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Duan L, Su L, He X, Du Y, Duan Y, Xu N, Wu R, Zhu Y, Shao R, Unverzagt FW, Hake AM, Jin Y, Gao S. Multi-element Exposure and Cognitive Function in Rural Elderly Chinese. Biol Trace Elem Res 2024; 202:1401-1410. [PMID: 37715918 DOI: 10.1007/s12011-023-03774-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 07/10/2023] [Indexed: 09/18/2023]
Abstract
To investigate the relationship between selenium (Se) based multi-element combined exposure and cognitive function in rural elderly individuals, a cross-sectional study was conducted. The study involved 416 older adults aged 60 and above, residing in four different areas of Enshi county, China, with varying soil Se levels. Inductively coupled plasma mass spectrometry (ICP-MS) was employed to measure the concentrations of Se, copper (Cu), iron (Fe), zinc (Zn), calcium (Ca), magnesium (Mg), cadmium (Cd), arsenic (As), and lead (Pb) in whole blood. Nine standard cognitive tests were applied to assess cognitive function. Analysis of the least absolute shrinkage and selection operator regression (LASSO), covariance (ANCOVA), and generalized linear model (GLM) were utilized to investigate the relationship between element exposure and cognitive function. The results of LASSO revealed that Se, Cu, Fe, Zn, Ca, and Pb were independently identified to be associated with cognition. Both ANCOVA and GLM demonstrated that Se and Ca were correlated with cognitive function. The multi-element model showed higher composite Z scores of 0.32 (95% CI: 0.09 to 0.55) for log-transformed Se (P = 0.007), 0.75 (95% CI: 0.01 to 1.49) for log-transformed Cu (P = 0.048), and a lower score of - 0.67 (95% CI: - 1.26 to - 0.08) for log-transformed Ca (P = 0.025). Furthermore, there was evidence that Se could counteract the negative impact of Ca on cognitive function (P for interaction = 0.031). Our findings suggested that higher levels of Se and Cu were associated with better cognitive function in the elderly and Se can counteract the cognitive damage caused by Ca.
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Affiliation(s)
- Lidan Duan
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
- Xiangya School of Public Health, Central South University, Changsha, 410000, China
| | - Liqin Su
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100050, China.
| | - Xiaohong He
- Enshi Tujia and Miao Autonomous Prefecture Center for Disease Control and Prevention, Enshi, 445000, China
| | - Yegang Du
- Shenzhen Academy of Metrology & Quality Inspection, Shenzhen, 518000, China
| | - Yanying Duan
- Xiangya School of Public Health, Central South University, Changsha, 410000, China
| | - Ning Xu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Rangpeng Wu
- Enshi Tujia and Miao Autonomous Prefecture Center for Disease Control and Prevention, Enshi, 445000, China
| | - Yunfeng Zhu
- Enshi Tujia and Miao Autonomous Prefecture Center for Disease Control and Prevention, Enshi, 445000, China
| | - Ranqi Shao
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Frederick W Unverzagt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Ann M Hake
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Yinlong Jin
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Sujuan Gao
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
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Luo J, Su L, He X, Du Y, Xu N, Wu R, Zhu Y, Wang T, Shao R, Unverzagt FW, Hake AM, Jin Y, Gao S. Blood Selenium and Serum Glutathione Peroxidase Levels Were Associated with Serum β-Amyloid in Older Adults. Biol Trace Elem Res 2023; 201:3679-3687. [PMID: 36370334 DOI: 10.1007/s12011-022-03480-4] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Studies have established the association between blood β-amyloid (Aβ) levels and Alzheimer's disease, but population-based studies concerning the association between selenium (Se) and Aβ levels in blood samples are very limited. Therefore, we explored the association in an elderly population with Se status and serum Aβ measures. METHODS A cross-sectional study on 469 elderly individuals from four rural counties with diverse soil Se levels was carried out. Fasting blood Se, serum selenoprotein P (SELENOP), and glutathione peroxidase (GPX), serum Aβ42, and Aβ40 were measured. Quantile regression models were used to determine the associations of blood Se, serum GPX, and SELENOP with Aβ levels. RESULTS Significant negative associations were observed between blood Se and serum Aβ42 and Aβ40 levels at all percentiles (P < 0.05). The associations were generally stronger at higher Aβ42 and Aβ40 percentiles than lower Aβ42 and Aβ40 percentiles. Blood Se was positively associated with serum Aβ42/Aβ40 ratio at 25th, 50th, and 75th percentiles. Significant positive associations were observed between serum GPX and Aβ42 and Aβ40 levels at all percentiles (P < 0.05). The positive associations were generally stronger at higher Aβ42 and Aβ40 percentiles than at lower percentiles. Serum GPX was negatively associated with Aβ42/Aβ40 ratio at 25th, 50th, 75th, and 95th percentiles. No associations with serum SELENOP and Aβ levels were observed. CONCLUSIONS Our results suggest that higher Se levels are associated with lower serum Aβ42 and Aβ40 levels and with higher Aβ42/Aβ40 ratio, and the results are specific for different selenoproteins.
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Affiliation(s)
- Jiao Luo
- CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing, 100050, China
- School of Public Health, Guizhou Medical University, Guiyang, 550025, China
| | - Liqin Su
- CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing, 100050, China.
| | - Xiaohong He
- Tujia and Miao Autonomous Prefecture Center for Disease Control and Prevention, Enshi, 445000, China
| | - Yegang Du
- Academy of Metrology & Quality Inspection, Shenzhen, 518000, China
| | - Ning Xu
- CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing, 100050, China
| | - Rangpeng Wu
- Tujia and Miao Autonomous Prefecture Center for Disease Control and Prevention, Enshi, 445000, China
| | - Yunfeng Zhu
- Tujia and Miao Autonomous Prefecture Center for Disease Control and Prevention, Enshi, 445000, China
| | - Ting Wang
- CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing, 100050, China
| | - Ranqi Shao
- CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing, 100050, China
| | - Frederick W Unverzagt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Ann M Hake
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Yinlong Jin
- CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing, 100050, China
| | - Sujuan Gao
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, 46202-2872, USA
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Wang T, Su L, Chen X, Wang S, Han X, Cheng Y, Lin S, Ding L, Liu J, Chen C, Unverzagt FW, Hake AM, Jin Y, Gao S. Higher blood selenium level is associated with lower risk of hyperhomocysteinemia in the elderly. J Trace Elem Med Biol 2023; 75:127078. [PMID: 36201939 DOI: 10.1016/j.jtemb.2022.127078] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/09/2022] [Accepted: 09/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Earlier studies have reported inconsistent association between selenium (Se) and homocysteine (Hcy) levels, while no evidence could be found from Chinese population. To fill this gap, we investigated the association between blood Se and hyperhomocysteinemia (HHcy) of rural elderly population in China. METHODS A cross-sectional study on 1823 participants aged 65 and older from four Chinese rural counties was carried out in this study. Whole blood Se and serum Hcy concentrations were measured in fasting blood samples. Analysis of covariance and restricted cubic spline models were used to examine the association between Se and Hcy levels. Logistic regression models were used to evaluate the risk of prevalent HHcy among four Se quartile groups after adjusting for covariates. RESULTS For this sample, the mean blood Se concentration was 156.34 (74.65) μg/L and the mean serum Hcy concentration was 17.25 (8.42) μmol/L. A significant non-linear relationship was found between blood Se and serum Hcy, the association was inverse when blood Se was less than 97.404 μg/L and greater than 156.919 μg/L. Participants in the top three blood Se quartile groups had significantly lower risk of prevalent HHcy compared with the lowest quartile group. When defined as Hcy> 10 μmol/L, the odds ratios and 95% confidence interval of HHcy were 0.600 (0.390, 0.924), 0.616 (0.398, 0.951) and 0.479 (0.314, 0.732) for Q2, Q3, and Q4 Se quartile groups compared with the Q1 group, respectively. When defined as Hcy≥ 15 μmol/L, the odds ratios and 95% confidence interval of HHcy were 0.833 (0.633, 1.098) and 0.827 (0.626, 1.092), 0.647 (0.489, 0.857) for Q2, Q3, and Q4 Se quartile groups compared with Q1 group. CONCLUSIONS Our findings suggest that higher blood Se level could be a protective factor for HHcy in the elderly.
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Affiliation(s)
- Ting Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; School of Public Health, Guizhou Medical University, Guiyang 550025, China
| | - Liqin Su
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
| | - Xi Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Sisi Wang
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Xu Han
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yibin Cheng
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Shaobin Lin
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Liang Ding
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Jingyi Liu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Chen Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Frederick W Unverzagt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Ann M Hake
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Yinlong Jin
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Sujuan Gao
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN 46202-2872, USA
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Liu H, Su L, Chen X, Wang S, Cheng Y, Lin S, Ding L, Liu J, Chen C, Unverzagt FW, Hake AM, Jin Y, Gao S. Higher blood cadmium level is associated with greater cognitive decline in rural Chinese adults aged 65 or older. Sci Total Environ 2021; 756:144072. [PMID: 33280862 PMCID: PMC7775354 DOI: 10.1016/j.scitotenv.2020.144072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 05/27/2023]
Abstract
Cadmium (Cd) exposure has been reported to have neurotoxic effects in animal studies and associated with increased Alzheimer's Disease mortality and lower cognitive function in cross-sectional and case-control studies. However, no results from longitudinal studies on Cd and cognitive decline are available. In this prospective cohort study, we recruited 1867 participants aged 65 years or older from rural areas in China, blood Cd and cognitive function were measured at baseline (2010-2012), and 1554 participants completed cognitive function tests during a 3-year follow-up (2013-2015). Cognitive function was evaluated using nine standardized cognitive tests: The Community Screening Instrument for Dementia, the CERAD Word List Learning, Word list recall, IU Story Recall, Animal Fluency Test, Boston Naming Test, Stick Design, Delayed Stick Design and the IU Token Test. Analysis of covariance models and logistic regression models were used to determine the association between Cd and standardized cognitive decline adjusting for covariates. The median blood Cd concentration of this study population was 2.12 μg/L, and the interquartile range was 1.42-4.64 μg/L. Significant association of higher Cd levels with lower cognitive scores were observed in five individual cognitive tests (Delayed Stick Design Test, Boston Naming Test, CERAD Word List Learning Test, Word List Recall Test and IU Story Recall Test) and the composite cognitive score adjusting for multi-covariates at baseline. Higher Cd levels were significantly associated with greater 3-year cognitive decline in Delayed Stick Design Test, Boston Naming Test, IU Token Test, Word List Recall Test and Composite cognitive score. For these cognitive tests, participants in the top two Cd quartile groups had significantly greater decline than those in the lowest Cd quartile group, while the two lowest Cd quartile groups were not significantly different. Our findings suggest that higher Cd exposure is associated with greater cognitive decline in older Chinese adults.
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Affiliation(s)
- Hang Liu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Liqin Su
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
| | - Xi Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Sisi Wang
- Center for Biostatistics, Bioinformatics and Big Data, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Yibin Cheng
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Shaobin Lin
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Liang Ding
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Jingyi Liu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Chen Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Frederick W Unverzagt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Ann M Hake
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Yinlong Jin
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Sujuan Gao
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN 46202-2872, USA
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Clemow DB, Johnson KW, Hochstetler HM, Ossipov MH, Hake AM, Blumenfeld AM. Lasmiditan mechanism of action - review of a selective 5-HT 1F agonist. J Headache Pain 2020; 21:71. [PMID: 32522164 PMCID: PMC7288483 DOI: 10.1186/s10194-020-01132-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [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] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/25/2020] [Indexed: 01/13/2023] Open
Abstract
Migraine is a leading cause of disability worldwide, but it is still underdiagnosed and undertreated. Research on the pathophysiology of this neurological disease led to the discovery that calcitonin gene-related peptide (CGRP) is a key neuropeptide involved in pain signaling during a migraine attack. CGRP-mediated neuronal sensitization and glutamate-based second- and third-order neuronal signaling may be an important component involved in migraine pain. The activation of several serotonergic receptor subtypes can block the release of CGRP, other neuropeptides, and neurotransmitters, and can relieve the symptoms of migraine. Triptans were the first therapeutics developed for the treatment of migraine, working through serotonin 5-HT1B/1D receptors. The discovery that the serotonin 1F (5-HT1F) receptor was expressed in the human trigeminal ganglion suggested that this receptor subtype may have a role in the treatment of migraine. The 5-HT1F receptor is found on terminals and cell bodies of trigeminal ganglion neurons and can modulate the release of CGRP from these nerves. Unlike 5-HT1B receptors, the activation of 5-HT1F receptors does not cause vasoconstriction.The potency of different serotonergic agonists towards 5-HT1F was correlated in an animal model of migraine (dural plasma protein extravasation model) leading to the development of lasmiditan. Lasmiditan is a newly approved acute treatment for migraine in the United States and is a lipophilic, highly selective 5-HT1F agonist that can cross the blood-brain barrier and act at peripheral nervous system (PNS) and central nervous system (CNS) sites.Lasmiditan activation of CNS-located 5-HT1F receptors (e.g., in the trigeminal nucleus caudalis) could potentially block the release of CGRP and the neurotransmitter glutamate, thus preventing and possibly reversing the development of central sensitization. Activation of 5-HT1F receptors in the thalamus can block secondary central sensitization of this region, which is associated with progression of migraine and extracephalic cutaneous allodynia. The 5-HT1F receptors are also elements of descending pain modulation, presenting another site where lasmiditan may alleviate migraine. There is emerging evidence that mitochondrial dysfunction might be implicated in the pathophysiology of migraine, and that 5-HT1F receptors can promote mitochondrial biogenesis. While the exact mechanism is unknown, evidence suggests that lasmiditan can alleviate migraine through 5-HT1F agonist activity that leads to inhibition of neuropeptide and neurotransmitter release and inhibition of PNS trigeminovascular and CNS pain signaling pathways.
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Affiliation(s)
| | | | | | | | - Ann M Hake
- Eli Lilly and Company, Indianapolis, IN, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
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Hake AM, Dacks PA, Arnerić SP. Concise informed consent to increase data and biospecimen access may accelerate innovative Alzheimer's disease treatments. Alzheimers Dement (N Y) 2017; 3:536-541. [PMID: 29124112 PMCID: PMC5671623 DOI: 10.1016/j.trci.2017.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction Informed consent forms that restrict the distribution of data and samples have been an impediment to advancing Alzheimer's disease (AD) understandings and treatments. The Coalition Against Major Disease public-private partnership developed concise addenda to responsibly broaden data access of informed consent forms. Methods Coalition Against Major Disease members identified key elements for ensuring data and biospecimen access, and patient privacy protection according to applicable US law. Collaboration with the Alzheimer's Association established the understandability and relevance of the addenda with AD patients and Care Partners. Results Two key findings are (1) patients with dementia and Care Partners were shocked that their data and samples are not broadly shared and (2) with diverse feedback, two concise addenda were created to enable data and sample sharing both within and outside future sponsored studies (see Boxes). Discussion Increasing the access of valuable anonymized patient-level clinical trial data has the potential to inform the foundational and regulatory science required to deliver innovative treatments for AD.
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Affiliation(s)
- Ann M Hake
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Penny A Dacks
- Alzheimer Drug Discovery Foundation, New York City, NY, USA
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Su LQ, Jin YL, Unverzagt FW, Cheng YB, Hake AM, Ran L, Ma F, Liu JY, Chen C, Bian JC, Wu XP, Gao S. Nail Selenium Level and Diabetes in Older People in Rural China. Biomed Environ Sci 2016; 29:818-824. [PMID: 27998388 DOI: 10.3967/bes2016.109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 11/01/2016] [Indexed: 06/06/2023]
Abstract
This cross-sectional study aimed to examine the association between selenium levels and diabetes in an older population with life-long natural exposure to selenium in rural China. A total of 1856 subjects aged 65 years or older from four Chinese rural counties with different environmental selenium levels were evaluated. Analysis of covariance models and logistic regression models were used to examine the relationship between nail selenium levels and serum glucose, serum insulin, insulin resistance [using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR)], and the risk of diabetes. The mean nail selenium level was 0.461 μg/g and the prevalence rate of diabetes was 8.3% in this population. The mean nail selenium level was significantly higher in the group with diabetes than in the group without diabetes (P<0.0001). The adjusted odds ratios for diabetes were 2.65 (95% CI: 1.48 to 4.73), 2.47 (95% CI: 1.37 to 4.45), and 3.30 (95% CI: 1.85 to 5.88) from the second selenium quartile to the fourth quartile, respectively, compared with the first quartile group. The mean serum glucose and HOMA-IR in the higher selenium quartile groups were significantly higher than those of the lowest quartile group. However, no significant differences in insulin were observed among the four quartile groups. A long-term, higher level of exposure to selenium may be associated with a higher risk of diabetes. Future studies are needed to elucidate the association between selenium and insulin resistance.
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Affiliation(s)
- Li Qin Su
- Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yin Long Jin
- Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Frederick W Unverzagt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Yi Bin Cheng
- Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Ann M Hake
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Liao Ran
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN 46202-2872, USA
| | - Feng Ma
- Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Jing Yi Liu
- Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Chen Chen
- Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Jian Chao Bian
- Shandong Institute for Prevention and Treatment of Endemic Disease in China, Jinan 250014, Shandong, China
| | - Xian Ping Wu
- Sichuan Provincial Center for Disease Control and Prevention in China, Chengdu 610041, Sichuan, China
| | - Sujuan Gao
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN 46202-2872, USA
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Su L, Jin Y, Unverzagt FW, Liang C, Cheng Y, Hake AM, Kuruppu D, Ma F, Liu J, Chen C, Bian J, Li P, Gao S. Longitudinal Association between Selenium Levels and Hypertension in a Rural Elderly Chinese Cohort. J Nutr Health Aging 2016; 20:983-988. [PMID: 27925137 DOI: 10.1007/s12603-016-0700-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Results from previous studies have been inconsistent on the association between selenium and hypertension, and very few studies on this subject have focused on the elderly population. The purpose of this study is to examine the relationship between selenium level and hypertension in a rural elderly Chinese cohort. DESIGN A longitudinal study was implemented and data were analyzed using logistic regression models and Cox proportional hazards regression model adjusting for potential confounders. The associations between selenium level and prevalent hypertension at baseline and between selenium and incident hypertension were examined. SETTING Community-based setting in four rural areas in China. SUBJECTS A total of 2000 elderly aged 65 years and over (mean 71.9±5.6 years) participated in this study. MEASUREMENTS Nail selenium levels were measured in all subjects at baseline. Blood pressure measures and self-reported hypertension history were collected at baseline, 2.5 years and 7 years later. Hypertension was defined as systolic blood pressure 140 mmHg or higher, diastolic blood pressure 90 mmHg or higher, or reported use of anti-hypertensive medication. RESULTS The rate of baseline hypertension was 63.50% in this cohort and the mean nail selenium level is 0.413±0.183μg/g. Multi-covariate adjusted cross-sectional analyses indicated that higher selenium level was associated with higher blood pressure measures at baseline and higher rates of hypertension. For the 635 participants with normal blood pressure at baseline, 360 had developed hypertension during follow-up. The incidence rate for hypertension was 45.83%, 52.27%, 62.50%, 70.48%, and 62.79% from the first selenium quintile to the fifth quintile respectively. Comparing to the lowest quintile group, the hazard ratios were 1.41 (95%CI: 1.03 to1.94), 1.93 (95%CI: 1.40 to 2.67), 2.35 (95%CI: 1.69 to 3.26) and 1.94 (95%CI: 1.36 to 22.77) for the second selenium quintile to the fifth quintile respectively. CONCLUSIONS Our findings suggest that high selenium may play a harmful role in the development of hypertension. Future studies are needed to confirm our findings and to elucidate a plausible biological mechanism.
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Affiliation(s)
- L Su
- Dr. Sujuan Gao, Department of Biostatistics, Indiana University School of Medicine, 410 West 10th Street, #3000, Indianapolis, IN 46202-2872, Phone: U.S. (317) 274-0820 Fax: (317)274-2678,
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Su L, Gao S, Unverzagt FW, Cheng Y, Hake AM, Xin P, Chen C, Liu J, Ma F, Bian J, Li P, Jin Y. Selenium Level and Dyslipidemia in Rural Elderly Chinese. PLoS One 2015; 10:e0136706. [PMID: 26380972 PMCID: PMC4575098 DOI: 10.1371/journal.pone.0136706] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 08/08/2015] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Higher selenium level has been hypothesized to have the potential to reduce the risk of cardiovascular diseases including dyslipidemia. However, results from previous studies are inconsistent. This study aims to determine the association between selenium level and dyslipidemia in elderly Chinese with relatively low selenium status. METHODS A cross-sectional study of 1859 participants aged 65 or older from four rural counties in China was conducted. Serum total cholesterol (TC), triglycerides (TG), high density lipoprotein-cholesterol (HDLC) and low-density lipoprotein-cholesterol (LDLC), nail selenium concentration and APOE genotype were measured in all subjects. The four types of dyslipidemia were defined as >5.17 mmol/L for High-TC, >1.69 mmol/L for High-TG, >3.36 mmol/L for High-LDLC, and <1.04 mmol/L for Low-HDLC according to Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults. Logistic models adjusting for age, gender, APOE genotype, body mass index, alcohol consumption, smoking, physical activity, medication use for cardiovascular diseases were used to examine the relationship between selenium levels and the risk of dyslipidemia. RESULTS Mean nail selenium concentration was 0.465 μg/gin this sample. Rates for High-TC, High-LDLC, High-TG, Low-HDLC were 18.13%, 13.23%, 12.21% and 32.76% respectively. Results from logistic models indicated that higher selenium levels were significantly associated with higher risk of High-TC, High-LDLC and lower risk of Low-HDLC adjusting for covariates (p < 0.0001). Compared with the lowest selenium quartile group, participants in selenium quartile groups 2, 3 and 4 had significantly higher rates of High-TC, High-LDLC, High-TG, and lower rate of Low-HDLC adjusting for covariates. No significant association was observed between selenium level and the risk of High-TG. APOEε4 carriers had higher rates of High-TC and High-LDLC. There was no interaction between selenium level and APOE with the rates of dyslipidemia. CONCLUSIONS Our results suggest long-term selenium exposure level may be associated with the risk of dyslipidemia in elderly population. Future studies are needed to examine the underlying mechanism of the association.
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Affiliation(s)
- Liqin Su
- Department of Environmental Impact Assessment, Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sujuan Gao
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Frederick W. Unverzagt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Yibin Cheng
- Department of Environmental Epidemiology, Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ann M. Hake
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Pengju Xin
- Department of Environmental Epidemiology, Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chen Chen
- Department of Environmental Epidemiology, Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jingyi Liu
- Department of Environmental Epidemiology, Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Feng Ma
- Department of Environmental Epidemiology, Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianchao Bian
- Shandong Institute for Prevention and Treatment of Endemic Disease in China, Jinan, China
| | - Ping Li
- Sichuan Provincial Center for Disease Control and Prevention in China, Chengdu, China
| | - Yinlong Jin
- Department of Environmental Epidemiology, Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, China
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Quaid KA, Murrell JR, Hake AM, Farlow MR, Ghetti B. Presymptomatic Genetic Testing with an APP Mutation in Early-Onset Alzheimer Disease: A Descriptive Study of Sibship Dynamics. J Genet Couns 2015; 9:327-41. [PMID: 26141474 DOI: 10.1023/a:1009406229745] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Early-onset Alzheimer disease (AD) accounts for only 5% of all cases of Alzheimer disease. To date, mutations in three different genes, the Amyloid precursor protein (APP), Presenilin 1 (PS1), and Presenilin 2 (PS2), have been identified as causative in early-onset AD, making predictive testing possible. Predictive testing for early-onset Alzheimer disease is a relatively new phenomenon. This paper describes the process of identifying a new mutation in the APP gene associated with early-onset AD, notifying family members, and offering participation in research as well as predictive testing. The goal is to share the complexities of predictive testing in a sibship newly identified as being at risk for an adult-onset, incurable neurodegenerative disease.
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Affiliation(s)
- K A Quaid
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, 975 West Walnut Street, Indianapolis, IN, 46202-5251
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11
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Henley DB, Dowsett SA, Chen YF, Liu-Seifert H, Grill JD, Doody RS, Aisen P, Raman R, Miller DS, Hake AM, Cummings J. Alzheimer's disease progression by geographical region in a clinical trial setting. Alzheimers Res Ther 2015; 7:43. [PMID: 26120369 PMCID: PMC4481070 DOI: 10.1186/s13195-015-0127-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 04/23/2015] [Indexed: 11/10/2022]
Abstract
INTRODUCTION To facilitate enrollment and meet local registration requirements, sponsors have increasingly implemented multi-national Alzheimer's disease (AD) studies. Geographic regions vary on many dimensions that may affect disease progression or its measurement. To aid researchers designing and implementing Phase 3 AD trials, we assessed disease progression across geographic regions using placebo data from four large, multi-national clinical trials of investigational compounds developed to target AD pathophysiology. METHODS Four similarly-designed 76 to 80 week, randomized, double-blind placebo-controlled trials with nearly identical entry criteria enrolled patients aged ≥55 years with mild or moderate NINCDS/ADRDA probable AD. Descriptive analyses were performed for observed mean score and observed mean change in score from baseline at each scheduled visit. Data included in the analyses were pooled from the intent-to-treat placebo-assigned overall (mild and moderate) AD dementia populations from all four studies. Disease progression was assessed as change from baseline for each of 5 scales - the AD Assessment Scale-cognitive subscale (ADAS-cog11), the AD Cooperative Study- Activities of Daily Living Scale (ADCS-ADL), Mini-Mental State Examination (MMSE), the Clinical Dementia Rating scored by the sum of boxes method (CDR-SB), and the Neuropsychiatric Inventory (NPI). RESULTS Regions were heterogeneous at baseline. At baseline, disease severity as measured by ADAS-cog11, ADCS-ADL, and CDR-SB was numerically worse for Eastern Europe/Russia compared with other regions. Of all regional populations, Eastern Europe/Russia showed the greatest cognitive and functional decline from baseline; Japan, Asia and/or S. America/Mexico showed the least cognitive and functional decline. CONCLUSIONS These data suggest that in multi-national clinical trials, AD progression or its measurement may differ across geographic regions; this may be in part due to heterogeneity across populations at baseline. The observed differences in AD progression between outcome measures across geographic regions may generalize to 'real-world' clinic populations, where heterogeneity is the norm. TRIAL REGISTRATIONS ClinicalTrials.gov NCT00594568 - IDENTITY. Registered 11 January 2008. ClinicalTrials.gov NCT00762411 - IDENTITY2. Registered 26 September 2008 ClinicalTrials.gov NCT00905372 - EXPEDITION. Registered 18 May 2009 ClinicalTrials.gov NCT00904683 - EXPEDITION2. Registered 18 May 2009.
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Affiliation(s)
- David B Henley
- Eli Lilly and Company, Indianapolis, IN 46285 USA ; Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | | | - Yun-Fei Chen
- Eli Lilly and Company, Indianapolis, IN 46285 USA
| | | | - Joshua D Grill
- University of California, Irvine, Institute for Memory Impairments and Neurological Disorders, 3206 Biological Sciences III, Irvine, CA 92697-4545 USA
| | - Rachelle S Doody
- University of California, Irvine, Institute for Memory Impairments and Neurological Disorders, 3206 Biological Sciences III, Irvine, CA 92697-4545 USA
| | - Paul Aisen
- Baylor College of Medicine, Department of Neurology, Houston, TX 77030 USA
| | - Rema Raman
- University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093-0717 USA
| | - David S Miller
- Dementia and Geriatric Psychiatry, Bracket, 575 E. Swedesford Rd, Ste 200, Wayne, PA 19087 USA
| | - Ann M Hake
- Eli Lilly and Company, Indianapolis, IN 46285 USA ; Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville, Las Vegas, NV 89106 USA
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Cheng Y, Jin Y, Unverzagt FW, Su L, Yang L, Ma F, Hake AM, Kettler C, Chen C, Liu J, Bian J, Li P, Murrell JR, Hendrie HC, Gao S. The relationship between cholesterol and cognitive function is homocysteine-dependent. Clin Interv Aging 2014; 9:1823-9. [PMID: 25364240 PMCID: PMC4211868 DOI: 10.2147/cia.s64766] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Previous studies have identified hyperlipidemia as a potential risk factor for dementia and Alzheimer’s disease. However, studies on cholesterol measured in late-life and cognitive function have been inconsistent. Few studies have explored nonlinear relationships or considered interactions with other biomarker measures. Methods A cross-sectional sample of 1,889 participants from four rural counties in the People’s Republic of China was included in this analysis. Serum total cholesterol, high-density lipoprotein, triglycerides, and homocysteine levels were measured in fasting blood samples. A composite cognitive score was derived based on nine standardized cognitive test scores. Analysis of covariance models were used to investigate the association between biomarker measures and the composite cognitive scores. Results There was a significant interaction between the homocysteine quartile group and the cholesterol quartile group on cognitive scores (P=0.0478). In participants with normal homocysteine levels, an inverse U-shaped relationship between total cholesterol level and cognitive score was found, indicating that both low and high cholesterol levels were associated with lower cognitive scores. In participants with high homocysteine levels, no significant association between cholesterol and cognition was found. Conclusion The relationship between cholesterol levels and cognitive function depends upon homocysteine levels, suggesting an interactive role between cholesterol and homocysteine on cognitive function in the elderly population. Additional research is required to confirm our findings in other populations, and to explore potential mechanisms underlying the lipid–homocysteine interaction.
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Affiliation(s)
- Yibin Cheng
- Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Yinlong Jin
- Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Frederick W Unverzagt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Liqin Su
- Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Lili Yang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Feng Ma
- Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Ann M Hake
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA ; Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Carla Kettler
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Chen Chen
- Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Jingyi Liu
- Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Jianchao Bian
- Shandong Institute for Prevention and Treatment of Endemic Disease in China, Jinan, People's Republic of China
| | - Ping Li
- Sichuan Provincial Center for Disease Control and Prevention in China, Chengdu, People's Republic of China
| | - Jill R Murrell
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hugh C Hendrie
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA ; Indiana University Center for Aging Research, Indianapolis, Indiana, USA ; Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Sujuan Gao
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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13
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Chen C, Jin Y, Unverzagt FW, Cheng Y, Hake AM, Liang C, Ma F, Su L, Liu J, Bian J, Li P, Gao S. The association between selenium and lipid levels: a longitudinal study in rural elderly Chinese. Arch Gerontol Geriatr 2014; 60:147-52. [PMID: 25263027 DOI: 10.1016/j.archger.2014.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 01/23/2014] [Revised: 09/10/2014] [Accepted: 09/11/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE A protective effect of selenium on lipid levels has been reported in populations with relatively low selenium status. However, recent studies found that high selenium exposure may lead to adverse cardiometabolic effects, particularly in selenium-replete populations. We examined the associations of selenium status with changes in lipid levels in a 7-year follow up of an elderly Chinese cohort including participants from selenium-deplete areas. METHODS Study population consisted of 140 elderly Chinese aged 65 or older with nail selenium levels measured at baseline (2003-2005). Lipid concentrations were measured in fasting blood samples collected at baseline and the 7-year follow-up (2010-2012). Analysis of covariance (ANCOVA) models was used to determine the association between baseline selenium status and changes in lipid levels from baseline to follow-up adjusting for other covariates. RESULTS Mean (±standard deviation) baseline selenium concentration was 0.41±0.2mg/kg. In prospective analysis, we found that individuals in the highest selenium quartile group showed 1.11 SD decrease on total-cholesterol (p<0.001), 0.41 SD increase on HDL-cholesterol (p<0.001) and 0.52 SD decrease on triglyceride after 7 years than those in the lowest selenium quartile group. The similar trends were seen with significant lipid changes in the 2nd and 3rd quartile groups. CONCLUSION Selenium has modest beneficial effects on blood lipid levels in a population with relatively low selenium status. Our result suggests adequate dietary selenium intake as a potential prevention strategy for lowering lipid levels in selenium deplete populations.
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Affiliation(s)
- Chen Chen
- Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yinlong Jin
- Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Frederick W Unverzagt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Yibin Cheng
- Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ann M Hake
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, United States; Eli Lilly and Company, Indianapolis, IN, United States
| | - Chaoke Liang
- Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Feng Ma
- Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Liqin Su
- Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jingyi Liu
- Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianchao Bian
- Shandong Institute for Prevention and Treatment of Endemic Disease in China, Jinan, China
| | - Ping Li
- Sichuan Provincial Center for Disease Control and Prevention in China, Chengdu, China
| | - Sujuan Gao
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, United States.
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14
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Gao S, Unverzagt FW, Hall KS, Lane KA, Murrell JR, Hake AM, Smith-Gamble V, Hendrie HC. Mild cognitive impairment, incidence, progression, and reversion: findings from a community-based cohort of elderly African Americans. Am J Geriatr Psychiatry 2014; 22:670-81. [PMID: 23831172 PMCID: PMC3842367 DOI: 10.1016/j.jagp.2013.02.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 02/05/2013] [Accepted: 02/15/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the long-term outcomes of community-based elderly African Americans by following their transitions from normal cognition to mild cognitive impairment (MCI) to dementia. METHODS Participants were from the community-based Indianapolis Dementia Project. A total of 4,104 African Americans were enrolled in 1992 or 2001 and followed until 2009 with regularly scheduled evaluation of cognitive assessment. A two-stage sampling was used at each evaluation to select individuals for extensive clinical assessment following the results of Stage 1 cognitive testing. Age- and gender-specific incidence, progression, and reversion rates for MCI were derived using the person-year method in a dynamic cohort and predicted probabilities from weighted multinomial logistic models of transitional probabilities among normal cognition, MCI, and dementia. RESULTS Annual overall incidence rate for MCI was 5.6% (95% confidence interval [CI]: 4.6%-6.6%). Annual progression rate from MCI to dementia was 5.9% (95% CI: 5.3%-6.5%), and annual reversion rate from MCI to normal was 18.6% (95% CI: 16.7%-20.4%). Both MCI incidence rates and MCI to dementia progression rates increased with age, whereas reversion rates from MCI to normal decreased with age. CONCLUSION MCI progression to dementia was much more frequent in the older age groups than in younger participants where reversion to normal cognition is more common. Future research is needed to determine factors related to the heterogeneous outcomes in MCI individuals.
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Affiliation(s)
- Sujuan Gao
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN.
| | | | - Kathleen S. Hall
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kathleen A. Lane
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jill R. Murrell
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ann M. Hake
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Valerie Smith-Gamble
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana,Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA
| | - Hugh C. Hendrie
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana,Indiana University Center for Aging Research, Indianapolis, IN,Regenstrief Institute, Inc., Indianapolis, IN
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15
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Gao S, Jin Y, Unverzagt FW, Cheng Y, Su L, Wang C, Ma F, Hake AM, Kettler C, Chen C, Liu J, Bian J, Li P, Murrell JR, Clark DO, Hendrie HC. Cognitive function, body mass index and mortality in a rural elderly Chinese cohort. ACTA ACUST UNITED AC 2014; 72:9. [PMID: 24666663 PMCID: PMC3974191 DOI: 10.1186/2049-3258-72-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 12/10/2013] [Indexed: 01/24/2023]
Abstract
BACKGROUND Previous studies have shown that poor cognition and low body mass index were associated with increased mortality. But few studies have investigated the association between cognition and mortality across the entire cognitive spectrum while adjusting for BMI. The objective of this study is to examine the associations between cognitive function, BMI and 7-year mortality in a rural elderly Chinese cohort. METHODS A prospective cohort of 2,000 Chinese age 65 and over from four rural counties in China were followed for 7-years. Cognitive function, BMI and other covariate information were obtained at baseline. Cox's proportional hazard models were used to determine the effects of cognitive function and BMI on mortality risk. RESULTS Of participants enrolled, 473 (23.7%) died during follow-up. Both lower cognitive function (HR = 1.48, p = 0.0049) and lower BMI (HR = 1.6, p < 0.0001) were independently associated with increased mortality risk compared to individuals with average cognitive function and normal weight. Higher cognitive function was associated with lower mortality risk (HR = 0.69, p = 0.0312). We found no significant difference in mortality risk between overweight/obese participants and those with normal weight. CONCLUSIONS Cognitive function and BMI were independent predictors of mortality risk. Intervention strategies for increasing cognitive function and maintaining adequate BMI may be important in reducing morality risk in the elderly population.
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Affiliation(s)
- Sujuan Gao
- Department of Biostatistics, Indiana University School of Medicine, 410 West 10th Street, #3000, Indianapolis IN 46202-2872, Indiana.
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16
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Spina S, Murrell JR, Hake AM, Epperson F, Vidal R, Farlow MR, Ghetti B. Neuropathological characterization of early onset Alzheimer disease associated with the V717L
APP
mutation. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.707.8] [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: 11/11/2022]
Affiliation(s)
| | | | - Ann M Hake
- NeurologyIndiana University School of MedicineIndianapolisIN
| | | | | | - Martin R Farlow
- NeurologyIndiana University School of MedicineIndianapolisIN
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Blekher TM, Yee RD, Kirkwood SC, Hake AM, Stout JC, Weaver MR, Foroud TM. Oculomotor control in asymptomatic and recently diagnosed individuals with the genetic marker for Huntington's disease. Vision Res 2004; 44:2729-36. [PMID: 15358067 DOI: 10.1016/j.visres.2004.06.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2003] [Revised: 06/09/2004] [Indexed: 10/26/2022]
Abstract
We compared oculomotor control among individuals in the early stages of Huntington's disease (HD), with that of individuals who are presymptomatic HD gene carriers (PSGC) and nongene carriers (NGC). The oculomotor testing paradigm included both traditional tests and a novel experimental procedure to assess visual scanning. Traditional tests elicited saccades, pursuit and optokinetic nystagmus (OKN). HD patients demonstrated marked delay in the initiation of volitional saccades (anti-saccade and memory-guided saccades), a reduced number of correct volitional saccades, reduced velocity of saccades, and a decreased OKN gain. We also studied visual scanning while the participants completed the Digit Symbol Subscale of the Wechsler Adult Intelligence Survey-Revised (WAIS-R). The HD participants demonstrated an abnormal gaze strategy, which may be associated with attention and/or planning deficits. Differences between the PSGC and NGC groups were only observed for two measures: PSGC had a decreased number of memory-guided saccades and a subtle delay in the initiation of volitional saccades. Our results suggest that oculomotor measures are a sensitive biomarker in the early stage of HD and demonstrate that the combination of more traditional oculomotor tests with visual scanning tests is useful in the evaluation of visual performance.
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Affiliation(s)
- T M Blekher
- Department of Ophthalmology, Indiana University School of Medicine, 702 Rotary Circle, RO-105, Indianapolis, IN 46202-5251, USA.
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Abstract
There are currently four compounds approved for use in the treatment of Alzheimer's disease (AD). These drugs are all cholinesterase (ChE) inhibitors, which are thought to provide predominantly symptomatic benefits by increasing the level of acetylcholine (ACh) in the synapse. Although there are slight differences in the mechanisms of action of these compounds, it remains to be determined whether any one of them has a significant therapeutic advantage over the others. Several other drugs have also been investigated for their potential use as either symptomatic or disease-modifying agents in the treatment of AD, with mixed results. Current therapeutic research is focused on addressing the underlying pathology of AD, in the hope of arresting or reversing the course of the disease. This review will provide an overview of the ChE inhibitors and other drugs used for treating the symptoms of AD, summarise the results of recent therapeutic trials, discuss directions of future research and outline the current treatment recommendations for AD.
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Affiliation(s)
- A M Hake
- Indiana University School of Medicine, Department of Neurology, Indianapolis, IN 46202, USA.
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Abstract
The four cholinesterase inhibitors now available for treatment of Alzheimer disease (AD) may be most beneficial, especially in the long run, if started early in the course of the disease. This paper reviews the efficacy, pharmacokinetics, metabolism, side effects, dosage, and precautions for the use of these agents, which may produce modest improvements in cognition, behavior, and the ability to perform activities of daily living.
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Affiliation(s)
- A M Hake
- Department of Neurology, Indiana University School of Medicine, Indianapolis 46202, USA.
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20
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Murrell JR, Hake AM, Quaid KA, Farlow MR, Ghetti B. Early-onset Alzheimer disease caused by a new mutation (V717L) in the amyloid precursor protein gene. Arch Neurol 2000; 57:885-7. [PMID: 10867787 DOI: 10.1001/archneur.57.6.885] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Alzheimer disease is the most common form of dementia. Mutations in the genes amyloid precursor protein (APP), presenilin 1(PS1) and presenilin 2(PS2) have been found in early-onset familial forms of Alzheimer disease OBJECTIVE To determine the cause of dementia in a family with early-onset illness. DESIGN, SETTING, AND PARTICIPANTS A family with a history of dementia was referred to the Indiana Alzheimer Disease Center, Indianapolis. All the research in this study was done in a university or university hospital. The proband and her 4 siblings took part in the study. The proband, who is still alive, showed symptoms of Alzheimer disease at 38 years of age. Genomic DNA was obtained from blood samples of 5 family members. The APPandPS1genes of the proband were screened for mutations by amplification followed by direct sequencing. RESULTS Sequence of exon 17 of the APPgene revealed a single nucleotide (guanine to cytosine) substitution in 1 allele, resulting in an amino acid change at codon 717 (valine to leucine). Each of the proband's siblings were tested for this mutation by direct sequencing. Two of the 4 were found to have the mutation; one of whom was recently clinically diagnosed at the age of 36 years. CONCLUSIONS A novel mutation in the APPgene (V717L) has been found in a family with a history of dementia, beginning in the mid to late 30s. The age of onset in this family is earlier than most of the other families with Alzheimer disease who also have APPmutations. Arch Neurol. 2000.
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Affiliation(s)
- J R Murrell
- Department of Pathology and Laboratory Medicine, 635 Barnhill Dr, Medical Science Bldg A128, Indianapolis, IN 46202, USA.
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Henderson VW, Paganini-Hill A, Miller BL, Elble RJ, Reyes PF, Shoupe D, McCleary CA, Klein RA, Hake AM, Farlow MR. Estrogen for Alzheimer's disease in women: randomized, double-blind, placebo-controlled trial. Neurology 2000; 54:295-301. [PMID: 10668686 DOI: 10.1212/wnl.54.2.295] [Citation(s) in RCA: 407] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AD, the most prevalent cause of dementia, affects twice as many women as men. Therapeutic options are limited, but results of prior studies support the hypothesis that estrogen treatment may improve symptoms of women with this disorder. METHODS Forty-two women with mild-to-moderate dementia due to AD were enrolled into a randomized, double-blind, placebo-controlled, parallel-group trial of unopposed conjugated equine estrogens (1.25 mg/day) for 16 weeks. RESULTS Outcome data were available for 40 women at 4 weeks and 36 women at 16 weeks. At both 4 and 16 weeks, there were no significant differences or statistical trends between treatment groups on the primary outcome measure (the cognitive subscale of the Alzheimer's Disease Assessment Scale), clinician-rated global impression of change, or caregiver-rated functional status. Exploratory analyses of mood and specific aspects of cognitive performance also failed to demonstrate substantial group differences. CONCLUSION Although conclusions are limited by small sample size and the possibility of a type II error, results suggest that short-term estrogen therapy does not improve symptoms of most women with AD. These findings do not address possible long-term effects of estrogen in AD, possible interactions between estrogen and other treatment modalities, or putative effects of estrogen in preventing or delaying onset of this disorder.
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Affiliation(s)
- V W Henderson
- Department of Neurology, University of Southern California, Los Angeles 90089, USA.
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