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Korthauer LE, Gemelli ZT, O'Shea D, Ott BR, Davis JD. Association between neuropsychological assessment and amyloid status in a clinical setting. Neuropsychology 2024; 38:337-346. [PMID: 38330360 DOI: 10.1037/neu0000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/10/2024] Open
Abstract
OBJECTIVE Large research cohorts show robust associations between neuropsychological tests and Alzheimer's disease (AD) biomarkers, but studies in clinical settings are limited. The increasing availability of AD biomarkers to the practicing clinician makes it important to understand the relationship between comprehensive clinical neuropsychological assessment and biomarker status. This study examined concordance between practicing clinical neuropsychologists' diagnostic impressions and AD biomarker status in patients seen at an outpatient medical center, with a secondary aim of defining the characteristics of discordant cases. METHOD Participants (N = 79) seen for clinical neuropsychological assessment who subsequently underwent lumbar puncture or amyloid positron emission tomography imaging were identified via retrospective chart review. Concordance between clinical neuropsychological diagnosis (non-AD, indeterminate, possible/probable AD) and AD biomarker status (negative, indeterminate, positive) was determined. Individual test score data were used to examine between-group differences based on amyloid status. RESULTS AD biomarker positive and negative patients did not differ on individual neuropsychological tests after correcting for multiple comparisons, though the small number of AD biomarker indeterminate individuals performed better than biomarker positive patients. However, there was 76.7% concordance between neuropsychologists' diagnostic impressions and AD biomarker status (88% sensitivity and 55% specificity of neuropsychological assessment in detecting AD biomarker status). AD biomarker negative patients diagnosed as possible/probable AD (discordant) versus non-AD (concordant) had significantly lower Neuropsychological Assessment Battery Story Delayed Recall, higher Wechsler Adult Intelligence Scale-Fourth Edition Coding, and higher Trail-Making A (i.e., an amnestic memory profile). CONCLUSIONS Comprehensive neuropsychological assessment showed modest concordance with AD biomarker status in patients seen in an outpatient medical center for routine clinical care. Low specificity for the clinical diagnosis of AD could be explained by the multiplicity of etiologies that cause memory impairment (i.e., TAR DNA-binding protein 43, suspected non-AD pathology). (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | | | - Deirdre O'Shea
- Department of Neurology, Miller School of Medicine, University of Miami
| | - Brian R Ott
- Department of Neurology, Alpert Medical School, Brown University
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Abstract
BACKGROUND Antidementia medication can provide symptomatic improvements in patients with Alzheimer's disease, but there is a lack of consensus guidance on when to start and stop treatment in the nursing home setting. METHODS We describe utilization patterns of cholinesterase inhibitors (ChEI) and memantine for 3,50,197 newly admitted NH residents with dementia between 2011 and 2018. RESULTS Overall, pre-admission use of antidementia medications declined from 2011 to 2018 (ChEIs: 44.5% to 36.9%; memantine: 27.4% to 23.2%). Older age, use of a feeding tube, and greater functional dependency were associated with lower odds of ChEI initiation. Coronary artery disease, parenteral nutrition, severe aggressive behaviors, severe cognitive impairment, and high functional dependency were associated with discontinuation of ChEIs. Comparison of clinical factors related to anti-dementia drug treatment changes from pre to post NH admission in 2011 and 2018 revealed a change toward lower likelihood of initiation of treatment among residents with more functional dependency and those with indicators of more complex illness as well as a change toward higher likelihood of discontinuation in residents having 2 or more hospital stays. CONCLUSIONS These prescribing trends highlight the need for additional research on the effects of initiating and discontinuing antidementia medications in the NH to provide clear guidance for clinicians when making treatment decisions for individual residents.
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Affiliation(s)
- Brian R. Ott
- Department of Neurology, Brown University Warren Alpert Medical School, Providence, RI
| | - Carl Hollins
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Jennifer Tjia
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Jonggyu Baek
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Qiaoxi Chen
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Kate L. Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Matthew Alcusky
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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Riester MR, D'Amico AM, Khan MA, Joyce NR, Pfeiffer MR, Margolis SA, Ott BR, Curry AE, Bayer TA, Zullo AR. Changes in the burden of medications that may impair driving among older adults before and after a motor vehicle crash. J Am Geriatr Soc 2024; 72:444-455. [PMID: 37905738 PMCID: PMC10922040 DOI: 10.1111/jgs.18643] [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] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/29/2023] [Accepted: 10/05/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Medications are one of the most easily modifiable risk factors for motor vehicle crashes (MVCs) among older adults, yet limited information exists on how the use of potentially driver-impairing (PDI) medications changes following an MVC. Therefore, we examined the number and types of PDI medication classes dispensed before and after an MVC. METHODS This observational study included Medicare fee-for-service beneficiaries aged ≥67 years who were involved in a police-reported MVC in New Jersey as a driver between 2008 and 2017. Analyses were conducted at the "person-crash" level because participants could be involved in more than one MVC. We examined the use of 36 PDI medication classes in the 120 days before and 120 days after MVC. We described the number and prevalence of PDI medication classes in the pre-MVC and post-MVC periods as well as the most common PDI medication classes started and stopped following the MVC. RESULTS Among 124,954 person-crashes, the mean (SD) age was 76.0 (6.5) years, 51.3% were female, and 83.9% were non-Hispanic White. The median (Q1 , Q3 ) number of PDI medication classes was 2 (1, 4) in both the pre-MVC and post-MVC periods. Overall, 20.3% had a net increase, 15.9% had a net decrease, and 63.8% had no net change in the number of PDI medication classes after MVC. Opioids, antihistamines, and thiazide diuretics were the top PDI medication classes stopped following MVC, at incidences of 6.2%, 2.1%, and 1.7%, respectively. The top medication classes started were opioids (8.3%), skeletal muscle relaxants (2.2%), and benzodiazepines (2.1%). CONCLUSIONS A majority of crash-involved older adults were exposed to multiple PDI medications before and after MVC. A greater proportion of person-crashes were associated with an increased rather than decreased number of PDI medications. The reasons why clinicians refrain from stopping PDI medications following an MVC remain to be elucidated.
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Affiliation(s)
- Melissa R Riester
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Health Care Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Adam M D'Amico
- Center for Gerontology and Health Care Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Marzan A Khan
- Center for Gerontology and Health Care Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Nina R Joyce
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Health Care Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Melissa R Pfeiffer
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Seth A Margolis
- Department of Neuropsychology, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Psychiatry & Human Behavior, Brown University, Providence, Rhode Island, USA
| | - Brian R Ott
- Department of Neurology, Brown University, Providence, Rhode Island, USA
| | - Allison E Curry
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas A Bayer
- Division of Geriatrics and Palliative Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
| | - Andrew R Zullo
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Health Care Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
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Plassman BL, Ford CB, Smith VA, DePasquale N, Burke JR, Korthauer L, Ott BR, Belanger E, Shepherd-Banigan ME, Couch E, Jutkowitz E, O’Brien EC, Sorenson C, Wetle TT, Van Houtven CH. Elevated Amyloid-β PET Scan and Cognitive and Functional Decline in Mild Cognitive Impairment and Dementia of Uncertain Etiology. J Alzheimers Dis 2024; 97:1161-1171. [PMID: 38306055 PMCID: PMC11034799 DOI: 10.3233/jad-230950] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Elevated amyloid-β (Aβ) on positron emission tomography (PET) scan is used to aid diagnosis of Alzheimer's disease (AD), but many prior studies have focused on patients with a typical AD phenotype such as amnestic mild cognitive impairment (MCI). Little is known about whether elevated Aβ on PET scan predicts rate of cognitive and functional decline among those with MCI or dementia that is clinically less typical of early AD, thus leading to etiologic uncertainty. OBJECTIVE We aimed to investigate whether elevated Aβ on PET scan predicts cognitive and functional decline over an 18-month period in those with MCI or dementia of uncertain etiology. METHODS In 1,028 individuals with MCI or dementia of uncertain etiology, we evaluated the association between elevated Aβ on PET scan and change on a telephone cognitive status measure administered to the participant and change in everyday function as reported by their care partner. RESULTS Individuals with either MCI or dementia and elevated Aβ (66.6% of the sample) showed greater cognitive decline compared to those without elevated Aβ on PET scan, whose cognition was relatively stable over 18 months. Those with either MCI or dementia and elevated Aβ were also reported to have greater functional decline compared to those without elevated Aβ, even though the latter group showed significant care partner-reported functional decline over time. CONCLUSIONS Elevated Aβ on PET scan can be helpful in predicting rates of both cognitive and functional decline, even among cognitively impaired individuals with atypical presentations of AD.
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Affiliation(s)
- Brenda L. Plassman
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
- Department of Neurology, School of Medicine, Duke University, NC, USA
| | - Cassie B. Ford
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Valerie A. Smith
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
- Durham ADAPT, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Nicole DePasquale
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - James R. Burke
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
- Department of Neurology, School of Medicine, Duke University, NC, USA
| | - Laura Korthauer
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Brian R. Ott
- Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Emmanuelle Belanger
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Megan E. Shepherd-Banigan
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Durham ADAPT, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Durham, NC, USA
| | - Elyse Couch
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Eric Jutkowitz
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Emily C. O’Brien
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Corinna Sorenson
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Durham, NC, USA
- Sanford School of Public Policy, Duke University, Durham, NC, USA
| | - Terrie T. Wetle
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Courtney H. Van Houtven
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Durham ADAPT, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Durham, NC, USA
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Lapane KL, Ott BR, Hargraves JL, Cosenza C, Liang S, Alcusky M. Changes in Antidementia Medications upon Admission to the Nursing Home: Who Decides and Why? Results From a National Survey of Nursing Home Administrators. J Am Med Dir Assoc 2024; 25:41-46.e5. [PMID: 38173265 PMCID: PMC10783796 DOI: 10.1016/j.jamda.2023.09.022] [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] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE Little is known about who is involved and what factors influence changes in antidementia medications for older adults living in nursing homes. The study sought to describe factors associated with initiation and discontinuation of antidementia medications in nursing home residents with dementia. DESIGN National survey of nursing homes with ≥30 beds; homes with dementia units were oversampled. SETTINGS AND PARTICIPANTS Nursing home administrators [eg, Directors of Nursing (DoNs)]. METHODS In 2022, 1293 homes were surveyed (response rate: 26.6%, n = 340). Weighted analyses provided nationally representative results corrected for nonresponse (n = 14,455). RESULTS DoNs reported that people always/almost always involved in antidementia medication decisions included nursing home prescriber (84.4%), nursing staff (33.2%), family (23.4%), resident (13.8%), community primary care provider (12.1%), and dementia specialist (5.8%). DoNs reported that antidementia medications were much more likely to be initiated if residents (55.8%) and family members (53.2%) wanted antidementia medications, a dementia specialist was involved (51.9%), resident had aggressive behaviors (44.8%), resisted care (31.6%), or had severe physical/cognitive impairment (22.3%). DoNs reported that antidementia medications were much more likely to be discontinued with dementia specialist involvement (46.5%), progression to severe impairment (39.2%), hospice involvement (31.5%), <6 months' prognosis (28.5%), emergence of aggressive behaviors (25.2%), or resisting care (19.0%) and much less likely to be discontinued if residents (30.2%) and family (27.3%) were reluctant to discontinue. One in 6 homes reported that residents had no immediate family/caregivers usually or almost always/always. CONCLUSIONS AND IMPLICATIONS DoNs report that family/caregivers and dementia specialists have significant influence on antidementia medication decisions in nursing homes, but many residents lack their involvement. Real-world evidence on the risks and benefits of antidementia medications in nursing homes is needed to inform clinical guidance about appropriate use of antidementia medications in nursing homes.
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Affiliation(s)
- Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Brian R Ott
- Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - J Lee Hargraves
- Center for Survey Research, University of Massachusetts Boston, Boston, MA, USA
| | - Carol Cosenza
- Center for Survey Research, University of Massachusetts Boston, Boston, MA, USA
| | - Shiwei Liang
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Matthew Alcusky
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Joyce NR, Khan MA, Zullo AR, Pfeiffer MR, Metzger KB, Margolis SA, Ott BR, Curry AE. Distance From Home to Motor Vehicle Crash Location: Implications for License Restrictions Among Medically-At-Risk Older Drivers. J Aging Soc Policy 2022:1-15. [PMID: 36463560 PMCID: PMC10239525 DOI: 10.1080/08959420.2022.2145791] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/11/2022] [Indexed: 12/07/2022]
Abstract
In 30 states, licensing agencies can restrict the distance from home that "medically-at-risk" drivers are permitted to drive. However, where older drivers crash relative to their home or how distance to crash varies by medical condition is unknown. Using geocoded crash locations and residential addresses linked to Medicare claims, we describe how the relationship between distance from home to crash varies by driver characteristics. We find that a majority of crashes occur within a few miles from home with little variation across driver demographics or medical conditions. Thus, distance restrictions may not reduce crash rates among older adults, and the tradeoff between safety and mobility warrants consideration.
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Affiliation(s)
- Nina R. Joyce
- Department of Epidemiology, Brown University School of Public Health
- Center for Gerontology and Health Care Research, Brown University School of Public Health
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia
| | - Marzan A. Khan
- Center for Gerontology and Health Care Research, Brown University School of Public Health
| | - Andrew R. Zullo
- Department of Epidemiology, Brown University School of Public Health
- Center for Gerontology and Health Care Research, Brown University School of Public Health
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia
- Department of Health Services Policy and Practice, Brown University School of Public Health
- Center of Innovation in Longterm Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island
| | - Melissa R. Pfeiffer
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia
| | - Kristina B. Metzger
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia
| | - Seth A. Margolis
- Department of Neurology, Warren Alpert Medical School of Brown University
- Department of Psychiatry & Human Behavior, Brown University, Providence, Rhode Island
| | - Brian R. Ott
- Department of Neurology, Warren Alpert Medical School of Brown University
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Allison E. Curry
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia
- Division of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania
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Tremont G, Davis J, Ott BR, Uebelacker L, Kenney L, Gillette T, Britton K, Sanborn V. Feasibility of a Yoga Intervention for Individuals with Mild Cognitive Impairment: A Randomized Controlled Trial. J Integr Complement Med 2022; 28:250-260. [PMID: 35294301 DOI: 10.1089/jicm.2021.0204] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Yoga is a potentially low risk intervention for cognitive impairment that combines mental and physical practice and includes instruction on breathing, stress reduction, and mindfulness meditation. Previous research documents that yoga can target modifiable risk factors for mild cognitive impairment (MCI) progression. The authors describe a randomized feasibility trial of yoga for individuals with MCI. Methods: Participants were 37 individuals with amnestic MCI who were randomly assigned to receive 12 weeks of twice-weekly yoga intervention (YI) or healthy living education (HLE) classes. Acceptability and feasibility were assessed by tracking adverse events, class attendance, and participant satisfaction. Participants completed neuropsychological and mood measures as well as measures of potential intervention mechanisms at baseline and immediately postintervention. Results: Participants in both conditions reported high levels of satisfaction and reasonable class attendance rates. Home practice rates were low. There were no adverse events deemed related to the YI. Results showed a medium effect size in favor of the YI in visuospatial skills. The yoga group also showed a large effect size indicating decline in perceived stress compared with the HLE group, whereas HLE resulted in greater reductions in depressive symptoms after the intervention (large effect size). Conclusions: Study findings indicated that the YI was safe, modestly feasible, and acceptable to older adults with MCI. The authors found preliminary evidence that yoga may improve visuospatial functioning in individuals with MCI. Results support stress reduction as a possible mechanism for the YI. Future studies should address a YI in a larger sample and include strategies to enhance engagement and home practice.
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Affiliation(s)
- Geoffrey Tremont
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jennifer Davis
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Brian R Ott
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.,Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Lisa Uebelacker
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Butler Hospital, Providence, RI, USA
| | - Lauren Kenney
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Tom Gillette
- Eyes of the World Yoga Center, Providence, RI, USA
| | - Karysa Britton
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Victoria Sanborn
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
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Maynard TR, Chapman KR, Sadhu S, Frink T, Mankodiya K, Davis JD, Uebelacker L, Ott BR, Tremont G. Beta test of a mobile health application for dementia caregivers. Alzheimers Dement 2022. [PMID: 34971069 DOI: 10.1002/alz.056312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Dementia caregivers are at risk for negative health outcomes. Caregiver interventions to address this risk are limited by time and personnel constraints. Mobile technology is one means of reaching many caregivers while mitigating these constraints. The aim of the current project was to obtain initial data from a month-long beta test of a new mobile health tablet App for dementia caregivers. METHOD A purposive sample of community-dwelling dementia caregivers was given access to the CARE-Well (Caregiver Assessment, Resources, and Education) App for one month. The App consisted of 6 primary sections: (1) Self-Assessment of Stress and Care Recipient Behavioral Problems; (2) Psychoeducation; (3) Goal Diary; (4) Managing Behavior Problems; (5) Online Message Forum; and (6) Video Library. Feedback was collected from caregivers in a qualitative interview following study completion. Data were analyzed via a mixed-methods approach. RESULT Caregivers (n = 10) were White, in their mid-60s (M = 66.2, SD = 12.12), and well educated (M = 16.00 years, SD = 1.63). Care recipients had either mild (80%) or moderate dementia (20%), and 90% had probable Alzheimer's disease. The average total time spent on the App across all participants was 754.29 minutes (SD = 1584.12). The most heavily used (in minutes) sections of the App were: Managing Behavior Problems (M = 592.10, SD = 1595.75), Video Library (M = 54.33, SD = 88.18) and Psychoeducation (M = 53.18, SD = 54.50). Qualitative feedback was predominantly positive. Caregivers reported Managing Behavior Problems to be the most helpful section followed by Psychoeducation and Online Message Forum. Caregivers reported difficulty with or disinterest in the Goal Diary section. In general, caregivers reported that the App would have been more helpful earlier in their care recipient's illness. CONCLUSION Results indicated that caregivers regularly used the App and provided mostly positive responses to content. Findings highlighted the importance of user feedback and an iterative approach for developing digital health technology for dementia caregivers. Future interventions that are introduced earlier in the disease process may be well-received and more beneficial to a wider range of dementia caregivers and their care recipients.
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Affiliation(s)
| | - Kimberly R Chapman
- Rhode Island Hospital, Providence, RI, USA.,Alpert Medical School Brown University, Providence, RI, USA
| | - Shehjar Sadhu
- University of Rhode Island, North Kingstown, RI, USA
| | - Travis Frink
- University of Rhode Island, North Kingstown, RI, USA
| | | | - Jennifer D Davis
- Rhode Island Hospital, Providence, RI, USA.,Alpert Medical School Brown University, Providence, RI, USA
| | - Lisa Uebelacker
- Alpert Medical School Brown University, Providence, RI, USA.,Butler Hospital/Brown University, Providence, RI, USA
| | - Brian R Ott
- Rhode Island Hospital, Providence, RI, USA.,Alpert Medical School Brown University, Providence, RI, USA
| | - Geoffrey Tremont
- Rhode Island Hospital, Providence, RI, USA.,Alpert Medical School Brown University, Providence, RI, USA
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Kelly DA, Davis JD, Daiello LA, Burke EM, Fernandez T, Tremont G, Ott BR, Margolis SA. Neuroticism moderates the association between beliefs about medications and reported adverse medication effects in mild cognitive impairment. Alzheimers Dement 2021. [DOI: 10.1002/alz.051822] [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: 11/05/2022]
Affiliation(s)
- Dana A Kelly
- Alpert Medical School Brown University Providence RI USA
- Rhode Island Hospital Providence RI USA
| | - Jennifer D Davis
- Alpert Medical School Brown University Providence RI USA
- Rhode Island Hospital Providence RI USA
| | - Lori A Daiello
- Alpert Medical School Brown University Providence RI USA
- Rhode Island Hospital Providence RI USA
| | | | | | - Geoffrey Tremont
- Alpert Medical School Brown University Providence RI USA
- Rhode Island Hospital Providence RI USA
| | - Brian R Ott
- Alpert Medical School Brown University Providence RI USA
- Rhode Island Hospital Providence RI USA
| | - Seth A Margolis
- Alpert Medical School Brown University Providence RI USA
- Rhode Island Hospital Providence RI USA
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Cheng S, Banerjee S, Daiello LA, Nakashima A, Jash S, Huang Z, Drake JD, Ernerudh J, Berg G, Padbury J, Saito S, Ott BR, Sharma S. Novel blood test for early biomarkers of preeclampsia and Alzheimer's disease. Sci Rep 2021; 11:15934. [PMID: 34354200 PMCID: PMC8342418 DOI: 10.1038/s41598-021-95611-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Received: 03/18/2021] [Accepted: 07/19/2021] [Indexed: 12/24/2022] Open
Abstract
A non-invasive and sensitive blood test has long been a goal for early stage disease diagnosis and treatment for Alzheimer's disease (AD) and other proteinopathy diseases. We previously reported that preeclampsia (PE), a severe pregnancy complication, is another proteinopathy disorder with impaired autophagy. We hypothesized that induced autophagy deficiency would promote accumulation of pathologic protein aggregates. Here, we describe a novel, sensitive assay that detects serum protein aggregates from patients with PE (n = 33 early onset and 33 late onset) and gestational age-matched controls (n = 77) as well as AD in both dementia and prodromal mild cognitive impairment (MCI, n = 24) stages with age-matched controls (n = 19). The assay employs exposure of genetically engineered, autophagy-deficient human trophoblasts (ADTs) to serum from patients. The aggregated protein complexes and their individual components, including transthyretin, amyloid β-42, α-synuclein, and phosphorylated tau231, can be detected and quantified by co-staining with ProteoStat, a rotor dye with affinity to aggregated proteins, and respective antibodies. Detection of protein aggregates in ADTs was not dependent on transcriptional upregulation of these biomarkers. The ROC curve analysis validated the robustness of the assay for its specificity and sensitivity (PE; AUC: 1, CI: 0.949-1.00; AD; AUC: 0.986, CI: 0.832-1.00). In conclusion, we have developed a novel, noninvasive diagnostic and predictive assay for AD, MCI and PE.
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Affiliation(s)
- Shibin Cheng
- grid.40263.330000 0004 1936 9094Department of Pediatrics, Women and Infants Hospital-Warren Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02905 USA
| | - Sayani Banerjee
- grid.40263.330000 0004 1936 9094Department of Pediatrics, Women and Infants Hospital-Warren Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02905 USA
| | - Lori A. Daiello
- grid.40263.330000 0004 1936 9094Department of Neurology, Warren Alpert Medical School of Brown University and Alzheimer’s Disease and Memory Disorders Center At Rhode Island Hospital, Providence, RI 02903 USA
| | - Akitoshi Nakashima
- grid.267346.20000 0001 2171 836XDepartment of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Sukanta Jash
- grid.40263.330000 0004 1936 9094Department of Pediatrics, Women and Infants Hospital-Warren Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02905 USA
| | - Zheping Huang
- grid.40263.330000 0004 1936 9094Department of Pediatrics, Women and Infants Hospital-Warren Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02905 USA
| | - Jonathan D. Drake
- grid.40263.330000 0004 1936 9094Department of Neurology, Warren Alpert Medical School of Brown University and Alzheimer’s Disease and Memory Disorders Center At Rhode Island Hospital, Providence, RI 02903 USA
| | - Jan Ernerudh
- grid.5640.70000 0001 2162 9922Department of Biomedical and Clinical Services, Linkoping University, Linkoping, Sweden
| | - Goran Berg
- grid.5640.70000 0001 2162 9922Department of Biomedical and Clinical Services, Linkoping University, Linkoping, Sweden
| | - James Padbury
- grid.40263.330000 0004 1936 9094Department of Pediatrics, Women and Infants Hospital-Warren Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02905 USA
| | - Shigeru Saito
- grid.267346.20000 0001 2171 836XDepartment of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Brian R. Ott
- grid.40263.330000 0004 1936 9094Department of Neurology, Warren Alpert Medical School of Brown University and Alzheimer’s Disease and Memory Disorders Center At Rhode Island Hospital, Providence, RI 02903 USA
| | - Surendra Sharma
- grid.40263.330000 0004 1936 9094Department of Pediatrics, Women and Infants Hospital-Warren Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02905 USA
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11
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Margolis SA, Kelly DA, Daiello LA, Davis J, Tremont G, Pillemer S, Denby C, Ott BR. Anticholinergic/Sedative Drug Burden and Subjective Cognitive Decline in Older Adults at Risk of Alzheimer's Disease. J Gerontol A Biol Sci Med Sci 2021; 76:1037-1043. [PMID: 32886748 DOI: 10.1093/gerona/glaa222] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Anticholinergic/sedative drug use, measured by the Drug Burden Index (DBI), has been linked to cognitive impairment in older adults. Subjective cognitive decline (SCD) may be among the first symptoms patients with Alzheimer's disease (AD) experience. We examined whether DBI values are associated with SCD in older adults at risk of AD. We hypothesized that increased DBI would be associated with greater SCD at older ages. METHOD Two-hundred-six community-dwelling, English-speaking adults (age = 65 ± 9 years) at risk of AD (42% apolipoprotein ε4 carriers; 78% with AD family history) were administered a single question to ascertain SCD: "Do you feel like your memory is becoming worse?" Response options were "No"; "Yes, but this does not worry me"; and "Yes, this worries me." DBI values were derived from self-reported medication regimens using older adult dosing recommendations. Adjusting for relevant covariates (comorbidities and polypharmacy), we examined independent effects of age and DBI on SCD, as well as the moderating effect of age on the DBI-SCD association at mean ± 1 SD of age. RESULTS Both SCD and anticholinergic/sedative drug burden were prevalent. Greater drug burden was predictive of SCD severity, but age alone was not. A significant DBI*Age interaction emerged with greater drug burden corresponding to more severe SCD among individuals age 65 and older. CONCLUSION Anticholinergic/sedative drug exposure was associated with greater SCD in adults 65 and older at risk for AD. Longitudinal research is needed to understand if this relationship is a pre-clinical marker of neurodegenerative disease and predictive of future cognitive decline.
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Affiliation(s)
- Seth A Margolis
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Rhode Island Hospital, Providence
| | - Dana A Kelly
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Rhode Island Hospital, Providence
| | - Lori A Daiello
- Alzheimer's Disease and Memory Disorders Center at Rhode Island Hospital, Providence.,Department of Neurology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jennifer Davis
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Rhode Island Hospital, Providence
| | - Geoffrey Tremont
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Rhode Island Hospital, Providence
| | - Sarah Pillemer
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Rhode Island Hospital, Providence
| | - Charles Denby
- Alzheimer's Disease and Memory Disorders Center at Rhode Island Hospital, Providence
| | - Brian R Ott
- Alzheimer's Disease and Memory Disorders Center at Rhode Island Hospital, Providence.,Department of Neurology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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12
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Drake JD, Chambers AB, Ott BR, Daiello LA. Peripheral Markers of Vascular Endothelial Dysfunction Show Independent but Additive Relationships with Brain-Based Biomarkers in Association with Functional Impairment in Alzheimer's Disease. J Alzheimers Dis 2021; 80:1553-1565. [PMID: 33720880 PMCID: PMC8150492 DOI: 10.3233/jad-200759] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 12/16/2022]
Abstract
BACKGROUND Cerebrovascular dysfunction confers risk for functional decline in Alzheimer's disease (AD), yet the clinical interplay of these two pathogenic processes is not well understood. OBJECTIVE We utilized Alzheimer's Disease Neuroimaging Initiative (ADNI) data to examine associations between peripherally derived soluble cell adhesion molecules (CAMs) and clinical diagnostic indicators of AD. METHODS Using generalized linear regression models, we examined cross-sectional relationships of soluble plasma vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and E-Selectin to baseline diagnosis and functional impairment (clinical dementia rating sum-of-boxes, CDR-SB) in the ADNI cohort (n = 112 AD, n = 396 mild cognitive impairment (MCI), n = 58 cognitively normal). We further analyzed associations of these biomarkers with brain-based AD biomarkers in a subset with available cerebrospinal fluid (CSF) data (n = 351). p-values derived from main effects and interaction terms from the linear regressions were used to assess the relationship between independent and dependent variables for significance (significance level was set at 0.05 a priori for all analysis). RESULTS Higher mean VCAM-1 (p = 0.0026) and ICAM-1 (p = 0.0189) levels were found in AD versus MCI groups; however, not in MCI versus cognitively normal groups. Only VCAM-1 was linked with CDR-SB scores (p = 0.0157), and APOE ɛ4 genotype modified this effect. We observed independent, additive associations when VCAM-1 and CSF amyloid-β (Aβ42), total tau, phosphorylated tau (P-tau), or P-tau/Aβ42 (all < p = 0.01) were combined in a CDR-SB model; ICAM-1 showed a similar pattern, but to a lesser extent. CONCLUSION Our findings indicate independent associations of plasma-based vascular biomarkers and CSF biomarkers with AD-related clinical impairment.
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Affiliation(s)
- Jonathan D Drake
- Alzheimer's Disease and Memory Disorders Center, Rhode Island Hospital, Providence, RI, USA.,Department of Neurology, Brown University Warren Alpert Medical School, Providence RI, USA
| | - Alison B Chambers
- Department of Medicine, Brown University Warren Alpert Medical School, Providence RI, USA
| | - Brian R Ott
- Alzheimer's Disease and Memory Disorders Center, Rhode Island Hospital, Providence, RI, USA.,Department of Neurology, Brown University Warren Alpert Medical School, Providence RI, USA
| | - Lori A Daiello
- Alzheimer's Disease and Memory Disorders Center, Rhode Island Hospital, Providence, RI, USA.,Department of Neurology, Brown University Warren Alpert Medical School, Providence RI, USA
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13
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Ott BR, Papandonatos GD, Burke EM, Erdman D, Carr DB, Davis JD. Video feedback intervention for cognitively impaired older drivers: A randomized clinical trial. Alzheimers Dement (N Y) 2021; 7:e12140. [PMID: 33718583 PMCID: PMC7927162 DOI: 10.1002/trc2.12140] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/19/2020] [Accepted: 12/08/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION This clinical trial aimed to determine whether in-car video feedback about unsafe driving events (UDE) to cognitively impaired older drivers and family members leads to a reduction in such driving behaviors. METHODS We randomized 51 cognitively impaired older drivers to receive either (1) a weekly progress report with recommendations and access to their videos, or (2) video monitoring alone without feedback over 3 months. RESULTS UDE frequency/1000 miles was reduced by 12% in feedback (rate ratio [RR] = 0.88, 95% confidence interval [CI] = .58-1.34), while remaining constant with only monitoring (RR = 1.01, 95% CI = .68-1.51). UDE severity/1000 miles was reduced by 37% in feedback (RR = 0.63, 95% CI = .31-1.27), but increased by 40% in monitoring (RR = 1.40, 95% CI = .68-2.90). Cognitive impairment moderated intervention effects (P = .03) on UDE frequency. DISCUSSION Results suggest the potential to improve driving safety among mild cognitively impaired older drivers using a behavior modification approach aimed at problem behaviors detected in their natural driving environment.
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Affiliation(s)
- Brian R. Ott
- Department of NeurologyWarren Alpert Medical School of Brown UniversityRhode Island HospitalProvidenceRhode IslandUSA
| | | | - Erin M. Burke
- Department of Psychiatry and Human BehaviorWarren Alpert Medical School of Brown UniversityRhode Island HospitalProvidenceRhode IslandUSA
| | - Donna Erdman
- Spaulding Cape CodDriving Assessment ProgramEast SandwichMassachusettsUSA
| | - David B. Carr
- Department of Medicine and NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Jennifer D. Davis
- Department of Psychiatry and Human BehaviorWarren Alpert Medical School of Brown UniversityRhode Island HospitalProvidenceRhode IslandUSA
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14
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Alber J, Arthur E, Goldfarb D, Drake J, Boxerman JL, Silver B, Ott BR, Johnson LN, Snyder PJ. The relationship between cerebral and retinal microbleeds in cerebral amyloid angiopathy (CAA): A pilot study. J Neurol Sci 2021; 423:117383. [PMID: 33684655 DOI: 10.1016/j.jns.2021.117383] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 01/26/2021] [Accepted: 02/26/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The standard in vivo diagnostic imaging technique for cerebral amyloid angiopathy (CAA) is costly and thereby of limited utility for point-of-care diagnosis and monitoring of treatment efficacy. Recent recognition that retinal changes may reflect cerebral changes in neurodegenerative disease provides an ideal opportunity for development of accessible and cost-effective biomarkers for point-of-care use in the detection and monitoring of CAA. In this pilot study, we examined structural and angiographic retinal changes in CAA patients relative to a control group, and compared retinal and cerebral pathology in a group of CAA patients. METHODS We used spectral domain optical coherence tomography (SD-OCT) to image the retina and compared retinal microbleeds to both cerebral microbleeds and white matter hyperintensities (WMH) in CAA patients, as seen on MRI. We compared retinal angiographic changes, along with structural retinal neuronal layer changes in CAA patients and cognitively normal older adults, and examined the relationship between retinal and cerebral microbleeds and cognition in CAA patients. RESULTS We found a trend level correlation between retinal and cerebral microbleeds in CAA patients. Moreover, we found a significant correlation between retinal microbleeds and episodic memory performance in CAA patients. There were no significant group differences between CAA patients and cognitively normal older adults on retinal angiographic or structural measurements. CONCLUSION Retinal microbleeds may reflect degree of cerebral microbleed burden in CAA. This picture was complicated by systolic hypertension in the CAA group, which is a confounding factor for the interpretation of these data. Our results stimulate motivation for pursuit of a more comprehensive prospective study to determine the feasibility of retinal biomarkers in CAA.
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Affiliation(s)
- Jessica Alber
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI, USA; George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, USA; Memory & Aging Program, Butler Hospital, Providence, RI, USA.
| | - Edmund Arthur
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI, USA; George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, USA; Memory & Aging Program, Butler Hospital, Providence, RI, USA
| | | | - Jonathan Drake
- Department of Neurology, Rhode Island Hospital, Providence, RI, USA; Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Jerrold L Boxerman
- Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA; Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, USA
| | - Brian Silver
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Brian R Ott
- Department of Neurology, Rhode Island Hospital, Providence, RI, USA; Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Lenworth N Johnson
- Department of Surgery (Ophthalmology), Alpert Medical School of Brown University, Providence, RI, USA
| | - Peter J Snyder
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI, USA; George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, USA; Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA; Department of Surgery (Ophthalmology), Alpert Medical School of Brown University, Providence, RI, USA
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15
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Korthauer LE, Denby C, Molina D, Wanjiku J, Daiello LA, Drake JD, Grill JD, Ott BR. Pilot study of an Alzheimer's disease risk assessment program in a primary care setting. Alzheimers Dement (Amst) 2021; 13:e12157. [PMID: 33665347 PMCID: PMC7896638 DOI: 10.1002/dad2.12157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/15/2020] [Accepted: 12/29/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The goal of this study was to pilot a referral-based cognitive screening and genetic testing program for Alzheimer's disease (AD) risk assessment in a primary care setting. METHODS Primary care providers (PCPs; N = 6) referred patients (N = 94; M = 63 years) to the Rhode Island Alzheimer's Disease Prevention Registry for apolipoprotein E (APOE) genotyping and cognitive screening. PCPs disclosed test results to patients and counseled them about risk factor modification. RESULTS Compared to the Registry as a whole, participants were younger, more likely to be non-White, and had lower cognitive screening scores. Mild cognitive impairment participants correctly reported a higher perceived risk of developing AD. Patients who recalled being counseled about modifiable risk factors were more likely to report positive health behavior changes. DISCUSSION A referral-based program for cognitive and genetic AD risk assessment in a primary care setting is feasible, acceptable to patients, and yielded a more demographically diverse sample than an AD prevention registry.
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Affiliation(s)
- Laura E. Korthauer
- Department of Psychiatry and Human BehaviorAlpert Medical School of Brown UniversityRhode Island HospitalProvidenceRhode IslandUSA
- Department of NeurologyAlpert Medical School of Brown UniversityRhode Island HospitalProvidenceRhode IslandUSA
| | - Charles Denby
- Department of NeurologyAlpert Medical School of Brown UniversityRhode Island HospitalProvidenceRhode IslandUSA
| | - David Molina
- Department of NeurologyAlpert Medical School of Brown UniversityRhode Island HospitalProvidenceRhode IslandUSA
| | - Janet Wanjiku
- Department of NeurologyAlpert Medical School of Brown UniversityRhode Island HospitalProvidenceRhode IslandUSA
| | - Lori A. Daiello
- Department of NeurologyAlpert Medical School of Brown UniversityRhode Island HospitalProvidenceRhode IslandUSA
| | - Jonathan D. Drake
- Department of NeurologyAlpert Medical School of Brown UniversityRhode Island HospitalProvidenceRhode IslandUSA
| | - Josh D. Grill
- Institute of Memory Impairments and Neurological DisordersDepartment of Psychiatry and Human BehaviorDepartment of Neurobiology and BehaviorUniversity of California IrvineIrvineCaliforniaUSA
| | - Brian R. Ott
- Department of NeurologyAlpert Medical School of Brown UniversityRhode Island HospitalProvidenceRhode IslandUSA
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16
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Gencer B, Mach F, Guo J, Im K, Ruzza A, Wang H, Kurtz CE, Pedersen TR, Keech AC, Ott BR, Sabatine MS, Giugliano RP. Cognition After Lowering LDL-Cholesterol With Evolocumab. J Am Coll Cardiol 2020; 75:2283-2293. [PMID: 32381158 DOI: 10.1016/j.jacc.2020.03.039] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [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: 12/02/2019] [Revised: 02/25/2020] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The EBBINGHAUS (Evaluating PCSK9 Binding Antibody Influence on Cognitive Health in High Cardiovascular Risk Subjects) trial demonstrated that evolocumab added to a background statin did not affect cognitive performance in a subset of 1,204 patients enrolled in FOURIER (Further Cardiovascular Outcomes Research With PCSK9 inhibitors in Subjects With Elevated Risk). OBJECTIVES The authors describe patient-reported cognition in the entire FOURIER trial using a self-survey. METHODS FOURIER was a randomized, double-blind, placebo-controlled trial involving patients with atherosclerotic cardiovascular disease and low-density lipoprotein cholesterol (LDL-C) levels ≥70 mg/dl or non-high-density cholesterol ≥100 mg/dl despite statin therapy. At the final visit, patients completed a 23-item survey on memory and executive domains from the Everyday Cognition (ECog) scale. Patients compared their levels of everyday function at the end of the trial with their levels at the beginning and scored as 1 (no change or improvement), 2 (occasionally worse), 3 (consistently little worse), or 4 (consistently much worse). ECog scores were compared by the 2 randomized treatment arms and by achieved LDL-C at 4 weeks. RESULTS A total of 22,655 patients completed ECog after a median duration of 2.2 years. The proportions of patients reporting cognitive decline (ECog score ≥2) at the end of the study were similar for placebo versus evolocumab, both for total score 3.6% versus 3.7% (p = 0.62) and for subdomains (memory, 5.8% vs. 6.0%; total executive, 3.6% vs. 3.7%). The proportion of patients reporting a decline in total cognitive score was similar among the 2,338 patients who achieved very low LDL-C levels (<20 mg/dl) compared to the 3,613 patients with LDL-C ≥100 mg/dl (3.8% vs. 4.5%, p = 0.57). CONCLUSIONS The addition of evolocumab to maximally tolerated statin therapy had no impact on patient-reported cognition after an average of 2.2 years of treatment, even among patients who achieved LDL-C <20 mg/dl.
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Affiliation(s)
- Baris Gencer
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - François Mach
- Cardiology Division, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jianping Guo
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - KyungAh Im
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Terje Rolf Pedersen
- Department of Preventive Cardiology, Oslo University Hospital, Aker and Medical Faculty, University of Oslo, Oslo, Norway
| | - Anthony C Keech
- Sydney Medical School, NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Brian R Ott
- Rhode Island Hospital, Brown University, Providence, Rhode Island
| | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert P Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Korthauer LE, Denby C, Molina D, Wanjiku J, Daiello LA, Drake JD, Grill JD, Ott BR. Implementation of a targeted screening program for Alzheimer's disease risk in a primary care setting. Alzheimers Dement 2020. [DOI: 10.1002/alz.043107] [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: 11/06/2022]
Affiliation(s)
- Laura E Korthauer
- Rhode Island Hospital Providence RI USA
- Alpert Medical School of Brown University Providence RI USA
| | | | | | | | - Lori A Daiello
- Alpert Medical School of Brown University Providence RI USA
| | | | | | - Brian R Ott
- Alpert Medical School of Brown University Providence RI USA
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18
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Ott BR, Papandonatos GD, Burke EM, Erdman D, Carr DB, Davis JD. A video feedback intervention for cognitively impaired older drivers. Alzheimers Dement 2020. [DOI: 10.1002/alz.041852] [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)
- Brian R Ott
- Alpert Medical School of Brown University Providence RI USA
- Rhode Island Hospital Providence RI USA
| | | | | | - Donna Erdman
- Driving Assessment Program Spaulding Cape Cod East Sandwich MA USA
| | - David B Carr
- Washington University School of Medicine St. Louis MO USA
| | - Jennifer D Davis
- Alpert Medical School of Brown University Providence RI USA
- Rhode Island Hospital Providence RI USA
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19
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Korthauer LE, Giugliano R, Guo J, Sabatine M, Sever P, Keech A, Pedersen T, Kurtz C, Ruff C, Mach F, Ott BR. Association of APOE genotype and lipid lowering with cognitive function in a randomized placebo‐controlled trial of Evolocumab. Alzheimers Dement 2020. [DOI: 10.1002/alz.047188] [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: 11/08/2022]
Affiliation(s)
| | | | | | | | - Peter Sever
- Imperial College London London United Kingdom
| | | | | | | | | | | | - Brian R Ott
- Alpert Medical School of Brown University Providence RI USA
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20
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Drake JD, Chambers A, Ott BR, Daiello LA. Peripheral markers of vascular endothelial dysfunction show independent but additive relationships with brain‐based biomarkers in association with functional impairment in Alzheimer’s disease. Alzheimers Dement 2020. [DOI: 10.1002/alz.046554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Brian R. Ott
- Alpert Medical School of Brown University Providence RI USA
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21
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Tremont G, Davis JD, Britton K, Kenney L, Sanborn V, Uebelacker L, Ott BR. A pilot trial of a yoga intervention versus healthy living education for mild cognitive impairment. Alzheimers Dement 2020. [DOI: 10.1002/alz.045341] [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: 11/05/2022]
Affiliation(s)
- Geoffrey Tremont
- Rhode Island Hospital Providence RI USA
- Rhode Island Hospital & Alpert Medical School of Brown University Neuropsychology Program Rhode Island Hospital RI USA
| | | | - Karysa Britton
- Rhode Island Hospital Neuropsychology Program Providence RI USA
| | - Lauren Kenney
- Rhode Island Hospital Neuropsychology Program Providence RI USA
| | | | | | - Brian R Ott
- Alpert Medical School of Brown University Providence RI USA
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22
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Daiello LA, Wang DJJ, Jones RN, Boxerman J, Tremont G, O'Bryant S, Kendall M, Cioffi WG, De Oliveira GS, Ott BR, Inouye SK. Blood‐brain barrier dysfunction and perioperative neurocognitive disorders: Cognitive Recovery after Elective Surgery (CREATES) study design and methods. Alzheimers Dement 2020. [DOI: 10.1002/alz.039363] [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: 11/07/2022]
Affiliation(s)
- Lori A Daiello
- Rhode Island Hospital Providence RI USA
- Alpert Medical School of Brown University Providence RI USA
| | - Danny JJ Wang
- University of Southern California Los Angeles CA USA
| | - Richard N Jones
- Warren Alpert Medical School of Brown University Providence RI USA
| | - Jerrold Boxerman
- Rhode Island Hospital Providence RI USA
- Alpert Medical School of Brown University Providence RI USA
| | - Geoffrey Tremont
- Rhode Island Hospital Providence RI USA
- Rhode Island Hospital & Alpert Medical School of Brown University Neuropsychology Program Rhode Island Hospital Providence RI USA
| | - Sid O'Bryant
- University of North Texas Health Science Center Fort Worth TX USA
| | - Mark Kendall
- Rhode Island Hospital Providence RI USA
- Alpert Medical School of Brown University Providence RI USA
| | - William G Cioffi
- Rhode Island Hospital Providence RI USA
- Alpert Medical School of Brown University Providence RI USA
| | - Gildasio S. De Oliveira
- Rhode Island Hospital Providence RI USA
- Alpert Medical School of Brown University Providence RI USA
| | - Brian R Ott
- Rhode Island Hospital Providence RI USA
- Alpert Medical School of Brown University Providence RI USA
| | - Sharon K Inouye
- Marcus Institute for Aging Research Hebrew SeniorLife Boston MA USA
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23
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Davis JD, Babulal GM, Papandonatos GD, Burke EM, Rosnick CB, Ott BR, Roe CM. Evaluation of Naturalistic Driving Behavior Using In-Vehicle Monitoring Technology in Preclinical and Early Alzheimer's Disease. Front Psychol 2020; 11:596257. [PMID: 33192943 PMCID: PMC7653196 DOI: 10.3389/fpsyg.2020.596257] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/05/2020] [Indexed: 11/13/2022] Open
Abstract
Cognitive impairment is a significant risk factor for hazardous driving among older drivers with Alzheimer's dementia, but little is known about how the driving behavior of mildly symptomatic compares with those in the preclinical, asymptomatic phase of Alzheimer's disease (AD). This study utilized two in-car technologies to characterize driving behavior in symptomatic and preclinical AD. The goals of this pilot study were to (1) describe unsafe driving behaviors in individuals with symptomatic early AD using G-force triggered video capture and (2) compare the driving habits of these symptomatic AD drivers to two groups of cognitively normal drivers, those with and those without evidence of cerebral amyloidosis (CN/A+ and CN/A-) using a global positioning system (GPS) datalogger. Thirty-three drivers (aged 60+ years) were studied over 3 months. G-force triggered video events captured instances of near-misses/collisions, traffic violations, risky driver conduct, and driving fundamentals. GPS data were sampled every 30 s and all instances of speeding, hard braking, and sudden acceleration were recorded. For the early AD participants, video capture identified driving unbelted, late response, driving too fast for conditions, traffic violations, poor judgment, and not scanning intersections as the most frequently occurring safety errors. When evaluating driving using the GPS datalogger, hard breaking events occurred most frequently on a per trip basis across all three groups. The CN/A+ group had the lowest event rate across all three event types with lower instances of speeding. Slower psychomotor speed (Trail Making Part A) was associated with fewer speeding events, more hard acceleration events, and more overall events. GPS tracked instances of speeding were correlated with total number of video-captured near-collisions/collisions and driving fundamentals. Results demonstrate the utility of electronic monitoring to identify potentially unsafe driving events in symptomatic and preclinical AD. Results suggest that drivers with preclinical AD may compensate for early, subtle cognitive changes by driving more slowly and cautiously than healthy older drivers or those with cognitive impairment. Self-regulatory changes in driving behavior appear to occur in the preclinical phase of AD, but safety concerns may not arise until symptoms of cognitive impairment emerge and the ability to self-monitor declines.
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Affiliation(s)
- Jennifer D. Davis
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Neuropsychology Program, Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
| | - Ganesh M. Babulal
- Department of Neurology, Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO, United States
| | | | - Erin M. Burke
- Neuropsychology Program, Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
| | - Christopher B. Rosnick
- Department of Neurology, Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO, United States
| | - Brian R. Ott
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Catherine M. Roe
- Department of Neurology, Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO, United States
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Roe CM, Stout SH, Rajasekar G, Ances BM, Jones JM, Head D, Benzinger TLS, Williams MM, Davis JD, Ott BR, Warren DK, Babulal GM. A 2.5-Year Longitudinal Assessment of Naturalistic Driving in Preclinical Alzheimer's Disease. J Alzheimers Dis 2020; 68:1625-1633. [PMID: 30958365 DOI: 10.3233/jad-181242] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 01/30/2023]
Abstract
BACKGROUND Emerging evidence shows that cognitively normal older adults with preclinical Alzheimer's disease (AD) make more errors and are more likely to receive a marginal/fail rating on a standardized road test compared to older adults without preclinical AD, but the extent to which preclinical AD impacts everyday driving behavior is unknown. OBJECTIVE To examine self-reported and naturalistic longitudinal driving behavior among persons with and without preclinical AD. METHOD We prospectively followed cognitively normal drivers (aged 65 + years) with (n = 10) and without preclinical AD (n = 10) for 2.5 years. Preclinical AD was assessed using amyloid positron emission tomography (PET) with Pittsburgh Compound B. The Driving Habits Questionnaire assessed self-reported driving outcomes. Naturalistic driving was captured using a commercial GPS data logger plugged into the on-board diagnostics II port of each participant's vehicle. Data were sampled every 30 seconds and all instances of speeding, hard braking, and sudden acceleration were recorded. RESULTS Preclinical AD participants went to fewer places/unique destinations, traveled fewer days, and took fewer trips than participants without preclinical AD. The preclinical AD group reported a smaller driving space, greater dependence on other drivers, and more difficulty driving due to vision difficulties. Persons with preclinical AD had fewer trips with any aggression and showed a greater decline across the 2.5-year follow-up period in the number of days driving per month and the number of trips between 1-5 miles. CONCLUSION Changes in driving occur even during the preclinical stage of AD.
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Affiliation(s)
- Catherine M Roe
- Charles F. and Joanne Knight Alzheimer's Disease Research Center, Washington University School of Medicine, MO, USA.,Department of Neurology, Washington University School of Medicine, MO, USA
| | - Sarah H Stout
- Charles F. and Joanne Knight Alzheimer's Disease Research Center, Washington University School of Medicine, MO, USA.,Department of Neurology, Washington University School of Medicine, MO, USA
| | - Ganesh Rajasekar
- Charles F. and Joanne Knight Alzheimer's Disease Research Center, Washington University School of Medicine, MO, USA.,Department of Neurology, Washington University School of Medicine, MO, USA
| | - Beau M Ances
- Charles F. and Joanne Knight Alzheimer's Disease Research Center, Washington University School of Medicine, MO, USA.,Department of Neurology, Washington University School of Medicine, MO, USA.,Department of Hope Center for Neurological Disorders, Washington University School of Medicine, MO, USA
| | - Jessica M Jones
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Denise Head
- Charles F. and Joanne Knight Alzheimer's Disease Research Center, Washington University School of Medicine, MO, USA.,Department of Radiology, Washington University School of Medicine, MO, USA
| | - Tammie L S Benzinger
- Charles F. and Joanne Knight Alzheimer's Disease Research Center, Washington University School of Medicine, MO, USA.,Department of Neurology, Washington University School of Medicine, MO, USA.,Department of Hope Center for Neurological Disorders, Washington University School of Medicine, MO, USA.,Department of Radiology, Washington University School of Medicine, MO, USA.,Department of Neurosurgery, Washington University School of Medicine, MO, USA
| | - Monique M Williams
- Department of BJC Medical Group, Washington University School of Medicine, MO, USA
| | | | - Brian R Ott
- Department of Brown University, School of Medicine, MO, USA
| | - David K Warren
- Department of Medicine, Washington University School of Medicine, MO, USA
| | - Ganesh M Babulal
- Charles F. and Joanne Knight Alzheimer's Disease Research Center, Washington University School of Medicine, MO, USA.,Department of Neurology, Washington University School of Medicine, MO, USA
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25
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Moharrer M, Wang S, Dougherty BE, Cybis W, Ott BR, Davis JD, Luo G. Evaluation of the Driving Safety of Visually Impaired Bioptic Drivers Based on Critical Events in Naturalistic Driving. Transl Vis Sci Technol 2020; 9:14. [PMID: 32855861 PMCID: PMC7422772 DOI: 10.1167/tvst.9.8.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/03/2020] [Accepted: 05/26/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose Visually impaired people may be allowed to drive if they wear bioptic telescopes. Bioptic driving safety is debatable, especially given that the telescopes are seldom used by most bioptic drivers. This preliminary study examined bioptic safety based on critical events that occurred in naturalistic daily driving. Methods Daily driving activities were recorded using in-car video recorders in 20 bioptic drivers (median age 55, visual acuity, 20/60-160) and 19 control subjects (median age 74) for two to eight weeks. In a secondary analysis, these subjects were compared with 44 cognitively impaired drivers with normal vision (median age 75). Results In 292 hours of driving by bioptic drivers and 169 hours by control drivers, seven bioptic drivers and three control drivers had eight and four near-collisions, respectively. Near-collision survival times were not significantly different between the two groups (hazard ratio [HR] = 1.93, P = 0.591) according to Cox hazards regression. Even without compensation for bioptic drivers' longer driving exposure, their odds ratio (OR) was not statistically significant (OR = 2.88, P = 0.18). When including cognitively impaired drivers with normal vision, cognition was a significant predictor of near collisions (HR = 3.86, P = 0.036), but vision loss was not (HR = 0.47, P = 0.317). Conclusions This preliminary study failed to find any evidence suggesting that bioptic drivers were more prone to near-collision than healthy drivers. Vision might be a less-significant factor than cognition. Translational Relevance Given that bioptic drivers use the telescope for less than 2% of the driving time, this study suggests that driving safety might not be substantially affected even when visual acuity is in the low vision range.
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Affiliation(s)
- Mojtaba Moharrer
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Shuhang Wang
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | | | - Walter Cybis
- Nazareth and Louis-Braille Institute, Longueuil, Quebec, Canada
| | - Brian R. Ott
- Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Jennifer D. Davis
- Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Gang Luo
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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26
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Korthauer LE, Heindel WC, Lai LY, Tremont G, Ott BR, Festa EK. Impaired integration of object feature knowledge in amnestic mild cognitive impairment. Neuropsychology 2020; 34:699-712. [PMID: 32551739 DOI: 10.1037/neu0000670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Accessing semantic representations of real-world objects requires integration of multimodal perceptual features that are represented across relevant neocortical areas. Early Alzheimer's disease (AD) neuropathology, including neurofibrillary tangles in the perirhinal cortex as well as disrupted cortico-cortical connectivity, would be expected to disrupt the integration of object features. This integration deficit may underlie AD patients' semantic memory deficits and would be predicted to be more prominent for living objects, which tend to be more defined by sensory features compared with nonliving objects. METHOD Two experiments were conducted to assess feature integration in cognitively healthy older adults and patients with amnestic mild cognitive impairment (MCI). In both experiments, pictures of real-world objects were presented in congruent or incongruent colors. Participants were instructed to make a speeded color congruency judgment (Experiment 1) or name the presented surface color (Experiment 2). RESULTS Across experiments, MCI patients showed a selective integration deficit for living, but not nonliving, objects across both experimental paradigms that was consistent with a deterioration in semantic structural representations rather than a deficit in controlled semantic retrieval. Planned secondary analyses with a subset of patients (Experiment 1) for whom PET imaging was available indicated that the degree of impairment was associated with the magnitude of cortical amyloid burden. CONCLUSIONS These findings suggest that early AD pathology leads to impaired integration of distributed semantic object representations. The development of integration tasks as sensitive markers of early AD pathology may lead to more effective diagnostic tools for early detection and intervention. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Laura E Korthauer
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University
| | - William C Heindel
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University
| | - Leslie Y Lai
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University
| | - Geoffrey Tremont
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University
| | - Brian R Ott
- Department of Neurology, Alpert Medical School, Brown University
| | - Elena K Festa
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University
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Alber J, Maruff P, Santos CY, Ott BR, Salloway SP, Yoo DC, Noto RB, Thompson LI, Goldfarb D, Arthur E, Song A, Snyder PJ. Disruption of cholinergic neurotransmission, within a cognitive challenge paradigm, is indicative of Aβ-related cognitive impairment in preclinical Alzheimer's disease after a 27-month delay interval. Alzheimers Res Ther 2020; 12:31. [PMID: 32209123 PMCID: PMC7093953 DOI: 10.1186/s13195-020-00599-1] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 03/11/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Abnormal beta-amyloid (Aβ) is associated with deleterious changes in central cholinergic tone in the very early stages of Alzheimer's disease (AD), which may be unmasked by a cholinergic antagonist (J Prev Alzheimers Dis 1:1-4, 2017). Previously, we established the scopolamine challenge test (SCT) as a "cognitive stress test" screening measure to identify individuals at risk for AD (Alzheimer's & Dementia 10(2):262-7, 2014) (Neurobiol. Aging 36(10):2709-15, 2015). Here we aim to demonstrate the potential of the SCT as an indicator of cognitive change and neocortical amyloid aggregation after a 27-month follow-up interval. METHODS Older adults (N = 63, aged 55-75 years) with self-reported memory difficulties and first-degree family history of AD completed the SCT and PET amyloid imaging at baseline and were then seen for cognitive testing at 9, 18, and 27 months post-baseline. Repeat PET amyloid imaging was completed at the time of the 27-month exam. RESULTS Significant differences in both cognitive performance and in Aβ neocortical burden were observed between participants who either failed vs. passed the SCT at baseline, after a 27-month follow-up period. CONCLUSIONS Cognitive response to the SCT (Alzheimer's & Dementia 10(2):262-7, 2014) at baseline is related to cognitive change and PET amyloid imaging results, over the course of 27 months, in preclinical AD. The SCT may be a clinically useful screening tool to identify individuals who are more likely to both have positive evidence of amyloidosis on PET imaging and to show measurable cognitive decline over several years.
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Affiliation(s)
- Jessica Alber
- Department of Biological & Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, 75 Lower College Road, 2nd Floor, Kingston, RI USA
- Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Paul Maruff
- Cogstate Ltd., Melbourne, Victoria Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria Australia
| | - Cláudia Y. Santos
- Department of Biological & Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, 75 Lower College Road, 2nd Floor, Kingston, RI USA
| | - Brian R. Ott
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI USA
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Stephen P. Salloway
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI USA
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Don C. Yoo
- Department of Radiology, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Richard B. Noto
- Department of Radiology, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Louisa I. Thompson
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI USA
| | | | - Edmund Arthur
- Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI USA
| | - Alex Song
- Brown University, Providence, RI USA
| | - Peter J. Snyder
- Department of Biological & Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, 75 Lower College Road, 2nd Floor, Kingston, RI USA
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI USA
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Abstract
Background Controlled naturalistic driving for examining impacts of cognitive impairment on driving safety is rare. Objective Evaluating the safety among drivers with mild cognitive impairment based on near collision incidents using naturalistic driving, and investigating its correlation with cognitive measures. Methods Frequency of near collisions of 44 cognitively impaired [Age = 75.1(±6.7), MMSE = 25.5(±2.5)] and 19 control group drivers [Age = 72.5(±7.8), MMSE = 29.3(±0.8)] were obtained from two weeks of recorded driving. Survival time free of predicted collision based on a previously established near-collision to collision estimate ratio of 11 : 1, for 140 hours of driving exposure was calculated. Participants were also tested using Mini-Mental Status Examination (MMSE), Trail A, and Trail B. Spearman correlation and Cox survival analysis were conducted. Results Near collision frequency per driving hour was correlated with MMSE (r = -0.258, p = 0.041). Survival analyses showed that cognitively impaired drivers might be prone to higher probability of having collision (p = 0.056) with a hazard ratio of 5.78 (p = 0.092). When all participants were combined, there was a significant difference (p < 0.017) in all the three cognitive measures between drivers with and without predicted collision, which were not significant within patient or control group alone (p > 0.186). Cox regression analysis showed MMSE as the only significant factor (p < 0.025) for survival time of predicted collision, but not age, gender, or driving experience. Conclusion The association between driving critical events and cognitive measures suggests that some drivers with mild cognitive impairment might have an elevated driving collision risk compared to control drivers. Standard clinical cognitive measures may be reasonable predictors.
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Affiliation(s)
- Mojtaba Moharrer
- Schepens Eye Research Institute, Mass Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Shuhang Wang
- Schepens Eye Research Institute, Mass Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jennifer D Davis
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Brian R Ott
- Alzheimer's Disease and Memory Disorders Center, Rhode Island Hospital, Providence, RI, USA.,Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Gang Luo
- Schepens Eye Research Institute, Mass Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Margolis SA, Festa EK, Papandonatos GD, Korthauer LE, Gonsalves MA, Oberman L, Heindel WC, Ott BR. A pilot study of repetitive transcranial magnetic stimulation in primary progressive aphasia. Brain Stimul 2019; 12:1340-1342. [DOI: 10.1016/j.brs.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022] Open
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Karpouzian-Rogers T, Heindel WC, Ott BR, Tremont G, Festa EK. Phasic alerting enhances spatial orienting in healthy aging but not in mild cognitive impairment. Neuropsychology 2019; 34:144-154. [PMID: 31464472 DOI: 10.1037/neu0000593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Previous studies in young adults have demonstrated strong functional links between phasic alerting and exogenous orienting. The present study examined changes in the dynamic interaction between these attentional networks in healthy aging and in amnestic mild cognitive impairment. METHOD Healthy young adults, healthy older adults, and patients with amnestic mild cognitive impairment (MCI) were asked to identify as quickly as possible the color of a target stimulus that appeared within one of 2 peripheral boxes. Orienting was manipulated by a brief flashing of the same (valid cue) or opposite (invalid cue) box in which the target subsequently appeared. Alerting was manipulated by presenting an auditory white noise burst simultaneously with the visual orienting cue on half of the trials. RESULTS All 3 groups displayed significant alerting and orienting effects but differed in the nature of the interaction between alerting and orienting. As expected, young adults displayed increased orienting under high alerting conditions through a selective enhancement of validly cued targets. While older adults displayed a greater effect of alerting on orienting compared to young adults, MCI patients did not display a significant interaction between attentional networks. CONCLUSIONS Results provide support for the presence of increased compensatory interactions between attentional networks in healthy aging that may be no longer effective with the emergence of clinical symptoms in MCI. The demonstration of qualitatively distinct effects of healthy aging and MCI suggests that behavioral tests of attentional network interactions may serve as cognitive markers in individuals at increased risk for developing AD. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | - Elena K Festa
- Department of Cognitive, Linguistic, and Psychological Sciences
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Santos CY, Getter C, Stoukides J, Ott BR, Salloway S, Renehan W, Grammas P. P4-015: CLINICAL TRIAL DESIGN FOR A PILOT STUDY EVALUATING THROMBIN INHIBITION IN ALZHEIMER'S DISEASE (THE BEACON TRIAL). Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3674] [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: 11/16/2022]
Affiliation(s)
- Cláudia Y. Santos
- George & Anne Ryan Institute for Neuroscience; Kingston RI USA
- Universidade de São Paulo; São Paulo Brazil
| | | | - John Stoukides
- Rhode Island Mood & Memory Research Institute; East Providence RI USA
| | - Brian R. Ott
- Alpert Medical School of Brown University; Providence RI USA
- Rhode Island Hospital; Providence RI USA
| | - Stephen Salloway
- Alpert Medical School of Brown University; Providence RI USA
- Butler Hospital; Providence RI USA
| | - William Renehan
- George & Anne Ryan Institute for Neuroscience; Kingston RI USA
- University of Rhode Island; Kingston RI USA
| | - Paula Grammas
- George & Anne Ryan Institute for Neuroscience; Kingston RI USA
- University of Rhode Island; Kingston RI USA
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de la Monte SM, Tong M, Daiello LA, Ott BR. Early-Stage Alzheimer's Disease Is Associated with Simultaneous Systemic and Central Nervous System Dysregulation of Insulin-Linked Metabolic Pathways. J Alzheimers Dis 2019; 68:657-668. [PMID: 30775986 PMCID: PMC10084886 DOI: 10.3233/jad-180906] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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: 01/30/2023]
Abstract
BACKGROUND Brain insulin resistance is a well-recognized abnormality in Alzheimer's disease (AD) and the likely mediator of impaired glucose utilization that emerges early and progresses with disease severity. Moreover, the rates of mild cognitive impairment (MCI) or AD are significantly greater in people with diabetes mellitus or obesity. OBJECTIVE This study was designed to determine whether systemic and central nervous system (CNS) insulin resistant disease states emerge together and thus may be integrally related. METHODS Insulin-related molecules were measured in paired human serum and cerebrospinal fluid (CSF) samples from 19 with MCI or early AD, and 21 controls using a multiplex ELISA platform. RESULTS In MCI/AD, both the CSF and serum samples had significantly elevated mean levels of C-peptide and an incretin, and reduced expression of Visfatin, whereas only CSF showed significant reductions in insulin and leptin and only serum had increased glucagon, PAI-1, and ghrelin. Although the overall CSF and serum responses reflected insulin resistance together with insulin deficiency, the specific alterations measured in CSF and serum were different. CONCLUSION In MCI and early-stage AD, CNS and systemic insulin-related metabolic dysfunctions, including insulin resistance, occur simultaneously, suggesting that they are integrally related and possibly mediated similar pathogenic factors.
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Affiliation(s)
- Suzanne M de la Monte
- Department of Pathology and Laboratory Medicine (Neuropathology), Rhode Island Hospital, the Providence VA Medical Center, and the Alpert Medical School of Brown University, Providence, RI, USA.,Department of Neurology, Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI, USA.,Department of Medicine, Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI, USA
| | - Ming Tong
- Department of Medicine, Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI, USA
| | - Lori A Daiello
- Department of Neurology, Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI, USA.,The Alzheimer's Disease and Memory Disorders Center, Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI, USA
| | - Brian R Ott
- Department of Neurology, Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI, USA.,The Alzheimer's Disease and Memory Disorders Center, Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI, USA
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33
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Babulal GM, Stout SH, Benzinger TLS, Ott BR, Carr DB, Webb M, Traub CM, Addison A, Morris JC, Warren DK, Roe CM. A Naturalistic Study of Driving Behavior in Older Adults and Preclinical Alzheimer Disease: A Pilot Study. J Appl Gerontol 2019; 38:277-289. [PMID: 28380718 PMCID: PMC5555816 DOI: 10.1177/0733464817690679] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A clinical consequence of symptomatic Alzheimer's disease (AD) is impaired driving performance. However, decline in driving performance may begin in the preclinical stage of AD. We used a naturalistic driving methodology to examine differences in driving behavior over one year in a small sample of cognitively normal older adults with ( n = 10) and without ( n = 10) preclinical AD. As expected with a small sample size, there were no statistically significant differences between the two groups, but older adults with preclinical AD drove less often, were less likely to drive at night, and had fewer aggressive behaviors such as hard braking, speeding, and sudden acceleration. The sample size required to power a larger study to determine differences was calculated.
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34
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Roe CM, Babulal GM, Mishra S, Gordon BA, Stout SH, Ott BR, Carr DB, Ances BM, Morris JC, Benzinger TLS. Tau and Amyloid Positron Emission Tomography Imaging Predict Driving Performance Among Older Adults with and without Preclinical Alzheimer's Disease. J Alzheimers Dis 2019; 61:509-513. [PMID: 29171997 DOI: 10.3233/jad-170521] [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] [Indexed: 12/13/2022]
Abstract
Abnormal levels of Alzheimer's disease (AD) biomarkers, measured by positron emission tomography imaging using amyloid-based radiotracers and cerebrospinal fluid, are associated with impaired driving performance in older adults. We examined whether preclinical AD staging, defined using amyloid imaging and tau imaging using the radiotracer T807 (AKA flortaucipir or AV-1451), was associated with receiving a marginal/fail rating on a standardized road test (n = 42). Participants at Stage 2 (positive amyloid and tau scans) of preclinical AD were more likely to receive a marginal/fail rating compared to participants at Stage 0 or 1. Stage 2 preclinical AD may manifest in worse driving performance.
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Affiliation(s)
- Catherine M Roe
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ganesh M Babulal
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Shruti Mishra
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Brian A Gordon
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Sarah H Stout
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Brian R Ott
- The Alzheimer's Disease and Memory Disorders Center, Alpert Medical School of Brown University, Providence, RI, USA
| | - David B Carr
- The Rehabilitation Institute of St. Louis, Washington University School of Medicine, St. Louis, MO, USA
| | - Beau M Ances
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - John C Morris
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Pathology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Immunology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA.,Department of Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.,The Rehabilitation Institute of St. Louis, Washington University School of Medicine, St. Louis, MO, USA.,The Alzheimer's Disease and Memory Disorders Center, Alpert Medical School of Brown University, Providence, RI, USA
| | - Tammie L S Benzinger
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA.,Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Abstract
Lane changes are important behaviors to study in driving research. Automated detection of lane-change events is required to address the need for data reduction of a vast amount of naturalistic driving videos. This paper presents a method to deal with weak lane-marker patterns as small as a couple of pixels wide. The proposed method is novel in its approach to detecting lane-change events by accumulating lane-marker candidates over time. Since the proposed method tracks lane markers in temporal domain, it is robust to low resolution and many different kinds of interferences. The proposed technique was tested using 490 h of naturalistic driving videos collected from 63 drivers. The lane-change events in a 10-h video set were first manually coded and compared with the outcome of the automated method. The method's sensitivity was 94.8% and the data reduction rate was 93.6%. The automated procedure was further evaluated using the remaining 480-h driving videos. The data reduction rate was 97.4%. All 4971 detected events were manually reviewed and classified as either true or false lane-change events. Bootstrapping showed that the false discovery rate from the larger data set was not significantly different from that of the 10-h manually coded data set. This study demonstrated that the temporal processing of lane markers is an effcient strategy for detecting lane-change events involving weak lane-marker patterns in naturalistic driving.
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Affiliation(s)
- Shuhang Wang
- Schepens Eye Research Institute, Mass. Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - Brian R Ott
- Rhode Island Hospital, Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Gang Luo
- Schepens Eye Research Institute, Mass. Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
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Ott BR, Jones RN, Daiello LA, de la Monte SM, Stopa EG, Johanson CE, Denby C, Grammas P. Blood-Cerebrospinal Fluid Barrier Gradients in Mild Cognitive Impairment and Alzheimer's Disease: Relationship to Inflammatory Cytokines and Chemokines. Front Aging Neurosci 2018; 10:245. [PMID: 30186149 PMCID: PMC6110816 DOI: 10.3389/fnagi.2018.00245] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [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] [Received: 10/04/2017] [Accepted: 07/25/2018] [Indexed: 01/30/2023] Open
Abstract
Background: The pathophysiology underlying altered blood-cerebrospinal fluid barrier (BCSFB) function in Alzheimer's disease (AD) is unknown but may relate to endothelial cell activation and cytokine mediated inflammation. Methods: Cerebrospinal fluid (CSF) and peripheral blood were concurrently collected from cognitively healthy controls (N = 21) and patients with mild cognitive impairment (MCI) (N = 8) or AD (N = 11). The paired serum and CSF samples were assayed for a panel of cytokines, chemokines, and related trophic factors using multiplex ELISAs. Dominance analysis models were conducted to determine the relative importance of the inflammatory factors in relationship to BCSFB permeability, as measured by CSF/serum ratios for urea, creatinine, and albumin. Results: BCSFB disruption to urea, a small molecule distributed by passive diffusion, had a full model coefficient of determination (r2) = 0.35, and large standardized dominance weights (>0.1) for monocyte chemoattractant protein-1, interleukin (IL)-15, IL-1rα, and IL-2 in serum. BCSFB disruption to creatinine, a larger molecule governed by active transport, had a full model r2 = 0.78, and large standardized dominance weights for monocyte inhibitor protein-1b in CSF and tumor necrosis factor-α in serum. BCSFB disruption to albumin, a much larger molecule, had a full model r2 = 0.62, and large standardized dominance weights for IL-17a, interferon-gamma, IL-2, and VEGF in CSF, as well IL-4 in serum. Conclusions: Inflammatory proteins have been widely documented in the AD brain. The results of the current study suggest that changes in BCSFB function resulting in altered permeability and transport are related to expression of specific inflammatory proteins, and that the shifting distribution of these proteins from serum to CSF in AD and MCI is correlated with more severe perturbations in BCSFB function.
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Affiliation(s)
- Brian R. Ott
- Department of Neurology, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, United States,George & Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, United States,*Correspondence: Brian R. Ott
| | - Richard N. Jones
- Department of Neurology, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, United States
| | - Lori A. Daiello
- Department of Neurology, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, United States
| | - Suzanne M. de la Monte
- George & Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, United States,Division of Neuropathology, Department of Pathology, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, United States
| | - Edward G. Stopa
- George & Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, United States,Division of Neuropathology, Department of Pathology, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, United States
| | - Conrad E. Johanson
- Department of Neurosurgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, United States
| | - Charles Denby
- Department of Neurology, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, United States
| | - Paula Grammas
- George & Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, United States
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Margolis SA, Festa EK, Korthauer LE, Gonsalves M, Oberman LM, Heindel WC, Ott BR. P2‐024: REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION IN PRIMARY PROGRESSIVE APHASIAS AND BEHAVIORAL VARIANT FRONTOTEMPORAL DEMENTIA: A CASE SERIES. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.708] [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: 11/16/2022]
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Reynolds GO, Margolis SA, Denby C, Poll K, Ott BR, Tremont G. P2‐629: EXERCISE BEHAVIORS IN OLDER ADULTS: CURRENT HABITS, WILLINGNESS TO CHANGE, AND ASSOCIATED BARRIERS/FACILITATORS. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1325] [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: 10/28/2022]
Affiliation(s)
| | | | | | | | | | - Geoffrey Tremont
- Rhode Island Hospital and Alpert Medical School of Brown UniversityNeuropsychology ProgramRIUSA
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Goldfarb D, Snyder PJ, Maruff P, Santos CY, Ott BR, Salloway S, Yoo DC, Noto RB, Alber J, Thompson LI, Song A. P1‐132: DISRUPTION OF CHOLINERGIC NEUROTRANSMISSION, WITHIN A COGNITIVE CHALLENGE PARADIGM, PREDICTS Aβ‐RELATED COGNITIVE IMPAIRMENT IN PRECLINICAL ALZHEIMER'S DISEASE AFTER A 27‐MONTH DELAY INTERVAL. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.135] [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: 10/28/2022]
Affiliation(s)
| | - Peter J. Snyder
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- University of Rhode IslandKingstonRIUSA
| | - Paul Maruff
- The Florey Institute of Neuroscience and Mental HealthMelbourneAustralia
- Cogstate Ltd.MelbourneAustralia
| | | | | | - Stephen Salloway
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Butler HospitalProvidenceRIUSA
| | - Don C. Yoo
- Alpert Medical School of Brown UniversityProvidenceRIUSA
| | | | - Jessica Alber
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Butler HospitalProvidenceRIUSA
| | - Louisa I. Thompson
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Butler HospitalProvidenceRIUSA
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Alber J, Goldfarb D, Drake J, Silver B, Ott BR, Snyder PJ. P1‐292: RETINAL CHANGES IN CEREBRAL AMYLOID ANGIOPATHY (CAA): RELATIONSHIP TO CEREBRAL PATHOLOGY. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.298] [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: 11/30/2022]
Affiliation(s)
- Jessica Alber
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Lifespan - Rhode Island HospitalProvidenceRIUSA
- Butler HospitalProvidenceRIUSA
| | | | - Jonathan Drake
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Lifespan - Rhode Island HospitalProvidenceRIUSA
| | - Brian Silver
- University of Massachusetts Medical SchoolWorcesterMAUSA
| | - Brian R. Ott
- LifespanProvidenceRIUSA
- Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - Peter J. Snyder
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- University of Rhode IslandKingstonRIUSA
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41
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Affiliation(s)
- Jonathan D. Drake
- Rhode Island HospitalProvidenceRIUSA
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- LifespanProvidenceRIUSA
| | - Lori A. Daiello
- Rhode Island HospitalProvidenceRIUSA
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- LifespanProvidenceRIUSA
| | - Alison Chambers
- Rhode Island HospitalProvidenceRIUSA
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- LifespanProvidenceRIUSA
| | - Brian R. Ott
- Rhode Island HospitalProvidenceRIUSA
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- LifespanProvidenceRIUSA
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42
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Pillemer S, Papandonatos GD, Crook C, Ott BR, Tremont G. The Modified Telephone-Administered Minnesota Cognitive Acuity Screen for Mild Cognitive Impairment. J Geriatr Psychiatry Neurol 2018; 31:123-128. [PMID: 29764279 DOI: 10.1177/0891988718776131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This study aimed to compare the sensitivity and specificity of a modified version of the Minnesota Cognitive Acuity Screen (MCAS-m), by adding learning and recognition memory components, to the original version MCAS to distinguish amnestic mild cognitive impairment (aMCI) from healthy controls (HCs). METHODS/DESIGN A total of 30 individuals with aMCI and 30 HCs underwent neuropsychological testing, neurologic examination, laboratory, and brain imaging tests. Once diagnosis was confirmed, participants completed the MCAS and MCAS-m in counterbalanced order. RESULTS The average administration time was 12.6 minutes for the MCAS and 13.5 minutes for the MCAS-m. Receiver operating characteristic curve analyses showed that the MCAS-m demonstrated 97% sensitivity and 97% specificity for distinguishing between aMCI and HC versus 97% and 87%, respectively, for the original MCAS in this sample. CONCLUSIONS Both the MCAS and the MCAS-m were highly sensitive when distinguishing between normal cognition and aMCI; however, the MCAS-m demonstrated a 10% increase in specificity compared to the original version. Improved specificity is particularly relevant to screening in larger community samples with lower base rates of MCI than clinic populations. This modified screening measure presents a brief and cost-effective tool for identifying MCI. Given the risk of progression from aMCI to Alzheimer disease dementia (AD), the MCAS-m represents a modest improvement in telephone-administered methods for the early detection of AD.
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Affiliation(s)
- Sarah Pillemer
- 1 Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.,2 Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Cara Crook
- 4 Department of Psychology, Fordham University, Bronx, NY USA
| | - Brian R Ott
- 5 Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Geoffrey Tremont
- 1 Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.,2 Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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43
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Affiliation(s)
| | | | - Brian R Ott
- Warren Alpert Medical School of Brown University, Providence, RI
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44
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Giugliano RP, Pedersen TR, Park JG, De Ferrari GM, Gaciong ZA, Ceska R, Toth K, Gouni-Berthold I, Lopez-Miranda J, Schiele F, Mach F, Ott BR, Kanevsky E, Pineda AL, Somaratne R, Wasserman SM, Keech AC, Sever PS, Sabatine MS. Clinical efficacy and safety of achieving very low LDL-cholesterol concentrations with the PCSK9 inhibitor evolocumab: a prespecified secondary analysis of the FOURIER trial. Lancet 2017; 390:1962-1971. [PMID: 28859947 DOI: 10.1016/s0140-6736(17)32290-0] [Citation(s) in RCA: 405] [Impact Index Per Article: 57.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/11/2017] [Accepted: 08/14/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND LDL cholesterol is a well established risk factor for atherosclerotic cardiovascular disease. How much one should or safely can lower this risk factor remains debated. We aimed to explore the relationship between progressively lower LDL-cholesterol concentrations achieved at 4 weeks and clinical efficacy and safety in the FOURIER trial of evolocumab, a monoclonal antibody to proprotein convertase subtilisin-kexin type 9 (PCSK9). METHODS In this prespecified secondary analysis of 25 982 patients from the randomised FOURIER trial, the relationship between achieved LDL-cholesterol concentration at 4 weeks and subsequent cardiovascular outcomes (primary endpoint was the composite of cardiovascular death, myocardial infarction, stroke, coronary revascularisation, or unstable angina; key secondary endpoint was the composite of cardiovascular death, myocardial infarction, or stroke) and ten prespecified safety events of interest was examined over a median of 2·2 years of follow-up. We used multivariable modelling to adjust for baseline factors associated with achieved LDL cholesterol. This trial is registered with ClinicalTrials.gov, number NCT01764633. FINDINGS Between Feb 8, 2013, and June 5, 2015, 27 564 patients were randomly assigned a treatment in the FOURIER study. 1025 (4%) patients did not have an LDL cholesterol measured at 4 weeks and 557 (2%) had already had a primary endpoint event or one of the ten prespecified safety events before the week-4 visit. From the remaining 25 982 patients (94% of those randomly assigned) 13 013 were assigned evolocumab and 12 969 were assigned placebo. 2669 (10%) of 25 982 patients achieved LDL-cholesterol concentrations of less than 0·5 mmol/L, 8003 (31%) patients achieved concentrations between 0·5 and less than 1·3 mmol/L, 3444 (13%) patients achieved concentrations between 1·3 and less than 1·8 mmol/L, 7471 (29%) patients achieved concentrations between 1·8 to less than 2·6 mmol/L, and 4395 (17%) patients achieved concentrations of 2·6 mmol/L or higher. There was a highly significant monotonic relationship between low LDL-cholesterol concentrations and lower risk of the primary and secondary efficacy composite endpoints extending to the bottom first percentile (LDL-cholesterol concentrations of less than 0·2 mmol/L; p=0·0012 for the primary endpoint, p=0·0001 for the secondary endpoint). Conversely, no significant association was observed between achieved LDL cholesterol and safety outcomes, either for all serious adverse events or any of the other nine prespecified safety events. INTERPRETATION There was a monotonic relationship between achieved LDL cholesterol and major cardiovascular outcomes down to LDL-cholesterol concentrations of less than 0·2 mmol/L. Conversely, there were no safety concerns with very low LDL-cholesterol concentrations over a median of 2·2 years. These data support further LDL-cholesterol lowering in patients with cardiovascular disease to well below current recommendations. FUNDING Amgen.
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Affiliation(s)
- Robert P Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Terje R Pedersen
- Oslo University Hospital, Ullevål and Medical Faculty, University of Oslo, Oslo, Norway
| | - Jeong-Gun Park
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Gaetano M De Ferrari
- Department of Molecular Medicine, University of Pavia and Cardiac Intensive Care Unit and Laboratories for Experimental Cardiology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Zbigniew A Gaciong
- Department of Internal Medicine, Hypertension and Vascular Diseases, The Medical University of Warsaw, Warsaw, Poland
| | - Richard Ceska
- Center of Preventive Cardiology, 3rd Department Internal Medicine, University General Hospital and 1st Medical Faculty, Prague, Czech Republic
| | - Kalman Toth
- 1st Department of Medicine, University of Pécs, Pécs, Hungary
| | - Ioanna Gouni-Berthold
- Polyclinic for Endocrinology, Diabetes, and Preventive Medicine, University of Cologne, Cologne, Germany
| | - Jose Lopez-Miranda
- Lipids and Atherosclerosis Unit, Maimonides Biomedical Research Institute of Cordoba, Reina Sofia University Hospital, University of Cordoba, CIBEROBN, Cordoba, Spain
| | | | - François Mach
- Hopital Cantonal, Hopitaux Universitaires de Geneva, Geneva, Switzerland
| | - Brian R Ott
- Rhode Island Hospital, Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Estella Kanevsky
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | - Anthony C Keech
- Sydney Medical School, National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Peter S Sever
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Giugliano RP, Mach F, Zavitz K, Kurtz C, Im K, Kanevsky E, Schneider J, Wang H, Keech A, Pedersen TR, Sabatine MS, Sever PS, Robinson JG, Honarpour N, Wasserman SM, Ott BR. Cognitive Function in a Randomized Trial of Evolocumab. N Engl J Med 2017; 377:633-643. [PMID: 28813214 DOI: 10.1056/nejmoa1701131] [Citation(s) in RCA: 311] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Findings from clinical trials of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors have led to concern that these drugs or the low levels of low-density lipoprotein (LDL) cholesterol that result from their use are associated with cognitive deficits. Methods In a subgroup of patients from a randomized, placebo-controlled trial of evolocumab added to statin therapy, we prospectively assessed cognitive function using the Cambridge Neuropsychological Test Automated Battery. The primary end point was the score on the spatial working memory strategy index of executive function (scores range from 4 to 28, with lower scores indicating a more efficient use of strategy and planning). Secondary end points were the scores for working memory (scores range from 0 to 279, with lower scores indicating fewer errors), episodic memory (scores range from 0 to 70, with lower scores indicating fewer errors), and psychomotor speed (scores range from 100 to 5100 msec, with faster times representing better performance). Assessments of cognitive function were performed at baseline, week 24, yearly, and at the end of the trial. The primary analysis was a noninferiority comparison of the mean change from baseline in the score on the spatial working memory strategy index of executive function between the patients who received evolocumab and those who received placebo; the noninferiority margin was set at 20% of the standard deviation of the score in the placebo group. Results A total of 1204 patients were followed for a median of 19 months; the mean (±SD) change from baseline over time in the raw score for the spatial working memory strategy index of executive function (primary end point) was -0.21±2.62 in the evolocumab group and -0.29±2.81 in the placebo group (P<0.001 for noninferiority; P=0.85 for superiority). There were no significant between-group differences in the secondary end points of scores for working memory (change in raw score, -0.52 in the evolocumab group and -0.93 in the placebo group), episodic memory (change in raw score, -1.53 and -1.53, respectively), or psychomotor speed (change in raw score, 5.2 msec and 0.9 msec, respectively). In an exploratory analysis, there were no associations between LDL cholesterol levels and cognitive changes. Conclusions In a randomized trial involving patients who received either evolocumab or placebo in addition to statin therapy, no significant between-group difference in cognitive function was observed over a median of 19 months. (Funded by Amgen; EBBINGHAUS ClinicalTrials.gov number, NCT02207634 .).
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Affiliation(s)
- Robert P Giugliano
- From the Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital, Boston (R.P.G., K.I., E.K., M.S.S.); Hôpital Cantonal, Hopitaux Universitaires de Genève, Geneva (F.M.); Cambridge Cognition, Cambridge (K.Z.), and International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London (P.S.S.) - both in the United Kingdom; Amgen, Thousand Oaks, CA (C.K., J.S., H.W., N.H., S.M.W.); Sydney Medical School, NHMRC Clinical Trials Centre, University of Sydney, Sydney (A.K.); Oslo University Hospital, Ullevål, and Medical Faculty, University of Oslo - both in Oslo (T.R.P.); University of Iowa, Iowa City (J.G.R.); and Rhode Island Hospital, Department of Neurology, Alpert Medical School of Brown University, Providence (B.R.O.)
| | - François Mach
- From the Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital, Boston (R.P.G., K.I., E.K., M.S.S.); Hôpital Cantonal, Hopitaux Universitaires de Genève, Geneva (F.M.); Cambridge Cognition, Cambridge (K.Z.), and International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London (P.S.S.) - both in the United Kingdom; Amgen, Thousand Oaks, CA (C.K., J.S., H.W., N.H., S.M.W.); Sydney Medical School, NHMRC Clinical Trials Centre, University of Sydney, Sydney (A.K.); Oslo University Hospital, Ullevål, and Medical Faculty, University of Oslo - both in Oslo (T.R.P.); University of Iowa, Iowa City (J.G.R.); and Rhode Island Hospital, Department of Neurology, Alpert Medical School of Brown University, Providence (B.R.O.)
| | - Kenton Zavitz
- From the Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital, Boston (R.P.G., K.I., E.K., M.S.S.); Hôpital Cantonal, Hopitaux Universitaires de Genève, Geneva (F.M.); Cambridge Cognition, Cambridge (K.Z.), and International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London (P.S.S.) - both in the United Kingdom; Amgen, Thousand Oaks, CA (C.K., J.S., H.W., N.H., S.M.W.); Sydney Medical School, NHMRC Clinical Trials Centre, University of Sydney, Sydney (A.K.); Oslo University Hospital, Ullevål, and Medical Faculty, University of Oslo - both in Oslo (T.R.P.); University of Iowa, Iowa City (J.G.R.); and Rhode Island Hospital, Department of Neurology, Alpert Medical School of Brown University, Providence (B.R.O.)
| | - Christopher Kurtz
- From the Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital, Boston (R.P.G., K.I., E.K., M.S.S.); Hôpital Cantonal, Hopitaux Universitaires de Genève, Geneva (F.M.); Cambridge Cognition, Cambridge (K.Z.), and International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London (P.S.S.) - both in the United Kingdom; Amgen, Thousand Oaks, CA (C.K., J.S., H.W., N.H., S.M.W.); Sydney Medical School, NHMRC Clinical Trials Centre, University of Sydney, Sydney (A.K.); Oslo University Hospital, Ullevål, and Medical Faculty, University of Oslo - both in Oslo (T.R.P.); University of Iowa, Iowa City (J.G.R.); and Rhode Island Hospital, Department of Neurology, Alpert Medical School of Brown University, Providence (B.R.O.)
| | - Kyungah Im
- From the Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital, Boston (R.P.G., K.I., E.K., M.S.S.); Hôpital Cantonal, Hopitaux Universitaires de Genève, Geneva (F.M.); Cambridge Cognition, Cambridge (K.Z.), and International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London (P.S.S.) - both in the United Kingdom; Amgen, Thousand Oaks, CA (C.K., J.S., H.W., N.H., S.M.W.); Sydney Medical School, NHMRC Clinical Trials Centre, University of Sydney, Sydney (A.K.); Oslo University Hospital, Ullevål, and Medical Faculty, University of Oslo - both in Oslo (T.R.P.); University of Iowa, Iowa City (J.G.R.); and Rhode Island Hospital, Department of Neurology, Alpert Medical School of Brown University, Providence (B.R.O.)
| | - Estella Kanevsky
- From the Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital, Boston (R.P.G., K.I., E.K., M.S.S.); Hôpital Cantonal, Hopitaux Universitaires de Genève, Geneva (F.M.); Cambridge Cognition, Cambridge (K.Z.), and International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London (P.S.S.) - both in the United Kingdom; Amgen, Thousand Oaks, CA (C.K., J.S., H.W., N.H., S.M.W.); Sydney Medical School, NHMRC Clinical Trials Centre, University of Sydney, Sydney (A.K.); Oslo University Hospital, Ullevål, and Medical Faculty, University of Oslo - both in Oslo (T.R.P.); University of Iowa, Iowa City (J.G.R.); and Rhode Island Hospital, Department of Neurology, Alpert Medical School of Brown University, Providence (B.R.O.)
| | - Jingjing Schneider
- From the Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital, Boston (R.P.G., K.I., E.K., M.S.S.); Hôpital Cantonal, Hopitaux Universitaires de Genève, Geneva (F.M.); Cambridge Cognition, Cambridge (K.Z.), and International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London (P.S.S.) - both in the United Kingdom; Amgen, Thousand Oaks, CA (C.K., J.S., H.W., N.H., S.M.W.); Sydney Medical School, NHMRC Clinical Trials Centre, University of Sydney, Sydney (A.K.); Oslo University Hospital, Ullevål, and Medical Faculty, University of Oslo - both in Oslo (T.R.P.); University of Iowa, Iowa City (J.G.R.); and Rhode Island Hospital, Department of Neurology, Alpert Medical School of Brown University, Providence (B.R.O.)
| | - Huei Wang
- From the Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital, Boston (R.P.G., K.I., E.K., M.S.S.); Hôpital Cantonal, Hopitaux Universitaires de Genève, Geneva (F.M.); Cambridge Cognition, Cambridge (K.Z.), and International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London (P.S.S.) - both in the United Kingdom; Amgen, Thousand Oaks, CA (C.K., J.S., H.W., N.H., S.M.W.); Sydney Medical School, NHMRC Clinical Trials Centre, University of Sydney, Sydney (A.K.); Oslo University Hospital, Ullevål, and Medical Faculty, University of Oslo - both in Oslo (T.R.P.); University of Iowa, Iowa City (J.G.R.); and Rhode Island Hospital, Department of Neurology, Alpert Medical School of Brown University, Providence (B.R.O.)
| | - Anthony Keech
- From the Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital, Boston (R.P.G., K.I., E.K., M.S.S.); Hôpital Cantonal, Hopitaux Universitaires de Genève, Geneva (F.M.); Cambridge Cognition, Cambridge (K.Z.), and International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London (P.S.S.) - both in the United Kingdom; Amgen, Thousand Oaks, CA (C.K., J.S., H.W., N.H., S.M.W.); Sydney Medical School, NHMRC Clinical Trials Centre, University of Sydney, Sydney (A.K.); Oslo University Hospital, Ullevål, and Medical Faculty, University of Oslo - both in Oslo (T.R.P.); University of Iowa, Iowa City (J.G.R.); and Rhode Island Hospital, Department of Neurology, Alpert Medical School of Brown University, Providence (B.R.O.)
| | - Terje R Pedersen
- From the Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital, Boston (R.P.G., K.I., E.K., M.S.S.); Hôpital Cantonal, Hopitaux Universitaires de Genève, Geneva (F.M.); Cambridge Cognition, Cambridge (K.Z.), and International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London (P.S.S.) - both in the United Kingdom; Amgen, Thousand Oaks, CA (C.K., J.S., H.W., N.H., S.M.W.); Sydney Medical School, NHMRC Clinical Trials Centre, University of Sydney, Sydney (A.K.); Oslo University Hospital, Ullevål, and Medical Faculty, University of Oslo - both in Oslo (T.R.P.); University of Iowa, Iowa City (J.G.R.); and Rhode Island Hospital, Department of Neurology, Alpert Medical School of Brown University, Providence (B.R.O.)
| | - Marc S Sabatine
- From the Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital, Boston (R.P.G., K.I., E.K., M.S.S.); Hôpital Cantonal, Hopitaux Universitaires de Genève, Geneva (F.M.); Cambridge Cognition, Cambridge (K.Z.), and International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London (P.S.S.) - both in the United Kingdom; Amgen, Thousand Oaks, CA (C.K., J.S., H.W., N.H., S.M.W.); Sydney Medical School, NHMRC Clinical Trials Centre, University of Sydney, Sydney (A.K.); Oslo University Hospital, Ullevål, and Medical Faculty, University of Oslo - both in Oslo (T.R.P.); University of Iowa, Iowa City (J.G.R.); and Rhode Island Hospital, Department of Neurology, Alpert Medical School of Brown University, Providence (B.R.O.)
| | - Peter S Sever
- From the Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital, Boston (R.P.G., K.I., E.K., M.S.S.); Hôpital Cantonal, Hopitaux Universitaires de Genève, Geneva (F.M.); Cambridge Cognition, Cambridge (K.Z.), and International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London (P.S.S.) - both in the United Kingdom; Amgen, Thousand Oaks, CA (C.K., J.S., H.W., N.H., S.M.W.); Sydney Medical School, NHMRC Clinical Trials Centre, University of Sydney, Sydney (A.K.); Oslo University Hospital, Ullevål, and Medical Faculty, University of Oslo - both in Oslo (T.R.P.); University of Iowa, Iowa City (J.G.R.); and Rhode Island Hospital, Department of Neurology, Alpert Medical School of Brown University, Providence (B.R.O.)
| | - Jennifer G Robinson
- From the Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital, Boston (R.P.G., K.I., E.K., M.S.S.); Hôpital Cantonal, Hopitaux Universitaires de Genève, Geneva (F.M.); Cambridge Cognition, Cambridge (K.Z.), and International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London (P.S.S.) - both in the United Kingdom; Amgen, Thousand Oaks, CA (C.K., J.S., H.W., N.H., S.M.W.); Sydney Medical School, NHMRC Clinical Trials Centre, University of Sydney, Sydney (A.K.); Oslo University Hospital, Ullevål, and Medical Faculty, University of Oslo - both in Oslo (T.R.P.); University of Iowa, Iowa City (J.G.R.); and Rhode Island Hospital, Department of Neurology, Alpert Medical School of Brown University, Providence (B.R.O.)
| | - Narimon Honarpour
- From the Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital, Boston (R.P.G., K.I., E.K., M.S.S.); Hôpital Cantonal, Hopitaux Universitaires de Genève, Geneva (F.M.); Cambridge Cognition, Cambridge (K.Z.), and International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London (P.S.S.) - both in the United Kingdom; Amgen, Thousand Oaks, CA (C.K., J.S., H.W., N.H., S.M.W.); Sydney Medical School, NHMRC Clinical Trials Centre, University of Sydney, Sydney (A.K.); Oslo University Hospital, Ullevål, and Medical Faculty, University of Oslo - both in Oslo (T.R.P.); University of Iowa, Iowa City (J.G.R.); and Rhode Island Hospital, Department of Neurology, Alpert Medical School of Brown University, Providence (B.R.O.)
| | - Scott M Wasserman
- From the Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital, Boston (R.P.G., K.I., E.K., M.S.S.); Hôpital Cantonal, Hopitaux Universitaires de Genève, Geneva (F.M.); Cambridge Cognition, Cambridge (K.Z.), and International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London (P.S.S.) - both in the United Kingdom; Amgen, Thousand Oaks, CA (C.K., J.S., H.W., N.H., S.M.W.); Sydney Medical School, NHMRC Clinical Trials Centre, University of Sydney, Sydney (A.K.); Oslo University Hospital, Ullevål, and Medical Faculty, University of Oslo - both in Oslo (T.R.P.); University of Iowa, Iowa City (J.G.R.); and Rhode Island Hospital, Department of Neurology, Alpert Medical School of Brown University, Providence (B.R.O.)
| | - Brian R Ott
- From the Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital, Boston (R.P.G., K.I., E.K., M.S.S.); Hôpital Cantonal, Hopitaux Universitaires de Genève, Geneva (F.M.); Cambridge Cognition, Cambridge (K.Z.), and International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London (P.S.S.) - both in the United Kingdom; Amgen, Thousand Oaks, CA (C.K., J.S., H.W., N.H., S.M.W.); Sydney Medical School, NHMRC Clinical Trials Centre, University of Sydney, Sydney (A.K.); Oslo University Hospital, Ullevål, and Medical Faculty, University of Oslo - both in Oslo (T.R.P.); University of Iowa, Iowa City (J.G.R.); and Rhode Island Hospital, Department of Neurology, Alpert Medical School of Brown University, Providence (B.R.O.)
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Festa EK, Katz AP, Ott BR, Tremont G, Heindel WC. Dissociable Effects of Aging and Mild Cognitive Impairment on Bottom-Up Audiovisual Integration. J Alzheimers Dis 2017; 59:155-167. [DOI: 10.3233/jad-161062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Elena K. Festa
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, RI, USA
| | - Andrew P. Katz
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, RI, USA
| | - Brian R. Ott
- Department of Neurology, Alpert Medical School, Brown University, Providence, RI, USA
- Department of Neurology, Rhode Island Hospital, Providence, RI, USA
| | - Geoffrey Tremont
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - William C. Heindel
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, RI, USA
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Daiello LA, Jones RN, Stopa EG, Grammas P, De La Monte SM, Johanson CE, Ott BR. [P2–089]: BLOOD‐BRAIN BARRIER GRADIENTS IN MILD COGNITIVE IMPAIRMENT AND ALZHEIMER's DISEASE: RELATIONSHIP TO INFLAMMATORY CYTOKINES AND CHEMOKINES. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.738] [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: 11/25/2022]
Affiliation(s)
- Lori A. Daiello
- Alzheimers Disease and Memory Disorders Center at Rhode Island HospitalProvidenceRIUSA
- Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - Richard N. Jones
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Rhode Island HospitalProvidenceRIUSA
| | - Edward G. Stopa
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Rhode Island HospitalProvidenceRIUSA
| | | | - Suzanne M. De La Monte
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Rhode Island HospitalProvidenceRIUSA
| | | | - Brian R. Ott
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Rhode Island HospitalProvidenceRIUSA
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Roe CM, Babulal GM, Stout SH, Fagan AM, Benzinger TL, Holtzman DM, Ott BR, Carr DB, Xiong C, Morris JC. [O2–01–05]: IMPACT OF COGNITIVE RESERVE AND PRECLINICAL AD ON LONGITUDINAL DRIVING PERFORMANCE. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.07.147] [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)
- Catherine M. Roe
- Washington University School of MedicineSt. LouisMOUSA
- Washington University in St. Louis School of MedicineSt. LouisMOUSA
- Alpert Medical School of Brown UniversityProvidenceRIUSA
| | | | | | - Anne M. Fagan
- Washington University School of MedicineSt. LouisMOUSA
| | | | | | - Brian R. Ott
- Washington University School of MedicineSt. LouisMOUSA
| | - David B. Carr
- Washington University School of MedicineSt. LouisMOUSA
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Margolis S, Tremont G, Denby C, Heller B, Ott BR. [P4–186]: SUBJECTIVE COGNITIVE DECLINE IN MEMBERS OF THE RHODE ISLAND ALZHEIMER PREVENTION REGISTRY. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.2053] [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)
- Seth Margolis
- Alpert Medical School Brown UniversityProvidenceRIUSA
| | - Geoffrey Tremont
- Neuropsychology Program Rhode Island HospitalProvidenceRIUSA
- Rhode Island Hospital & Alpert Medical School of Brown University, Neuropsychology Program, Rhode Island HospitalProvidenceRIUSA
| | | | | | - Brian R. Ott
- Rhode Island HospitalProvidenceRIUSA
- Alpert Medical School of Brown UniversityProvidenceRIUSA
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Ott BR, Davis JD, Bixby K. Video Feedback Intervention to Enhance the Safety of Older Drivers With Cognitive Impairment. Am J Occup Ther 2017; 71:7102260020p1-7102260020p7. [PMID: 28218593 DOI: 10.5014/ajot.2017.020404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To demonstrate that g-force technology can be used to help older adults with cognitive impairment improve their driving safety as part of an in-car video feedback intervention. METHOD Unsafe driving events triggered g-forces leading to capture of video clips. The program included 3 mo of monitoring without intervention, 3 mo of intervention (weekly written progress reports, a DVD of unsafe driving events, and weekly telephone contacts), and 3 mo of postintervention monitoring. RESULTS Mean total unsafe driving events per 1,000 miles were reduced from baseline by 38% for 9 of 12 participants during the intervention and by 55% for 7 participants during postintervention monitoring. Mean total unsafe driving severity scores per 1,000 miles were reduced from baseline by 43% during the intervention and by 56% during postintervention monitoring. CONCLUSION Preliminary results suggest that driving safety among older drivers with cognitive impairment can be improved using a behavior modification approach aimed at problem behaviors detected in their natural driving environment.
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Affiliation(s)
- Brian R Ott
- Brian R. Ott, MD, is Professor, Department of Neurology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence;
| | - Jennifer D Davis
- Jennifer D. Davis, PhD, is Associate Professor, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence
| | - Kimberly Bixby
- Kimberly Bixby is Research Assistant, Department of Neurology, Rhode Island Hospital, Providence
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