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Reig M, Galle PR, Kudo M, Finn R, Llovet JM, Metti AL, Schelman WR, Liang K, Wang C, Widau RC, Abada P, Zhu AX. Pattern of progression in advanced hepatocellular carcinoma treated with ramucirumab. Liver Int 2021; 41:598-607. [PMID: 33188713 PMCID: PMC7898500 DOI: 10.1111/liv.14731] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/23/2020] [Accepted: 11/08/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Radiological progression patterns to first-line sorafenib have been associated with post-progression and overall survival in advanced hepatocellular carcinoma, but these associations remain unknown for therapies in second- and later-line settings. This post hoc analysis of REACH and REACH-2 examined outcomes by radiological progression patterns in the second-line setting of patients with advanced hepatocellular carcinoma treated with ramucirumab or placebo. METHODS Patients with advanced hepatocellular carcinoma, Child-Pugh A and Eastern Cooperative Oncology Group Performance Status 0 or 1 with prior sorafenib were randomized to receive ramucirumab 8mg/kg or placebo every 2 weeks. Among 625 patients with ≥1 progression pattern (new extrahepatic lesion [including new macrovascular invasion], new intrahepatic lesion, extrahepatic growth or intrahepatic growth), data were analysed by trial and for pooled individual patient data for REACH-2 and REACH (alpha-fetoprotein ≥400 ng/mL). Cox models evaluated prognostic implications of progression patterns on overall and post-progression survival. RESULTS Post-progression survival was worse among those with new extrahepatic lesions in REACH (HR 2.33, 95% CI 1.51-3.60), REACH-2 (HR 1.49, 95% CI 0.72-3.08) and the pooled population (HR 1.75, 95% CI 1.12-2.74) compared to other progression patterns. Overall survival was also significantly reduced in those with new extrahepatic lesions across studies. Ramucirumab provided an overall survival benefit across progression patterns, including patients with new extrahepatic lesions (HR 0.56, 95% CI 0.39-0.80) in the pooled population. CONCLUSIONS The emergence of new extrahepatic lesions in the second-line setting is a poor prognostic factor for post-progression survival. The benefit of ramucirumab for overall survival was consistent across progression patterns.
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Affiliation(s)
- Maria Reig
- Barcelona Clinic Liver Cancer Group, Liver UnitHospital Clínic of Barcelona. IDIBAPS. CIBERehd. University of BarcelonaBarcelonaSpain
| | - Peter R. Galle
- Department of Internal MedicineMainz University Medical CenterMainzGermany
| | - Masatoshi Kudo
- Departments of Gastroenterology and HepatologyKindai University Faculty of MedicineOsakaJapan
| | - Richard Finn
- Division of Hematology/OncologyUniversity of CaliforniaLos AngelesCAUSA
| | - Josep M. Llovet
- Mount Sinai Liver Cancer Program, Division of Liver Diseases, Tisch Cancer InstituteIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Translational Research in Hepatic Oncology, Liver UnitIDIBAPS, Hospital Clinic Barcelona, University of BarcelonaBarcelonaSpain
- Institució Catalana d’Estudis Avançats (ICREA)BarcelonaSpain
| | | | | | - Kun Liang
- Eli Lilly and CompanyBranchburgNJUSA
| | | | | | | | - Andrew X. Zhu
- Massachusetts General Hospital Cancer CenterHarvard Medical SchoolBostonMAUSA
- Jiahui International Cancer CenterJiahui HealthShanghaiChina
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Rosano C, Metti AL, Rosso AL, Studenski S, Bohnen NI. Influence of Striatal Dopamine, Cerebral Small Vessel Disease, and Other Risk Factors on Age-Related Parkinsonian Motor Signs. J Gerontol A Biol Sci Med Sci 2021; 75:696-701. [PMID: 31425570 DOI: 10.1093/gerona/glz161] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Parkinsonian motor signs are common and disabling in older adults without Parkinson's disease (PD), but its risk factors are not completely understood. We assessed the influence of striatal dopamine levels, cerebral small vessel disease, and other factors on age-related parkinsonian motor signs in non-PD adults. METHODS Striatal dopamine transporter (DAT) binding was quantified via [11C]-CFT positron emission tomography in 87 neurologically intact adults (20-85 years, 57.47% female) with concurrent data on: Unified Parkinson's Disease Rating Scale motor (UPDRSm), white matter hyperintensities (WMH), and other risk factors (grip strength, vibratory sensitivity, cardio- and cerebro-vascular comorbidities). Sex-adjusted nonparametric models first estimated the associations of age, DAT, WMH, and other factors with UPDRSm; next, interactions of age by DAT, WMH, or other factors were tested. To quantify the influence of DAT, WMH, and other risk factors on the main association of age with UPDRSm, multivariable mediation models with bootstrapped confidence intervals (CI) were used. RESULTS Older age, lower DAT, higher WMH, and worse risk factors significantly predicted worse UPDRSm (sex-adjusted p < .04 for all). DAT, but not WMH or other factors, positively and significantly interacted with age (p = .02). DAT significantly reduced the age-UPDRSm association by 30% (results of fully adjusted mediation model: indirect effect: 0.027; bootstrapped 95% CI: 0.0007, 0.074). CONCLUSIONS Striatal dopamine appears to influence to some extent the relationship between age and parkinsonian signs. However, much of the variance of parkinsonian signs appears unexplained. Longitudinal studies to elucidate the multifactorial causes of this common condition of older age are warranted.
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Affiliation(s)
- Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, Pennsylvania
| | - Andrea L Metti
- Department of Epidemiology, Graduate School of Public Health, Pennsylvania
| | - Andrea L Rosso
- Department of Epidemiology, Graduate School of Public Health, Pennsylvania
| | - Stephanie Studenski
- Department of Geriatric Medicine, School of Medicine, University of Pittsburgh, Pennsylvania
| | - Nicolaas I Bohnen
- Departments of Radiology, Neurology and Division of Nuclear Medicine and Department of Veterans Affairs, University of Michigan, Ann Arbor
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Rosso AL, Metti AL, Faulkner K, Redfern M, Yaffe K, Launer L, Elizabeth Shaaban C, Nadkarni NK, Rosano C. Complex Walking Tasks and Risk for Cognitive Decline in High Functioning Older Adults. J Alzheimers Dis 2020; 71:S65-S73. [PMID: 30814353 DOI: 10.3233/jad-181140] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Performance on complex walking tasks may provide a screen for future cognitive decline. OBJECTIVE To identify walking tasks that are most strongly associated with subsequent cognitive decline. METHODS Community-dwelling older adults with Modified Mini-Mental State (3MS) >85 at baseline (n = 223; mean age = 78.7, 52.5% women, 25.6% black) completed usual-pace walking and three complex walking tasks (fast-pace, narrow-path, visuospatial dual-task). Slope of 3MS scores for up to 9 subsequent years (average = 5.2) were used to calculate a cognitive maintainer (slope ≥0) or decliner (slope <0) outcome variable. Logistic regression models assessed associations between gait speeds and being a cognitive decliner. A sensitivity analysis in a subsample of individuals (n = 66) confirmed results with adjudicated mild cognitive impairment (MCI) or dementia at 8-9 years post-walking assessment. RESULTS Cognitive decliners were 52.5% of the sample and on average were slower for all walking tasks compared to maintainers. In models adjusted for demographic and health variables, faster fast-pace (OR = 0.87 per 0.1 m/s, 95% CI: 0.78, 0.97) and dual-task (OR = 0.84 per 0.1 m/s, 95% CI: 0.73, 0.96) gait speeds were associated with lower likelihood of being a cognitive decliner. Usual-pace gait speed was not associated (OR = 0.96 per 0.1 m/s, 95% CI: 0.85, 1.08). Results were nearly identical in analyses with adjudicated MCI or dementia as the outcome. CONCLUSION Fast-pace and dual-task walking may provide simple and effective tools for assessing risk for cognitive decline in older individuals with high cognitive function. Such screening tools are important for strategies to prevent or delay onset of clinically meaningful change.
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Affiliation(s)
- Andrea L Rosso
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrea L Metti
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kimberly Faulkner
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mark Redfern
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kristine Yaffe
- Department of Psychiatry, Neurology and Epidemiology, University of California, San Francisco, CA, USA
| | - Lenore Launer
- Intramural Research Program, National Institute on Aging, Bethesda, MD, USA
| | - C Elizabeth Shaaban
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Neelesh K Nadkarni
- Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Sparto PJ, Rosso AL, Divecha AA, Metti AL, Rosano C. Shared neural substrates of cognitive function and postural control in older adults. Alzheimers Dement 2020; 16:621-629. [PMID: 32147950 DOI: 10.1002/alz.12053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 10/04/2019] [Accepted: 12/05/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Poor cognitive function and postural control co-occur in older adults. It is unclear whether they share neural substrates. METHODS Postural sway error during a novel visual tracking (VT) condition and gray matter volume (GMV) were compared between participants with normal cognition (NC), mild cognitive impairment (MCI), or dementia (n = 179, mean age 82, 56% females, 56% white). Associations between VT error, cognitive function, and GMV were examined. RESULTS Greater VT error was associated with having dementia compared to NC or MCI (odds ratio [95% CI] = 2.15 [1.38, 3.36] and 1.58 [1.05, 2.38]). Regions with lower GMV related to greater VT error and worse cognition were: bilateral hippocampi, parahippocampi, entorhinal, and parietal cortices (all P ≤0.05). GMV of bilateral hippocampi and left parahippocampus explained >20% of VT error between dementia and NC. DISCUSSION Postural control during visuospatial tasks and dementia may share neural substrates, specifically memory-related regions.
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Affiliation(s)
- Patrick J Sparto
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrea L Rosso
- Department of Epidemiology, Graduate School, of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ayushi A Divecha
- Department of Epidemiology, Graduate School, of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrea L Metti
- Department of Epidemiology, Graduate School, of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Caterina Rosano
- Department of Epidemiology, Graduate School, of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Best JR, Liu-Ambrose T, Metti AL, Rosso AL, Satterfield S, Studenski S, Newman AB, Rosano C. Longitudinal Associations Between Walking Speed and Amount of Self-reported Time Spent Walking Over a 9-Year Period in Older Women and Men. J Gerontol A Biol Sci Med Sci 2019; 73:1265-1271. [PMID: 28977349 DOI: 10.1093/gerona/glx129] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/21/2017] [Indexed: 01/06/2023] Open
Abstract
Background Age-related limitations in mobility and decreased physical activity appear to be linked cross-sectionally; however, large-scale, longitudinal analyses of the associations between age-related changes in mobility and engagement in physical activity are lacking. In this longitudinal study, we hypothesized that early mobility limitations would contribute to later decreases in physical activity to a larger degree than the reciprocal association of early decreases in physical activity to later mobility limitations. Methods Participants were 2,876 initially well-functioning community-dwelling older adults (aged 70-79 years at baseline; 52% women; 39% black) studied over a 9-year period. Usual walking speed and self-reported physical activity (based on minutes per week of walking) were assessed at Years 0 (ie, baseline), 4, and 9. A cross-lagged, longitudinal model assessed the bidirectional associations between walking speed and physical activity over time. Results Early change in walking speed between Years 0 and 4 predicted late change in physical activity between Years 4 and 9 (β = .13 p < .001). However, early change in physical activity did not predict late change in walking speed (β = -.01, p = .79). The difference between these two predictive associations was highly significant (p < .001). Associations were independent of baseline demographic and physical health variables, as well as longitudinal changes in grip and quadriceps strength. Conclusions The results suggest declining walking speed as a precursor to declining engagement in physical activity, but the converse association was not evident. Improving walking speed may be a method to increase physical activity among elderly individuals.
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Affiliation(s)
- John R Best
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, British Columbia, Canada
| | - Andrea L Metti
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Andrea L Rosso
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Stephanie Studenski
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
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Rosso AL, Metti AL, Faulkner K, Brach JS, Studenski SA, Redfern M, Rosano C. Associations of Usual Pace and Complex Task Gait Speeds With Incident Mobility Disability. J Am Geriatr Soc 2019; 67:2072-2076. [PMID: 31318048 DOI: 10.1111/jgs.16049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND/OBJECTIVES To assess whether gait speed under complex conditions predicts long-term risk for mobility disability as well as or better than usual-pace gait speed. DESIGN Longitudinal cohort study. SETTING/PARTICIPANTS Subsample of Health Aging and Body Composition study with follow-up from 2002 to 2003 to 2010 to 2011, including 337 community-dwelling adults (mean age = 78.5 years, 50.7% female, 26.1% black). MEASUREMENTS Associations of gait speed measured under usual-pace, fast-pace, dual-task, and narrow-path conditions with mobility disability, defined by any self-reported difficulty walking ¼ mile assessed annually, were tested by Cox proportional hazard models adjusted for demographic and health characteristics. Models were fitted for each walking condition, and R2 statistics were used to compare predictive value across models. Models were repeated for persistent mobility disability, defined as at least two consecutive years of mobility disability. RESULTS Mobility disability occurred in 204 (60.5%) participants over the 8-year follow-up. There was a lower hazard of developing mobility disability with faster gait speed under all conditions. Hazard ratios, confidence intervals, and R2 of gait speed predicting mobility disability were similar across all four walking conditions (R2 range = 0.22-0.27), but were strongest for dual-task gait speed (hazard ratio [95% confidence interval], R2 of fully adjusted models = 0.81 [0.75-0.88], 0.27). Results were comparable for persistent mobility disability (R2 range = 0.26-0.28). CONCLUSION Slower gait speed under both usual-pace and complex conditions may be a clinical indicator of future risk of mobility disability. These results support the call for increased use of gait speed measures in routine geriatric care. J Am Geriatr Soc 67:2072-2076, 2019.
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Affiliation(s)
- Andrea L Rosso
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrea L Metti
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kimberly Faulkner
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jennifer S Brach
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stephanie A Studenski
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mark Redfern
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Massa RE, Rosso A, Metti AL, Sparto PJ, Aizenstein H, Ferrucci L, Divecha A, Rosano C. Neuroimaging correlates of lateral postural control in older ambulatory adults. Aging Clin Exp Res 2019; 31:611-619. [PMID: 30168099 DOI: 10.1007/s40520-018-1028-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/17/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND In older adults, impaired postural control contributes to falls, a major source of morbidity. Understanding central mechanisms may help identify individuals at risk for impaired postural control. AIMS To determine the relationship between gray matter volume (GMV), white matter hyperintensities (WMH), mean diffusivity (MD), and fractional anisotropy (FA) with lateral postural control. METHODS Neuroimaging and postural control were assessed in 193 community-dwelling older adults (mean age 82, 55.4% female, 44.6% black). GMV, WMH, and diffusion tensor-derived markers of microstructure (MD and FA) were quantified for total brain and regions of interest. Lateral postural control was defined as the root mean square error (RMSE) of lateral sway during a visual feedback test. Associations were assessed with linear regression, adjusted for total brain atrophy and risk factors for impaired postural control. RESULTS RMSE was higher for women than men (p < 0.001) and inversely correlated with gait speed (r = - 0.20, p = 0.01), modified mini-mental state (r = - 0.27, p < 0.001), digit symbol substitution test (r = - 0.20, p = 0.01) and quadriceps strength (r = - 0.18, p = 0.01). RMSE was inversely associated with GMV of bilateral precuneus (r = - 0.26, p = 0.01) and FA of corpus callosum and selected tracts in the right hemisphere (anterior thalamic radiation, cingulum, inferior longitudinal and fronto-occipital fasciculi), independent of covariates (r = - 0.34 to - 0.18, p ≤ 0.04). DISCUSSION Lower GMV and microstructural white matter integrity in selected networks can explain worse lateral postural control in older ambulatory adults without neurologic diseases. CONCLUSION Neuroimaging markers of poor postural control in healthy aging may help identify increased fall risk and design preventative fall strategies.
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Metti AL, Best JR, Shaaban CE, Ganguli M, Rosano C. Longitudinal changes in physical function and physical activity in older adults. Age Ageing 2018; 47:558-564. [PMID: 29546417 PMCID: PMC6693378 DOI: 10.1093/ageing/afy025] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 01/11/2018] [Accepted: 02/21/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND physical function (PF) and physical activity (PA) both decline as adults age and have been linked to negative outcomes, including dementia, depression and cardiovascular diseases. Although declines in each are associated with numerous negative outcomes, the longitudinal relationship between these two measures is unclear. OBJECTIVE to examine the dynamic, bidirectional associations between declines in PF and PA. DESIGN prospective cohort. SETTING the Monongahela-Youghiogheny Healthy Aging Team (MYHAT) study. SUBJECTS about 1,404 men and women, 76.96 ± 7.2 years, 62.4% female and 95.2% white. METHODS over nine annual assessment cycles, PF was evaluated via the timed Up-and-Go task and PA via a self-reported questionnaire. Piecewise latent growth models examined bidirectional associations between PA and PF to determine whether the initial values (intercept) or early slope (cycles 1-5) (in either PF or PA) predicted later slope (cycles 5-9) (in either PF or PA). RESULTS initial PF significantly predicted early (standardised β= -0.10, P < 0.001) and later (standardised β= -0.09, P = 0.01) PA slopes. Initial PA significantly predicted later (standardised β = -0.09, P = 0.04) but not early PF slope. Associations were independent of baseline memory test scores, baseline cognitive status, later cognitive status and age. Early physical function slope neither predicts later PA slope nor did early PA slope predict later PF slope (both P values >0.10). CONCLUSIONS the relationship between PF and PA is bidirectional, with PF more consistently predicting declines of PA, both in the short- and long-term. Intervening on PF impairments may improve PA engagement, which could in turn promote PF and translate to beneficial effects on cognitive function, cardiovascular health and mood.
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Affiliation(s)
- Andrea L Metti
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - John R Best
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - C Elizabeth Shaaban
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary Ganguli
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Nunley KA, Metti AL, Klein R, Klein BE, Saxton JA, Orchard TJ, Costacou T, Aizenstein HJ, Rosano C. Long-term changes in retinal vascular diameter and cognitive impairment in type 1 diabetes. Diab Vasc Dis Res 2018; 15:223-232. [PMID: 29488397 DOI: 10.1177/1479164118758581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To assess associations between cognitive impairment and longitudinal changes in retinal microvasculature, over 18 years, in adults with type 1 diabetes. RESEARCH DESIGN AND METHODS Participants of the Pittsburgh Epidemiology of Diabetes Complications Study received ≥3 fundus photographs between baseline (1986-1988) and time of cognitive assessment (2010-2015: N = 119; 52% male; mean age and type 1 diabetes duration 43 and 34 years, respectively). Central retinal arteriolar equivalent and central retinal venular equivalent were estimated via computer-based methods; overall magnitude and speed of narrowing were quantified as cumulative average and slope, respectively. Median regression models estimated associations of central retinal arteriolar equivalent and central retinal venular equivalent measures with cognitive impairment status, adjusted for type 1 diabetes duration. Interactions with HbA1c, proliferative retinopathy and white matter hyperintensities were assessed. RESULTS Compared with participants without cognitive impairment, those with clinically relevant cognitive impairment experienced 1.8% greater and 31.1% faster central retinal arteriolar equivalent narrowing during prior years (t = -2.93, p = 0.004 and t = -3.97, p < 0.0001, respectively). Interactions with HbA1c, proliferative retinopathy and white matter hyperintensities were not significant. No associations were found between central retinal arteriolar equivalent at baseline, at time of cognitive testing, or any central retinal venular equivalent measures, and cognitive impairment. CONCLUSION Long-term arterial retinal changes could indicate type 1 diabetes-related cognitive impairment. Studies examining longitudinal central retinal arteriolar equivalent changes as early biomarkers of cognitive impairment risk are warranted.
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Affiliation(s)
- Karen A Nunley
- 1 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrea L Metti
- 1 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ronald Klein
- 2 Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Barbara E Klein
- 2 Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Judith A Saxton
- 3 Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Trevor J Orchard
- 1 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tina Costacou
- 1 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Howard J Aizenstein
- 4 Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Caterina Rosano
- 1 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Rosso AL, Metti AL, Glynn NW, Boudreau RM, Rejeski WJ, Bohnen N, Chen H, Johannsen NM, King AC, Manini TM, Pahor M, Studenski SA, Fragoso CAV, Rosano C. Dopamine-Related Genotypes and Physical Activity Change During an Intervention: The Lifestyle Interventions and Independence for Elders Study. J Am Geriatr Soc 2018; 66:1172-1179. [PMID: 29637543 DOI: 10.1111/jgs.15369] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To determine whether intervention-induced physical activity (PA) changes in sedentary older adults differed according to dopamine-related genotype. DESIGN Randomized clinical trial (Lifestyle Interventions and Independence for Elders Trial (2010-13)). SETTING Multicenter study, 8 U.S. LOCATIONS PARTICIPANTS Volunteer sample of sedentary adults aged 70 to 89 at risk of disability (N=1635). INTERVENTIONS Structured PA versus health education (HE) for an average of 2.6 years. MEASUREMENTS Single-nucleotide polymorphisms of dopamine-related genes (dopamine receptor (DR) D1, DRD2, DRD3, and catechol-O-methyltransferase (COMT)) were assessed. Average moderate to vigorous PA (MVPA) was calculated using accelerometry (min/d) at baseline and 6, 12, and 24 months. Between-arm MVPA differences according to genotype and genotype with square root-transformed MVPA separately according to arm were tested, stratified according to race, and adjusted for multiple comparisons. RESULTS White participants in the PA arm (n=513) had higher average square root transformed MVPA (4.91±1.91)than those in the HE arm (n=538) (4.51±1.82) (p=.001). Between-arm differences were greater for DRD2 Met/Met (high dopamine; HE: 4.76±1.80, PA: 5.53±1.60, p=.03) than Val/Val (low dopamine; HE: 4.58±1.92, PA: 4.81±1.83, p=.16); results were similar for COMT. In the PA arm, DRD2 Met/Met was associated with higher average MVPA (5.39±2.00) than Met/Val (4.46±2.51) (p=.01) and Val/Val (4.65±2.71) (p=.01). There were no associations for other genes. Associations were not significant in blacks but followed similar trends. CONCLUSION Higher dopamine signaling may support changes in PA during an intervention. The role of dopamine-related pathways in promoting PA participation and enhancing response to interventions in sedentary older adults should be studied. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01072500.
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Affiliation(s)
- Andrea L Rosso
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrea L Metti
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nancy W Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Nicolaas Bohnen
- Department of Neurology, University of Michigan, Ann Arbor, Michigan.,Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Haiying Chen
- Department of Biostatistical Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Neil M Johannsen
- School of Kinesiology, Louisiana State University, Baton Rouge, Louisiana
| | - Abby C King
- Department of Health Research and Policy, Stanford University, Palo Alto, California
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | | | - Carlos A Vaz Fragoso
- Department of Geriatrics, School of Medicine, Yale University, New Haven, Connecticut
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Rosso AL, Metti AL, Boudreau RM, Glynn NW, Rejeski WJ, Rosano C. [O3–11–02]: DOPAMINE‐RELATED GENES AND SUSTAINED PHYSICAL ACTIVITY ADHERENCE IN ADULTS AT RISK FOR DEMENTIA. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.07.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Andrea L. Rosso
- University of PittsburghPittsburghPAUSA
- Wake Forest UniversityWinston‐SalemNCUSA
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Rosso AL, Verghese J, Metti AL, Boudreau RM, Aizenstein HJ, Kritchevsky S, Harris T, Yaffe K, Satterfield S, Studenski S, Rosano C. Slowing gait and risk for cognitive impairment: The hippocampus as a shared neural substrate. Neurology 2017; 89:336-342. [PMID: 28659421 DOI: 10.1212/wnl.0000000000004153] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 04/24/2017] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To identify the shared neuroimaging signature of gait slowing and cognitive impairment. METHODS We assessed a cohort of older adults (n = 175, mean age 73 years, 57% female, 65% white) with repeated measures of gait speed over 14 years, MRI for gray matter volume (GMV) at year 10 or 11, and adjudicated cognitive status at year 14. Gait slowing was calculated by bayesian slopes corrected for intercepts, with higher values indicating faster decline. GMV was normalized to intracranial volume, with lower values indicating greater atrophy for 10 regions of interest (hippocampus, anterior and posterior cingulate, primary and supplementary motor cortices, posterior parietal lobe, middle frontal lobe, caudate, putamen, pallidum). Nonparametric correlations adjusted for demographics, comorbidities, muscle strength, and knee pain assessed associations of time to walk with GMV. Logistic regression models calculated odds ratios (ORs) of gait slowing with dementia or mild cognitive impairment with and without adjustment for GMV. RESULTS Gait slowing was associated with cognitive impairment at year 14 (OR per 0.1 s/y slowing 1.47; 95% confidence interval 1.04-2.07). The right hippocampus was the only region that was related to both gait slowing (ρ = -0.16, p = 0.03) and cognitive impairment (OR 0.17, p = 0.009). Adjustment for right hippocampal volume attenuated the association of gait slowing with cognitive impairment by 23%. CONCLUSIONS The association between gait slowing and cognitive impairment is supported by a shared neural substrate that includes a smaller right hippocampus. This finding underscores the value of long-term gait slowing as an early indicator of dementia risk.
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Affiliation(s)
- Andrea L Rosso
- From the Department of Epidemiology (A.L.R., A.L.M., R.M.B., C.R.), School of Public Health, and Departments of Psychiatry and Bioengineering (H.J.A.), University of Pittsburgh, PA; Department of Neurology and Medicine (J.V.), Albert Einstein College of Medicine, Bronx, NY; Sticht Center for Healthy Aging and Alzheimer's Prevention (S.B.K.), Wake Forest School of Medicine, Winston-Salem, NC; Laboratory of Epidemiology and Population Sciences (T.B.H.), IRP, National Institute on Aging, NIH, Bethesda, MD; Departments of Psychiatry, Neurology, and Epidemiology (K.Y.), University of California, San Francisco; Department of Preventive Medicine (S. Satterfield), University of Tennessee Health Science Center, Memphis; and Longitudinal Studies Section (S. Studenski), National Institute on Aging, Baltimore, MD.
| | - Joe Verghese
- From the Department of Epidemiology (A.L.R., A.L.M., R.M.B., C.R.), School of Public Health, and Departments of Psychiatry and Bioengineering (H.J.A.), University of Pittsburgh, PA; Department of Neurology and Medicine (J.V.), Albert Einstein College of Medicine, Bronx, NY; Sticht Center for Healthy Aging and Alzheimer's Prevention (S.B.K.), Wake Forest School of Medicine, Winston-Salem, NC; Laboratory of Epidemiology and Population Sciences (T.B.H.), IRP, National Institute on Aging, NIH, Bethesda, MD; Departments of Psychiatry, Neurology, and Epidemiology (K.Y.), University of California, San Francisco; Department of Preventive Medicine (S. Satterfield), University of Tennessee Health Science Center, Memphis; and Longitudinal Studies Section (S. Studenski), National Institute on Aging, Baltimore, MD
| | - Andrea L Metti
- From the Department of Epidemiology (A.L.R., A.L.M., R.M.B., C.R.), School of Public Health, and Departments of Psychiatry and Bioengineering (H.J.A.), University of Pittsburgh, PA; Department of Neurology and Medicine (J.V.), Albert Einstein College of Medicine, Bronx, NY; Sticht Center for Healthy Aging and Alzheimer's Prevention (S.B.K.), Wake Forest School of Medicine, Winston-Salem, NC; Laboratory of Epidemiology and Population Sciences (T.B.H.), IRP, National Institute on Aging, NIH, Bethesda, MD; Departments of Psychiatry, Neurology, and Epidemiology (K.Y.), University of California, San Francisco; Department of Preventive Medicine (S. Satterfield), University of Tennessee Health Science Center, Memphis; and Longitudinal Studies Section (S. Studenski), National Institute on Aging, Baltimore, MD
| | - Robert M Boudreau
- From the Department of Epidemiology (A.L.R., A.L.M., R.M.B., C.R.), School of Public Health, and Departments of Psychiatry and Bioengineering (H.J.A.), University of Pittsburgh, PA; Department of Neurology and Medicine (J.V.), Albert Einstein College of Medicine, Bronx, NY; Sticht Center for Healthy Aging and Alzheimer's Prevention (S.B.K.), Wake Forest School of Medicine, Winston-Salem, NC; Laboratory of Epidemiology and Population Sciences (T.B.H.), IRP, National Institute on Aging, NIH, Bethesda, MD; Departments of Psychiatry, Neurology, and Epidemiology (K.Y.), University of California, San Francisco; Department of Preventive Medicine (S. Satterfield), University of Tennessee Health Science Center, Memphis; and Longitudinal Studies Section (S. Studenski), National Institute on Aging, Baltimore, MD
| | - Howard J Aizenstein
- From the Department of Epidemiology (A.L.R., A.L.M., R.M.B., C.R.), School of Public Health, and Departments of Psychiatry and Bioengineering (H.J.A.), University of Pittsburgh, PA; Department of Neurology and Medicine (J.V.), Albert Einstein College of Medicine, Bronx, NY; Sticht Center for Healthy Aging and Alzheimer's Prevention (S.B.K.), Wake Forest School of Medicine, Winston-Salem, NC; Laboratory of Epidemiology and Population Sciences (T.B.H.), IRP, National Institute on Aging, NIH, Bethesda, MD; Departments of Psychiatry, Neurology, and Epidemiology (K.Y.), University of California, San Francisco; Department of Preventive Medicine (S. Satterfield), University of Tennessee Health Science Center, Memphis; and Longitudinal Studies Section (S. Studenski), National Institute on Aging, Baltimore, MD
| | - Stephen Kritchevsky
- From the Department of Epidemiology (A.L.R., A.L.M., R.M.B., C.R.), School of Public Health, and Departments of Psychiatry and Bioengineering (H.J.A.), University of Pittsburgh, PA; Department of Neurology and Medicine (J.V.), Albert Einstein College of Medicine, Bronx, NY; Sticht Center for Healthy Aging and Alzheimer's Prevention (S.B.K.), Wake Forest School of Medicine, Winston-Salem, NC; Laboratory of Epidemiology and Population Sciences (T.B.H.), IRP, National Institute on Aging, NIH, Bethesda, MD; Departments of Psychiatry, Neurology, and Epidemiology (K.Y.), University of California, San Francisco; Department of Preventive Medicine (S. Satterfield), University of Tennessee Health Science Center, Memphis; and Longitudinal Studies Section (S. Studenski), National Institute on Aging, Baltimore, MD
| | - Tamara Harris
- From the Department of Epidemiology (A.L.R., A.L.M., R.M.B., C.R.), School of Public Health, and Departments of Psychiatry and Bioengineering (H.J.A.), University of Pittsburgh, PA; Department of Neurology and Medicine (J.V.), Albert Einstein College of Medicine, Bronx, NY; Sticht Center for Healthy Aging and Alzheimer's Prevention (S.B.K.), Wake Forest School of Medicine, Winston-Salem, NC; Laboratory of Epidemiology and Population Sciences (T.B.H.), IRP, National Institute on Aging, NIH, Bethesda, MD; Departments of Psychiatry, Neurology, and Epidemiology (K.Y.), University of California, San Francisco; Department of Preventive Medicine (S. Satterfield), University of Tennessee Health Science Center, Memphis; and Longitudinal Studies Section (S. Studenski), National Institute on Aging, Baltimore, MD
| | - Kristine Yaffe
- From the Department of Epidemiology (A.L.R., A.L.M., R.M.B., C.R.), School of Public Health, and Departments of Psychiatry and Bioengineering (H.J.A.), University of Pittsburgh, PA; Department of Neurology and Medicine (J.V.), Albert Einstein College of Medicine, Bronx, NY; Sticht Center for Healthy Aging and Alzheimer's Prevention (S.B.K.), Wake Forest School of Medicine, Winston-Salem, NC; Laboratory of Epidemiology and Population Sciences (T.B.H.), IRP, National Institute on Aging, NIH, Bethesda, MD; Departments of Psychiatry, Neurology, and Epidemiology (K.Y.), University of California, San Francisco; Department of Preventive Medicine (S. Satterfield), University of Tennessee Health Science Center, Memphis; and Longitudinal Studies Section (S. Studenski), National Institute on Aging, Baltimore, MD
| | - Suzanne Satterfield
- From the Department of Epidemiology (A.L.R., A.L.M., R.M.B., C.R.), School of Public Health, and Departments of Psychiatry and Bioengineering (H.J.A.), University of Pittsburgh, PA; Department of Neurology and Medicine (J.V.), Albert Einstein College of Medicine, Bronx, NY; Sticht Center for Healthy Aging and Alzheimer's Prevention (S.B.K.), Wake Forest School of Medicine, Winston-Salem, NC; Laboratory of Epidemiology and Population Sciences (T.B.H.), IRP, National Institute on Aging, NIH, Bethesda, MD; Departments of Psychiatry, Neurology, and Epidemiology (K.Y.), University of California, San Francisco; Department of Preventive Medicine (S. Satterfield), University of Tennessee Health Science Center, Memphis; and Longitudinal Studies Section (S. Studenski), National Institute on Aging, Baltimore, MD
| | - Stephanie Studenski
- From the Department of Epidemiology (A.L.R., A.L.M., R.M.B., C.R.), School of Public Health, and Departments of Psychiatry and Bioengineering (H.J.A.), University of Pittsburgh, PA; Department of Neurology and Medicine (J.V.), Albert Einstein College of Medicine, Bronx, NY; Sticht Center for Healthy Aging and Alzheimer's Prevention (S.B.K.), Wake Forest School of Medicine, Winston-Salem, NC; Laboratory of Epidemiology and Population Sciences (T.B.H.), IRP, National Institute on Aging, NIH, Bethesda, MD; Departments of Psychiatry, Neurology, and Epidemiology (K.Y.), University of California, San Francisco; Department of Preventive Medicine (S. Satterfield), University of Tennessee Health Science Center, Memphis; and Longitudinal Studies Section (S. Studenski), National Institute on Aging, Baltimore, MD
| | - Caterina Rosano
- From the Department of Epidemiology (A.L.R., A.L.M., R.M.B., C.R.), School of Public Health, and Departments of Psychiatry and Bioengineering (H.J.A.), University of Pittsburgh, PA; Department of Neurology and Medicine (J.V.), Albert Einstein College of Medicine, Bronx, NY; Sticht Center for Healthy Aging and Alzheimer's Prevention (S.B.K.), Wake Forest School of Medicine, Winston-Salem, NC; Laboratory of Epidemiology and Population Sciences (T.B.H.), IRP, National Institute on Aging, NIH, Bethesda, MD; Departments of Psychiatry, Neurology, and Epidemiology (K.Y.), University of California, San Francisco; Department of Preventive Medicine (S. Satterfield), University of Tennessee Health Science Center, Memphis; and Longitudinal Studies Section (S. Studenski), National Institute on Aging, Baltimore, MD
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Metti AL, Rosano C, Boudreau R, Massa R, Yaffe K, Satterfield S, Harris T, Rosso AL. Catechol-O-Methyltransferase Genotype and Gait Speed Changes over 10 Years in Older Adults. J Am Geriatr Soc 2017. [PMID: 28640434 DOI: 10.1111/jgs.14980] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the association between catechol-O-methyltransferase (COMT) genotype and 6-m walk time and to determine whether these associations are quadratic in nature, similar to previously reported U-shaped associations between dopamine and gait and cognition. DESIGN Prospective cohort study. SETTING Health, Aging and Body Composition Study. PARTICIPANTS Black (n = 850) and white (n = 1,352) men and women with a mean age of 73.5 ± 2.85 at baseline. MEASUREMENTS Mixed models were used to assess the association between the COMT genotype and 6-m walk time, cross-sectionally and longitudinally over 10 years. Models were assessed unstratified and stratified according to race because allele distributions were different between white and black participants. RESULTS There was a significant U-shaped association between COMT genotype and 6-m walk time: those with higher (Val/Val) and lower (Met/Met) dopamine slowed more over 10 years (0.22 ± 0.02 seconds per visit and 0.23 ± 0.02 seconds per visit, respectively) than those with the intermediate (Met/Val) dopamine (0.20 ± 0.02 seconds per visit) (P = .005). Stratified results showed a significant relationship in black (P = .01) but not white (P = .15) participants. CONCLUSION These findings indicate a role of dopaminergic regulation of gait speed in community-dwelling older adults and of prefrontal cortex involvement in gait performance. Future work should investigate the molecular integrity of dopaminergic networks and gait changes over time and structural changes in the brain with COMT and gait decline in older adults.
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Affiliation(s)
- Andrea L Metti
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robyn Massa
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kristine Yaffe
- Department of Psychiatry, University of California San Francisco, San Francisco, California.,Department of Neurology, University of California San Francisco, San Francisco, California.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee at Memphis, Memphis, Tennessee
| | - Tamara Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, Maryland
| | - Andrea L Rosso
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Rao AS, Scher AI, Vieira RVA, Merikangas KR, Metti AL, Peterlin BL. The Impact of Post-Traumatic Stress Disorder on the Burden of Migraine: Results From the National Comorbidity Survey-Replication. Headache 2015; 55:1323-41. [PMID: 26473981 DOI: 10.1111/head.12698] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) has been linked with migraine in prior studies. OBJECTIVE To evaluate the individual and joint burdens of migraine and PTSD in a population-based cohort. METHODS The National Comorbidity Survey-Replication (NCS-R) is a general population study conducted in the United States from February 2001-April 2003. PTSD and migraine were assessed, and four groups defined based on their migraine and PTSD status. The four groups included those with no migraine and no PTSD (controls, n=4535), those with migraine and without PTSD (migraine alone, n=236), those with PTSD and without migraine (PTSD alone, n=244), and those with both migraine and PTSD (mig+PTSD, n=68). Logistic and Poisson regression models were used to assess the association between dichotomous/multilevel outcome variables indicating financial, health, and interpersonal burdens and each migraine/PTSD group. RESULTS Compared to controls, those with Mig+PTSD were more likely to be in the low poverty index (48% vs 41%, AOR 2.16; CI: 1.10, 4.24) and were less likely to be working for pay or profit in the past week (50% vs 68%, AOR 0.42; CI: 0.24, 0.74) but not those with migraine or PTSD alone. Additionally, the number of days where work quality was cut due to physical or mental health or substance abuse in the past month was greater in all groups compared to controls: (1) migraine alone: mean 2.57 (SEM 0.32) vs mean 1.09 (SEM 0.08) days, ARR=2.39; CI: 2.19, 2.62; (2) PTSD alone: mean 2.43 (SEM 0.33) vs mean 1.09 (SEM 0.08) days, ARR=2.09; CI: 1.91, 2.29; (3) mig+PTSD: mean 8.2 (SEM 0.79) vs 1.09 (SEM 0.08) days, ARR 6.79; CI 6.16, 7.49; and was over 2.5-fold greater in those mig+PTSD than migraine alone (mean 8.0 [SEM 0.79] vs 2.6 days [SEM 0.72], ARR 2.77; CI: 2.45, 3.14). The likelihood of having difficulty getting along or maintaining a social life was also increased in all groups relative to controls: (1) migraine alone: 21% vs 5.4%, AOR 4.20; CI: 2.62, 6.74; (2) PTSD alone: 18% vs 5.4%, AOR 3.40; CI: 2.40, 4.82; (3) Mig+PTSD: 39% vs 5.4%, AOR 9.95; CI: 5.72, 17.32, and was 2-fold greater in those with Mig+PTSD as compared to those with migraine alone (AOR 2.32; CI: 1.15, 4.69). CONCLUSIONS These findings support the need for those who treat migraine patients to be aware of the comorbidity with PTSD, as these patients may be particularly prone to adverse financial, health, and interpersonal disease burdens.
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Affiliation(s)
- Aruna S Rao
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ann I Scher
- Uniformed Services University, Bethesda, MD, USA
| | - Rebeca V A Vieira
- Department of Psychology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Kathleen R Merikangas
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | | | - B Lee Peterlin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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15
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Metti AL, Aizenstein H, Yaffe K, Boudreau RM, Newman A, Launer L, Gianaros PJ, Lopez OL, Saxton J, Ives DG, Kritchevsky S, Vallejo AN, Rosano C. Trajectories of peripheral interleukin-6, structure of the hippocampus, and cognitive impairment over 14 years in older adults. Neurobiol Aging 2015; 36:3038-3044. [PMID: 26279115 DOI: 10.1016/j.neurobiolaging.2015.07.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/20/2015] [Accepted: 07/22/2015] [Indexed: 01/21/2023]
Abstract
We aimed to investigate if trajectory components (baseline level, slope, and variability) of peripheral interleukin-6 (IL-6) over time were related to cognitive impairment and smaller hippocampal volume and if hippocampal volume explained the associations between IL-6 and cognitive impairment. Multivariable regression models were used to test the association between IL-6 trajectory components with change in neuroimaging measures of the hippocampus and with cognitive impairment among 135 older adults (70-79 years at baseline) from the Healthy Brain Project over 14 years. IL-6 variability was positively associated with cognitive impairment (odds ratio [OR] = 5.86, 95% confidence interval [CI]: 1.24, 27.61) and with greater decrease per year of gray matter volume of the hippocampus (β = -0.008, standard error = 0.004, p = 0.03). After adjustment for hippocampal volume, the OR of cognitive impairment decreased for each unit of IL-6 variability and CIs widened (OR = 4.36, 95% CI: 0.67, 28.29). Neither baseline levels nor slopes of IL-6 were related to cognitive impairment or hippocampal volume. We believe this has potential clinical and public health implications by suggesting adults with stable levels of peripheral IL-6 may be better targets for intervention studies for slowing or preventing cognitive decline.
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Affiliation(s)
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kristine Yaffe
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; Department of Neurology, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anne Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lenore Launer
- Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, MD, USA
| | - Peter J Gianaros
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Oscar L Lopez
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Judith Saxton
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Diane G Ives
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephen Kritchevsky
- Department of Internal Medicine, Wake Forest University, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Abbe N Vallejo
- Division of Pediatric Rheumatology, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA; Department of Pediatrics and Immunology, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Kaup AR, Nettiksimmons J, Harris TB, Sink KM, Satterfield S, Metti AL, Ayonayon HN, Yaffe K. Cognitive resilience to apolipoprotein E ε4: contributing factors in black and white older adults. JAMA Neurol 2015; 72:340-8. [PMID: 25599330 DOI: 10.1001/jamaneurol.2014.3978] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Apolipoprotein E (APOE) ε4 is an established risk factor for cognitive decline and the development of dementia, but other factors may help to minimize its effects. OBJECTIVE Using APOE ε4 as an indicator of high risk, we investigated factors associated with cognitive resilience among black and white older adults who are APOE ε4 carriers. DESIGN, SETTING, AND PARTICIPANTS Participants included 2487 community-dwelling older (aged 69-80 years at baseline) black and white adults examined at 2 community clinics in the prospective cohort Health, Aging, and Body Composition (Health ABC) study. The baseline visits occurred from May 1997 through June 1998. Our primary analytic cohort consisted of 670 APOE ε4 carriers (329 black and 341 white participants) who were free of cognitive impairment at baseline and underwent repeated cognitive testing during an 11-year follow-up (through 2008) using the Modified Mini-Mental State Examination. MAIN OUTCOMES AND MEASURES We stratified all analyses by race. Using the Modified Mini-Mental State Examination scores, we assessed normative cognitive change in the entire cohort (n = 2487) and classified the APOE ε4 carriers as being cognitively resilient vs nonresilient by comparing their cognitive trajectories with those of the entire cohort. We then conducted bivariate analyses and multivariable random forest and logistic regression analyses to explore factors predictive of cognitive resilience in APOE ε4 carriers. RESULTS Among white APOE ε4 carriers, the strongest predictors of cognitive resilience were, in relative order of importance, no recent negative life events, a higher literacy level, advanced age, a higher educational level, and more time spent reading. Among black APOE ε4 carriers, the strongest predictors of cognitive resilience were, in relative order of importance, a higher literacy level, a higher educational level, female sex, and the absence of diabetes mellitus. In follow-up logistic regression models, higher literacy level (adjusted odds ratio [OR], 9.50 [95% CI, 2.67-60.89]), a higher educational level (adjusted OR for college graduate vs less than high school, 3.81 [95% CI, 1.13-17.56]), and age (adjusted OR for 73-76 vs 69-72 years, 2.01 [95% CI, 1.13-3.63]) had significant independent effects in predicting cognitive resilience among white APOE ε4 carriers. Among black APOE ε4 carriers, a higher literacy level (adjusted OR, 2.27 [95% CI, 1.29-4.06]) and a higher educational level (adjusted OR for high school graduate/some college vs less than high school, 2.86 [95% CI, 1.54-5.49]; adjusted OR for college graduate vs less than high school, 2.52 [95% CI, 1.14-5.62]) had significant independent effects in predicting cognitive resilience. CONCLUSIONS AND RELEVANCE Although APOE ε4 carriers are at high risk for cognitive decline, our findings suggest possible intervention targets, including the enhancement of cognitive reserve and improvement of other psychosocial and health factors, to promote cognitive resilience among black and white APOE ε4 carriers.
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Affiliation(s)
- Allison R Kaup
- Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, California2Department of Psychiatry, University of California, San Francisco
| | | | - Tamara B Harris
- Laboratory of Epidemiology and Populations Science, Intramural Research Program, National Institute on Aging, Bethesda, Maryland
| | - Kaycee M Sink
- Section on Gerontology and Geriatric Medicine, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Andrea L Metti
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hilsa N Ayonayon
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Kristine Yaffe
- Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, California2Department of Psychiatry, University of California, San Francisco7Department of Epidemiology and Biostatistics
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Kaup AR, Simonsick EM, Harris TB, Satterfield S, Metti AL, Ayonayon HN, Rubin SM, Yaffe K. Older adults with limited literacy are at increased risk for likely dementia. J Gerontol A Biol Sci Med Sci 2014; 69:900-6. [PMID: 24158765 PMCID: PMC4067115 DOI: 10.1093/gerona/glt176] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/06/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Low literacy is common among the elderly and possibly more reflective of educational attainment than years of school completed. We examined the association between literacy and risk of likely dementia in older adults. METHODS Participants were 2,458 black and white elders (aged 71-82) from the Health, Aging and Body Composition study, who completed the Rapid Estimate of Adult Literacy in Medicine and were followed for 8 years. Participants were free of dementia at baseline; incidence of likely dementia was defined by hospital records, prescription for dementia medication, or decline in Modified Mini-Mental State Examination score. We conducted Cox proportional hazard models to evaluate the association between literacy and incidence of likely dementia. Demographics, education, income, comorbidities, lifestyle variables, and apolipoprotein E (APOE) ε4 status were included in adjusted analyses. RESULTS Twenty-three percent of participants had limited literacy (<9th-grade level). Limited literacy, as opposed to adequate literacy (≥9th-grade level), was associated with greater incidence of likely dementia (25.5% vs17.0%; unadjusted hazard ratio [HR] = 1.75, 95% confidence interval 1.44-2.13); this association remained significant after adjustment. There was a trend for an interaction between literacy and APOE ε4 status (p = .07); the association between limited literacy and greater incidence of likely dementia was strong among ε4 noncarriers (unadjusted HR = 1.85) but nonsignificant among ε4 carriers (unadjusted HR = 1.25). CONCLUSIONS Limited literacy is an important risk factor for likely dementia, especially among APOE ε4-negative older adults, and may prove fruitful to target in interventions aimed at reducing dementia risk.
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Affiliation(s)
- Allison R Kaup
- Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco VA Medical Center, California. Department of Psychiatry, University of California San Francisco.
| | - Eleanor M Simonsick
- National Institute on Aging, Translational Gerontology Branch, Harbor Hospital, Baltimore, Maryland
| | - Tamara B Harris
- Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, Maryland
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Andrea L Metti
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | | | | | - Kristine Yaffe
- Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco VA Medical Center, California. Department of Psychiatry, University of California San Francisco. Department of Epidemiology and Biostatistics and Department of Neurology, University of California San Francisco
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18
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Metti AL, Yaffe K, Boudreau RM, Simonsick EM, Carnahan RM, Satterfield S, Harris TB, Ayonayon HN, Rosano C, Cauley JA. Trajectories of inflammatory markers and cognitive decline over 10 years. Neurobiol Aging 2014; 35:2785-2790. [PMID: 24997674 DOI: 10.1016/j.neurobiolaging.2014.05.030] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 05/22/2014] [Accepted: 05/31/2014] [Indexed: 10/25/2022]
Abstract
We aimed to examine trajectories of inflammatory markers and cognitive decline over 10 years. Cox proportional hazards models were used to examine the association between interleukin-6 and C-reactive protein (CRP) trajectory components (slope, variability, and baseline level) and cognitive decline among 1323 adults, aged 70-79 years in the Health, Aging, and Body Composition Study. We tested for interactions by sex and apolipoprotein E (APOE) genotype. In models adjusted for multiple covariates and comorbidities, extreme CRP variability was significantly associated with cognitive decline (hazard ratio [HR] 1.6, 95% confidence interval [CI]: 1.1-2.3). This association was modified by sex and APOE e4 (p < 0.001 for both), such that the association remained among women (HR = 1.8; 95% CI: 1.1, 3.0) and among those with no APOE e4 allele (HR = 1.6; 95% CI: 1.1, 2.5). There were no significant associations between slope or baseline level of CRP and cognitive decline nor between interleukin-6 and cognitive decline. We believe CRP variability likely reflects poor control of or greater changes in vascular or metabolic disease over time, which in turn is associated with cognitive decline.
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Affiliation(s)
- Andrea L Metti
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Kristine Yaffe
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; Department of Neurology, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Ryan M Carnahan
- Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, IA, USA
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee, Memphis, TN, USA
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD, USA
| | - Hilsa N Ayonayon
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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19
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Metti AL, Yaffe K, Boudreau RM, Ganguli M, Lopez OL, Stone KL, Cauley JA. Change in inflammatory markers and cognitive status in the oldest-old women from the Study of Osteoporotic Fractures. J Am Geriatr Soc 2014; 62:662-6. [PMID: 24697580 DOI: 10.1111/jgs.12739] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the association between interleukin-6 (IL-6), IL-6 soluble receptor (sR), and soluble tumor necrosis factor receptor-1 (sTNF-R1) and cognitive status in the oldest-old women. DESIGN Twenty-year longitudinal cohort study. SETTING Four clinical sites in the United States. PARTICIPANTS Women from the Study of Osteoporotic Fractures (N = 905; mean age 88.3 ± 2.8 at cognitive status adjudication). MEASUREMENTS At Year 20, cognitive status was adjudicated as normal, mild cognitive impairment (MCI), or dementia. Inflammatory markers were measured from blood serum at Years 10 and 16 in a random sample of women. RESULTS Over 10 years, 199 (22.0%) women developed MCI and 145 (16.0%) dementia. There were no significant associations between IL-6 or sTNF-R1 and cognitive status. High IL-6-sR (≥ 37,401.36 pg/mL, highest tertile) at Year 16 was significantly associated with lower risk of dementia (odds ratio (OR) = 0.54, 95% confidence interval (CI) = 0.30-0.97) than in women with lower levels (<37,401.36 pg/mL, lower two tertiles). Women with high IL-6-sR at both time points (OR = 0.39, 95% CI = 0.17-0.89) or who transitioned to a high level (OR = 0.35, 95% CI = 0.14-0.88) had a lower risk of dementia. CONCLUSION In this cohort of white, high-functioning oldest-old women, a consistently high or an increasing level of IL-6-sR was associated with lower risk of dementia. Compared with other studies of younger-old adults, this suggests that the effect of inflammation on dementia may differ in younger-old and the oldest-old individuals. Understanding these differences will be crucial in interpreting results from ongoing clinical trials and in targeting therapeutic strategies to the oldest-old individuals.
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Affiliation(s)
- Andrea L Metti
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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20
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Hong CH, Falvey C, Harris TB, Simonsick EM, Satterfield S, Ferrucci L, Metti AL, Patel KV, Yaffe K. Anemia and risk of dementia in older adults: findings from the Health ABC study. Neurology 2013; 81:528-33. [PMID: 23902706 DOI: 10.1212/wnl.0b013e31829e701d] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To determine whether anemia is associated with incident dementia in older adults. METHODS We studied 2,552 older adults (mean age 76.1 years; 38.9% black; 51.8% female) participating in the Health, Aging, and Body Composition study and free of dementia at baseline. We defined anemia using WHO criteria (hemoglobin concentration <13 g/dL for men and <12 g/dL for women). Dementia diagnosis was determined by dementia medication use, hospital records, or a change in modified mini-mental state (3MS) score of more than 1.5 SD from mean. Discrete time Cox proportional hazard regression models were used to examine the hazard for developing dementia associated with anemia. RESULTS Of 2,552 participants, 393 (15.4%) older adults had anemia at baseline [corrected]. Over 11 years of follow-up, 455 (17.8%) participants developed dementia. In the unadjusted model, those with baseline anemia had an increased risk of dementia (23% vs. 17%, hazard ratio = 1.64; 95% confidence interval 1.30, 2.07) compared to those without anemia. The association remained significant after adjusting for demographics, APOE ε4, baseline 3MS score, comorbidities, and renal function. Additional adjustment for other anemia measures (mean corpuscular volume, red cell distribution width), erythropoietin, and C-reactive protein did not appreciably change the results. There was no interaction by sex and race on risk of developing dementia. CONCLUSION Among older adults, anemia is associated with an increased risk of developing dementia. Findings suggest that further study of anemia as a risk factor for dementia and a target for intervention for cognitive health is warranted.
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Affiliation(s)
- Chang Hyung Hong
- Department of Psychiatry and Institute on Aging, Ajou University School of Medicine, Suwon, Republic of Korea
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21
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Abstract
Dementia is a huge public health concern today owing to the exponentially increasing number of older adults it affects each year, and there has been a large number of investigators looking at potential biomarkers of dementia. Peripheral inflammatory markers have emerged as one potential class of markers that may be useful in predicting those individuals at a greater risk of developing dementia, or in expounding the underlying mechanisms or pathways of this complex disease. Although some evidence has been promising, indicating that peripheral inflammatory markers are indeed crucial in brain changes that occur in both normal aging and in dementia, results have been mixed on their usefulness for predicting dementia or cognitive decline in older adults. Here, the authors present a review of existing studies investigating inflammatory markers as potential biomarkers of dementia, highlighting some strengths and limitations of the current research and discuss the future directions for this field.
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Affiliation(s)
- Andrea L Metti
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA ; University of Pittsburgh Department of Epidemiology, Center for Aging & Population Health, 130 N Bellefield, Room 456, Pittsburgh, PA 15213, USA
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22
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Koyama A, O'Brien J, Weuve J, Blacker D, Metti AL, Yaffe K. The role of peripheral inflammatory markers in dementia and Alzheimer's disease: a meta-analysis. J Gerontol A Biol Sci Med Sci 2012; 68:433-40. [PMID: 22982688 DOI: 10.1093/gerona/gls187] [Citation(s) in RCA: 208] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies that have investigated the association between markers of inflammation and risk of dementia are conflicting. Therefore, the researchers conducted a systematic review and meta-analysis of observational studies with the hypothesis that an increased level of peripheral proinflammatory markers would be associated with risk of all-cause dementia or Alzheimer's disease (AD). METHODS The researchers conducted a literature search of observational studies indexed in the PubMed and PsycInfo databases. Selected studies included those with at least one peripheral inflammatory biomarker and its association with risk of all-cause dementia or AD. Random effects models were used to generate pooled hazard ratios (HRs) comparing the top versus bottom quantile of inflammatory marker level. Heterogeneity was assessed using the I (2) statistic. RESULTS Seven studies were identified, combining for a total 5,717 participants, 746 cases of all-cause dementia and 565 cases of AD. An increased level of C-reactive protein was associated with a 45% increased risk of all-cause dementia (HR: 1.45; 95% CI: 1.10, 1.91). Similarly, a higher level of interleukin-6 was associated with a 32% increased risk (HR: 1.32; 95% CI: 1.06, 1.64) of all-cause dementia. For AD alone, the association with C-reactive protein was less pronounced (HR: 1.21; 95% CI: 1.03, 1.42) and interleukin-6 was not associated with risk of AD (HR: 1.06; 95% CI: 0.83, 1.35). No significant heterogeneity was found in any of the meta-analyses (I (2) = 0%-40%, p ≥ .16). CONCLUSIONS An increased peripheral level of inflammatory markers is associated with a modest increase in risk of all-cause dementia. Evidence for an association with risk of AD alone is limited.
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Affiliation(s)
- Alain Koyama
- San Francisco VA Medical Center, 4150 Clement St., VAMC 116H, San Francisco, CA 94121, USA.
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Metti AL, Cauley JA, Newman AB, Ayonayon HN, Barry LC, Kuller LM, Satterfield S, Simonsick EM, Yaffe K. Plasma beta amyloid level and depression in older adults. J Gerontol A Biol Sci Med Sci 2012; 68:74-9. [PMID: 22499763 DOI: 10.1093/gerona/gls093] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Older adults with depression have an increased risk of developing dementia. Low plasma beta-amyloid 42 (Aβ42) and Aβ42/Aβ40 have emerged as promising biomarkers of dementia. The association between depression and plasma Aβ is unclear. METHODS In this longitudinal study of 988 community-dwelling elders from the Health Aging and Body Composition study, depression was assessed with the Center for Epidemiologic Studies-Depression Scale 10-item version. We determined the association between Aβ42 and Aβ42/Aβ40 tertile and depression at baseline and over 9 years. We also stratified the models to determine if apolipoprotein E e4 allele status modified the associations. RESULTS Mean baseline age was 74.0 ± 3.0 years, 51 (5.2%) participants had depression, 545 (55.2%) were women, 531 (53.7%) were black, and 286 (30.7%) had one or more apolipoprotein E e4 allele. At baseline, there was no association between Aβ42/Aβ40 or Aβ42 and depression. Over 9 years, 220 (23.5%) participants developed depression. In adjusted Cox proportional hazards models, among those with one or more e4 allele, low Aβ42/Aβ40 was associated with an increased risk of developing depression over time (low 10.8% vs high 3.2%, hazard ratio = 2.38, 95% confidence interval: 1.15-4.92). Among those with no e4 allele, there was no association between Aβ42/Aβ40 and risk of depression over time (13.3% vs 17.5%, hazard ratio = 0.80, 95% confidence interval: 0.52-1.23; p value for interaction = .003). CONCLUSIONS The association between low plasma Aβ42/Aβ40 and increased risk of incident depression among those with one or more apolipoprotein E e4 allele implies a synergistic relationship similar to that found with dementia. Future work should investigate the interrelationships among plasma Aβ42/Aβ40, depression, and dementia.
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Affiliation(s)
- Andrea L Metti
- Center for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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