathological Biomarkers in Subjects at Risk for Alzheimer's Disease: A Pilot Study. JAR Life 2023; 12:84. [PMID: 37808442 PMCID: PMC10551122 DOI: 10.14283/jarlife.2023.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
[This corrects the article DOI: 10.14283/jarlife.2023.13.].
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Affiliation(s)
- P M Doraiswamy
- Neurocognitive Disorders Program, Department of Psychiatry and Behavioural Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
- Duke Institute for Brain Sciences, Duke University School of Medicine, Durham, NC, USA
| | - M G Miller
- Duke Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - C A Hellegers
- Neurocognitive Disorders Program, Department of Psychiatry and Behavioural Sciences, Duke University School of Medicine, Durham, NC, USA
| | - A Nwosu
- Neurocognitive Disorders Program, Department of Psychiatry and Behavioural Sciences, Duke University School of Medicine, Durham, NC, USA
| | - J Choe
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA
| | - D M Murdoch
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA
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Doraiswamy PM, Miller MG, Hellegers CA, Nwosu A, Choe J, Murdoch DM. Blueberry Supplementation Effects on Neuronal and Pathological Biomarkers in Subjects at Risk for Alzheimer's Disease: A Pilot Study. JAR Life 2023; 12:77-83. [PMID: 37637274 PMCID: PMC10450204 DOI: 10.14283/jarlife.2023.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/27/2023] [Indexed: 08/29/2023]
Abstract
Background There is a need to develop non-invasive practical lifestyle interventions for preventing Alzheimer's disease (AD) in people at risk, such as those with mild cognitive impairment (MCI). Blueberry consumption has been associated with reduced risk of dementia in some epidemiologic studies and with improvements in cognition in healthy aging adults. Blood-based biomarkers have emerged at the forefront of AD therapeutics research spurred by the development of reliable ultra-sensitive "single-molecule array" assays with 100-1000-fold greater sensitivity over traditional platforms. Objective The purpose of this study was to examine the effect of blueberry supplementation in MCI on six blood biomarkers: amyloid-beta 40 (Aβ40), amyloid-beta 42 (Aβ42), phosphorylated Tau181 (ptau181), neurofilament light (NfL), Glial Fibrillary acidic protein (GFAP), and Brain-Derived Neurotrophic Factor (BDNF). Methods This was a 12-week, open-label, pilot trial of 10 participants with MCI (mean age 80.2 years + 5.16). Subjects consumed 36 grams per day of lyophilized blueberry powder in a split dose consumed with breakfast and dinner. Baseline and endpoint venous blood was analyzed using an ultrasensitive SIMOA assay. Our aim was to test if blueberry supplementation would particularly impact p-tau181, NfL, and GFAP elevations associated with the neurodegenerative process. Results There were no statistically significant (p < 0.05) changes from baseline to endpoint for any of the biomarker values or in the ratios of Aβ42 / Aβ40 and ptau181/ Aβ42. Adverse effects were mild and transient; supplementation was relatively well tolerated with all subjects completing the study. Conclusion To our knowledge, this is the first study to prospectively examine the effects of blueberry supplementation on a panel of blood biomarkers reflecting the neurodegenerative process. Our findings raise two possibilities - a potential stabilization of the neurodegenerative process or a lack of a direct and acute effect on beta-amyloid/tau/glial markers. A larger controlled study is warranted.
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Affiliation(s)
- P M Doraiswamy
- Neurocognitive Disorders Program, Department of Psychiatry and Behavioural Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
- Duke Institute for Brain Sciences, Duke University School of Medicine, Durham, NC, USA
| | - M G Miller
- Duke Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - C A Hellegers
- Neurocognitive Disorders Program, Department of Psychiatry and Behavioural Sciences, Duke University School of Medicine, Durham, NC, USA
| | - A Nwosu
- Neurocognitive Disorders Program, Department of Psychiatry and Behavioural Sciences, Duke University School of Medicine, Durham, NC, USA
| | - J Choe
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA
| | - D M Murdoch
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA
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Oladele RO, Irurhe NK, Foden P, Akanmu AS, Gbaja-Biamila T, Nwosu A, Ekundayo HA, Ogunsola FT, Richardson MD, Denning DW. Chronic pulmonary aspergillosis as a cause of smear-negative TB and/or TB treatment failure in Nigerians. Int J Tuberc Lung Dis 2018; 21:1056-1061. [PMID: 28826456 DOI: 10.5588/ijtld.17.0060] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate chronic pulmonary aspergillosis (CPA) as an alternative diagnosis of smear-negative tuberculosis (TB) and treatment failure in TB patients in Nigeria. METHODS We conducted a cross-sectional multicentre survey in human immunodeficiency virus (HIV) positive and negative adult patients at the end of their TB treatment in clinics in Lagos and Ilorin states. All were assessed using clinical examination, chest X-ray (CXR) and aspergillus immunoglobulin G (IgG) serology, and some for sputum fungal culture. CPA was defined as a positive Aspergillus fumigatus IgG titre with compatible CXR or a positive sputum culture of Aspergillus with a visible fungal ball on CXR with symptoms of underlying lung disease. RESULTS Of 208 patients recruited between June 2014 and May 2015, 153 (73.6%) were HIV-positive. The mean age was 39.8 years, 124 (59.6%) were female and 39 (18.8%) were unable to work. The median CD4 count was 169.5 cells/ml (range 4-593) in HIV-infected patients with positive Aspergillus IgG. Overall, 109 (52.4%) had documented TB, 140 (67.3%) had a productive cough and 50 had haemoptysis. CPA prevalence was 8.7%; 10 (6.5%) had HIV infection and 8 (14.5%) were HIV-negative (Fisher's exact P = 0.092). CONCLUSION CPA is a neglected disease in Nigeria, and most cases match the World Health Organization diagnostic criteria for smear-negative TB.
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Affiliation(s)
- R O Oladele
- College of Medicine, University of Lagos, Lagos, Nigeria, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester
| | - N K Irurhe
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - P Foden
- Medical Statistics Department, University Hospital of South Manchester, Manchester, UK
| | - A S Akanmu
- College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - A Nwosu
- College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - F T Ogunsola
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - M D Richardson
- Mycology Reference Centre Manchester, University Hospital of South Manchester, Manchester, National Aspergillosis Centre, University Hospital of South Manchester, Manchester, UK
| | - D W Denning
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, National Aspergillosis Centre, University Hospital of South Manchester, Manchester, UK
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Nwosu A, Marley K, Sulaivany E, Dickman A, Littlewood C. An evaluation of the use of traditional opioids and immediate-release fentanyl in the management of breakthrough cancer pain in an integrated cancer network. BMJ Support Palliat Care 2012. [DOI: 10.1136/bmjspcare-2012-000264.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Irizarry L, Rupp J, Smart J, Nwosu A, Tzamaloukas A. Diagnostic difficulties with mycobacteria peritonitis in a CAPD patient. ARCH ESP UROL 1996; 16:427. [PMID: 8863341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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